L'eclampsie a la Clinique de Gynecologie-Obstetrique du C.H.U. Tokoin-Lome (Togo)

71 cas d'eclampsie pour 7713 accouchements effectues a la Clinique de Gynecologie Obstetrique du C.H.U. Tokoin-Lome; du 1er janvier au 31 decembre 1993; ont ete repertories. L'incidence de cette pathologie etait de 0;92 pour cent soit 1 eclampsie sur 109 accouchements. Les ages allant de 15 a 25 ans etaient les plus affectes (35 cas). La frequence de l'eclampsie ante-partum etait 49;30 pour cent; celle du per-partum s'elevait a 32;40 pour cent contre 18;30 pour cent de celle du post-partum. Les saisons froides etaient les moments favoris. Les maternites satellites etaient les grandes pourvoyeuses (67 cas). La negligence des consultations prenatales (23 cas d'eclampsie sans consultation prenatale) etait le principal facteur favorisant. Aussi le nombre de cas d'eclampsie du per-partum et du post-partum; reflete la deficience dans la prise en charge des parturientes. Le pronostic foetal facheux (31;03 pour cent de mortinatalite dont 22;41 pour cent de mort per-partum) peut-etre ameliore par la cesarienne d'indication eclectique. Quant au pronostic maternel; il etait domine par 2 deces. La persuasion des gestantes de l'utilite des consultations prenatales; la bonne conduite de ces consultations prenatales; et la prise en charge efficiente des parturientes; reduiraient l'incidence de l'eclampsie

l'hematome retroplacentaire (HRP) a la Clinique de Gynecologie-Obstetrique du CHU Tokoin-Lome (Togo) de 1988 a 1992

Sur une periode de 5 ans (de 1988 a 1992); les auteurs ont collige 211 cas d'HRP pour 44.316 accouchements effectues a la maternite de la Clinique de Gynecologie et d'Obstetrique du CHU-Tokoin-Lome (Togo). La frequence s'elevait a 0;47 pour cent. Les principaux facteurs de risque ont ete : le jeune age; la pauciparite; la toxemie gravidique et le traumatisme direct. Le pronostic maternel etait marque par l'anemie aigue et le deces. Quant au pronostic foetal; il a ete domine par le deces enregistre surtout chez les parturientes transferees. Les elements du pronostic aussi bien maternel que foetal ont ete le retard du diagnostic et la deficience dans la prise en charge de cette pathologie gravidique

[Simultaneous intrauterine and extrauterine pregnancy in the presence of inert intrauterine device: a case report]. / Grossesse intra-utérine et grossesse extra-utérine simultanées sur un dispositif intra-utérin inerte: un cas.

The authors report a case of simultaneous intra-uterine and ectopic pregnancy in the presence of a Lippes loop (inert intra-uterine device) which appeared to have been well tolerated for four years. Predisposing factors appeared to be infection, evidenced by the peri-adnexal adhesions found at surgery for the ectopic pregnancy, together with spontaneous multiple ovulation. The intra-uterine pregnancy culminated in a spontaneous abortion. Although apparently very rare, the association of intra-uterine pregnancy and ectopic pregnancy in the presence of an intra-uterine device should be born in mind whenever intrauterine contraception fails.

[Coexistence of a partial hydatiform mole and a viable twin pregnancy. A case seen at the Sokode regional hospital (Togo)]. / Coexistence d'une môle hydatiforme partielle et d'une grossesse gémellaire viable. Un cas au centre hospitalier régional de Sokodé (Togo).

A case was seen of partial hydatidiform mole coexisting with a viable twin pregnancy. Apart from prematurity which created early problems in caring for these girls twins, born with a good Apgar score and birth weights of 1400 g and 1350 g, the outcome was satisfactory for both the mother and daughters, who thrived marvelously. The incidence of this clinical form of trophoblastic disease which is 1/10,000 deliveries in our series confirms it rarity as reported by many authors.

[Maternal mortality at the Tokoin Lome University Hospital Center from 1990 to 1992]. / La mortalité maternelle au CHU Tokoin Lomé de 1990 à 1992.

190 deaths of mothers per 24,668 deliveries with 21,603 live births were recorded at the Gynaecology-Obstetrics clinic of the CHU Tokoin hospital, Lome, between 1st January 1990 and 31st December 1992. Maternal mortality was estimated to be 379.5 per 100,000 live births and this incidence is increasing. The main risk factors are a low level of education, mothers less than 20 years or more than 35 years in age, first births and high multiparity. Referred patients were most frequently involved (148 deaths out of the 190 reported). The most frequent aetiological factors were haemorrhage (53 deaths), infection (50 deaths), anaemia (39 deaths) and preeclampsia (10 deaths). These factors reflect the shortcomings of the pre-natal monitoring and care provided in our health centres and hospitals. Improvement in the living conditions of women and a change in the health policy of the country could help to reduce maternal mortality rates.

[Anemia at delivery in Lome (Togo): prevalence, risk factors and consequences in newborn infants]. / L'anémie à l'accouchement à Lomé (Togo): prévalence, facteurs de risque et répercussions chez le nouveau-né.

A prevalence study was carried out on 125 mothers and their newborns in Lome (Togo): at delivery 48% of the mothers and 30% of the newborns were anaemic according to WHO criteria. Iron deficiency was the major determinant of anaemia in the mothers, as three out of four showed at least one biochemical indicator of iron deficiency. Folate deficiency was detected in 68% of the mothers but did not influence their haematological parameters. Severe iron deficiency in the mothers (serum iron < 7 mumol/l) was associated with a decrease in serum iron in the newborns, thus demonstrating an impaired iron transfer to the fetus. Folate supplementation of the mothers during pregnancy improved their newborn's folate status. A systematic ferro-folic supplementation is needed during pregnancy and would be beneficial to both mothers and newborns. Supplements could be given to women at prenatal care clinics. Attendance in these centers by 98% of pregnant women in Lomé allows us to anticipate a good coverage for such an intervention.

Les facteurs socio-culturels : facteurs de risque de mortinatalite a partir de 308 cas de morts foetales in-utero

De janvier 1984 a juin 1986 une enquete prospective concernant 15.782 naissances a ete menee en vue d'etudier la mort foetale in-utero a la maternite du CHU de Lome. 308 cas ont ete enregistres. Le mode de recrutement a ete decrit. Pour chaque variable; le risque relatif a ete calcule pour un intervalle de confiance de 95 pour cent. Les differentes proportions observees ont ete soumises au test de X2 avec un degre de signification a 5 pour cent et 1 pour cent selon qu'il s'agit d'une variable ou d'un groupe de variables. Le risque de mortinatalite est plus eleve dans le groupe de femmes de conditions socio-economique et socio-culturelle defavorisees. Ce risque diminue avec l'amelioration de ces conditions. L'interet de ce travail a ete souligne