Simulation training for emergency obstetric and neonatal care in Senegal preliminary results.

To describe a new training approach for emergency obstetric and neonatal care (EmONC) introduced in Senegal to strengthen the skills of healthcare providers. The approach was based on skills training according to the so-called "humanist" method and on "lifesaving skills". Simulated practice took place in the classroom through 13 clinical stations summarizing the clinical skills needed for EmONC. Evaluation took place in all phases, and the results were recorded in a database to document the progress of each learner. This approach was used to train 432 providers in 10 months and to document the increase in each participants' technical achievements. The combination of training with the "learning by doing" model ensured that providers learned and mastered all EmONC skills and reduced the missed learning opportunities observed in former EmONC training sessions. Assessing the impact of training on EmONC indicators and introducing this learning modality in basic training are the two major challenges we currently face.

[Evolution and thromboembolic complications of the idiopathic peripartal cardiomyopathy at Dakar University Hospital: forward-looking study about 33 cases]. / Évolution et complications thromboemboliques de la myocardiopathie idiopathique du péripartum au CHU de Dakar: étude prospective à propos de 33 cas.

UNLABELLED: The aims of this work are to study the nursery futures during idiopathic myocardiopathy of peripartum (IMPP), to measure the prevalence of thromboses and spontaneous contrast during the IMPP and to determine their evolution. METHODOLOGY: It is about a longitudinal exploratory study carried out with the Aristide-Le-Dantec teaching hospital of Dakar, beginning January 2001 to November 2004, having included 33 patients. RESULTS: The average age of the patients was 26 years; the average pregnancy was of 3.39 gestures. The signs of cardiac insufficiency were constant and four patients (12%) had presented an ischemic cerebral vascular accident. We had raised an auricular case of fibrillation and tachycardia atrial multifocal. The transthoracic echography (ETT) noted an aspect of hypokinetic myocardiopathy dilated with deterioration of the systolic function of the left ventricle, a thrombus in ten patients (30.3%) and a spontaneous contrast in two cases (6%). The transoesophageal echocardiography (ETO) was superposable with the ETT with regard to dimensions of the cardiac cavities and the presence of thrombus but its sensitivity was higher (100% against 66%) with regard to the detection of contrasts spontaneous. All the patients had the treatment of a congestive heart failure associated to an anticoagulant treatment. The evolution was marked by an improvement of the heart failure. The thrombus and spontaneous contrast had disappeared in all the patients. The absence of anaemia and the presence of spontaneous contrast (p=0.003) were correlated with the presence of thrombosis (p=0.05). CONCLUSION: The idiopathic myocardiopathy of the peripartum is a relatively frequent affection in zone Soudano-Sahelian. Occurrence of thromboses is frequent at the time of this affection. Our study confirms the superiority of the echocardiography transoesophageal in the detection of intracardiac spontaneous contrast. The evolution can be favourable subject to a rigorous care and a regular surveillance.

[Pregnancies associated with valvular prosthesis at Dakar Teaching Hospital: prognosis, epidemiological, clinical and therapeutical aspects]. / Prothèse valvulaire cardiaque et grossesse au CHU de Dakar: aspects épidémiologiques, cliniques, pronostiques et modalités thérapeutiques.

OBJECTIVE: The persistence of the rheumatic valvular cardiopathie and the access to cardiac surgery make this association frequent. This work will deal with a description of the epidemiological and clinic profile and the evaluation of the cares to the pregnancies with cardiac valvular prostheses. METHODOLOGY: We took a retrospective study beginning from 1987 to 2006 about 14 cases, which had benefited from collaboration between the Gynaecologic and Obstetric Clinic and the Cardiological Clinic of the University Hospital Center of Dakar. RESULTS: The frequency of pregnancies with valvular prosthesis was of 0.12 per thousand. The average age of our patients was of 27.7 years. The average pregnancy was of 2.3 gestures with extremes of 1st to 12th gestures. The pregnancies were not, in any case, planned. An auricular fibrillation was noticed in four patients. The fraction of ejection of the left ventricle was superior or equal to 60% in 10 cases, the prosthesis was lightly blocked in two cases. Despite the use of anti-vitamin K during the first trimester with 42.86% of the patients, the anticoagulation was effective with the entire cases excepted one who died by lung embolism. The delivery was, in seven cases, realized by caesarean and in two cases by natural way. Two cases of premature and foetal hypotrophy have been noticed. There was no case of malformed children. CONCLUSION: With a multidisciplinary care, the carry of valvular prosthesis can be compatible with pregnancy. The lack of embryopathy and malformed children could incite to propose the oral anticoagulation during the whole sequence of pregnancy.

[Sexual abuse: epidemiological, clinical aspects and management at gynaecological and obstetrical department of Dakar University Hospital]. / Profil épidémioclinique et prise en charge des victimes d'abus sexuels à la clinique gynécologique et obstétricale du CHU de Dakar.

OBJECTIVES: To carry out the epidemiological and clinical characteristics of supposed victims of sexual abuse and to evaluate case management. PATIENTS AND METHODS: A prospective study was conducted about cases of presumed sexual abuse received at the gynaecological and obstetrical clinic department of Aristide-le-Dantec hospital from January 2003 to May 2005. RESULTS: A total of 55 cases were reported and represented 0.4% of admissions in the clinic during the period of study. Twenty percent of them (20%) were referred on judicial requisition. The mean time between sexual abuse and consultation was 15 days. Victims were 14 years old in average, nulligeste in 96.5% of cases and living in the suburban area of Dakar. The presumed "violenter" was a man of 32 years, belonging to the environment of the victim in 70% of cases (spiritual guide, joint-tenant, friend of the family...). The type of sexual assault was an unprotected genito-genital intercourse in 67.3% of cases. On the clinical plan, 70.9% of patients suffered recent genital traumatism, 54.5% genital examination showed hymeneal lesions. The HIV test was positive in two cases. During the follow-up of the patients, three pregnancies occurred and for only 9.1%, a psychological assistance was proposed. CONCLUSION: Sexual abuses represent a current sociocultural issue. Prevention required large information campaign. Early management is necessary in order to prevent the sexual transmitted diseases and psychological side effects.

[The histological aspect of the uterine vein wall according to age and parity]. / Effets de l'age et de la grossesse sur les veines uterines de la femme Senegalaise.

Veinous pathology is increasingly involved in numerous gynecological and obstetrical conditions. This study describes the histological aspects of uterine vein wall according to age and parity. Uterine vein were taken during autopsy of 50 black women of various age and parity. Necroscopic samples of uterine veins were taken from 50 black women of various and diverse age and parity. Microscopic stains were used to assess histological modifications of veinous walls according to age and parity. The disorganization of elastic fibers, collagen fibers of the media, the muscular wall and elastic fibers of the adventice increased with age. The main histological modifications associated with increasing parity were the increase of collagen tissue and the disorganization of the veinous wall. This study provides useful information for other studies regarding the histological analysis of pelvic veins removed during caesarian section for vascular pathology such eclampsia, abruption.

Temporal divergence in the pattern of messenger RNA expression in bovine embryos cultured from the zygote to blastocyst stage in vitro or in vivo.

The objective of this study was to examine the time during the postfertilization period that gene expression patterns in in vitro-cultured bovine embryos diverge from those of their in vivo-cultured counterparts. Presumptive bovine zygotes were produced by in vitro maturation and fertilization of immature oocytes collected from the ovaries of slaughtered animals. Approximately 20 h post insemination (hpi), zygotes were denuded and randomly divided into two groups for culture either in vitro, in synthetic oviduct fluid medium, or in vivo, in the ewe oviduct. Embryos were recovered from both systems at approximately 30 hpi (2-cell), 2 (4-cell), 3 (8-cell), 4 (16-cell), 5 (early morula), 6 (compact morula), or 7 (blastocyst) days post insemination. On recovery, they were examined for stage of development and snap frozen in liquid nitrogen for the analysis of transcript abundance using real-time polymerase chain reaction. The transcripts studied were glucose transporter 5, sarcosine oxidase, mitochondrial Mn-superoxide dismutase, connexin 43, interferon tau, insulin-like growth factor II, apoptosis regulator box-alpha and insulin-like growth factor-I receptor, most of which are known from our previous work to differ in terms of transcript abundance in blastocysts derived from culture in vitro or in vivo. The results demonstrate that the relative abundance of the transcripts studied varies throughout the preimplantation period and is strongly influenced by the culture environment. In addition, the data demonstrate that changes in transcript abundance in blastocyst stage embryos are in many cases a consequence of perturbed transcription earlier in development. Depending on the transcript, these differences may be evident by as little as 10 h of initiation of culture. Such information has implications not only for basic biology but also for human assisted reproduction in which there is a move toward culturing embryos to the blastocyst stage, necessitating prolonged culture in vitro under potentially deleterious conditions.

[3 cases of vulvar epidermal cysts after female genital mutilation]. / Trois cas de kystes épidermiques de la vulve après mutilations génitales féminines.

We report three cases of tumors of the vulva following an excision during childhood, in patients aged 22 to 25. The achieved surgical removal gave correct aesthetic and functional results. Histological examination of these tumors revealed epidermal cyst containing keratin. Because of clinical, psychological and social impact of female excision, steps should be taken against such traditional practices.

[Giant ovarian cyst and pregnancy (a case report)]. / Kyste géant de l'ovaire et grossesse (à propos d'un cas).

We report a case of giant ovarian cyst in pregnancy of 23 weeks of amenorrhea revealed by digestive and respiratory compression. As the absence of ultrasonographic and biologic malignancy criterias, several punctures of the cyst were done permitting the evolution of pregnancy until the preterm period. An annexectomy done in the immediate post-partum permitted to avoid the frequent mechanical accidents during this period. From this case, we discuss clinical and therapeutic problems of this association.

[Complications of tubal sterilization by minilaparotomy under local anesthesia]. / Complications de la stérilisation tubaire par minilaparotomie sous anesthésie locale.

Between January 1, 1991 and June 30, 1996, physicians performed 800 cases of tubal ligation via minilaparotomy under local anaesthesia in the Obstetrics and Gynecology clinic of the Dakar University Teaching Hospital (Senegal). There were complications in 7 (0.87%) cases (bladder and bowel injuries: 6 cases, and post operative infection: 1 case). The most frequent risk factors were: surgeon skill (lack of experience of surgeon in minilaparotomy), type of patients (obesity, previous abdominal surgery). It was concluded, proper training and experience of the surgical team is needed to minimize sterilization related complications.

PIP: Although only a small percentage of reproductive-aged women in Africa opt for sexual sterilization, it is the most widely used method of family planning worldwide. Most female sterilizations in Africa are performed using minilaparotomy under local anesthesia. While this approach offers benefits, especially when only inadequate equipment is available, it can also result in operation-related consequences. Results are presented from a retrospective study of records on 7 cases involving complications recorded at the Gynecological and Obstetrical Clinic of the University Hospital in Dakar in a series of 800 tubal ligations performed using minilaparotomy under local anesthesia between the beginning of January and the end of June 1996. The complication rate of 0.87% is comparable to that reported in the literature. There were 3 cases of bladder injury, 3 cases of bowel injury, and 1 case of post-operative infection. The injuries, of which the average length was 1.5 cm, were repaired immediately under general anesthesia. The tubal ligation was then performed. Main risk factors for complications were operator inexperience and the poor choice of candidates being obese and having histories of abdominal surgery. Despite the possibility of complications, tubal ligation through minilaparotomy under local anesthesia should be considered simple, safe, and affordable.