[Socio-demographic and prognostic aspects of unfollowed pregnancies of patients admitted in the Department of Gynaecology-Obstetric of Gabriel Toure Hospital]. / Aspects socio-demographiques et pronostic des grossesses non suivies chez les patientes admises dans le Service de Gynecologie-Obstetrique de l'Hopital Gabriel Toure.

UNLABELLED: The prenatal followed up permit, on the one hand, to track down risk pregnancies, to appreciate the evolution of pregnancy and its repercussion on the maternal state, to finally make the prognosis of the childbirth and on the other hand to identify risk pregnancies and to assure a management outside emergency context. They contribute this fact to the meaningful reduction of the maternal mortality. The non followed up pregnancies are characterized by their important maternal and fetal mortality and morbidity. The aim of our survey was to determine the frequency of the unfollowed pregnancies, to describe the socio demographic profile of the women and to determine the prognosis of these pregnancies. MATERIAL AND METHODS: Our survey had for setting the service of Gynecology and obstetrics of Gabriel Touré hospital. Center of cares, research and formation, this service that is 3rd level in the sanitary pyramid in Mali, receives emergencies from other motherhoods of lower level. Were include in this survey, women who delivered in the service and hadn't done any prenatal consultation. Criterias of non inclusion were next one: women having done at least a prenatal consultation, women having delivered in another sanitary structure, all cases of non assisted childbirths, women whose gestational age is lower to 28 weeks and/or fetal weight lower than 500 grams. Every case has been matched to a witness (consistent woman who has been followed and delivered in the service) according to criterias of age and parity. The statistical tests used to study associations between variables are the chi2 with a significativity doorstep of P = 0.05 and Odd ratio (OR). RESULTS: We recorded 2173 childbirths and 286 non followed pregnancies been 13.16% of frequency. The middle age of our patient was 23 years with extremes of 16 and 44 years, nullipareses represented 25.9% of cases. The domestic helps were more numerous in the group of cases with 4.9% against 0.3% in the witness group (P = 0.0006, OR = 14.6; IC [2.01, 30.05]). The maternal prognosis is marked by 2.1% of death (P = 0.013). Fetal prognosis is bad with 10.9% of child stillborn (P = 0.0007; OR = 3.19) and 21.5% of morbid APGAR. CONCLUSION: The absence of prenatal consultation is associated to a height maternal and fetal mortality and morbidity.

[Frequency of cord prolapse: etiological factors and fetal prognosis in 47 cases in a health center]. / La procidence du cordon: facteurs etiologiques et pronostic foetal a propos de 47 cas colliges dans un centre de sante de reference.

UNLABELLED: Cord prolapse constitute an imprevisible accident of the period of labor and an important cause of perinatal mortality. The aim of our study was to determine the frequency of cord prolapse, its etiological factors and to evaluate fetal prognosis. MATERIAL AND METHODS: Our study was done in the department of obstetric and gynecology of the Treichville university teaching hospital. It is a descriptive prospective study that covers 4 years period, from January 1st 1997 to December 31st 2000. RESULTS: We did record 16.924 deliveries with 47 cases of cord prolapse representing a frequency of 0.28% The influencial factors for occurrence of cord prolapse were: prematurity, multiple pregnancy, dystocic presentations and spontaneous rupture of membranes. 28% of our patients had pregnancy not at term. Twin pregnancies represented 23.4% and in 91% of the cases, prolapsed concerned the second twin. Our rate of cord prolapse associated with vertex presentation was 23.4%; 42.5% in breech and 12.8% in the case of shoulder presentation. Spontaneous rupture of membranes was the most frequent type. In 61.7% of the cases, the delivery was done by caesarian section. Cord prolapse was greatly lethal for the fetus with 36.2% of death occurring before the 5th minute of life. CONCLUSION: Umbilical cord prolapse is a grave obstetrical complication that compromises fetal prognosis.

[Association of extrauterine and intrauterine pregnancy: 3 cases]. / Association grossesse extra uterine et intra uterine: a propos de 3 cas.

Extra uterine pregnancy (GEU) constitutes, by its frequency a problem of public health, by its gravity an obstetric emergency and a problem of fertility for the woman. It represents the chief reason of maternal death during the first quarter of pregnancy. The association of extra-uterine and intra-uterine pregnancy is a particular case of twin pregnancy said ditopic. It is rare, but non exceptional. The authors bring three cases to remind us of its existence.