[Evaluation of the Practice of Caesarean Section According to Robson's Classification in a Health District of Ouagadougou, Burkina Faso]. / Évaluation de la pratique de la césarienne selon la classification de Robson dans un district sanitaire de Ouagadougou, Burkina Faso.

The control of the caesarean rate is nowadays an important concern for the obstetric world, the priority being to make every effort to practice a caesarean in all the women who need it only instead of reaching a specific rate. The purpose of the present study was to apply the Robson classification to the evaluation of the practice of caesarean section at the maternity of the Bogodogo District Hospital. It turned to be an analytical cross-sectional study which was carried out from January 1st, 2013 till December 31st, 2015. The information sources used included the computer base of caesarean sections, the delivery records, the operating room records, the delivery hall and the monthly activity reports. The overall hospital frequency of caesarean section was 33.3%. The rate of caesarean section expected during the same period according to the C-Model was 9.7%. Patients in groups 5 (with a scar uterus) and 6 (nulliparous with siege presentation) of the Robson classification had all a caesarean section and contributed to the overall rate of caesarean for 30 and 8.6% respectively. Low-risk women (groups 1, 2, 3 and 4) had a relative contribution of 31.3% to the overall rate of caesarean section. Improvement of the antenatal assessment of the prognosis of childbirth, particularly in the case of uterine scar or siege presentation, improvement of the quality of the supervision of the delivery work and the fight against prematurity will help to control the rate of caesarean section at the Bogodogo District Hospital.

Le contrôle du taux de césariennes est, de nos jours, une préoccupation importante pour le monde obstétrical, la priorité étant de tout mettre en œuvre pour pratiquer une césarienne chez toutes les femmes qui en ont besoin plutôt que d'atteindre un taux spécifique. La présente étude a pour objectif d'appliquer la classification de Robson à l'évaluation de la pratique de la césarienne à la maternité de l'hôpital de district de Bogodogo. Il s'agit d'une étude transversale descriptive sur une période de trois ans, du 1er janvier 2013 au 31 décembre 2015. La base informatique des dossiers de césarienne, les dossiers d'accouchement, les registres du bloc opératoire, de la salle d'accouchement et les rapports mensuels d'activités étaient les sources d'information utilisées. La fréquence hospitalière globale de césarienne était de 33,3 %. Le taux de césarienne attendu durant la même période selon le C-Model était de 9,7 %. Les patientes des groupes 5 (avec un utérus cicatriciel) et 6 (nullipares avec présentation de siège) de la classification de Robson ont toutes bénéficié d'une césarienne et ont contribué au taux global de césarienne pour respectivement 30 % et 8,6 %. La contribution relative cumulée au taux global de césarienne des groupes 1, 2, 3 et 4 (femmes à bas risque de césarienne) était de 31,3 %. L'amélioration de l'évaluation anténatale du pronostic de l'accouchement, notamment en cas de cicatrice utérine ou de présentation de siège, l'amélioration de la qualité de la surveillance du travail d'accouchement et la lutte contre la prématurité contribueront à maitriser le taux de césarienne à l'hôpital de district de Bogodogo.

[Clitoral reconstruction after female genital mutilation at CHU Yalgado of Ouagadougou, Burkina Faso. About 68 patients operated]. / Reconstruction clitoridienne après mutilation génitale féminine au CHU Yalgado de Ouagadougou, Burkina Faso. À propos de 68 patientes opérées.

OBJECTIVE: The objective of this survey was to assess the results of a new clitoral transposition technique in the obstetrics and gynecology department of CHUYO. MATERIALS AND METHOD: A cohort of 68 women victims of genital mutilation has received clitoral reconstruction by a new technique of transposition of the clitoris. They were operated and followed for 12 months in CHUYO gynecology ward in Ouagadougou. We evaluated the management of pain, anatomical aspect, functional and occurrence of complications. RESULTS: Anatomically have no new increase was within a neoclitoris, and a very satisfactory ratio of 100 % of women with clitoral massif visible in the 12th month assessment. Functionally, before clitoral reconstruction half of the women had mild pain or discomfort during sexual intercourse. However, clitoral reconstruction after the 6th month and 12th month this pain or mild discomfort were 3.18 % and 0 % respectively. In addition, we noted a sensitive neoclitoris in all women, after one year. Very few postoperative complications were observed in this series compared to previous series. CONCLUSION: These results are of interest in this new clitoral transposition technique in favor of women victims of genital mutilation.

[Obstetric endometritis at the UTH-Yalgado Ouedraogo of Ouagadougou (Burkina Faso): about the management of 102 cases]. / Les endométrites obstétricales au CHU-Yalgado Ouédraogo de Ouagadougou (Burkina Faso). À propos de la prise en charge d'une série de 102 cas.

This is a descriptive cross-sectional study over a nine months period conducted at the UTH-Yalgado Ouédraogo from all patients in whom the diagnosis of endometritis at obstetrical been laid. Endo-cervical and vaginal swabs were taken from all these patients. Commensal bacteria and anaerobes were investigated in the laboratory. During the study period, 102 cases of obstetric endometritis were recorded that to say a frequency of 1.4% of admissions. The average age of patients was 25.2 years [17-43]. The childbirth mean was 2.5 ± 2 [0-7]. The reason for consultation was dominated by hyperthermia in 98% of cases. The bacterial ecosystem was mainly dominated by Escherichia coli (49.2%), Staphylococcus aureus (29.5%), Streptococcus sp (4.9%). The acid + amoxicillin clavulanic showed low activity on most germs. The average hospital stay of patients was 6.30 days [1-33]. A maternal death was recorded in 3 patients that to say fatality rate of 2.9%. The lethality of endometritis at the UTH-Yalgado Ouedraogo is greater than the rate of 1% allowed by WHO. The resistance of germs is high enough with amoxicillin. The systematization of the bacteriological study is expected to guide the antibiotic to help better fight against maternal mortality.

Oncogenic Human Papillomavirus Infection and Genotype Characterization among Women in Orodara, Western Burkina Faso.

BACKGROUND AND OBJECTIVE: Cervical cancer usually occurs several years after persistent infection with oncogenic or high-risk human papillomavirus. The objective of this study was to determine carriage of 14 genotypes of high-risk human papillomavirus among women at Orodara and then characterize the genotypes found in these women. MATERIALS AND METHODS: From June to July 2015, 120 women from the general population were recruited in the health district of Orodara. They voluntarily agreed to participate in the study. Endocervical samples were taken from these women prior to screening for precancerous lesions by visual inspection with acetic acid and lugol's iodine. Identification of high-risk human papillomavirus genotype was done using real-time PCR. RESULTS: High-risk human papillomavirus prevalence was 38.3% and the most common genotypes were HPV 52 (25.4%), HPV 33 (20.6%) and HPV 59 (11.1%). The HPV 66 was also identified with a prevalence of 9.5%. CONCLUSION: The HPV 16 and HPV 18 which are frequently associated with cancer worldwide were not found among the most frequent oncogenic HPV in women in Orodara.

[Eclampsia at the University hospital Yalgado of Ouagadougou (Burkina Faso) from 1 April 2013 to 31 March 2014]. / L'éclampsie au CHU-Yalgado de Ouagadougou (Burkina Faso) du 1er avril 2013 au 31 mars 2014.

The objective of this study was to describe the epidemiological, clinical, therapeutic and prognostic aspects of the eclampsia in the obstetrics and gynecology department at the University Teaching Hospital Yalgado Ouedraogo of Ouagadougou. It has been a descriptive crosssectional study over a period of 12 months from 1 April 2013 to 31 March 2014. The main criterion for inclusion in our sample was the occurrence of seizures in a pregnant more than 20 weeks of gestation or recently delivered with elevation of blood pressure and the presence of albumin in the urine. The patients were followed from the onset of the crisis until hospital discharge. Data were collected and analyzed using Epi Info 3.5.1. The significance level of 5% was used for data comparison. We identified 203 cases of eclampsia for 6063 deliveries that to say a frequency of 3.3%. The average age of patients was 27.5 years [14-46]. In socio-demographic terms, patients were housewives in 62.5% of cases, the average rate of the past-deliver number was 4.2 [0-11] and 47.7% of patients were living as married. Clinically, they were referred in 72.4% of cases and were initially admitted into the service for elevation of blood pressure in 40.3% of cases. The mean gestational age was 31.5 weeks [23-41]; diastolic blood pressure exceeded 110 mmHg in 63.1% of cases. Therapeutically, all the patients benefited from a treatment based in anticonvulsant by magnesium sulfate and antihypertensive therapy by nicardipine, clonidine or alpha-methyl-dopa. Maternal prognosis was marked by significant morbidity in 46 cases (22.6%) and mortality in 13 patients that to say a fatality rate of 6.4%. The fetal one was dominated by a perinatal lethality in 31.5% of the cases. Eclampsia is a major cause of maternal and perinatal mortality in the University Teaching Hospital of Ouagadougou. The adoption of strategies for screening during antenatal consultations and early management should contribute to the reduction of the mortality in the mother and child couple in Burkina Faso.

[Obstetric emergency and non-emergency transfers to the university teaching hospital Yalgado ouedraogo of Ouagadougou: A 3-year study of their epidemiologic, clinical, and prognostic aspects]. / Références et évacuations obstétricales dans le contexte de la subvention des soins obstétricaux et néonataux d'urgence : aspects épidémiologiques, cliniques et pronostiques sur une période de trente-six mois au CHU Yalgado de Ouagadougou.

OBJECTIVE: to describe the epidemiologic, clinical, and prognostic aspects of the emergency and non-emergency transfers of obstetric patients to Yalgado Ouédraogo University Hospital Center (UHC-YO) in Ouagadougou. this retrospective descriptive study looked at the outcomes of women transferred, on an emergency basis or not, to the obstetrics department of the UHC-YO. The study population comprised all women transferred to the department during 2010, 2011, and 2012. during the study period, there were 9,806 admissions for obstetric disorders: 43% were transfers. The patients' mean age was 26.11 years [(13-49]. Women transferred from health care facilities within the city of Ouagadougou accounted for 96% of the sample. The leading reason for these transfers - emergency or not - was preeclampsia and eclampsia (24.57%). We recorded a total of 161 maternal deaths, for a mortality rate of 3.9%. Approximately 26.55% of the newborns received immediate intensive care and were then transferred to the neonatology department. maternal and neonatal prognosis is always poor in cases transferred to UHC-YO, despite increased funding for emergency obstetric and neonatal care. Increased population awareness of the importance of prenatal consultation and adequate funding for health care facilities to provide equipment for emergency transfers and staff training in the management of obstetric and neonatal emergencies would probably improve these mortality and morbidity rates.

[Improving the provision of major obstetric interventions by task delegation in Africa: An example from the Bogodogo health district hospital in Ouagadougou, Burkina Faso]. / Amélioration de l'offre des soins obstétricaux par la délégation des tâches en milieu africain Exemple de l'hôpital du district sanitaire de Bogodogo à Ouagadougou, Burkina Faso.

OBJECTIVE: To describe the role of task delegation in the practice of major obstetric procedures in the Bogodogo health district hospital. MATERIALS AND METHODS: This descriptive and analytic prospective study took place in the hospital's department of obstetrics and gynecology from February through October 2013. It included all women undergoing a major obstetric surgical intervention, performed by either by a gynecologist-obstetrician or by a nurse specializing in surgery. Data were collected from individual records and analyzed by SPSS and Epidata software. RESULTS: There were 601 major obstetric interventions during the study period. The women's mean age was 26.7 years. Cesarean deliveries accounted for 90% of these procedures, followed by laparotomy (7.7%). The Misgav-Ladach technique was used for cesareans by 86.5% of the obstetricians and 95.3% of the nurses specialized in surgery. The primary complications were anemia and postpartum hemorrhage. Maternal mortality did not differ significantly between the groups of operators, nor did maternal, fetal, and neonatal outcomes. CONCLUSION: Task delegation in obstetric surgery at the Bogodogo district hospital is effective. Its extension to the national level would make it possible to overcome the lack of highly qualified human resources to enable adequate availability of major obstetric interventions in rural hospitals.

[Unsafe abortions in countries that restrict legal abortions. Epidemiologic, clinical, and prognostic aspects at the University Hospital Center Yalgado-Ouédraogo of Ouagadougou]. / L'avortement clandestin dans les pays à restriction légale sur les avortements. Aspects épidémiologiques, cliniques et pronostiques au CHU Yalgado-Ouédraogo de Ouagadougou.

OBJECTIVE: to describe the epidemiologic, clinical, and prognostic aspects of the management of the complications of women who had unsafe (illegal) abortions. MATERIAL AND METHODS: this prospective, descriptive cross-sectional study took place the Yalgado Ouédraogo University Hospital Center (UHC-YO) in Ouagadougou during the 12-month period from June 2012 to May 2013. The study included all women admitted to the obstetrics-gynecology department during the study period and diagnosed after clinical examination with complications of an unsafe abortion. Data were collected with standardized case report forms. The analysis was conducted with Epi Info 3.5.1 software and Student's, Fisher's, and Pearson's Chi-square tests to compare the data. The threshold for statistical significance was set at 5%. RESULTS: during the study period, 111 women were admitted for complications of unsafe abortions, for a rate of 1 per 47 deliveries. The women's mean age was 23.6 years and ranged from 15 to 45 years. More than half the women (n=62, 55%) were pregnant for the first time. Hemorrhage was the primary reason for admission: 78 women, or 75%. Only 18 women (16%) admitted to having had an illegal intentional abortions. Complications included endometritis in 10 women (11%), anemia in 6 (5%), and hepatonephritis, also in 6 (5%). Six women died, for a mortality rate of 24%. CONCLUSION: the epidemiologic profile of women with complications from unsafe abortions is that of a young women pregnant for the first time, who has no income-producing activity. Morbidity is dominated by infectious or hemorrhagic complications and mortality is high. Strengthening activities for prevention, health and sex education, and dissemination of knowledge of and access to contraceptive methods will help to reduce these abortions and their consequences.

[Factors associated with preterm birth in an urban African environment: A case-control study at the University Teaching Hospital of Ouagadougou and Saint Camille Medical Center]. / Les facteurs associés à l'accouchement prématuré en milieu urbain africain À propos d'une étude cas témoins au CHU-YO et au centre médical Saint-Camille de Ouagadougou.

OBJECTIVE: To study the risk factors associated with preterm delivery in two busy obstetrics centers in Ouagadougou. MATERIAL AND METHODS: This prospective case-control study included 115 women with preterm deliveries and 230 control patients, or two controls per case, recruited from January through June 2011. The study took place in the maternity and neonatology departments of the University Hospital Center Yalgado-Ouédraogo (UHC-YO) and the Saint-Camille medical center, in the same city. Stillbirths were excluded from the study. Case infants were born at gestational ages ranging from 28 to 37 weeks. RESULTS: During the study period, the preterm delivery rate was 6.1%. Multivariate analysis with logistic regression enabled us to identify the factors associated with preterm delivery. These factors were: advanced maternal age (>30 years) (OR = 0.4 [0.2-0.8]), history of intentional abortions (OR = 3.3 [1.43-7.6], high stress (OR = 4.03 [2.14-3.39]), too few prenatal care visits (OR = 4.92 [3.03-8]), fever during pregnancy (OR = 1.59 [1.01-2.5]), premature rupture of membranes (OR = 3.72 [1.11-4.34]), urinary infections (OR = 2.55 [1.55-4.19]), and threatened preterm delivery (OR = 3.3 [1.43-7.6]). CONCLUSION: Preterm delivery is very frequent at both these Ouagadougou health care facilities. Many factors are associated with preterm birth, including social and demographic as well as clinical characteristics. The effort to reduce the rate of preterm births, which are associated with neonatal morbidity, must be strengthened by refocusing on prenatal consultations.

[Cesarean deliveries in a district hospital in Ouagadougou. Epidemiological, clinical, and prognostic study of 3381 cases]. / La pratique de la césarienne dans un hôpital de district à Ouagadougou. Aspects épidémiologiques, cliniques et pronostiques à propos de 3381 cas.

OBJECTIVE: to study the epidemiologic aspects, indications, and prognosis of cesarean deliveries at the maternity ward of the Bogodogo health district hospital in Ouagadougou. METHODOLOGY: This retrospective study examined records for the years 2005 through 2008. Data were collected from the computer database of records of cesareans at the hospital. RESULTS: Of 11,142 deliveries during the study period, 3381 were cesareans, for a hospital cesarean rate of 30.3%. The epidemiological profile of these women showed that: 55% of the women had been transferred to the hospital on an emergency basis; their mean age was 26.8 years (range: 15 to 48 years), their mean parity 4 (range: 1 to 13), and 87% of the cesareans were performed in emergency situations. The principal indications for the cesareans were fetal distress (22.9%), fetopelvic disproportion (17.2%), previous cesarean delivery (12.8%), preeclampsia/eclampsia (7.9%), and pelvic abnormalities (7.8%). Maternal morbidity was reported for 1.6% of the women; 63% of these involved hemorrhages. The lethality rate of maternal complications was 0.7%. The stillbirth rate was 3.1% and the early neonatal mortality rate 0.1%. CONCLUSION: The cesarean rate at the Bogodogo district hospital is similar to international rates. Maternal and fetal morbidity are not high. The example of the Bogodogo hospital deserves to be followed by other districts in Africa in order to meet the Millennium Development Objectives.

[Epidemiology and characterization of high-risk genotypes of human Papillomavirus in a population of sexually active adolescents in Ouagadougou]. / Épidémiologie et caractérisation des génotypes à haut risque de Papillomavirus humain dans une population d'adolescentes sexuellement actives à Ouagadougou.

OBJECTIVE: This cross-sectional study was to determine the prevalence and characterization of high-risk HPV genotypes circulating among adolescents in Ouagadougou. METHODS: From September to December 2013, 200 adolescents recruited from a youth counseling center have voluntarily accepted a swab of the endocervical canal. The identification of the genotypes of the human Papillomavirus (HPV) was performed by real-time polymerase chain reaction technique. RESULTS: The mean age of adolescents was 18.7±0.7 years and 83/200 adolescents were positive for at least one high-risk genotype HPV a prevalence of 41.5%. Twelve genotypes corresponding to 136 infections were characterized: HPV 52 (22.8%), HPV 59 (14.0%), HPV 39 (13.2%), HPV 35 (10.3%), HPV 51 (10.3%), HPV 56 (8.8%), HPV 16 (5.2%), HPV 18 (5.2%), HPV 58 (4.4%), HPV 31 (3.6%), HPV 45 (1.5%), HPV 33 (0.7%). Multiple infections (2-5 virus) statistically associated with age (p=0.0318) was detected in 42.2% of infected females. If the number of sexual partners was statistically associated with the porting of HPV (OR=2.18; 95% CI=1.17 to 4.09), early sexual intercourse and the recent change of sexual partner were not (p>0,05) CONCLUSION: The prevalence of carriage of HPV in this study is high, as described in young people at the start of sexual activity. Identified genotypes are different from those targeted by prophylactic vaccines currently available. A larger study to map genotypes of high-risk HPV circulating in West Africa is necessary for a suitable vaccine.

Place de l'echographie du premier trimestre de la grossesse dans la determination du sexe foetal : experience du departement de gynecologie obstetrique du CHU-YO (a propos de 311 cas)

Objectif : Decrire l'experience du departement de gynecologie obstetrique du CHU-YO dans la determination echographique du sexe fotal au premier trimestre de la grossesse Patientes et methodes : Il s'agissait d'une etude prospective de type descriptif pendant une periode de 30 mois allant du 1er fevrier 2013 au 30 juin 2014 au sein de l'unite d'echographie gynecologique et obstetricale du CHU-YO de Ouagadougou. L'echantillon d'etude a ete constitue de 311 fotus. Ont ete incluses dans cet echantillon toute les gestantes venue pour une echographie obstetricale en dehors de toute situation d'urgence dont l'age gestationnel etait compris entre la 11eme et la 14eme semaine d'amenorrhee et ayant exprime le desir de connaitre le sexe fotal. Les methodes decrites par Mazza et par Efrat ont ete utilisees pour la determination du sexe fotal. Les patientes ont ete suivies jusqu'a leur accouchement apres verification clinique du sexe des nouveau-nes. Le recueil des donnees a ete fait sur une fiche de collecte individuelle de donnees. La participation a l'etude a ete conditionnee a la signature d'un consentement eclaire par les patientes.Resultats : La determination du sexe fotal a ete possible chez 280 des 311 fotus; soit un taux de faisabilite de 89;7%. Chez les 31 autres cas; il n'a pas ete possible de determiner le sexe fotal; la position du fotus ne permettant pas de bien voir le bourgeon genital. Au niveau de la fiabilite; des 238 fotus qui ont ete suivis; la determination du sexe fotal a ete correcte chez 204 fotus soit un taux de succes de 85;7%. L'exactitude etait meilleure lorsque la determination du sexe etait faite apres 12 semaines d'amenorrhee. Il n'y avait pas de difference significative dans les mesures selon que la grossesse etait monofoetale ou multiple. Conclusion : La determination echographique du sexe fotal au premier pourrait etre une option efficace; simple; disponible et peu couteuse dans les pays en voie de developpement

[Practice of reconstructive plastic surgery of the clitoris after genital mutilation in Burkina Faso. Report of 94 cases]. / Pratique de la chirurgie plastique reconstructrice du clitoris après mutilations génitales au Burkina Faso. À propos de 94cas.

PURPOSE OF THE STUDY: To describe and evaluate the results of reconstructive plastic surgery of the clitoris in order to promote reproductive health. PATIENTS AND METHOD: We conducted a retrospective study from 2007 to 2010. Ninety-four women were included in our study. RESULTS: The mean age was 32.3 years. The evaluation of the experience of sexuality before reconstruction showed that 41.5 % of patients had never had a sexual desire before surgery, more than half did not have a clitoral orgasm and dyspareunia was experienced by about a third of them. The main reason for consultation in our series was related to sexual dysfunction in more than half of our study population. All patients were operated using the technique of Dr Pierre Foldès. Evaluation with a decline of at least 6 months after surgery showed us a massive restoration of the clitoris at 89.7 %. There was a significant difference between sexual desire before and after surgery. A significant improvement in sexuality was observed in 83.6 % of patients. However, there was no significant difference between orgasm before and after surgery. This showed us that getting an orgasm is multifactorial and it is not enough to have a clitoris to have an orgasm, you have to use it. CONCLUSION: Regardless of the anatomical and functional results, all women were satisfied with respect to body found.

[Epidemiology, characterization of genotypes of human papillomavirus in a population of women in Ouagadougou]. / Épidémiologie et caractérisation des génotypes de papillomavirus humain dans une population de femmes à Ouagadougou.

OBJECTIVES: This work was carried out in order to determine the prevalence of different HPV genotypes in a population of women attending gynecological consultation. MATERIAL AND METHODS: From May to June 2010, cervical samples were obtained from 300 women attending gynecological consultation in two health centers in Ouagadougou. The strains of HPV genotyping was done using the technique of polymerase chain reaction (PCR) followed by reverse hybridization on nitrocellulose strips. RESULTS: Among the 73 women(24.3%) infected with HPV, only 27.4% (20/73) of them were infected with a HPV low risk (BR), the 72.6% (53/73). Other women were infected with at least one high risk HPV (HR). By combining the HPV genotypes found without taking into account the number of infected women, we found a total of 84 HPV among whom we have high-risk HPV : HPV-50'S(26/84 or 31.0%), HPV-18 (12/84 or 14.3%), HPV-16 (9/84 or 10.7%), HPV-30'S (5/84 or 5.9%), HPV-HR (5/84 or 5.9%) and HPV-45 (3/84 or 3.6%) and low-risk HPV: HPV-6 (15/84 or 17.9%) and HPV-BR (9/84 or 10.7%). We have found no HPV-11. DISCUSSION AND CONCLUSION: The prevalence of HPV found in our series is comparable to that found in the world. To complete this study, it would be necessary to investigate the prevalence of HPV found in cervical lesions in Burkina Faso.

[Study of factors favouring the occurrence of Plasmodium falciparum in pregnant women in the health district of Bogodogo]. / Étude des facteurs favorisant la survenue du paludisme àPlasmodium falciparum chez les femmes enceintes dans le district sanitaire de Bogodogo à Ouagadougou, Burkina Faso.

OBJECTIVE: The behaviour of pregnant women live in towards prevention, attitude health workers, access measures prejudices and inadequate in urban design contribute to course the persistence of malaria. Objective analyse the factors leading to occurrence of malaria in women speakers in the health district Bogodogo. PATIENTS AND METHODS: He acts sectional study was place in the rainy season period high malaria transmission. The test rapid diagnosis (TDR) using soluble antigens (HRPII) of Plasmodium falciparum was the diagnostic method used in this work and carried on 810 pregnant women in the health area District Bogodogo in Ouagadougou, Burkina Faso. Results The overall prevalence of antigen HRPII P. falciparum was 18.6% with a CI [16.1-21.5] to 95%. It follows from this work that the risk of infection malaria was significantly higher among pregnant women: that were not educated, lived in outlying areas called "zones not off" of the town and villages nearby, who were not using net. For various reasons, the administration of sulfadoxine/pyrimethamine was not supervised and less than 50% of women regularly slept under a mosquito net. CONCLUSION: The fight against malaria in pregnant women should focus on communication for change of behaviour of pregnant women and also of health professionals. The fight antivector must be considered in rural areas.

[Reconstructive surgery of the clitoris after sexual mutilation]. / Chirurgie plastique reconstructrice du clitoris après mutilations sexuelles.

Ritual sexual mutilations cause gynaecologic, urologic and obstetric complications. Their surgical treatments like clitoris reconstruction or desinfibulation have been well studied. We describe the Dr Pierre Foldes's (2004, 2006a, b) surgical technique of clitoris reconstruction after ritual excision. After scar resection, clitoris knee and corporeal bodies are liberated with meticulous nerve sparing. A new clitoridian glans is created by cuneiform plasty and then reimplanted in an anatomic situation. The aim of the technique is to restore a normal anatomy and to obtain a sensory and functional organ. We also describe the desinfibulation technique in this article.

Effective program against mother-to-child transmission of HIV at Saint Camille Medical Centre in Burkina Faso.

The present research was aimed to prevent mother-to-child transmission of HIV; to use RT-PCR in order to detect, 6 months after birth, infected children; and to test the antiretroviral resistance of both children and mothers in order to offer them a suitable therapy. At the Saint Camille Medical Centre, 3,127 pregnant women (aged 15-44 years) accepted to be enrolled in the mother-to-child transmission prevention protocol that envisages: (i) Voluntary Counselling and Testing for all the pregnant women; (ii) Antiretroviral therapy for HIV positive pregnant women and for their newborns; (iii) either powdered milk feeding or short breast-feeding and RT-PCR test for their children; (iv) finally, pol gene sequencing and antiretroviral resistance identifications among HIV positive mothers and children. Among the patients, 227/3,127 HIV seropositive women were found: 221/227 HIV-1, 4/227 HIV-2, and 2/227 mixed HIV infections. The RT-PCR test allowed the detection of 3/213 (1.4%) HIV infected children: 0/109 (0%) from mothers under ARV therapy and 3/104 (2.8%) from mothers treated with Nevirapine. All children had recombinant HIV-1 strain (CRF06_CPX) with: minor PR mutations (M36I, K20I) and RT mutations (R211K). Among them, two twins had Non-Nucleoside Reverse Transcriptase Inhibitor mutation (Y18CY). Both mothers acquired a major PR mutation (V8IV), investigated 6 months after a single-dose of Nevirapine. Prevention by single-dose of Nevirapine reduced significantly mother-to-child transmission of HIV, but caused many mutations and resistance to antiretroviral drugs. Based on present study the antiretroviral therapy protocol, together with the artificial-feeding, might represent the ideal strategy to avoid transmission of HIV from mother-to-child.

[Abruptio placentae: epidemiological, clinical and prognostic aspects with respect to a 177 case series]. / Hématome rétroplacentaire: aspects épidémiocliniques et pronostiques à propos d'une série de 177 cas.

OBJECTIVE: A retrospective study based on 177 cases of abruptio placentae, and describing the epidemiological, clinical and prognosis aspects. PATIENTS AND METHODS: A hundred and seventy-seven cases, corresponding to 185 children, were registered over a five-year period in the department of gynecology and obstetrics of the CHNYO of Ouagadougou. RESULTS: Abruptio placentae occurrence rate was about 9.6 per 1000 deliveries. In our study, this type of accident was most frequent with 30 to 34-year-old women (31.1%), with multiparous ones (56.5%), and with those suffering from arterial hypertension linked to pregnancy (31.1%). The clinical picture was most often complete, 83.1% of patients having reached grade 3 of abruptio placentae with complete symptomatology and foetal death. Vaginal delivery was preferred to cesarean section in 64.4% of the cases. Maternal death rate was about 3.9% and mainly caused by severe anemia (61.6%) and puerperal infections (7.9%). Foetal prognosis was dominated by the high rate of mortinatality (85.9%). DISCUSSION AND CONCLUSION: To reduce maternal mortality as well as morbidity due to abruptio placentae, correct prenatal follow-up, early diagnosis and prompt evacuation of the womb are required.

[Features of hysterosalpingography performed in Burkina Faso]. / Particularités des hystérosalpingographies réalisées en milieu Burkinabé

PURPOSE: The goal of this study was to describe the distinctive hysterosalpingographic features of women with infertility in Burkina Faso. MATERIALS AND METHODS: We performed a retrospective study of 1019 women who were referred for infertility between January 1996 to June 1997 at the National Hospital Centre of Ouagadougou. Clinical and radiological features were reviewed and statistical data analysed on the software EPI Info 5.0. RESULTS: The mean age of the patients was 28+/-0,3 years. Primary infertility was found in 34.4% and secondary infertility in 65.6%. Abnormalities on plain film were present in 6.9% of the cases. Hysterosalpingography was abnormal in 62.1% of the cases. Tubal abnormalities were found in 62% and uterine lesions in 38.3%. The main hysterosalpingographic abnormalities were tubal obstructions, hydrosalpinx, uterine fibromas, and trauma sequelae in 25,9%, 25,3%, 16,5% and 10% of cases respectively. Seventy one percent of tubal and uterine lesions represent outcomes of chronic infections and underground abortions. CONCLUSION: In Burkina Faso, hysterosalpingographic abnormalities are characterized by the predominance of infectious and traumatic sequelae. Such a frequency could be reduced by active politics against underground abortion and information about genital infections.

[Fetal weight gain curve for a cohort of 126 pregnant women at Ouagadougou, Burkino Faso]. / Courbe foetale de croissance pondérale à Ouagadougou (Bukina Faso). A propos d'une cohorte de 126 gestantes.

We carried out a prospective study at Ouagadougou, from March 1 1997 to April 30 1998, in which we plotted curves of fetal weight gain, estimated by ultrasound biometry, with the aim of comparing our results to those of other authors and establishing a local chart. We established a growth curve from 936 fetal weights estimated during the follow up of 126 pregnant women. The mean age of the women included was 26 +/- 0,8 years and 52.4% were of the mean socioeconomic level. We identified significant differences between our weight gain curve and those of other authors. The factors involved in this difference are unclear but may be nutritive, ecological and ethnic in nature. Further work is required to produce local charts, to optimize the estimation of fetal weight.