[Adverse prognostic factors for preeclampsia in Madagascar]. / Facteurs de mauvais pronostic en cas de pré-éclampsie à Madagascar.

INTRODUCTION: Hypertensive disorders of pregnancy are serious diseases that cause high rates of maternal and fetal morbidity and mortality. Our goal was to determine the epidemiological, clinical, and laboratory findings associated with complications in these patients after the onset of hypertension. METHODS: This retrospective analytical study examined the files of women with hypertension who delivered at the Hospital of Gynecology Obstetrics in Befelatanana, Madagascar, in 2008-2010. RESULTS: During this four-year study period, 1320 women giving birth at our center had been hypertensive during pregnancy, for a prevalence of 5.11%; 409 (30.98%) had preeclampsia. The main maternal complications were eclampsia (14.46%), renal failure (3.40%), maternal death (3.03%), and placental abruption (2.95%). For the fetus, maternal preeclampsia was complicated by preterm birth (35.07%), perinatal death (21.42%), perinatal asphyxia (14.50%), and fetal growth restriction (9.71%). Patients younger than 20 years were at the highest risk of eclampsia (RR 2.18, 95% CI [(1.83 to 3.75]). Primiparity and history of eclampsia or fetal growth restriction were risk factors for eclampsia. Hyperproteinuria and elevated serum creatinine concentrations were associated with adverse fetal outcome. Isolated hyperuricemia was not associated with outcome. CONCLUSION: When preeclampsia has been diagnosed, some aspects of obstetric history and impaired kidney function are poor prognostic factors that can require early emergency delivery.

[Neonatal prognosis for pulsating umbilical cord prolapse at the Befelatanana hospital of Madagascar]. / Pronostic néonatal de la procidence du cordon ombilical pulsatile à l'hôpital de Befelatanana Madagascar.

UNLABELLED: Umbilical cord prolapse is an obstetrical emergency that is life-threatening for the fetus. This retrospective cross-sectional study examined cases of pulsating umbilical cord prolapses at our level-3 maternity unit over the past three years and sought to assess their prognosis. Cord prolapse occurred in 0.27% of deliveries. The women's mean age was 28 years, and 51% of the women were multiparous. Cesarean deliveries were performed in 96% of cases. Factors affecting neonatal outcome were the degree of cord prolapse (p = 0.0002981) and the appearance of amniotic fluid (p = 0.004078). The neonatal complications included admission to neonatal intensive care (33%), perinatal asphyxia (31%), prematurity (29%), neonatal infection (4%), and neonatal mortality (10%). CONCLUSION: The fetus must be delivered rapidly, especially when the umbilical cord drops outside the mother's body and the amniotic fluid is meconial.

[Ectopic pregnancy in Madagascar: 107 cases]. / Grossesse extra-utérine à Madagascar: 107 observations.

INTRODUCTION: Ectopic pregnancy is a serious gynecological disease requiring early diagnosis and treatment. The aim of this study is to analyze the epidemiologic, diagnostic and therapeutic aspects of this disease in a reference hospital in Madagascar. PATIENTS AND METHODS: This prospective and descriptive study included all women diagnosed with and treated for ectopic pregnancy at the University Hospital of Gynecology and Obstetrics of Befelatanana during the 6-month period from January 1 to June 30, 2011. RESULTS: We recorded 107 cases of ectopic pregnancy, accounting for 2.48% of all deliveries and 5.71% of surgical procedures. The age group most often concerned was that aged 31 to 35 years (28.97%). The main risk factors were a history of miscarriages (36.45%), spontaneous abortions (29.90%), sexually transmitted infections (21.50%), and smoking (16.82%). Amenorrhea was followed by pelvic pain and then bleeding in 78.50% of patients. Tubal rupture occurred in 71% of the cases. Ultrasonography contributed to the diagnosis in 93.5% of patients and a pregnancy test in 91.6% of cases. All cases were treated and resolved by surgery, with salpingectomy in 90.7%. Anemia was the main complication and blood transfusions were required for 27.1% of the women. CONCLUSION: The prevention of risk factors, the education of the population to consult early, and the use of laparoscopic surgery are useful for improving the treatment and prognosis of ectopic pregnancy.

[Comparison of efficacy of chloroquine versus sulfadoxine-pyrimethamine in malaria prevention in pregnant women in the Toamasina region (Madagascar)]. / Comparaison de l'efficacité de la chloroquine versus sulfadoxine-pyriméthamine dans la prévention du paludisme chez la femme enceinte dans la région de Toamasina (Madagascar).

Malaria still represents a great cause of death in sub-Saharan African areas, mainly among pregnant women. We conducted this prospective study during two years in a malaria-endemic stable region in the east of Madagascar (Toamasina) with an aim to compare the efficacy of weekly chloroquine (CQ) and the use of intermittent presumptive treatment by sulfadoxine-pyrimethamine (SP). 519 pregnant women were included in this study (CQ = 285; SP = 256). Socio-demographical characteristics of each group were identical. We found more peripheral parasitemia (CQ = 8.07% vs SP = 2.73%; P = 0.0068) and severe malaria in the CQ group (CQ = 1.75% vs SP = 0%; P = 0.0332). Anemia was more frequent in the CQ group (CQ = 4.21% vs SP = 0.35%; P = 0.0038). Placental infestation rate was also higher in the CQ group (CQ = 7.01% vs SP = 0.39%; P = 0.00001). Low birth weight and fetal death were lower in the SP group respectively [(CQ = 4.21% vs SP = 0.78%; P = 0.0121) and (CQ = 1.75%vs SP = 0%; P = 0.0332)].

Les hysterectomies obstetricales realisees au service de Maternite du CHU de Toamasina Madagascar

Objectif: Decrire les facteurs de risque; les indications; les types d'hysterectomie realises et leurs complications rencontrees. Methodes: Il s'agit d'une etude retrospective des hysterectomies obstetricales realisees dans le service de Maternite du Centre Hospitalier Universitaire de Toamasina sur une periode de cinq ans; du 1er janvier 2005 au 31 decembre 2009. Resultats: Vingt-six cas d'hysterectomie obstetricale ont ete realises sur un nombre total de 13978 accouchements soit une frequence de 0;19. Les femmes les plus a risque etaient surtout celles agees entre 20 et 35ans (Odds Ratio = 12;27 ; IC a 95= 2;91 - 51;76; p=0;001) et les grandes multipares (Odds Ratio = 8;94 ; IC a 95= 2;14 - 37;32 ; p=0;001). La presence de suivi prenatal etait associee a un risque moindre (Odds Ratio = 0;2 ; IC a 95= 0;06 - 0;65 ; p=0; 01). L'indication etait dominee par les ruptures uterines (69) et les hemorragies de la delivrance (19). Une hysterectomie subtotale interannexielle a ete realise dans 81des cas. Les complications etaient surtout l'etat de choc (73); les infections (19); et les fistules vesico-vaginales (11;5). Le taux de mortalite maternel et foetal etait eleves; respectivement de 7;69et 81. Conclusion: Une meilleure prise en charge de la grossesse et de l'accouchement permettra de reduire les indications de l'hysterectomie obstetricale. D'autres techniques chirurgicales alternatives meritent d'etre largement diffusees

Aspects du paludisme a Plasmodium falciparum pendant la grossesse selon les cas observes au CHU de Toamasina Madagascar

Objectif: Decrire les facteurs de risque; les signes cliniques et les complications du paludisme a Plasmodium falciparum pendant la grossesse. Methodes: Il s'agit d'une etude prospective de 12 mois portant sur les patientes enceintes presentant une parasitemie positive au Plasmodium falciparum vues au Service Maternite du Centre Hospitalier de Toamasina. Resultats: Quarante cas de paludisme etaient diagnostiques sur 642 femmes enceintes soit une frequence de 6;23. La transmission etait maximale pendant les saisons humides. L'age inferieur a 19 ans (47;5); la primiparite (62;5)predominaient chez les femmes avec parasitemie positive a Plasmodium falciparum. Les taux de frequentation des consultations prenatales et de la prise d'au moins une dose de etaient faible respectivement de 27;5et de 22;5. La valeur predictive positive des signes cliniques classiques du paludisme etait faible.Les complications etaient dominees par l'anemie maternelle et l'hypotrophie foetale respectivement 40(p0;0001) et 5(p0;05). Conclusion: L'approche diagnostique du paludisme basee sur les symptomes avait une valeur predictive positive faible pendant la grossesse. Une goutte epaisse ou au moins un test de diagnostic rapide doit etre systematiquement realisee devant tout acces febrile