The women knowledge, attitude, and perceptions of pre-eclampsia and eclampsia in Madagascar

Background: Preeclampsia is a complication of pregnancy responsible for high rates of morbidity and mortality, particularly in Africa and Madagascar. The objective of present study was to assess patients' knowledge, attitudes and beliefs about pre-eclampsia in Madagascar.Methods: This is an observational study on the knowledge, belief and attitudes of women seen at the Befelatanana Gynecology and Obstetrics Hospital and conducted by questionnaires from 1 December 2017 to 30 May 2018.Results: During the study period, 102 patients agreed to answer our questionnaire. Terminology exists in the local language to describe convulsions and hypertension, but there were no terms that are specific to pregnancy. More than half of our patients knew preeclampsia. In 41% of cases, patients attributed excessive salt intake as a cause of high blood pressure during pregnancy and in 20% secondary to stress. Headache was the best-known symptom of patients. Signs of danger such as epigastric pain, genital bleeding, visual disturbances, convulsions and decreased sensation of fetal movements are not well known to patients. One-third did not know it was lethal. Regarding fetal complications, the occurrence of fetal death in utero was the best known. The majority of patients were aware that blood pressure measurements and urine dipstick testing were mandatory during pregnancy follow-up. To prevent preeclampsia, 46.07% thought that reducing salt intake would reduce the occurrence of preeclampsia.Conclusions: Few patients are aware of preeclampsia, its danger signs and its complications, especially during prenatal consultation. This requires the improvement of knowledge of all health actor. Community health workers should receive basic and ongoing training to facilitate dialogue and information for pregnant and non-pregnant women in each society

Infected delayed puerperal hematoma complicated by retention of urine: a case report and literature review

The puerperal hematoma corresponds to a tissue cleavage, most often paravaginal or vulvar, in which the vascular wounds, linked to the detachment, have no spontaneous tendency to haemostasis. The aggravation of this pathology is progressive. Diagnosis and management must be an obstetric emergency. Author report a case of infected puerperal hematoma complicated by rectal compression and acute retention of urine. This is a 26-year-old patient with a history of chronic hypertension. Labor was induced by misoprostol. The delivery was uneventful at 37 weeks vaginally. Ten days after delivery, she returned to the obstetrical emergency service for acute urine retention. The examination with the vaginal speculum showed a tumefaction of six centimeters on the left lateral side of the vagina. Surgical treatment has been performed. The suite was without particularity. The diagnosis of puerperal hematoma must be early. Even for the delayed form, the complications are identical. Blood loss, compression of proximity organs and infection are the most common complications. The care must be multidisciplinary. Resuscitation of the patient associated with haemostasis of the vessel is the main treatment in cases of large hematoma with hemodynamic instability

Uterine atony risk factor after vaginal delivery in a tertiary hospital in Antananarivo, Madagascar

Background: Postpartum hemorrhage is the leading cause of maternal death in developing countries. Uterine atony is the cause in 80% of cases. Through this study, we want to determine risk factors for uterine atony after vaginal delivery route with oxytocin-mediated delivery.Methods: This is a retrospective case-control study ranging from January 1st 2017 to June 31st 2018 at the Befelatanana University Hospital Centre of Gynecology-Obstetrics. The cases consisted of patients who had spontaneous vaginal delivery in the centre and had uterine atony. Authors studied maternal, obstetrical, neonatal parameters. Authors used the R software for the statistical analysis of the results.Results: We found 40 cases of uterine atony out of 5421 deliveries with a prevalence of 0,73%. The average age was 27.73 years old±6.46 years old (p=0.113). The average parity was 2.67±1.62 (p=0.22). The total duration of labor was 6.88±2.95 hours (p=0.0187). The average duration of rupture of the membrane was 5.80±11.90 hours (0.003376). We found as risk factor of uterine atony the increase in oxytocin infusion rate during labor (OR=18.67, 95% CI 2.21-157.57), the artificial rupture of membranes (OR=5, 27, 95% CI 2.11-13.19), artificial induction of labor (OR=7.08, 95% CI 2.06-24.28) and labor over six hours (OR=2.53, 95% CI) % 1.18-5.47). In univariate analysis, premature delivery and a hypotrophic fetus were a factor risk of uterine atony (OR=3.07, 95% CI 1.27-7.44 and OR=3.43 95% CI 1.48-8.09 respectively) but this risk is not statistically significant in multivariate analysis with logistic regression (OR=1.27, 95% CI 0.40-3.84 and OR=2.19 95% CI 0.77-6.22). The main treatment was uterotonic drug use (72.5%). Authors identified seven cases of haemostasis hysterectomy and two cases of maternal death.Conclusions: Present study confirms risk factors for uterine atony already known as prolonged labor and increased oxytocic infusion rate. Unrecognized factors have been identified as a risk factor for uterine atony such as the duration of rupture of the membranes and artificial rupture of the membranes. A minimal inflammation hypothesis that reduces susceptibility to oxytocin may explain this association. Knowing these factors would reduce the occurrence of uterine atony to reduce maternal mortality

Emergency peripartum hysterectomy in a tertiary hospital in Antananarivo, Madagascar

Background: Postpartum hemorrhage is one of the leading causes of maternal death in the entire world. It affects 10% of deliveries. Emergency peripartum hysterectomy (EPH)defined as a lifesaving procedure involving the removal of the uterus to treat severe postpartum hemorrhage is one of the last-resort treatments for severe postpartum hemorrhage in case of failure of other techniques. Through this study, we aimed both to describe the epidemiological profile, to determine the etiologies, and maternal complications of EPH.Methods: It is about a descriptive retrospective study from January 1st, 2016 to January 1st, 2017 at the Befelatanana University Hospital of Obstetrics and Gynecology. We included all patients who underwent Emergency peripartum hysterectomy after 22 weeks of Amenorrhea (WA) regardless of the delivery route in the centre. We used the R software for the statistical analysis of the results.Results: We had 31 cases of EPH during this period with a prevalence of 0.44%. The average age was 26.38±5.61 years. Mean gestational age was 37±3.59 weeks of amenorrhea. In the 83.87% of cases, the patient received less than four prenatal consultations. Patients were referred in 45.16% of the cases. The delivery route was by cesarean section in 48.39% of cases. Eleven patients (35.48%) received a blood transfusion. Hysterectomy was subtotal in 96.77% of the cases. We had five (16.13%) maternal deaths during the study period. The leading cause of death was hemorrhagic shock (80%). The etiology of hysterectomy was dominated by uterine atony complicated by hemorrhage (48.39%), followed by retroplacental hematoma (25.81%) and uterine rupture (22.58%).Conclusions: EPH still holds its place in the management of postpartum hemorrhage in Madagascar. Maternal mortality remains high. Uterine atony was the most common indication for EPH. The prevention of postpartum hemorrhage by management of the third stage of labour should be carried out by any health actor

Uterine malformations and pregnancy: about 11 cases seen university hospital center of gynecology- obstetric Befelatanana Antananarivo Madagascar

Birth defects in the uterus result from abnormal fusion of the miler ducts and / or failure. Uterine malformations are a common cause of infertility, but if pregnancy occurs absorption from the septum. They are relatively frequent and concern 0.1-3% of the female population, such a situation is potentially high risk obstetric. We report here, 11 cases of uterine malformations during pregnancy seen at the CHUGOB from May 01, 2017 to May 01, 2018. We observed 11 cases of uterine malformations during pregnancy, including 3 cases of didelphus uterus, 3 cases of pseudo-unicornuate uterus, 3 cases of bicornuate uterus, 1 case of septate uterus and 1 case of true unicornuate uterus. The age of the parturients ranged from 22 to 26 with a mean of 23.63 years. Regarding pregnancy, 5 women were primigest, 4 were paucigest and 2 were multiparous. For gestational age, 09 cases came to term and 2 cases pregnancy stopped at 17 weeks. The average birth weight was 2215g. The diagnosis of the malformation was made before the caesarean section in 2 out of 10 cases. Eight out of 10 cases of the fetuses were alive. Congenital uterine malformations are often asymptomatic. The occurrence of pregnancy in a malformed uterus is a rare but potentially serious situation. The diagnosis of these abnormalities is based on new advanced imaging means such as 3D ultrasound

Obstetrical and neonatal prognosis of a teenage primiparous pregnancy at the Zafisaona Gabriel Majunga university hospital center

Background: Women's fertility is early and high in Madagascar. Through this study, want to know the obstetric and neonatal risks in teenage primiparous pregnancies.Methods: Carried out a retrospective comparative study of teenage primiparous pregnancies who gave birth beyond 22 weeks of amenorrhea (SA) at the Zafisaona Gabriel Mahajanga university hospital between the period from January 1 to March 31, 2015. The control group is made up of first-time mothers aged 20 to 35 who gave birth in the same center.Results: The mean age of the patients was 16.77±1.12 years. In 43.1% of cases, the pregnancy was poorly followed. 22.41% of new-borns to adolescent mothers were hypotrophic at birth. Teenage primiparous pregnancies had a risk of poor pregnancy monitoring compared to their elders (RR: 2.17, 95% CI [1.35-3.47]) and a risk of giving birth to a low birth weight child (RR: 2.1, 95% CI [1.05-4.44]). The risk of preeclampsia, death in utero, caesarean section, instrumental extraction was identical between the two groups. Regarding the outcome of newborns, the frequency of premature birth, early neonatal infection, neonatal asphyxia, early neonatal death was not significant.Conclusions: Apart from fetal hypotrophy, adolescent girls have the same maternal, fetal and neonatal prognosis as their elders

Management of uncomplicated malaria in febrile under five-year-old children by community health workers in Madagascar: reliability of malaria rapid diagnostic tests

<p>Abstract</p> <p>Background</p> <p>Early diagnosis, as well as prompt and effective treatment of uncomplicated malaria, are essential components of the anti-malaria strategy in Madagascar to prevent severe malaria, reduce mortality and limit malaria transmission. The purpose of this study was to assess the performance of the malaria rapid diagnostic tests (RDTs) used by community health workers (CHWs) by comparing RDT results with two reference methods (microscopy and Polymerase Chain Reaction, PCR).</p> <p>Methods</p> <p>Eight CHWs in two districts, each with a different level of endemic malaria transmission, were trained to use RDTs in the management of febrile children under five years of age. RDTs were performed by CHWs in all febrile children who consulted for fever. In parallel, retrospective parasitological diagnoses were made by microscopy and PCR. The results of these different diagnostic methods were analysed to evaluate the diagnostic performance of the RDTs administered by the CHWs. The stability of the RDTs stored by CHWs was also evaluated.</p> <p>Results</p> <p>Among 190 febrile children with suspected malaria who visited CHWs between February 2009 and February 2010, 89.5% were found to be positive for malaria parasites by PCR, 51.6% were positive by microscopy and 55.8% were positive by RDT. The performance accuracy of the RDTs used by CHWs in terms of sensitivity, specificity, positive and negative predictive values was greater than 85%. Concordance between microscopy and RDT, estimated by the Kappa value was 0.83 (95% CI: 0.75-0.91). RDTs stored by CHWs for 24 months were capable of detecting <it>Plasmodium falciparum </it>in blood at a level of 200 parasites/μl.</p> <p>Conclusion</p> <p>Introduction of easy-to-use diagnostic tools, such as RDTs, at the community level appears to be an effective strategy for improving febrile patient management and for reducing excessive use of anti-malarial drugs.</p

Chloroquine Clinical Failures in P. falciparum Malaria Are Associated with Mutant Pfmdr-1, Not Pfcrt in Madagascar

Molecular studies have demonstrated that mutations in the Plasmodium falciparum chloroquine resistance transporter gene (Pfcrt) play a major role in chloroquine resistance, while mutations in P. falciparum multidrug resistance gene (Pfmdr-1) act as modulator. In Madagascar, the high rate of chloroquine treatment failure (44%) appears disconnected from the overall level of in vitro CQ susceptibility (prevalence of CQ-resistant parasites <5%) or Pfcrt mutant isolates (<1%), strongly contrasting with sub-Saharan African countries. Previous studies showed a high frequency of Pfmdr-1 mutant parasites (>60% of isolates), but did not explore their association with P. falciparum chloroquine resistance. To document the association of Pfmdr-1 alleles with chloroquine resistance in Madagascar, 249 P. falciparum samples collected from patients enrolled in a chloroquine in vivo efficacy study were genotyped in Pfcrt/Pfmdr-1 genes as well as the estimation of the Pfmdr-1 copy number. Except 2 isolates, all samples displayed a wild-type Pfcrt allele without Pfmdr-1 amplification. Chloroquine treatment failures were significantly associated with Pfmdr-1 86Y mutant codon (OR = 4.6). The cumulative incidence of recurrence of patients carrying the Pfmdr-1 86Y mutation at day 0 (21 days) was shorter than patients carrying Pfmdr-1 86N wild type codon (28 days). In an independent set of 90 selected isolates, in vitro susceptibility to chloroquine was not associated with Pfmdr-1 polymorphisms. Analysis of two microsatellites flanking Pfmdr-1 allele showed that mutations occurred on multiple genetic backgrounds. In Madagascar, Pfmdr-1 polymorphism is associated with late chloroquine clinical failures and unrelated with in vitro susceptibility or Pfcrt genotype. These results highlight the limits of the current in vitro tests routinely used to monitor CQ drug resistance in this unique context. Gaining insight about the mechanisms that regulate polymorphism in Pfmdr1 remains important, particularly regarding the evolution and spread of Pfmdr-1 alleles in P. falciparum populations under changing drug pressure which may have important consequences in terms of antimalarial use management

Chorioamnionitis at the Befelatanana university hospital centre of obstetric gynecology in Antananarivo Madagascar: epidemiology, taken care and forecast

Background: The chorioamnionitis corresponds to an infection of the ovular cavity. She puts game neonatal and maternal forecast. This study had as objectives to describe the epidemiological aspects, the taking care and the forecast of the chorioamnionitis to the gynecology teaching hospital and obstetrics Befelatanana, Madagascar.Methods: It is about a descriptive, retrospective and transverse study, during a period of 6 months going from January, 2016 till July 2016. The pregnant women introducing a premature break of membranes (RPM) complicated with chorioamnionitis hospitalized in CHU-GOB during this period had been included.Results: Authors found 35 cases of chorioamnionitis, that is 38.1% premature breaks of membranes. The medium age of the patients was 20±5, 16 years old (extreme from 17 to 36 years). Primiparous was found in 82.9%. The chorioamnionitis had happened in 68.5% cases after 37 weeks of amenorrhea. The delay between RPM and happened of chorioamnionitis was of 6 hours. The picture of chorioamnionitis was complete in 54.3%. Delivery was by low way in 33.3%. Authors had found 88.60% case of endometritis, 8.6% case of parietal suppuration post caesarian section but without any maternal decease. Neonatal complications were marked by a score of Apgar &lt;7 - five minutes in 74.3%, neonatal infection in 25.7% and precocious neonatal decease in 11.4%.Conclusions: The chorioamniotite concerned primiparous especially young urgent. The application of the protocol of taking care of the premature break of membranes is necessary for the reduction of the happening of the chorioamniotitis