Materno-fetal outcomes in pre eclampsia in a rural hospital of Antananarivo Madagascar

Background: Pre-eclampsia is a human-pregnancy-specific disease defined as the occurrence of hypertension and significant proteinuria in a previously healthy woman on or after the 20th week of gestation. It is one of the leading causes of maternal and perinatal morbidity and mortality worldwide. The aim of this study is to determine the prevalence of pre-eclampsia and to evaluate its maternal and fetal outcomes in a rural area.Methods: This is a cross-sectional study carried out at the Bejofo Mahitsy hospital. It is a District Hospital Referral Center, which is located on the outskirts of the capital, 32 km from Antananarivo, Madagascar. This work was carried out during 24 months, from January 2014 to December 2016. We have included all hospitalized pregnant patients with SBP ≥140 or DBP ≥90mmHg, significant proteinuria> 300mg/24H with or without edema.Results: During this period, we recorded 97 cases of pre-eclampsia, frequency of 1.68%. The mean age of the parturient was 28 years old and 46.39% of the patients were primiparous. At the admission to the hospital, 37 (38,14%) did not show any particular signs. Concerning the severe high blood pressure, 47 pregnant patients (48,46%) had SBP greater than 160 mm Hg and 26 womens (26,80%) had DBP greater than 110 mm Hg. Caesarean section was the method of delivery widely adopted in 74.22 %. Maternal morbidity was represented by eclampsia in 21.65%, Retroplacentary Hematoma in 3% and HELLP syndrome in 4.12%. Fetal morbidity was important with 35% of premature newborns, 25.77% was small for gestational age and 12.37% was with neonatal asphyxia. Intra uterine fetal mortality was found in 11.34% and the perinatal mortality rate was 8.73%.Conclusions: There is a high frequency of pre-eclampsia in our setting and the consequences of pre-eclampsia for neonatal mortality and morbidity outcome are alarmingly high pre-eclampsia. Prevention necessarily involves quality prenatal follow-up such as screening, early and appropriate care of hypertension during pregnancy

Acute non-puerperal uterine inversion: a case report in Madagascar

The acute non-puerperal uterine inversion is a rare gynecologic complication. It is a medical-surgical emergency. We report the case of a 46-years-old Malagasy woman who is admitted at emergency room with vaginal painful mass and vaginal heavy bleeding. Uterine inversion which is due to a fundic submucosal myoma was found on clinical examination. The management was surgical and done by an abdominal hysterectomy

Spontaneous umbilical cord hematoma causing still birth: a case report in Madagascar

Spontaneous umbilical cord hematoma is uncommon complication during delivery. It is responsible for severe fetal distress or death. We report a case of a 28 year-old primigravida Malagasy woman at the 37th weeks of gestation. She was admitted in the delivery room for beat oscillating on the fetal heart monitoring at the beginning of labour. Cesarean section was indicated for acute fetal distress in monitoring at dilation 5cm of the cervix traduced by some decelerations.  But she gives birth to a still born female fetus by vaginal way short time after. A 5,5 cm hematoma was discovered on umbilical cord. This still birth may be due to anoxia during acute compression of the umbilical vessels by the hematoma. So, placental and cord examinations in cases of unexplained fetal hypoxia and stillbirth are very important

Ectopic pregnancy at Soavinandriana hospital center, Antananarivo, Madagascar

Background: In the first trimester pregnancy, ectopic pregnancy is the most life-threatening gynecological emergency. The aim of this study was to estimate the epidemiological, diagnostic and therapeutic aspects of ectopic pregnancy in Antananarivo, Soavinandriana Hospital Center.Methods: This was a prospective study carried out among consecutive patients of ectopic pregnancy admitted from January 2014 to February 2016. All cases of diagnosed ectopic pregnancy admitted and managed in the gynecological ward were included in the study. These were reviewed and information was extracted regarding women characteristics, clinical features, diagnosis, management and post-operative complications.Results: During this period, there were 41 ectopic pregnancies. The incidence was therefore 20/1000 births. The mean age was 32,26years. The peak age of incidence was the 30-39 years age group. Nulliparous were the most sufferers. The commonest risk factors identified were previous genital infection. (n=17; 41,46%) previous induced abortions (n=15; 36,58%) and the age ≥35 years old (n =16; 39,02%). Twenty seven patients (n=11) did not have a quantitative measurement of the β subunit of human chorionic gonadotropin (β-hCG). Pelvic ultrasound (transabdominal) was performed on all patients. The majority of patients had a laparotomy (n=35, 85,36%). Tubal pregnancies were noted in 90% (n=37) cases.Conclusions: Health educations on early presentation in hospitals are expected to reduce the incidence of EP and the consequent loss of reproductive potential. The majority of risk factors we identified can be early detected and treated

Twin Reversed Arterial Perfusion (TRAP) Syndrome or acardiac twin: a case report in Madagascar

TRAP syndrome is a rare complication of monochorionic twin pregnancy. It is characterized by the association of an acardiac twin with a healthy twin. The acardiac twin is a parasite who put the healthy twin at high risk of cardiac failure. We report a case in a 25-year-old Malagasy woman, primigravida, who had a consultation at gestational week 31 for significant dyspnea and a threat of premature delivery. Ultrasound scans discovered an acute polyhydramnios, fetus with anasarca and low cardiac activity, and a para-fetal mass. She gives birth to a male newborn and an acardiac twin without head an upper body. The first twin died short time after birth

Spontaneous pregnancy at term with uterus didelphys: a case report

The uterus didelphys results from the absence of fusion of the bilateral mullerian ducts. It is a rare pathology. This malformation concerns 5% of uterine malformations from mullerian ducts and affects one woman in 1,000-30,000. Obstetrical complications of this malformation are numerous. The chance of reaching term for pregnancies with didelphys uterus is reported as 20%–30%. Authors report a case of spontaneous term pregnancy in a 21-year-old primiparous woman with a didelphic uterus. The patient had an unexplained seizure with fetal bradycardia. An emergency cesarean section was performed and allowed the birth of a hypotropic neonate of 2240g and the discovery of didelphic uterus. Pregnancy developed in the left hemi-uterus. Speculum examination at the end of the procedure showed a longitudinal vaginal septum. There was no associated urinary tract and renal malformation. Scheduled cesarean will be performed from her next pregnancy. The uterus didelphys should be diagnosed early. MRI and 3D echography are necessary for diagnosis. Pregnancy is often complicated, and follow-up needs to be planned. Cesarean section is not systematic

Acute non-puerperal uterine inversion: a case report in Madagascar

The acute non-puerperal uterine inversion is a rare gynecologic complication. It is a medical-surgical emergency. We report the case of a 46-years-old Malagasy woman who is admitted at emergency room with vaginal painful mass and vaginal heavy bleeding. Uterine inversion which is due to a fundic submucosal myoma was found on clinical examination. The management was surgical and done by an abdominal hysterectomy

Spontaneous umbilical cord hematoma causing still birth: a case report in Madagascar

Spontaneous umbilical cord hematoma is uncommon complication during delivery. It is responsible for severe fetal distress or death. We report a case of a 28 year-old primigravida Malagasy woman at the 37th weeks of gestation. She was admitted in the delivery room for beat oscillating on the fetal heart monitoring at the beginning of labour. Cesarean section was indicated for acute fetal distress in monitoring at dilation 5cm of the cervix traduced by some decelerations.  But she gives birth to a still born female fetus by vaginal way short time after. A 5,5 cm hematoma was discovered on umbilical cord. This still birth may be due to anoxia during acute compression of the umbilical vessels by the hematoma. So, placental and cord examinations in cases of unexplained fetal hypoxia and stillbirth are very important

Twin Reversed Arterial Perfusion (TRAP) Syndrome or acardiac twin: a case report in Madagascar

TRAP syndrome is a rare complication of monochorionic twin pregnancy. It is characterized by the association of an acardiac twin with a healthy twin. The acardiac twin is a parasite who put the healthy twin at high risk of cardiac failure. We report a case in a 25-year-old Malagasy woman, primigravida, who had a consultation at gestational week 31 for significant dyspnea and a threat of premature delivery. Ultrasound scans discovered an acute polyhydramnios, fetus with anasarca and low cardiac activity, and a para-fetal mass. She gives birth to a male newborn and an acardiac twin without head an upper body. The first twin died short time after birth