Impacts of common staff on indicators of sanitary evacuation: experience of the gynecology service of Treichville Teaching Hospital

Background: In order to improve the quality of care for patients discharged in our department, since 1996 we have initiated monthly meetings called "common staffs", with the heads of the peripheral maternities who evacuate patients, during which we analyse reference indicators and the SONUs. The objective of this study was to describe the impact of the common staff on the indicators of the reference.Methods: We carried out a retrospective cross-sectional study on the balance sheets of the common staff over the 20 years of practice.Results: In 20 years, 132 meetings were organized, during which 24,337 files were analyzed. In 1996 the indicators of evacuations were at alarming levels: the time taken between the diagnosis and the decision to evacuate was long (more than 1 hour in 83.4%), 73% of the evacuation records were poorly informed, the majority evacuations were by non-medical vehicle (54.8%), pre-discharge management was incorrect in several patients (47%), and maternal and fetal lethality were high (5% and 10%, respectively). Over time, these indicators have improved and have had a favourable impact on maternal and fetal mortality rates, which have gradually decreased. At the same time, the results of the last three years of the evacuees coming from the maternities who do not participate in our staffs, shows that the indicators are still alarming, at levels where we were at the beginning of common staffs.Conclusions: The joint staff proved to be a good practice to promote in the Gynecology and Obstetrics Departments. It helped to improve the quality of care for referred patients

Results of the multicentric management of infertility couples in Abidjan (Cote d’Ivoire)

Background: The management of infertile couples has seen many advances characterized today by the different techniques of medically assisted procreation (MAP) that are increasingly practiced in the developed countries. The objective of present study is to describe our experience of multicentric management of infertile couples in our ivorian context.Methods: This is a retrospective and cohort study with descriptive purpose over 210 couples treated for infertility in the gynecology services of the University and Hospital Center of Treichville and a private clinic in Abidjan, from 1st February 2013 to 31st January 2017 (48 months).Results: The frequency of infertility was 14%, and the average age was 34.3 years for women and 43.2 years for men. The etiologies were found in 199 couples (94.8%), particularly in 136 women and 113 men. The main causes were uterine (58.1%), and hormonal (26.5%) in women and of infectious origin in men (79.7%). The majority of the patients (113 women and 97 men) received an etiologic treatment, dominated by myomectomia in women (67 patients) and targeted antiobitherapy in men (84.5%). Moreover 113 couples (53.8%) received a medically assisted procreation. After the management 110 couples (52.4%) got pregnant.Conclusions: The multicenter management has enabled infertile couples to have access to modern methods in their care

Problem of obstetrical evacuations of patients coming from maternities outside the coverage zone of the university and hospital center of Treichville (Abidjan-Côte d’Ivoire)

Background: In developing countries, the organization of obstetrical evacuations is experiencing real problems causing certain preventable maternal and fetal morbidity and mortality. Objective of present study was to describe the sociodemographic characteristics and conditions of transfer of patients from peripheral maternities not dependent on the health coverage zone of the University and Hospital Center of Treichville (called maternity out of zone).Methods: This is a prospective and descriptive study, conducted at the maternity of the University and Hospital Center of Treichville, from 1st August 2012 to 31st July 2014 about 266 patients evacuated from maternity out of zone.Results: Only 30% of the patients had properly documented evacuation records. Patients had an average age of 26.9 years, poor follow-up of their pregnancy (92.1%), and were generally low socio-economic level: without monthly income (61.7%), not attending school (35.3%). The majority of evacuations were decided by midwives (60.9%) and were done by taxi (69.5%). In 71.4% of the cases, the patients were re-evacuated to our department with the main reason for the unavailability of the operating rooms (84.3%). 46.6% of the patients took more than 3 hours to arrive in our department and 35% arrived in an aggravated condition and sometimes without venous routes. In our department, complications occurred in 27.1% of the patients, and maternal and fetal death rates were respectively 1.5% and 21.3%.Conclusions: This study revealed malfunctions encountered during evacuations: unsafe transportation, transfer card misinformed, long transfer time

Post abortion care: experience of the gynecological and obstetrical service of Treichville university hospital center, Abidjan-Cote D’ivoire

Background: The objectives of our study were to determine the sociodemographic characteristics of the patients received in our service for abortion and to describe the Post Abortion Cares (PAC) that have been administered since the 2014 reorganization.Methods: This was a descriptive and prospective study over 12 months taking into account patients admitted to our department for abortion.Results: The frequency of abortions was 24%. The majority of patients were less than 25 years old (84.95%) and single (74.33%) had a low level of study (71.68%), an induced abortion history (73.75%) and a notion of contraceptive use (58%). On admission 15.48% of abortions were complicated. Patients mostly received, during their stay, abortion emergency cares (71.68%), contraception (81.25%) and HIV test (90.26%). They also benefited at 6 weeks from the cervical cancer screening (78.57%).Conclusions: The reorganization of the practice of abortion care permitted us to have the expected results

Polyflagellated macrocephalic spermatozoa: failure factor in IVF/ICSI

The authors report two cases of male infertility characterized by spermatic abnormalities of polyflagellated macrocephalic spermatozoa type affecting the entire gametes population. They demonstrate, on the one hand, the technical limitations of microinjection with such spermatozoa due to the large volume of their head and, on the other hand, the unfavourable outcome of the IVF-ICSI with this type of spermatozoa carrying abnormalities constituent. Molecular analysis of the somatic DNA of these subjects revealed a homozygous c.144delC mutation of the Aurora Kinase C gene. Consanguinity at the level of these subjects’ parents appears to be the main risk factor.  This situation constitutes a factor of failure of the IVF and leads to direct the couple towards the donation of gametes or the adoption as solution to the parental project

Epidemiological and diagnostic aspects of spontaneous miscarriage in the department of gynecology-obstetric of the university hospital of Treichville in Abidjan

Background: Describe the epidemiological and diagnostic of spontaneous aspects of early miscarriage in the department of the Gynecology Obsteric of Treichville University Teaching Hospital of   Treichville in Abidjan.Methods: A cross-sectional study was performed from January 2016 to March 2017 on patients received for an early miscarriage (gestational age less than 14 weeks of amenorrhea).Results: We recorded 337 cases of miscarriage and it shows that miscarriage was frequently estimated at 58 percent. Our patients had a average age of 32.9 years, 60.4 percent of them with primary education and 48 percent are housewives. The patients were paucigestes in 46 percent and the majority of them were nulliparous (62 percent). 6 percent with history of high blood pressure; diabetes (3 percent) and 31 percent of patients were HIV positive. Patients had pelvic pain at the admission in (55 percent). A miscarriage appears before 10 weeks of amenorrhea (76.1 percent) of cases. Ultrasound showed ovular debris (47 percent) of patients and (55.4 percent) were chromosomal abnormalities on anatomy-pathological examination.Conclusions: Spontaneous abortions are common and pathological examination is essential for diagnosis

Maternal mortality in the context of political free health care on pregnancy and birth to the Treichville teaching hospital, Abidjan-Côte d’Ivoire

Background: Maternal mortality continues to be a drama in the countries of Sub Saharan Africa. Despite the efforts of the world through the millennium development goals (MDGs) 5 and 6, the situation remains very worrying in this region. If in developed countries, maternal mortality is an indicator of the quality of obstetric care, for poor countries, it is an indicator of social and economic development.Methods: Our study was designed to assess the impact of free support of pregnancy and childbirth on maternal mortality at treichville teaching hospital in Abidjan. We conducted a retrospective descriptive study of deaths of our service over the period September 2012 to August 2013 taking into account the hospital data.Results: During this period, we recorded 32 deaths per 3173 live births. Eight out of ten patients were younger than 35 years. And half had no education. 93.75% of patients were evacuated to another structure and more than half of the deaths occurred less than two hours after admission to our service. Bleeding causes dominate with 37.50% of postpartum haemorrhage.Conclusions: Maternal death rates in our service remain high despite the policy of free care and factors of this mortality remain unchanged for decades

Panorama of fetal malformations at the maternity of Treichville teaching hospital (Abidjan - Côte d’Ivoire)

Background: Congenital malformation is responsible for spontaneous abortion, the birth of a child born dead or a child with disabilities that can lead to long-term disability and have a detrimental impact on the individual, his family and society. The etiologies are diverse. The discovery in our maternity is not rare. The absence and high cost of these prenatal diagnostic are a brake on the detection of congenital malformations. It is these various malformations diagnosed in the ante natal and at birth in our service that we describe in this work which aims to make their panorama.Methods: The purpose of this cross-sectional and descriptive study curried out between 1 January 2003 and 31 December 2013 (10 years) was to describe the various congenital malformations observed at the maternity of the Gynecology and Obstetrics ward of the Treichville University Hospital Center and to identify the socio-demographic characteristics of mothers. This study concerned all women who had given birth at the Treichville University Hospital Center and whose child had a malformation.Results: During the period, 151 parturients gave birth to at least one child with a congenital malformation and among 30,698 newborns, 161 newborns (0.52%) had a malformation. Pregnant women were between 20 and 30 years old (66%), were primiparous in 46.4% of the cases, and 41.7% were housewives. The malformations were isolated in 101 newborns (62.4%), multiple in 60 newborns (37.6%), and dominated by those of the osteoarticular system and the nervous system. Fetal malformations had a poor prognosis in 77 cases (48%) and the fetus was stillborn in 44 cases (27%).Conclusions: Congenital malformations are a reality at the maternity clinic at Treichville. In our countries, the ultrasound stays a fundamental element for the congenital diagnosis of the malformations. A good training of the doctors in prenatal diagnosis is also necessary to make of good diagnoses who will allow a better care of new-born

Review of mastectomy in the department of gynecology at the Treichville teaching hospital, Abidjan-Cote d’Ivoire

Background: Mastectomy plays a key role in the management of breast cancer in our regions of sub-Saharan Africa. Because the advanced forms represent the essential stages of the diagnosis and some therapeutic means remain unavailable. Objective of this study was to report the experience of the practice of mastectomy in the treatment of breast cancer in our service.Methods: This is a retrospective and prospective, descriptive study conducted from January 1, 2013 to May 31, 2017 (age 05) at the University Hospital of Treichville involving 56 breast cancer patients who had undergone a mastectomy.Results: The frequency of the mastectomy was 28.5% and the average age of our patients was 48 years old. The majority of patients had an average socio-economic level (66%). 85.6% of our cancers discovered at advanced stages (T3 and T4). Adenocarcinoma accounted for 96% and infiltrating ductal carcinoma 82% of adenocarcinoma.Patey mastectomy associated with axillary dissection was performed in 96.4% and simple mastectomy in 3.5%. The results of axillary dissection reported lymph node invasion in 38 patients; With an average number of lymph nodes taken from 6.1 and an average number of ganglia affected is 3. Neoadjuvant chemotherapy was administered in 96.4% and adjuvant chemotherapy in 91%. Radiotherapy was performed in 34%. Complications were dominated by lymphoceles in 34% of cases. The 5-year survival of patients operating in the service is 37.8%.Conclusions: Mastectomy is at the forefront of breast cancer surgery in our service. She is supervised by chemotherapy. Radiotherapy remains inaccessible for most patients. Early detection would lead to conservative treatment and a reduction in the postoperative complication rate

Prospection préliminaire de la biodiversité des Insectes des sables littoraux de Mauritanie

The general results of two field trips in the Mauritanian littoral are presented. Our first investigations demonstrate the complexity of the entomofaunas of these littoral deserts. A real development of a Mauritanian entomology would be necessary for the needed exhaustive and long duration studies.Les résultats généraux de deux missions effectuées sur le littoral mauritanien sont présentés. Ces premières investigations font ressortir la complexité des peuplements entomiques de ces déserts littoraux. Cette entomofaune mériterait que se développent sur place des études exhaustives et de longue durée.Caussanel Claude, Dia A.t., Nel André, Ould Bouraya Issac, Thibaud Jean-marc. Prospection préliminaire de la biodiversité des Insectes des sables littoraux de Mauritanie. In: Bulletin de la Société entomologique de France, volume 102 (1), mars 1997. pp. 67-72