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

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

Etiology and maternofetal issue of acute pulmonary edema in prepartum at the Befelatanana university hospital of gynecology and obstetrics

Background: Pulmonary edema is defined as the as the ultrafiltration of plasma through the capillary wall to the interstitium and pulmonary alveoli. It is a rare pathology and difficult diagnosis. Through this study, we wanted to know the etiologies and maternofetal issue of acute pulmonary edema manifesting in prepartum. It is a rare pathology and difficult diagnosis. Through this study, we wanted to know the causes and maternofetal issue of acute pulmonary edema manifested in prepartum.Methods: It is about a descriptive retrospective study from January 1st, 2014 to April 30th, 2018 at the Befelatanana University Hospital of Obstetrics and Gynecology. We included all pregnant patients of 20 weeks and above with acute antepartum pulmonary edema. We excluded postpartum APE. Data collection and analysis was performed on the Excel Stat 2007 Software.Results: We had 36 cases of acute pulmonary edema during this period with an incidence of 0.001%. The average age was 28.75±8.72 years. Mean gestational age was 32 ± 7.82SA. Pregnancy was poorly followed in more than half of the cases. 15% did not perform prenatal follow-up. Caesarean section was the chosen delivery route in 82% of cases. Among the childbirth, 73% were premature, 63% asphyxiated and 56% hypotrophic. We had 52% of maternal death and 44, 44% of fetal loss. The main etiology was dominated by preeclampsia and its complications (63.88%) followed by cardiopathy (25%). A case of malaria during pregnancy was identified as the cause of APE.Conclusions: Acute pulmonary edema during pregnancy is a serious pathology because the maternal prognosis is catastrophic with 50% maternal and foetal mortality in our context. The identification of patients at risk, the monitoring of pregnancy, the effective management of the pathology involved are necessary to reduce the incidence and maternal mortality secondary to pulmonary edema