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

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

Retained plastic instrument after 5 years of illegal abortion: a case report and literature review

The retained of a foreign body during a surgical procedure is defined by the forgetting of a material, left by inattention in the body of the patient during this act. It is a rare event but is responsible for high morbidity and mortality. Authors report a retained foreign body incidentally discovered during a caesarean section. The patient had performed an illegal abortion by endo-uterine instrument which was complicated by uterine perforation five years previously. She was pregnant at 37 weeks and presented to the emergency department for bleeding and diagnosed as placenta previa. The antecedent of abortion had not been informed because it is an illegal act in Madagascar. The plastic instrument was in the broad ligament in contact with the ureter and the uterine artery. Caesarean section, the removal of the catheter and postoperative recovery was uneventful. Foreign body retention remains a malpractice and the diagnosis must be made in the face of chronic pain in patients who have undergone surgery

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

Epidemiological, clinical and therapeutic profile of the umbilical cord prolapse at the Befelatanana University Hospital Centre of Obstetric Gynecology in Antananarivo, Madagascar

Background: Umbilical cord prolapse is a major obstetrical emergency that threatens the fetal prognosis during labor. The objective of this study was to describe the epidemiologic and clinical profile of pulsatile cord prolapse at the Befelatanana University Hospital of Obstetric Gynecology.Methods: It is about a retrospective cross-sectional study conducted at the Befelatanana University Hospital of Obstetrics and Gynecology in Antananarivo over a period of 3 years, from January 1st, 2012 to December 31st, 2014. We have identified all cases of umbilical cord prolapse. We studied obstetric, neonatal and maternal parameters.Results: We found 70 cases of pulsatile umbilical cord prolapse, a prevalence of 0.28% of deliveries. The average age of the patients was 28 ± 3.2 years with extremes ranging from 18 to 43 years. Multiparous women predominated with (51.43%) Pregnancy was long term, with 71.43% of cases associated with placenta praevia, lateral prolapse of the limb, long cord and contracted pelvis. The prolapse of the cord was 1st degree with 44.29% of cases. All patients had received (100%) of oxygen therapy. Almost all patients were caesarized (95.71%). Neonatal complications were represented by admission to neonatal intensive care unit (32.86%), perinatal asphyxia (31.43%), prematurity (28.57%), neonatal infection (4.29%) and neonatal death (10%).Conclusions: The umbilical cord prolapse is relatively rare. Fetal extraction in the shortest possible time, especially when the cord is externalized, which is the main determining factor of neonatal prognosis

Assessing the challenges and initiatives to increase women’s integration into science in Madagascar

We present here a commentary essay on the challenges and perspectives on the recruitment and retention of Malagasy women in STEM (Science, Technology, Engineering, and Mathematics). We base the essay on our personal experience as Malagasy women scientists and support the arguments with the responses of 60 Malagasy women scientists to an online survey that was shared among Malagasy scientists. We identified that the main causes for a limited number of Malagasy women in STEM relied upon traditional expectations and heavily ingrained cultural values. The situation becomes more complicated when accounting for familial constraints, financial constraints, and communication gaps between students and professors. This is obviously an unfortunate situation; however, there have been bridging-gap initiatives—financial, awareness to family pressure, and knowledge difference between senior and junior scientists—that should be continued to provide support to promising students and enhance STEM education as a tool for development in Madagascar. RésuméCet essai discute les défis et les perspectives dans le recrutement et le maintien des femmes citoyennes de Madagascar dans les sciences, la technologie, l’ingénierie et les mathématiques (STIM). Les arguments présentés sont basés sur nos expériences personnelles en tant que femmes scientifiques nées et ayant grandies à Madagascar. Ces arguments sont soutenus par des informations issues d’un sondage effectué en ligne auprès de 60 femmes scientifiques, s’identifiant elles-mêmes originaires de Madagascar. Les raisons pour lesquelles ces femmes sont peu nombreuses à participer activement dans les domaines des STIM à Madagascar sont liées à des contraintes traditionnelles et à des valeurs culturelles fortement ancrées depuis leur enfance. La situation se complique lorsqu’on tient compte des contraintes financières et des écarts de communication entre étudiants et professeurs. Si cette situation est évidemment regrettable, il existe cependant des initiatives visant à combler le fossé qui sont financières, ou qui s’inscrivent dans la sensibilisation à la pression familiale et à la différence de connaissances entre les scientifiques seniors et juniors. Ces encouragements devraient être poursuivis afin d'apporter un soutien aux étudiantes prometteuses et d'améliorer l'enseignement des femmes en STIM qui sont importantes pour le développement de Madagascar

Associated factors of precocious sexual intercourse among schooled teenagers in Antsirabe town, Madagascar

Background: Teenagers are defined by world health organization as persons between 10 and 19 years of age. When this generation has a sexual intercourse, it is considered to be early. The main aim of this investigation is to identify associated factors of precocious sexual intercourse.Methods: A cross-sectional study was conducted at the high schools in Antsirabe town among teenagers.Results: Among 636 teenagers, 19.8% are prematurely initiated. The median age of first sexual experience is 16 years of age. The average age for this first sexual experience takes place at 15.5 (1.4) years of age for boys and at 16.6 (1.2) years for girls. One kind of sociodemographic profile is associated to the first precocious sexual intercourse. Poor school performance, urban life, alcohol, tobacco and drug use are also significantly associated with this precocious sexual experience. From the relationship standpoint, 6= lack of sexual education by the head of household, the absence of religious diligence, the influence of customs, internet access and accession a social network are indeed associated to this problem.Conclusions: In order to meet these results, the ministry of public health should design on Facebook, education program about forward sexuality