Médical interruption of pregnancy in the 2nd and 3rd trimester of pregnancy: about 42 cases collged ať the Tunis Maternity and Neonatology Center “Service A”

Background: Study IMGs in the 2nd or 3rd trimester of pregnancy in department “A” of the CMNT.Methods: Descriptive and analytical cross-sectional study in the “A” obstetrics gynecology department of the CMNT from January to June 2012. The variables studied related to sociodemographic characteristics, diagnosis, management and prognosis. Undiagnosed fetal abnormalities in the 1st trimester, serious maternal pathologies are the inclusion criteria. IMGs for embryofetopathies and MFIUs were not included in the study.Results: The average age was 32 years with an average term of 27 weeks of amenorrhea and 01 day. The indication was 97.6% fetal. Fetal malformations were divided into 54.8% neurological abnormalities, 4.8% renal abnormalities, 4.8% digestive abnormalities, 4.8% bone abnormalities, 2.4% pulmonary abnormalities and 2.4% cardiac abnormalities. The foeto-pathological examination was carried out 64.3% confirming the antenatal diagnosis with an ultrasound sensitivity of 67.6% in the 2nd trimester and 83.3% in the 3rd trimester. The overall expulsion time was 30.6 hours (28 SA), an overall success rate at 24 hours of 97.6% with one uterine rupture, 3 uterine retentions and hemorrhage. No cases of maternal death or infection were observed.Conclusions: The delay in the diagnosis of fetal pathologies makes it difficult to decide on abortion for practitioners and parents. Antenatal ultrasound and fetal karyotype represented the means that made it possible to pose or suspect the diagnosis of fetal abnormality

Roles of specific Plasmodium falciparum mutations in resistance to amodiaquine and sulfadoxine-pyrimethamine in Burkina Faso.

We evaluated associations between key polymorphisms in target genes and responses to treatment with sulfadoxine-pyrimethamine (SP) or amodiaquine (AQ) for uncomplicated Plasmodium falciparum malaria in Bobo-Dioulasso, Burkina Faso. Presence of the dihydrofolate reductase (dhfr) 108N or 59R mutations (but not dhfr 51I or dihydropteroate synthetase [dhps] 437G) and P. falciparum chloroquine resistance transporter (pfcrt) 76T or P. falciparum multidrug resistance 1 (pfmdr1) 86Y or 1246Y mutations (but not pfmdr1 184F) predicted recrudescence after treatment with SP and AQ, respectively. Treatment led to significant increases in the prevalence of the same mutations (except 1246Y) in new infections that presented after therapy. The dhfr 164L and dhps 540E mutations were not seen in any isolates. These results clarify the key roles of a small number of mutations in P. falciparum resistance to SP and AQ in west Africa

Amodiaquine, sulfadoxine-pyrimethamine, and combination therapy for uncomplicated falciparum malaria: a randomized controlled trial from Burkina Faso.

Increasing resistance to chloroquine necessitates the evaluation of other antimalarial therapies in Africa. We compared the efficacies of amodiaquine (AQ), sulfadoxine-pyrimethamine (SP), and AQ + SP for the treatment of uncomplicated falciparum malaria in a randomized trial of patients 6 months of age or older in Bobo-Dioulasso, Burkina Faso. Of the 944 patients enrolled, 829 (88%; 53% under 5 years of age) were assigned 28-day efficacy outcomes. For all regimens, early treatment failures were uncommon (< 2%). Considering all treatment failures based on WHO criteria, AQ + SP was most efficacious (failures in 4.2%), followed by SP (9.1%) and AQ (17.9%; P < 0.02 for all pairwise comparisons). Considering only clinical failures, relative efficacies were similar (failures in 2.1% with AQ + SP, 6.5% with SP, and 13.2% with AQ; P < 0.02 for all pairwise comparisons). The risk of recrudescence was lower with AQ + SP (2.1%) compared with SP (6.1%, P = 0.02) and AQ (8.1%, P = 0.001). Risks of new infection were lower with AQ + SP (2.1%) and SP (2.4%) compared with AQ (9.1%, P < 0.001 for both comparisons). No serious adverse events were seen. AQ + SP appears to offer a highly effective, inexpensive, and available therapy for the treatment of uncomplicated malaria in Burkina Faso

Oral misoprostol as first-line care for incomplete abortion in Burkina Faso

AbstractObjectiveTo explore 400-μg sublingual misoprostol as primary treatment in lower-level facilities with no previous experience providing postabortion care.MethodsWomen presenting with incomplete abortion were offered a single dose of 400-μg sublingual misoprostol. Incomplete abortion was defined as uterine size consistent with fewer than 12weeks of gestation, open cervical os, and reports of past or present history of vaginal bleeding. Women returned to the clinic 1week after misoprostol administration for follow-up. At that time, they were discharged if the uterine evacuation was a success or were offered a second follow-up visit or surgical completion if still incomplete.ResultsOne-hundred women received misoprostol; outcome data were unavailable for 1 woman. Complete uterine evacuation was achieved for 97 (98.0%) women. Satisfaction was high, with nearly all women indicating that they were “satisfied” (n=57 [57.6%]) or “very satisfied” (n=41 [41.4%]) with their experience. Adverse effects were considered “tolerable” by 72 of 97 (74.2%) women. Ninety-seven of 99 (98.0%) participants indicated that they would choose misoprostol for incomplete abortion care in the future and 95 of 97 (97.9%) stated that they would recommend it to a friend.ConclusionMisoprostol is a viable option for treatment of incomplete abortion at mid-level facilities.Clinical trials.gov: NCT00466999