Prolapsus Gravidique: Facteurs de Risque, Complications et Prise en Charge en Afrique Sub-Saharienne

Objectif :  Le but de cette étude était d’aborder les caractéristiques socio démographie, les aspects thérapeutiques et le pronostic du prolapsus utérin extériorisé survenu pour la première fois pendant la grossesse. Patientes et Méthodes : Il s’agissait d’une étude prospective sur une période de 12 mois (1er janvier au 31 décembre 2021) portant sur les patientes prise en charge pour prolapsus gestationnel. Résultats: Sept cas ont été enregistrés durant la période d’étude. La fréquence du prolapsus gestationnel était de 2 cas/1000 accouchements dans notre service. Les patientes étaient jeunes (28-31 ans), multipares avec un âge moyen de 28,57 ans et une parité moyenne de quatre enfants. Elles étaient très jeunes à leurs premier accouchement (16-20 ans). La plupart de facteurs de risques décrits dans la littérature étaient retrouvés chez nos patientes. La rupture prématurée des membranes (2 cas, 28,57%), la chorioamniotite (1 cas, 14,28%), l’accouchement prématuré (1 cas, 14,28%), l’hémorragie de la délivrance (1 cas, 14,28%) et l’anémie (1 cas, 14,28%) ont été les complications retrouvées. Un traitement conservateur a été réalisé chez toutes les patientes (100%). L’évolution était favorable avec une régression spontanée du prolapsus dans le post-partum immédiat chez toutes nos patientes (100%). Après six mois de suivi, les prolapsus n´ont pas récidivés. Conclusion : Le prolapsus gestationnel n’est pas exceptionnel dans notre contexte. Malgré son caractère angoissant pour la patiente, sa famille et l’équipe obstétricale, une attitude conservatrice peut se discuter devant un prolapsus apparu pour la première fois au cours de la grossesse chez une patiente jeune sans antécédents pathologiques particuliers.   Objective : The aim of this study was to address the socio-demographic characteristics, therapeutic aspects and prognosis of externalized uterine prolapse occurring for the first time during pregnancy. Patients and Methods : This was a prospective study over a period of 12 months (January 1 to December 31, 2021) focusing on patients treated for gravidarum prolapse. Results : Seven cases were recorded during the study period. The frequency of gravidarum prolapse was 2 cases/1000 deliveries in our department. The patients were young (28-31 years old), multiparous with an average age of 28.57 years and an average parity of four children. They were very young when they first gave birth (16-20 years old). Most of the risk factors described in the literature were found in our patients. Premature rupture of membranes (2 cases, 28.57%), chorioamnionitis (1 case, 14.28%), premature delivery (1 case, 14.28%), postpartum hemorrhage (1 case, 14.28%) and anemia (1 case, 14.28%) were the complications found. Conservative treatment was carried out in all patients (100%). The evolution was favorable with spontaneous regression of the prolapse in the immediate postpartum period in all our patients (100%). After six months of follow-up, the prolapses have not recurred. Conclusion : gravidarum prolapse is not exceptional in our context. Despite its distressing nature for the patient, her family and the obstetric team, a conservative attitude can be questioned when faced with a prolapse appearing for the first time during pregnancy in a young patient without any particular pathological history

Anti-fibrinolytic agents in post partum haemorrhage: a systematic review

BACKGROUND: Post partum haemorrhage is a leading cause of maternal death worldwide. It also contributes to maternal morbidity as women may require a hysterectomy to control bleeding, or may require a blood transfusion, which can transmit viral infections. Anti-fibrinolytic agents have been proposed as a treatment for post partum haemorrhage. We conducted a systematic review to assess the effectiveness and safety of anti-fibrinolytic agents in post partum bleeding. METHODS: All randomised controlled trials of anti-fibrinolytic agents given for bleeding during the postpartum period were included in this review. We searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled trials, Web of Science, metaRegister of controlled trials, LILACS, Reproductive Health Library, African healthline, POPLINE, MedCarib, CINAHL, Clinicaltrials.gov and the reference lists of eligible trials. Two authors extracted data. Methodological quality was assessed by evaluating allocation concealment. The primary outcome was maternal mortality. Secondary outcomes were blood loss, blood transfusion, hysterectomy, mean haemoglobin concentration, thrombo-embolic events and other adverse effects. RESULTS: We identified three randomised controlled trials involving 461 participants. The trials compared tranexamic acid with no treatment and reported blood loss after delivery. In all three trials, allocation concealment was either inadequate or unclear. The administration of tranexamic acid was associated with a reduction in blood loss of 92 millilitres (95%CI 76 to 109). The most frequently reported adverse effect of tranexamic acid was nausea, although the increase was easily compatible with the play of chance (RR 4.63, 95%CI 0.23 to 95.14). CONCLUSION: Tranexamic acid may reduce blood loss in post partum haemorrhage. However, the quality of the currently available evidence is poor. Adequately powered, high quality randomised controlled trials are needed

Mole hydatiforme partielle compliquee d’anarsarque fœtale : A propos d’un cas rare

La môle hydatiforme partielle désigne un produit de conception avec des villosités molaires entourant une cavité amniotique pourvue d'un embryon. Elle comporte 69 chromosomes (le plus souvent XXY, XXX, XYY) et correspondent au syndrome triploïde (môle embryonnée). De rares môles partielles sont aneuploïdes (haploïde ou tétraploïde). La circonstance diagnostique la plus commune étant le tableau d’avortement spontané au premier trimestre. Rarement les môles partielles persistent au-delà du premier trimestre et sont alors source de complications maternelles et fœtales et de confusion diagnostique. Nous rapportons un cas rare de grossesse molaire partielle diagnostiquée tardivement à 30 semaines d’aménorrhée compliquée d’hématome rétroplacentaire, et d’anarsaque fœtale.   English title: Partial hydatiform mole complicated by fetal hydrops: A case report Partial hydatidiform mole was a product of conception with molar villi  surrounding an amniotic cavity with an embryo. It has 69 chromosomes (most often XXY, XXX, XYY) and correspond to the triploid syndrome (embryonic mole). Rare partial moles are aneuploid (haploid or tetraploid). The most common diagnostic circumstance being the first trimester spontaneous abortion picture. Rarely, partial moles persist beyond the first trimester and are then a source of maternal and fetal complications and diagnostic confusion. We report a rare case of partial molar pregnancy diagnosed late at 30 weeks with amenorrhea complicated by retroplacental hematoma, and fetal hydrops

Vibratory stress relief - an investigation of the torsional stress effect in welded shafts

In this study the effect of torsional vibration on residual stresses was investigated. Three types of shaft specimen were processed, namely (a) a homogeneous shaft, (b) a shaft welded on a circumferential line and (c) a spot-welded shaft. The first two types of shaft showed some redistribution in the residual stresses under applied torsional loads. On the spot-welded shafts the residual stresses were found to decrease significantly at a very low level of vibration induced stress