Mariannes Noires : la condition noire au féminin

Sept Françaises d’origine africaine et caribéenne nous entraînent dans leurs explorations d’une expérience commune, celle d’être noire et française, noire en France. Elles sont artistes, entrepreneures, intellectuelles, et nous parlent de leur quotidien, de leurs aspirations, de leurs combats. Ces femmes sont françaises, mais leur francité naît et s’épanouit dans des différences culturelles et esthétiques que ce pays a encore du mal à intégrer. Mariannes noires, ce sont sept récits qui s’enlacent et se font écho afin de lever un coin du voile sur des expériences noires en France. Avec Alice Diop, Maboula Soumahoro, Isabelle Boni-Claverie, Aline Tacite, Bintou Dembélé, Elisabeth Ndala et Fati Niang.What is it to be Black in France? Black and French? Mariannes noires follows seven French women of African and Caribbean descent. They are filmmakers, dancers, entrepreneurs and intellectuals whose Frenchness is rooted in a cultural space stretching from metropolitan France to Africa and its many diasporas. The documentary is a mosaic of seven narratives that raise the veil on multicultural France. With Alice Diop, Maboula Soumahoro, Isabelle Boni-Claverie, Aline Tacite, Bintou Dembélé, Elisabeth Ndala, and Fati Niang.Siete mujeres francesas de origen africano y caribeño nos comparten sus exploraciones de una experiencia en común, la de ser negra y francesa, negra en Francia. Son artistas, empresarias, intelectuales, y nos hablan de la vida cotidiana, de sus aspiraciones, de sus combates. Estas mujeres son francesas, pero esta característica nace y se desarrolla en el marco de diferencias culturales y estéticas que a Francia todavía le cuesta integrar. Mariannes noires, son siete relatos entrelazados que se responden unos a otros para levantar parte del velo que cubre las experiencias negras en Francia. Con Alice Diop, Maboula Soumahoro, Isabelle Boni-Claverie, Aline Tacite, Bintou Dembélé, Elisabeth Ndala, y Fati Niang.Sete mulheres francesas de origem africana e caribenha levam-nos a partilhar suas explorações de uma experiência comum, ser negra e francesa, ser negra em França. Elas são artistas, empresárias, intelectuais, e falam sobre o seu cotidiano, suas aspirações, seus combates. Estas mulheres são francesas, mas a sua identidade francesa nasce e realiza-se em diferenças culturais e estéticas que este país integra com dificuldade. Mariannes Noires apresenta sete retratos que se entrelaçam e ressoam para desvendar algumas experiências negras em França. Com Alice Diop, Maboula Soumahoro, Isabelle Boni-Claverie, Aline Tacite, Bintou Dembélé, Elisabeth Ndala, e Fati Niang

Analysis of cesarean section rate according to Robson’s classification in an urban health centre in Senegal

Background: Robson, proposed a new classification system, the Robson’s Ten-Group Classification System to allow critical analysis according to characteristics of pregnancy. The objective was to describe caesarean rates in an urban health centre in Dakar using Robson’s Ten groups classificationMethods: This study was performed in Philippe Senghor health centre in Dakar (Senegal), a secondary health centre that performs CS since 2011. Before this date, only midwifes performed deliveries in this centre. The study took place between 1 January and 31 December 2013. All patients who delivered during this period by CS were included.Women were classified in 10 groups according to Robson’s classification, using maternal characteristics and obstetrical history. For each group, we calculated its relative size and its contribution to the overall caesarean rate.Results: The overall rate of caesarean was 18.2%. The main contributors to the overall caesarean rate were primiparous women in spontaneous labour (group 1) and women with previous caesarean section (group 5). Further analysis of group 1 showed that more than half of CS indications in this group were fetal-pelvic disproportion in 55.2% and fetal hypoxia in 27%.Conclusion: The Robson’s classification is easy to use. Each maternity unit can compare its rates with those of units with similar level, to find whether some groups of women have very high rates of caesarean sections. Attention should be made because CS rates is rising up and will be problematic in our low resource countries. It is time to implement obstetric audits to lower the CS rates

Severe pre-eclampsia: epidemiological, diagnostic, therapeutic and prognostic aspects at Hospital Principal Dakar from January 2019 to December 2020

Background: Preeclampsia, major public health problem, is one of the leading causes of maternal and infant mortality. It is increasingly frequent in our referral health centers, especially in its severe form. Methods: Retrospective descriptive and analytical study about severe preeclampsia at the Maternity of Hospital Principal Dakar, from 01 January 2019 to 31 December 2020. Results: Frequency of severe preeclampsia was 3.09%. Medical evacuation (70.59%) was the most frequent mode of admission. Patients were in average 29.8 years and primipare. Personal medical history was dominated by high blood pressure (16.29%). The average gestational age was 34+2 days, but pregnancy was carried to term by the majority of patients. Functional signs were dominated by headache (40.65%). Blood pressure was greater than or equal to 160/90 mmHg (90.32%). Hyperuricemia was the most frequent biological anomaly after proteinuria (45.1%). Complications were dominated by retroplacental hematoma (4.49%) and intrauterine growth retardation (IUGR) (28.48%). Calcium channel blockers (81.88%) were the main antihypertensive agents administered. Caesarean section was the most common delivery method (80.46%). The maternal prognosis was good, with no maternal deaths recorded. Perinatal mortality was 173.9%. Conclusions: Preeclampsia remains a fearsome pregnancy’s pathology. Raising awareness of pregnant women during ANC on the risks of pre-eclampsia, retraining of health personnel, close and early monitoring of women at risk and management in a multidisciplinary setting help to improve the maternal-fetal prognosis.

Funiculars anomalies during childbirth: about 562 cases collected in Pikine National Hospital

Background: Establish an epidemiological description of the different types of umbilical cord anomalies in our reference structure and to assess their impact on the prognosis of childbirth.Methods: We conducted a descriptive study, cross over a period of one year in Obstetrics and Gynecology Service Level III of Pikine Hospital. We included all women in labor have reached the term less than 28 weeks gestation and delivering a newborn with umbilical cord abnormality diagnosed during labor or during the expulsion.Results: During this period, we compiled 562 anomalies of the umbilical cord, which gave a frequency of 23.8%. Length discrepancies were far the most frequent (67.4%). Only the prolapsed cord was an independent risk factor for cesarean section (p = 0.036). The rate of episiotomy and tear was significantly higher in case of brevity (primitive or induced) cord (p = 0.042). Apgar score ≤7 was significantly related to the presence of brevity (p = 0.000), excessive length (p = 0.048) or cord prolapse (p = 0.037).Conclusions: This study has allowed us to see that the funicular abnormalities impede the smooth running of childbirth. Their occurrence is facilitated by the excess amniotic fluid, prematurity and low birth weight. Their research during prenatal ultrasounds should be systematic

Unruptured tubal pregnancy in the second trimester

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Maternal and perinatal outcomes in multiple versus singleton pregnancies in Dakar, Senegal: a cross sectional study over 10 years

Background: The birth of twins is a singular event in most societies, and even more when it comes to multiple births. The objective of this study was to investigate maternal and perinatal outcomes in multiple versus singleton pregnancies.Methods: Cross-sectional study carried out at Philippe Maguilen Senghor health center in Dakar, Senegal from January 1, 2011 to June 30, 2019. Data were extracted from this E-perinatal electronic database and then analyzed in statistical package for social science software (SPSS 24, Mac version).Results: A total 42,870 mothers delivered 44,149 newborns including 1250 twins (2.8%) and 29 triplets. The mean maternal age was 27 years. Mothers with multiple pregnancies had 3 times the odds of poor maternal outcome compared to mothers with single pregnancies (OR 2.42, 95% CI; 1.98-2.94, p <0.001, for high blood pressure; OR, 2.66; 95% CI, 2.11-3.32, p= <0.001, for severe pre-eclampsia; and OR, 3.04; 95% CI, 1.64-5.66, p <0.001, for postpartum hemorrhage). Likewise, women with multiple gestations had significantly higher rates of preterm birth (OR 5.62; 95% CI: 4.91-6.41, p <0.001), breech presentations (OR = 11.02; CI = 9.68-12.53, p <0.001) and neonatal deaths (OR = 2.94; CI = 9.6852-12.5328 p= 0.004) as compared to women with singleton gestations. Furthermore, women with multifetal gestations had increased risk for caesarean section (OR 2.14; 95% CI: 1.91-2.41, p <0.001) compared with their singleton counterparts. The risks for episiotomy and perineal injuries were higher for women with singleton gestations as compared to multiple gestation mothers.Conclusions: This study results are in line with previous findings and contradict others. Particular attention should always be paid to multiple pregnancies’ management. However, the pattern of certain complications traditionally correlated with multiple pregnancies is to be confirmed

Completeness of information in electronic compared with paper-based patients’ records in a maternity setting in Dakar, Senegal

Background: Evaluate the consistency of information in paper-based records when registered in parallel with an electronic medical record.Methods: The study was performed at PMSHC in Dakar Senegal. From the end of year 2016, patients’ files were recorded on both paper-based and electronically. Additionally, previous records were electronically registered. To investigate the completeness of records before and after the electronic recording system has been implemented, information about some maternal and fetal/neonatal characteristics were assessed. When the variable was recorded, the system returned 1, unrecorded variables were coded as 0. We then calculated, for each variable, the unrecorded rate before 2017 and after that date. The study period extended from 2011 to June 2019, a nearly ten-year period. Data were extracted from E-perinatal to MS excel 2019 then SPSS 25 software. Frequencies of unrecorded variables were compared with chi-squared test at a level of significance of 5%.Results: A total of 48,270 unique patients’ records were identified during the eight-year period.  Among the study population, data for patients’ age, address and parity were available most of the time before and after 2017 (0.5% missing data versus 0.3% for age and 2.6% versus 1.3% for home address and from 0.3% to 0.0% for parity). However, phone number, maternal weight, maternal height, last menstrual period and blood group were found to be missing up to 96% before 2017. From 2017, these rates experienced a sudden decrease at a significant level: from 82.4% to 27.8% for phone number, from 96% to 56.3% for maternal weight and from 60.1% to 21.3% for blood group. Regarding newborns’ data, it was found that fetal height, head circumference and chest circumference were missing up to just under 25% before 2017. After that date, their completeness improved and flattened under 5%.Conclusions: Structured and computerized files reduce missing data. There is an urgent need the Ministry of health provides hospitals and health care providers with guidelines that describes the standardized information that should be gathered and shared in health and care records

Hepatocellular carcinoma associated with pregnancy about 2 cases at the gynecological and obstetrical clinic of the Aristide Le Dantec hospital, Dakar, Senegal

The objective of our study was to report 2 cases of hepatocellular carcinomas associated with pregnancy followed in our structure and to review the literature. Our patients were 30 and 37-year-old multi-gesture females with chronic unattended viral hepatitis B in whom the diagnosis of hepatocellular carcinoma was made in the third trimester of pregnancy at 31 weeks of amenorrhea and 4 days and at 32 weeks of amenorrhea after the incidental finding of tumor hepatomegaly on abdominal-pelvic ultrasound. The main clinical signs were jaundice and hepatomegaly and paraclinical signs were dominated by hepatic cytolysis and anemia in addition to ultrasound images. Follow-up of pregnancies revealed no particularities. A caesarean section was scheduled at 32 weeks of amenorrhea and 32 weeks of amenorrhea and 3 days allowing the birth of two preterm newborns weighing 1210 and 1500 gm with Apgar scores of 8-10/10 and 7-9/10 respectively at the fifth minute. The immediate post-operative follow-up was simple. However, the maternal-fetal prognosis was poor with the death of both patients in a multi-visceral failure table occurring respectively at 6 weeks and 3 weeks after caesarean section. The newborns had died 8 days after birth. Although rare, these two cases challenge any obstetrician to think about liver cancer in pregnant women, especially those with chronic hepatitis B. Ultrasound examination of the liver, or even better, the MRI, which is more efficient, in order to suspect early on a possible liver cancer. Indeed, early diagnosis and a thorough medical approach are essential for the treatment of HCC in pregnant patients

Active management of third stage of labour with low doses of oral misoprostol and oxytocin on low: risk parturient in a Sub-Saharan hospital, Dakar, Sénégal

Background: Assess the effectiveness of oral misoprostol as an alternative to oxytocin in the active management of the third stage of labour in Dakar/Senegal.Methods: Randomized controlled clinical trial conducted in the maternity ward of a university hospital on 304 women who had vaginal delivery. These women were randomly assigned into 2 groups based on active delivery conditions: the first group received an oral administration of misoprostol (400 mcg) and the second group 5 IU oxytocin through intravenous route.Results: The average volume of blood loss was 196.55 ml in the misoprostol group and 208.39 ml in the oxytocin group (p=0.63). The incidence of postpartum haemorrhage (>500 cc) was 6.49% in the misoprostol group and 9.33% in the oxytocin group (p=0.358). The average rate of haemo globin decline was 0.38 g/dl in the misoprostol group and 0.29 g/dl in the oxytocin group (p=0.99). The proportion of hyperthermia, shivering, and nausea in the misoprostol and oxytocin groups were respectively: 2.59% against 0.6% (p=0.123), 7.14% against 2% (p=0.001) and 2.59% against 0.6% (p=0.498).Conclusions: In Senegal, Misoprostol despite its side effects, is an effective alternative to oxytocin in the active management of the third stage of labour for low-risk parturient women to reduce the risk of maternal deaths due to post-partum hemorrhage