Late pregnancies outcome: assessment of the obstetrical risks at the university hospital of gynaecology and obstetrics, Befelatanana, Madagascar

Background: Late pregnancies incur more obstetric complications compared to pregnancies which happen at age 20 to 34. The obstetrician meets difficult challenges to bring these late pregnancies to term delivery, while minimizing the harmful impacts of this non-modifiable risk factor. In addition, few studies have addressed the issue in developing countries, particularly in Madagascar. This study aims to specify the frequency of late pregnancies and to determine maternal and foetal outcome of these pregnancies over age 40, at the University Hospital of Gynaecology and Obstetrics of Befelatanana (HUGOB), Madagascar.Methods: A cross-sectional study was conducted, including women over 40 years old who delivered after 22 weeks in the exposed group, and randomly recruited parturients aged 20 to 34 who gave birth after 22 weeks in the unexposed group.Results: In Madagascar, and particularly at the HUGOB, frequency of late pregnancies after age 40 is low (1.40%). Our study demonstrates these late pregnancies generate more obstetric complications, including pregnancy-induced hypertension and preeclampsia, caesarean section, postpartum haemorrhage, prematurity, foetal distress and foetal death in utero. Some pathology known to complicate these pregnancies such as gestational diabetes and chromosomal defects were probably underestimated in our study because of insufficient means of screening.Conclusions: Advanced maternal age is a significant risk factor of bad pregnancy outcome. Therefore, monitoring of pregnancy for these women should be far more rigorous in order to identify and manage often predictable complications in this situation

A case of recto-vaginal obstetrical fistula treated by the Martius lamp, seen at Befelatanana Madagascar

The rectovaginal fistulas are a pathological epithelialized communication between the vagina and the rectum, its frequency is 10 to 30%, and it is a disabling pathology because of the social repercussion. Many flap techniques have been described but the aim is to present a simple procedure according to a particular technique called Martius. This is a case of woman presenting a low rectovaginal fistula on obstetrical trauma. The surgical technique consists of a repair according to the technique of Martius. The operative follow-up was simple and the patient was able to resume sexual activity and normal anal sphincter function. It is a simple technique, easy to achieve for the technical platform in Madagascar whose evaluation of the results for a larger population should be considered. This technique therefore deserves to be known and widely used

Prenatal Consultation Associated with Maternal and Fetal Complications During Delivery in Military Hospital of Soavinandriana Madagascar

Maternal and fetal complications represent a public health problem. The aim of this study is to identify the effects of prenatal consultation (PNC) in pregnant women to the maternal and fetal complications of deliveries in Military hospital of Soavinandriana (CENHOSOA). This is an analytical study using "Historical Cohort" comparing two groups of population, one group have done PNC or "PNC+" and the other group without PNC or "PNC-".The study was conducted in the CENHOSOA over a period of 13 months from 01 May 2012 to May 31, 2013. During the study period, we have include 296 (23.2%) belonged to the group of PNC- and 982 (76.8%) to the PNC+. The proportion of term birth is lower in PNC- than PNC+ (80.4% versus 93.3%,  p<10-6). The cesarean section was high in the PNC- group in comparison with the "PNC+" (32.1% versus 24.1% p<10-2). Group of PNC- have a relative risk RR = 6.64, 95% CI [1.22 – 36.05] of dyspnea. Infections and phlebitis are non significant in the two groups. Concerning fetal complication, PNC- group had RR=1.99, 95% CI [1.13 – 3.52] to have APGAR score<7 and RR=2.65, 95% CI [1.58 – 4.47] of weight <2,000mg. Concerning complications conducting in deaths, mother with PNC- had RR=3.32, 95% CI [0.21 – 52.88] of maternal death and newborns had RR=2.65, 95% CI [0.72 – 9.82] to intrauterine fetal death. In brief, maternal and fetal complications have been more frequent among women who have not had PNC. The state should promote the practice of adequate and well-conducted PNC for the good of the mother and the baby

Recurrent ipsilateral ectopic pregnancy after partial salpingectomy: case-report

Ectopic pregnancy is a life-threatening condition occurring in 1-2% of all pregnancies. The most common site of implantation for an ectopic pregnancy is the fallopian tube. Authors report a case of recurrent ipsilateral ectopic pregnancy following right partial salpingectomy of a 29-Year-Old woman that led to tubal rupture. The pregnancy was conceived spontaneously. Diagnostic of ruptured ectopic pregnancy was done after clinical and ultrasonography examination. The presence of a massive hemoperitoneum with a positive pregnancy urinary test that lead us to the diagnosis of ectopic pregnancy. She underwent a laparotomy for a suspicion of ruptured ectopic pregnancy. The ectopic pregnancy was identified in the left remnant fallopian tube. Partial salpingectomy, removal of tubal stump, and resection of the uterine cornua, was performed. The postoperative recovery was uneventful. She has stayed for five days at the Hospital. All patients, even though they have already received a definitive contraception by tubal section and ligature or unilateral or by bilateral salpingectomy for any reason, must seek an ectopic pregnancy in case of pelvic pain, vaginal bleeding and/ or amenorrhea. Authors propose to carry a total salpingectomy after a chosen surgical treatment

Heterotopic in spontaneous ruptured pregnancy with a living birth term: a case report in Madagascar

Heterotopic pregnancy is defined as the coexistence of an intrauterine pregnancy (UGI) and an ectopic pregnancy (EUS), regardless of its location. It is a rare pathology. Here, we report the case of a 29-year-old patient who had a heterotopic in spontaneous pregnancy complicated by hemoperitoneum at 7 weeks of amenorrhea. A laparotomy with salpingectomy was performed. The result was favourable with a live birth with 37 SA of the GIU. A heterotopic pregnancy must always be eliminated in the presence of acute pelvic pain in the pregnant woman. Laparotomy is a therapeutic alternative if laparoscopy is not available

Place of the misoprostol in 600 µg in intrarectale in case of hemorrhage of the post partum by uterine atony at the Befelatanana University Hospital Centre of Obstetric Gynecology in Antananarivo, Madagascar

Background: The hemorrhage of the post-partum (HPP) represents a major problem of public health because it hires the vital and obstetrical forecast of the mother in case of delay of taking care. Present study aims at assessing the effectiveness of the administration of 03 tablets of misoprostol in intra-rectal in the taking care of HPP by uterine atony and to determine the épidémio-clinical profile of HPP by atony.Methods: Authors performed a retrospective and descriptive study concerning the effectiveness of the misoprostol in the taking care of HPP by uterine atony. This study started from December 1st, 2016 till March 31st, 2017. The data processing was performed by Epi info 7 and Excel.Results: The rate of HPP represented 3.8% deliveries which 69.4% was due to uterine atony. HPP by uterine atony represented 2.60% deliveries. It happened at the women from 25 to 34 years old (46.16%), pauciparous (76.93%), with a lower working time at 8 hours (71.15%) and having performed at least 4 CPN (63.47%), giving of urgent babies with a medium weight of 3073.43 g. The administration of the misoprostol was efficient in 90.40% and we noticed no side effect or of serious complications during the taking care of HPP by uterine atony.Conclusions: HPP remains another major preoccupation of the obstetricians in our country because it is an emergency that can put into play the vital forecast and which requires a catch in quick load. The administration of 03 tablets (600 µg) of misoprostol in intra-rectal during HPP by uterine atony deserves its place in the armory of taking care because it is a sure method, efficient and easy to manipulate

Mammary lipofiling seen to the hospital complex of Dax

Background: Taken care therapeutics of breast cancer is in constant evolution. She links, according to the stadium of illness, a specific treatment of the cancer and mammary reconstruction which makes integral part of the treatment of breast cancer today. The lipofilling or lipostructure is one of the techniques used in mammary reconstruction.Methods: A descriptive retrospective study on lipofilling accomplished in Hospital complex of Dax, France from January 1st, 2016 till October 31st, 2017 was accomplished, to assess the rate of aesthetic and psychological satisfaction of the patients on the basis of breast Q, then to assess its effectiveness and its security. The statistical analysis was made with the software Excel of Microsoft Office 2007.Results: Authors could record 52 lipofillings at 40 patients among 1212 gynecological surgical operations is 4.29% surgical activities. 47 cases (90.38%) of lipofilling were accomplished at 35 patients after a surgery for breast cancer accomplishing a frequency of 3.87% of surgical activity. The women from 49 to 54 years old are the most concerned the median age of which was of 52 years (37 and 73 years) and the patients are still sexually active in 26 cases (74.29%). The mastectomy was practiced in 32 cases (91.45%). An immediate reconstruction was accomplished at 29 (82.86%) patients. The back big rag autologous was used in 22 cases (62.85%). In 33 cases (94.27%), the lipofilling was accomplished to supplement the reconstruction among which by the back big rag at 22 patients (62.5%) and by mammary prosthesis at 11 patients (31.42%). One took a sample in 32 cases of a volume from 400 to 700 ml of grease average of which was 456.38 ml (200-800 ml). A volume from 200 to 300 ml was injected at 17 patients (36.17%) with an average of 264.14 ml (100-600 ml). No repetition of the cancer was recorded during this study. A score of more than 60 was recorded in every domain for the valuation of satisfaction in more than 90% cases.Conclusions: With the evolution of the taking care of the cancers of breast, mammary reconstruction by lipofilling is a technology which goes know a big development. It is a new way of natural reconstruction at the mastectomy patients who wish, more and more a less aggressive surgical gesture with good result

Infiltration Pariétale De Lidocaïne Et Douleur Post-Césarienne Au Centre Hospitalier Universitaire De Gynécologie Obstetrique Befelatanana, Madagascar

Introduction: One of the main problem to the operated patients is the fear ofuncontrolled postoperative pain.Objective: Evaluation of Lidocaïne infiltration after cesarean section pain.Methods: Comparative randomized study, at the University Hospital ofGynecology and Obstetrics of Befelatanana, during 10 months, among 80 women undergoing ceasarean sectioon under spinal anesthesia. Group A (n = 40) was infiltratedbefore skin closure with 400 mg of Lidocaïne and group B (n = 40) not infiltrated. We evaluated the postoperative EVA scores at H1, H2, H3, H4, H8, H12.Results: The intensity of postoperative pain was respectively 17.3 ± 10.3 mm at H3,23.5 ± 14.9 mm at H4, 23.3 ± 16.3 mm at H8, 17.6 ± 11. 5 mm at H12 against 30.6 ±7.3 mm at H3, 39.6 ± 7.4 mm at H4, 40.1 ± 13.2 mm at H8, 29.1 ± 7.4 mm at H12. The dose of additional analgesic administered in group A was significantly decreased with600 ± 744. 2 mg compared to 2000 ± 226. 45 mg for group B. The request time foradditional analgesia is on average 590. 02 ± 203. 81 minutes for group A against 237. 7± 31. 41 minutes for group B.Conclusion: Parietal infiltration with Lidocaïne in the management of post-caesarean pain provides a higher relief than analgesic treatment without Lidocaïne.

Assessment of the use of partographs in the region of Analamanga

Background: Maternal mortality is associated with an ever-worrying trend in Madagascar. The partograph, set up by the WHO, is topical when it comes to maternal and child mortality-reducing strategies, especially in developing countries. This study assesses the effect of partograph use on maternal and neonatal mortality in maternity wards of ten basic health centres (BHC) and three hospitals located in the districts of Avaradrano, Atsimondrano, Ambohidratrimo, including the district hospital (DH) of Ambohidroa.Methods: Across-sectional survey was conducted in selected districts, using parturients’ medical records during year 2010. Data were derived from the partographs of women meeting the following criteria: a spontaneous onset of labour, an uniparous pregnancy, a term birth, a foetal cephalic presentation, with no extra complication.Results: Neither maternal nor neonatal death was found where a partograph has been used. Partograph use rate is 64.8%. The main reasons for not using partographs include absence of training and lack of skilled health personnel. 128 abnormalities were identified with a correct management rate of 60.9%.Conclusions: Although implementation of the partograph appears to be easy and inexpensive, its use still collides with huge difficulties. It requires a qualified aid and a suitable environment to have a positive and significant impact on maternal and perinatal mortalities related to birth

Epidemiological profile, maternal and neonatal issue of uterine rupture at the Befelatanana Obstetrics and Gynecology University Hospital

Background: Uterine rupture is an obstetric emergency. It involves the life of the mother and the fetus. The main objective of this study was to describe the epidemiological-clinical profile of uterine rupture in Befelatanana Obstetrics and Gynecology University Hospital from January 2016 to April 2018.Methods: This is a retrospective and descriptive study conducted from January 1, 2016 to April 30, 2018 at the Befelatanana Hospital Centre of Gynecology-Obstetrics. All pregnant patients with uterine rupture were included.Results: We recorded 35 cases of uterine rupture in 13184 deliveries with a prevalence of 2.65%. The average age was 27.69±6.21 years old. More than half of the pregnant women attended at least four prenatal care consultations. Uterine rupture occurred after a vaginal delivery attempt outside the centre in 62.86%. There were 77.14% cases occurring on non-scarred uterus and 14.29% on mechanical dystocia. A case of fetal macrosomia has been reported. There were 28.57% maternal deaths and 51.43% perinatal deaths, half of which were fetal deaths in utero and the other half were early neonatal deaths.Conclusions: Uterine rupture remains high in Madagascar. Quality antenatal care and training of the personal would be needed