Fetal outcome in emergency versus elective cesarean sections at Souissi Maternity Hospital, Rabat, Morocco

Introduction: Perinatal mortality rates have come down in cesarean sections, but fetal morbidity is still high in comparison to vaginal delivery and the complications are more commonly seen in emergency than in elective cesarean sections. The objective of the study was to compare the fetal outcome and the indications in elective versus emergency cesarean section performed in a tertiary maternity hospital. Methods: This comparative cross-sectional prospective study of all the cases undergoing elective and emergency cesarean section for any indication at Souissi maternity hospital of Rabat, Morocco, was carried from January 1, to February 28, 2014. Data were analyzed with emphasis on fetal outcome and cesarean sections indications. Mothers who had definite antenatal complications that would adversely affect fetal outcome were excluded from the study. Results: There was 588 (17.83%) cesarean sections among 3297 births of which emergency cesarean section accounted for 446 (75.85%) and elective cesarean section for 142 cases (24.15%). Of the various factors analyzed in relation to the two types of cesarean sections, statistically significant associations were found between emergency cesarean section and younger mothers (P < 0.001), maternal illiteracy (P = 0.049), primiparity (P = 0.005), insufficient prenatal care (P < 0.001), referral from other institution for pregnancy complications or delivery (P < 0.001), cesarean section performed under general anesthesia (P < 0.001), lower birth weight (P < 0.016), neonatal morbidity and early mortality (P < 0.001), and admission in neonatal intensive care unit (P = 0.024). The commonest indication of emergency cesarean section was fetal distress (30.49%), while the most frequent indication in elective cesarean section was previous cesarean delivery (47.18%). Conclusion: The overall fetal complications rate was higher in emergency cesarean section than in elective cesarean section. Early recognition and referral of mothers who are likely to undergo cesarean section may reduce the incidence of emergency cesarean sections and thus decrease fetal complications.Pan African Medical Journal 2016; 2

Phytochemicals screening, cytotoxicity and antioxidant activity of the Origanum majorana growing in Casablanca, Morocco

Origanum majorana is a plant from the Lamiaceae family. It is a medicinal plant used in traditional medicine in Morocco to treat various diseases. This work aims to determine the phytochemical composition of Marjoram, as well as to evaluate its cytotoxic effect on the cells of healthy subjects. All parts of the plant (roots, leaves, stems, etc.) were subjected to selective extraction with different solvents of increasing polarity (Diethyl ether, Dichloromethane, Ethanol, Methanol) using the rotary steamer. The yields obtained are respectively 1.34%, 4.57%, 9.98%, and 10%. The phytochemical tests carried out have detected the presence of polyphenols, tannins, flavonoids, terpenoids, sterols, saponins, and reducing sugars. In contrast, the absence of the family of cardiotonic alkaloids, quinones, and heterosides. Origanum majorana L. exhibited concentration-dependent inhibitory effects on 2,2′-diphenylpicrylhydrazyl (DPPH) with IC50 equal 2.308 mg/ml, related to the presence of the same content of polyphenols and flavonoids but with the lowest concentration of tannin content. The cytotoxicity of the hydro-ethanolic extract of Marjoram was evaluated by the MTT colorimetric method. However, the results obtained that the examined extract was devoid of cytotoxic activity, on the other hand, it induced cell proliferation. O. majorana has good potential to prevent diseases caused by the overproduction of free radicals, and that it can be used as natural antioxidant agents and cell proliferation dependant on concentration.</p

Epidémiologie et facteurs de risque des anomalies de fermeture du tube neural: données marocaines

Introduction: les anomalies de fermeture du tube neural sont des défauts congénitaux de la formation du système nerveux central. L'incidence varie entre 3 et 40 cas pour 10000 dans le monde. Il existe des facteurs de risque de survenue de cette affection. La prévention reste un élément important dans la prise en charge. L'objectif de ceete étude est d'étudier les paramètres sociodémographiques, maternels, obstétricaux et néonatals des anomalies de fermeture du tube neural et analyser les facteurs de risque responsables dans notre contexte. Méthodes: étude prospective cas-témoin sur 4 ans. Ont été recrutés tous les cas portant une malformation du tube neural isolée ou associée à d'autres malformations. Les données maternelles, obstétricales et néonatales ont été enregistrées. L'analyse statistique était réalisée par le biais d'un logiciel de statistiques SPSS version 17.0 pour Windows. Résultats: soixante huit cas ont été inclus. Quatre-vingts cinq pour cent des malformations étaient isolées. L'anencéphalie était l'anomalie la plus retrouvée (67 %). L'âge maternel moyen était 31,03±7,50 ans. La consanguinité parentale était notée dans 9 cas. Un niveau socio-économique bas et un non suivi des grossesses ont été rapportés dans 29 % des cas. L'étude a retrouvé des antécédents de mort-nés et de morts néonatales dans 4 % des cas. La consommation de Fenugrec était significativement associée aux malformations du tube neural et a été retrouvée dans 8 cas contre 1 cas dans le groupe sain. La voie haute d'accouchement était utilisée dans 29 % des cas. L'âge gestationnel moyen était de 35,55±4,16 semaines d'aménorrhée. Il n'y avait pas de prédominance de sexe. On avait noté une relation significative entre les malformations du tube neural et l'avènement d'une asphyxie périnatale, 15 cas présentaient un apgar à 0 à la première minute et 12 cas un apgar inférieur à 7 à la cinquième minute. Conclusion: le bas niveau socio-économique, le non suivi des grossesses et la consommation maternelle de fenugrec en période gestationnelle étaient des facteurs prédictifs de développement d'anomalies du tube neural dans notre contexte.The Pan African Medical Journal 2015;2

Vitamin D status in Moroccan pregnant women and newborns: reports of 102 cases

Introduction: vitamin D insufficiency to pregnant women has been associated with a number of adverse consequences, and has been recognized as a public health concern. The aim of this study was to evaluate vitamin D status of Morrocan pregnant women and their newborns. Our study is being the first of its kind in Morocco, as it supports the program of systematic supplementation of pregnant women in the third quarter. Its results have established a new program for the fight against the deficit of various nutrients, thereby intake of vitamin D has become routine. So this work is a true example of action research. Methods: it’s an observational and a cross sectional study. The data was collected prospectively from the 1st January to 31 December 2012 in the labor room of the Souissi maternity hospital, at the Ibn Sina university center of Rabat in Morocco. Women included were consented to participate in the study. Data on epidemiological, sociodemographic and clinical characteristics was recolted by interview, physical exam and biochemistry parameters. Hypovitaminosis D is defined as serum level of vitamin D ≤ 50 nmol/l (20 ng/ml).  Results: our study included 102 cases of mother-newborn pairs. The average age of mothers was 28.3 +/- 6.7 years (range 17-43 years), 90.1% of women enrolled had a hypovitaminosis D , the average weight of newborns was 3377.9 +/- 509g (2270 - 4880g) . Hypovitaminosis D is not correlated with the origin, season, body mass index, birth interval and birth weight. It was positively correlated with maternal serum calcium (p=0.000). Conclusion: the maternal hypovitaminosis D is real public health problem. The prevention is necessary, by the systematic vitamin D supplementation for pregnant women.The Pan African Medical Journal 2016;2