[Maternal and foetal prognostic in excised women delivery]

INTRODUCTION

The female circumcision constitutes by their frequency and complications a real problem of public health.

MATERIAL AND METHOD

Our study aims at comparing the maternal land fetal complications of the spontaneous vaginal delivery in the excised women and non-excised. We led a comparative survey case witness implying 227 excised pregnant women at the maternity in CHU YO of Ouagadougou.

RESULTS

The prevalence of the excision from January 1st to July 31, 2006 was 72.86%. The distribution of female genital mutilations in this population is the following: type I=27.75%, type II=69.61%, type III=2.64%. The middle age was 25 years and 79.30% of women were aged less than 30 years. Islam appeared like a factor of exposure to the practice of the excision with 67.40% of women excised that practise it against 41.90% at the non-excised group (P<0,0001). The maternal complications were dominated by the duration of fetal expulsion prolonged and perineal tears. The duration of fetal expulsion was superior to 30 minutes for 34.56% of excised woman childbirths 9 times more frequently than women non-excised (P=0.001). The frequency of perineal tears was 10.13% in the group of women excised against 5.73% in the group of the non-excised (P=0.008). These perineal lesions were more frequent with the primiparae and women excised at the 2nd and 3rd degree. The neobirth asphyxia affected 4.4% of newborns from mother excised against 0.2% in the non-excised group (RR=5.18; P=0.006). In the group of excised them the rate of mortinatality was 22.03 for 1000 births, against 8.81 for 1000 births in the group of the non-excised (P=0.22).

CONCLUSION

The prevention of these complications with the excised woman rests on the episiotomy and the instrumental extraction in the FGM of type III.

[Cervix cancer screening in a health district (Burkina Faso) by voluntary biopsies after the application of acetic acid and lugol]

A voluntary screening of uterus cervix cancer took place in Kossodo health district from February 1st 2001 to April 30th 2002. It involved the age-group women of 25 to 59 years. This study included 239 women given a participation rate of 6.8%. We had sampled young women in three categories with average age of 38 years: a) doing a remunerated job (64.9%); b) mostly educated (85.3%); and c) married (86.2%). The visual inspection was the method used after the application of 4% acetic acid followed by that of lugol. In all 74 biopsies have been undertaken. Furthermore, we have noticed a 4.2% prevalence of pre-cancerous injuries. The cancerous lesions represented 2.5% of the sampling and the inflammatory lesions 13.4%. VPH infection was found on 2.5% samples and condylomatous injuries in 5% cases. This experience would deserve to be carried out always and a cervix cancer screening campaign held at national level.

[Abruptio placentae: epidemiological, clinical and prognostic aspects with respect to a 177 case series]

OBJECTIVE

A retrospective study based on 177 cases of abruptio placentae, and describing the epidemiological, clinical and prognosis aspects.

PATIENTS AND METHODS

A hundred and seventy-seven cases, corresponding to 185 children, were registered over a five-year period in the department of gynecology and obstetrics of the CHNYO of Ouagadougou.

RESULTS

Abruptio placentae occurrence rate was about 9.6 per 1000 deliveries. In our study, this type of accident was most frequent with 30 to 34-year-old women (31.1%), with multiparous ones (56.5%), and with those suffering from arterial hypertension linked to pregnancy (31.1%). The clinical picture was most often complete, 83.1% of patients having reached grade 3 of abruptio placentae with complete symptomatology and foetal death. Vaginal delivery was preferred to cesarean section in 64.4% of the cases. Maternal death rate was about 3.9% and mainly caused by severe anemia (61.6%) and puerperal infections (7.9%). Foetal prognosis was dominated by the high rate of mortinatality (85.9%).

DISCUSSION AND CONCLUSION

To reduce maternal mortality as well as morbidity due to abruptio placentae, correct prenatal follow-up, early diagnosis and prompt evacuation of the womb are required.

[Infibulation complications: three vaginal plastic surgeries at Kossodo (Burkina Faso)]

From 01 November 2000 to 31 October 2001, three cases of infibulation were referred to the gynecological and obstetrical sanitary branch of Kossodo, which corresponds to 1.6% frequency. It concerns young patients (average age = 19 years), Mossi, who had an excision done between age 6 and 14. The main reason for reference was the impossibility to have sexual intercourse. There were no post chirurgical consequences. The possible consequences are psychological trauma, dyspaneuria, dystocy of flabby tissues during future deliveries.

[External genital excision sequelae at the Yalgado Ouedraogo national central hospital: epidemiology and surgical treatment]

By a prospective study in one year time, the authors noticed that female genital mutilation complications were 7.3 per cent of external gynecologic consultations and most complications were overdraft between 15 and 24 years old (36 cases out of 49). The main consultation motives were dyspareunia and difficult sexual relationship. Surgery under local anesthetic was very efficient (more than 90% success) and cheaper than surgery under general anesthetic.

[Maternal mortality in adolescents at the university hospital of Ouagadougu]

This retrospective study evaluates the adolescent mortality rate at the University Hospital of Ouagadougou in the year 1995. Twenty lethal cases were collected amongst 646 deliveries giving birth to 490 children. The in-hospital adolescent maternal mortality rate come to be 4081 for 100,000 living births (4.08%) and represented 16.3% of all maternal deaths occurring during the study period. The most frequent causes of death were related to clandestine abortion (30%) and chronic anemia due to malnutrition (30%). Pregnancy in an adolescent girl is a high-risk event that requires special care due to a precarious global health status.

[Eighty cases of uterine rupture at the maternity service of the National Hospital Center of Ouagadougou , Burkina Faso]

In this retrospective study, we recall the frequency of uterine ruptures within a national health center of West Africa and propose solutions in order to reduce the incidence. This very high frequency was 23/1000, i.e. one uterine rupture for 44 deliveries. The feto-maternal prognosis was poor with a high stillbirth rate and maternal mortality. Maternal mortality which was 35% of cases represented 22.7% of the causes of maternal mortality observed within the unit during the survey. The stillbirth rate was 95% representing 145/1000 of the hospital stillbirth rate recorded during the survey. Maternal morbidity was also high because 14% of those who survived presented a parietal suppuration with the release of suture during the immediate postsurgical period. The seriousness of the feto-maternal prognosis is linked to a lack of adequate patient management. The importance of uterine ruptures in the obstetrical activity of the unit needs a joint and urgent action of all intervening parties within the sanitary system in order to contend with this scourge, which is the sign of poor quality health care in Obstetrics.

[Adnexal torsion during pregnancy. Diagnostic and therapeutic problems in Burkina Faso]

The authors report a case of adnexal torsion during early pregnancy. Because of a late diagnosis they had to practise an unilateral adnexectomy with a conservative medical treatment of the pregnancy. They recommend an early surgical treatment, that will save the adnexa and permit a normal evolution of the pregnancy. In a young patient, the loss of an ovary may be a tragic event.