Objectives: This paper aims to study the epidemiology and causes of fetal deaths in utero at Regional Hospital Amath Dansokho of Kedougou (RHADK). Methodology: This was a retrospective epidemiological study conducted ...Objectives: This paper aims to study the epidemiology and causes of fetal deaths in utero at Regional Hospital Amath Dansokho of Kedougou (RHADK). Methodology: This was a retrospective epidemiological study conducted at the Maternity Ward of the Regional Hospital Amath Dansokho of Kedougou from June 01, 2022 to June 30, 2023, including all patients seen for delivery care. Data were analyzed using Statistical Package for Social Science (SPSS 22, Windows version). The parameters studied were the frequency of in-utero fetal death, sociodemographic characteristics, pregnancy and delivery data, neonatal data and cause-of-death classification according to the Cause of Death and Associated Conditions (CODAC) classification. Results: We recorded 1628 deliveries, with 231 cases of in-utero fetal death, a frequency of 14.2%. Fetal death occurred most frequently in multiparous women (64.5%). The majority of patients (72.3%) were transferred. 51.9% of patients with fetal death had at least 3 antenatal visits. On admission, fetal heart rate was absent in 73.2% of patients. The etiology of in-utero fetal death was dominated by maternal factors (high blood pressure, anaemia and diabetes), which accounted for 36.9% of deaths, followed by placental pathologies (retroplacental haematoma) and intrapartum pathologies (uterine rupture, abnormal presentation). Conclusion: In-utero fetal death can be prevented, and is mainly due to direct obstetric complications. The focus should be on the prevention and management of hypertensive disorders and their complications during pregnancy, the fight against anaemia and, above all, the rapid and correct management of dystocia.展开更多
<strong>Objectives:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">To compare between hysterosalpingography (HSG) and laparoscop...<strong>Objectives:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">To compare between hysterosalpingography (HSG) and laparoscopic findings in patients tested for infertility and thereby to determine the significance of the latter examination. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">This was a descriptive study performed in two Gynecology departments in the Dakar (Senegal). Included were 84 patients with suspicious tubal-infertility who underwent HSG followed by laparoscopy. The Kappa (K) statistics was used to clarify the concordance between HSG vs. laparoscopy findings. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Kappa concordance between HSG and laparoscopy showed the followings: 0.08 for proximal tubal obstructions (poor agreement), 0.40 for distal tubal obstructions (moderate agreement), and -</span></span><span style="font-family:;" "=""><span><span style="font-family:Verdana;">0.08 for peritoneal adhesions (no agreement). Laparoscopy revealed pelvic adhesions in 84% of cases, pelvic endometriosis in 12% of cases, and apparently normal tubes in 12%. According to the distal tubal operability score, 16.6% of the lesions were classified as stage 4 and 23.8% at stage 1. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">HSG and laparoscopy findings did not agree in patients with tubal infertility, and thus, laparoscopy should be employed, especially when HSG showed abnormal findings. HSG has a low diagnostic value in adhesions.</span></span></span>展开更多
<strong>Objective</strong><strong>:</strong> <span><span><span style="font-family:""><span style="font-family:Verdana;">Maternal mortality remai...<strong>Objective</strong><strong>:</strong> <span><span><span style="font-family:""><span style="font-family:Verdana;">Maternal mortality remains a major concern in developing countries. This survey aims to suggest strategic plans that would help decrease maternal and perinatal mortality in the suburbs. It is a descriptive study that shows the different causes of maternal deaths during pregnancy and puerperium period. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">It is a retrospective descriptive study done between January 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> 2016 and the 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> of December 2018. We have collected information on all deaths due to mortality issues in Five (5) maternity clinics around Dakar. The record shows that teach centre have an average of 4000 deliveries per year. The data collected from the hospital records were inputted using Sphinx software (version 5). These data were analysed using Epi Info software (version 3.5). After analysing these data, recommendations were made to minimize the different causes of maternal deaths. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">We recorded 154 maternal deaths out of 32,420 live births. The direct causes of maternal deaths were a result of preeclampsia and its complications (31.2%), postpartum haemorrhage (24.7%), abruption placentae (20.8%) and obstructed labour (7.8%). The indirect causes were mainly sickle cell disease (1.3%), heart disease (1.3%) and gynaecological cancers (1.3%). Maternal deaths were also associated with fetal loss in 47.4% of 153 maternal deaths, need for blood transfusion 59% while none of the reference structures in the suburbs of Dakar has a blood bank;with a need for admission in intensive care unit was noted as 40%. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Thus, preeclampsia and its complications are the leading cause of maternal deaths in suburban settings. Timely availability of resuscitation units and liable blood products could drastically reduce maternal deaths from direct obstetric complications.</span></span></span></span>展开更多
<strong>Background: </strong>Women with gestational diabetes mellitus (GDM) have a significantly increased risk for developing type 2 diabetes after delivery. The purpose of this study was to determine the...<strong>Background: </strong>Women with gestational diabetes mellitus (GDM) have a significantly increased risk for developing type 2 diabetes after delivery. The purpose of this study was to determine the postpartum glycemic status among women with GDM in an Endocrinology-Diabetology department in Sub-Saharan Area. <strong>Methods:</strong> It was a prospective cohort study conducted between January 1, 2013, and July 31, 2018 (over period of 5 years and 7 months) at Pikine National Hospital, Dakar, Senegal. Postpartum glucose status was evaluated at least 6 weeks post-partum among women with history of GDM according to IADPSG criteria. The glycemic status after delivery was pointed referring to 2006 WHO criteria. <strong>Results:</strong> Overall 53 patients were included in this study. Fasting plasma glucose was performed as a screening test in 94% of the cases. A type 2 diabetes after GDM as diagnosed in 6 patients, accounting for a prevalence of 11.32%. An Impaired Fasting Glucose (IFG) was revealed in 5 patients (9.43%). The patients underwent a screening test in the first year after delivery in 54.70% of the cases, over a half of whom during the post-partum period range from the 6<sup>th</sup> to the 12<sup>th</sup> week. Insulin usage during pregnancy was statistically correlated with the occurrence of postpartum diabetes. <strong>Conclusion:</strong> Diabetes prevention and early diagnosis require a glycemic status monitoring among women with history of GDM.展开更多
The objective of this study is to characterize and assess the risk of collapse of woody plant formations in the Fathala forest. In recent years, this forest has suffered a sharp reduction in its plant cover to the poi...The objective of this study is to characterize and assess the risk of collapse of woody plant formations in the Fathala forest. In recent years, this forest has suffered a sharp reduction in its plant cover to the point of compromising the survival of populations of certain animal species such as the Red colobuses. The methods used are respectively constituted by the transect method, the dendrometric statements method and that of establishing the red list of ecosystems of the IUCN. The specific richness comprises 56 species divided into 47 genera and 22 families. The density is higher in the unfenced area (369 ind/ha in clear forest and 53 ind/ha in gallery forest) compared to the fenced area (160 ind/ha in clear forest versus 48 ind/ha in gallery forest). A study of the plant formations shows a strong degradation of the ecosystems passing from a clear and dry Sudanese forest to a wooded savannah. The cover rate in the fenced area is 20% in gallery forests and 25% in clear forests;in the unfenced area, it is 19% and 23% in gallery forests and clear forests, respectively. The application of the IUCN criteria shows an annual rate of collapse is -<span style="font-family:Verdana;">6 ind/ha in gallery forests and </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">4 ind/ha in clear forests. The annual rate of cover collapse would be </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">3.75% and </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">2.9% for gallery forests and clear forests, respectively. These results classify the forest in the Critically Endangered category. The main factors responsible for this degradation are, among others, anthropogenic actions and climatic pejoration. These results could constitute a basic tool for undertaking an improvement in the management of this forest, which is a living environment for an animal species.</span>展开更多
<strong>Introduction:</strong> <span style="font-family:""><span style="font-family:Verdana;">Maternal mortality is a public health problem of more concern to developin...<strong>Introduction:</strong> <span style="font-family:""><span style="font-family:Verdana;">Maternal mortality is a public health problem of more concern to developing countries. As part of improving the maternofoetal prognosis during pregnancy and childbirth, it is essential to carry out regular follow-ups of pregnant women (FE) through antenatal consultations (ANC). In fact, the World Health Organization (WHO) recommends at least four ANC at regular intervals during pregnancy. In Senegal the completion rate varies greatly depending on the region. In the District of Kédougou it was 41% in 2017 (DHIS2). The national target was not achieved despite the interventions. Thus we studied the determinants of CPN completion in the health district of Kedougou in 2017. </span><b><span style="font-family:Verdana;">Method:</span></b><span style="font-family:Verdana;"> The study is of a descriptive and analytical cross-sectional type and concerned a sample of 884 women who gave birth between October 2017 and September 2018. They were chosen by a sample whose distribution in the district was made according to the quota method while respecting the demographic weight of each area of </span></span><span style="font-family:Verdana;">responsibility of the District.</span><span style="font-family:""> <b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The results of our study showed that the average age of women was 24 years with an average number of pregnancies equal to 3. The ANC completion rate at 37%</span></span><span style="font-family:Verdana;"> was</span><span style="font-family:""><span style="font-family:Verdana;"> lower than the administrative data rate which was 41%. The determinants with a statistically most significant link with the completion of ANC are respectively satisfaction with the care and quality of service, the level of information of women regarding PNC, marital status, affordability and distance from the location of the ANC. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Increasing women</span></span><span style="font-family:Verdana;">’</span><span style="font-family:Verdana;">s incomes, increasing communication about ANC, and bringing health services closer together are needed to improve the completion rate of antenatal care visits.</span>展开更多
<strong>Introduction: </strong><span><span><span style="font-family:""><span style="font-family:Verdana;">In Senegal, according to the 2017 Demographic Heal...<strong>Introduction: </strong><span><span><span style="font-family:""><span style="font-family:Verdana;">In Senegal, according to the 2017 Demographic Health Survey, </span><span style="font-family:Verdana;">about 22% of married women have an unmet need for family planning. Globally</span><span style="font-family:Verdana;">, 61% of women do not have access to postpartum family planning. </span><b><span style="font-family:Verdana;">Material </span><span style="font-family:Verdana;">and Method: </span></b><span style="font-family:Verdana;">This is a prospective, descriptive and analytical study from March</span><span style="font-family:Verdana;"> 05, 2017 to January 31, 2018. The interrogation was done in the hospital ward with filling in the data collection form. The data collected was first coded and then entered, using the sphinx software. The data analysis was done with Epi info version 7 software and included a descriptive and analytical component. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">The average age of the patients was 26 years with extremes of 15 and </span><span style="font-family:Verdana;">48 years. Average gestation was 2.3 with extremes of 1 and 8 pregnancies. More </span><span style="font-family:Verdana;">than half of the women (64.7%) had delivered by caesarean in an emergency setting. More than half of the women (66.7%) had chosen the hormonal contraceptive method within 48 hours of delivery and the implant was the type of </span><span><span style="font-family:Verdana;">contraceptive prescribed in almost half of the cases (49.3%). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Integrating postpartum family planning into programs will ultimately help to dramat</span></span><span style="font-family:Verdana;">ically decrease high-risk pregnancies, decrease the </span><span style="font-family:Verdana;">unmet need for family plannin</span><span style="font-family:Verdana;">g (FP), and improve the health and survival of mothers and children.</span></span></span></span>展开更多
<strong>Objective: </strong><span><span><span style="font-family:""><span style="font-family:Verdana;">The purpose of this study was to analyze the opinions...<strong>Objective: </strong><span><span><span style="font-family:""><span style="font-family:Verdana;">The purpose of this study was to analyze the opinions of gynecologists, midwives, and interns/Specialist students practicing in Senegal about the use of IUD, and to assess factors that stand as obstacles to IUD prescribing. </span><b><span style="font-family:Verdana;">Patients and methods: </span></b><span style="font-family:Verdana;">An online questionnaire was developed to assess providers’ IUD practices and attitudes. The questionnaire was based on the one used in a Swiss study on the same topic. The platform used was Google forms. The questionnaire was shared in associative platforms involving gynecologists, midwives and interns/Specialist students. </span><b><span style="font-family:Verdana;">Results and comments: </span></b><span style="font-family:Verdana;">We received 292 feedbacks. Gynecologists represented 13.7% of the sample, interns and specialist students 11.3% and midwives 76%. Parity is a determining factor in IUD selection. The care-providers were concerned about the followings, which might have prevented the use of IUD, even </span><span style="font-family:Verdana;">though it </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">was</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> indicated: infections (75.7%), pelvic pain (61.3%), expulsion (48.3%), increased risk of perforation (46.9%), women’s appreciation </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">(45.2%), ectopic pregnancy (33.9%) and sexual behavior (28.4%). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Our study reveals that providers’ apprehensions and concerns severely limit the availability of IUDs. These concerns are often unfounded, based on personal experiences and not on official recommendations. Parity is a major obstacle.</span></span></span></span>展开更多
<strong>Background:</strong> <span style="font-family:""><span style="font-family:Verdana;">Ovarian pregnancy is a rare entity of ectopic pregnancy, with a prevalence i...<strong>Background:</strong> <span style="font-family:""><span style="font-family:Verdana;">Ovarian pregnancy is a rare entity of ectopic pregnancy, with a prevalence in the literature estimated between 1/2500 to 1/5000 births. The majority of ovarian pregnancies are diagnosed in the 1st trimester due to the noisy symptomatology. However, in small proportions, they may continue into the 2nd or 3rd trimester, making their diagnosis more difficult. </span><b><span style="font-family:Verdana;">Aim: </span></b><span style="font-family:Verdana;">We report a case of ovarian pregnancy in a 26-year-old patient, discovered intraoperatively as a large unruptured ovarian mass. </span><b><span style="font-family:Verdana;">Case report: </span></b><span style="font-family:Verdana;">A 26-year-old woman referred to the maternity ward for management of fetal death in utero at 31 weeks of amenorrhea associated with overlying placenta previa. Ultrasound performed in the department, was in favor of an abdominal pregnancy stopped at 31 SA with a placenta that seemed to adhere to the posterior wall of the uterus, which was empty. A Laparotomy was performed, on exploration, a large right ovarian mass was found, the site of the pregnancy. A right adnexectomy, after adhesiolysis, was performed. The incision of the operative part revealed a macerated female fetus. The clinical evolution was favorable. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">We report on a case of unruptured ovarian pregnancy, discovered in the 3rd trimester of pregnancy. The ultrasound diagnosis of an ovarian pregnancy beyond the 2nd trimester remains a challenge, the management remains surgical.</span></span>展开更多
The counter-referral system is particularly important for care during pregnancy, childbirth and the post-partum period as it facilitates access to emergency obstetric and neonatal care. It allows people to access care...The counter-referral system is particularly important for care during pregnancy, childbirth and the post-partum period as it facilitates access to emergency obstetric and neonatal care. It allows people to access care that is not likely to be provided at the base and to manage certain complications arising in emergency settings. We therefore looked at the evaluation of obstetric evacuations from the Touba Ndamatou public health. Methodology: This was a retrospective study of descriptive and analytical type extending over a period of 12 months from January 1, 2020 to December 31, 2020 at the public hospital health establishment (PHHE) of Touba Ndamatou. Results: One thousand five hundred and sixty (1560) patients evacuated for obstetrical reasons were collected out of a total admission of 5560, i.e., a frequency of 28%. The average age of the patients was 25.54 years. The mean gestation was 3.24 pregnancies. The average parity was 3.04 deliveries. Almost all of our patients (99%) were married. Slightly more than one in two women (53.6%) had performed at least 2 or 3 Prenatal consultations. 80% of parturients had traveled a distance of less than 20 km. 623 patients came by their own means (54.6%). Evacuation was provided by an ambulance in 509 patients, i.e., 44.6%. Arterial hypertension and its complications were the frequent reason for evacuations with approximately one in four patients (26.2%). Only 3.6% of patients had qualified personnel on board being evacuated. In our series, 13 deaths were recorded, i.e., 1.1% of cases. The distance traveled seemed not to influence the future of the mother (p = 0.51). The non-accompaniment of the patient during the evacuation by a medical staff seemed to influence the prognosis of the mother (p = 0.031). Fetal morbidity was higher among evacuees not accompanied by medical personnel. The state of apparent death was observed in the majority of cases in patients received over a distance of more than 20 km. Conclusion: Evacuation requires a clear definition of the roles and responsibilities of each level of the health pyramid, good organization in the health structures as well as within the community, and a good information system.展开更多
<strong>Background</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">: </span>&...<strong>Background</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">: </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Molar pregnancy is a rare condition;its ectopic form is even rarer occurring in 1.5 per 1,000,000 pregnancies.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Aim</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span><span><b><span style="font-family:;" "=""> </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">We report a case of ectopic molar pregnancy located in the fallopian tube and draw attention to the importance of systematic histological examination in any ectopic pregnancy.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Case report</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">: </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">A 32-year-old primigravida woman presented with metrorrhagia in a context of about 2 months of amenorrhea. An ectopic pregnancy was diagnosed by ultrasonography. A Laparotomy was performed and a ruptured left ampullary ectopic pregnancy was found, and a total left salpingectomy was performed. The pathologic examination </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">the histological examination show an aspect of a partial molar ectopic tubal pregnancy. </span><b><span style="font-family:Verdana;">Conclusion</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span><span><b><span style="font-family:;" "=""> </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Ectopic molar pregnancy is a rare entity, its diagnosis requires histological confirmation. Beta-HCG monitoring is the essential tool for monitoring the postoperative evolution.</span></span></span>展开更多
OBJECTIVES: 1) To draw up the epidemiological profile of patients who have benefited from cervical cancer screening by visual inspection after application of acetic acid (VIA) and then describe the results of the test...OBJECTIVES: 1) To draw up the epidemiological profile of patients who have benefited from cervical cancer screening by visual inspection after application of acetic acid (VIA) and then describe the results of the test, the colposcopy, histological and therapeutic aspects in case of dysplasia. 2) To evaluate the performance of IVA in cervical cancer screening and its feasibility in low-resource countries. MATERIALS AND METHODS: This was a prospective and descriptive study carried out from 06 June 2015 to 31 January 2016 (7 months) at the Maternity Center at Nabil Choucair health center in Dakar. The patients had been screened for cervical cancer by visual inspection, which consisted of applying 3% acetic acid after setting up a vaginal speculum. The test was considered positive if there were intense white areas in the cervix. Colposcopy was performed in case of a positive VIA result. This colposcopy included an unprepared examination, an examination after application of 3% acetic acid and an examination after application of Lugol solution. The colposcopic report is made according to the terminology of the French Society of Colposcopy and Cervico-Vaginal Pathology. Patients with major changes or unsatisfactory colposcopy had undergone diathermic loop resection. Surgical specimens were sent to pathologic anatomy and follow-up was performed according to the results of the histology. The studied parameters concerned the socio-demographic aspects, the results of the VIA test, the results of the colposcopy after a positive test, the therapeutic aspects in case atypical transformation zone grade 2 or of unsatisfactory colposcopy, the results of the histology after the conization and the followed. The collection of data was done thanks to a file and the statistical analysis thanks to the software Epi-info version 7. RESULTS: 899 patients were involved in the study. The epidemiologic profile of our patient was a multipara in a period of genital activity, aged 42.2 years with a mean gestational weight of 4.5, and a parity of 4. In our series, the patients had their first sexual intercourse with 20.8 years old. In our study, 84 patients (10.2%) had positive results after visual inspection after acetic acid applications. All patients with positive results after application of 3% acetic acid had colposcopy. In our study, 27 patients had major changes and/or unsatisfactory colposcopy and underwent diathermic loop resection for diagnostic and therapeutic purposes. Anatomo-pathological examination of the cone room revealed cervicitis in 22.2% of cases, flat condyloma in 7.4% of cases, CIN2 in 22.2% of cases, and CIN3 in 18.5% of cases. All the conizations were in sano. The postoperative course was simple. CONCLUSION: Cervical cancer is a real public health problem in developing countries. To do to human resources, developing countries like Senegal must put in place simple, inexpensive, effective strategies that must globally respond to “screen and treat”.展开更多
The diagnosis and management of ovarian cystic tumor is sometimes difficult. In this manuscript, we wish to summarize this issue by showing three cases. Ultrasound and Color Doppler are very useful to diagnose the pre...The diagnosis and management of ovarian cystic tumor is sometimes difficult. In this manuscript, we wish to summarize this issue by showing three cases. Ultrasound and Color Doppler are very useful to diagnose the presence of this tumor but also to distinguish between benign and malignant. Pelvic MRI is also a strong tool and is sometimes mandatory. HE4 and CA125 are often useful as a serum diagnostic marker of malignancy, but not always so. Recently, laparoscopic management has gained popularity;however, great caution should be exercised during laparoscopic operative procedures, as this may lead to intraperitoneal malignant cell spreading/proliferation when the tumor is malignant. During the surgery of malignant tumor, irrespective of laparoscopic or laparotomic, intraperitoneal rupture should be avoided. Since the final diagnosis must be made by histological examination, the patient must always be informed of this possibility.展开更多
Introduction: Sexual abuse or sexual assault is part of violence against women, as is physical violence, female genital mutilation and forced marriage. According to the Criminal Code, this is any sexual offense commit...Introduction: Sexual abuse or sexual assault is part of violence against women, as is physical violence, female genital mutilation and forced marriage. According to the Criminal Code, this is any sexual offense committed with violence, coercion, threat or surprise on the person of others. It is a criminal act punishable by the laws in force in almost every country in the world. Study Objectives: 1) draw up an epidemiological profile of female victims of sexual abuse;2) develop the treatment protocol. Methodology: This is a 7-year descriptive retrospective study from January 1, 2010 to December 31, 2016 at the Center Hospitalier National de Pikine (Dakar). Included in this study were all of the patients admitted during our investigation period who were the victims of suspected or certain sexual abuse, with or without requisition. For each case, the following parameters were studied: the epidemiological characteristics (age, gestation, parity and place of residence), the circumstances of the attack (time and place), the characteristics of the aggressor (age, link with the victim, number of aggressor), the type of sexual contact, the possible lesions found during the physical examination (genital and extra-genital), the mode of admission, the delay of the consultation, the attitude after the sexual abuse, the gynecological and obstetrical status of the victim, the repercussions and psychological follow-up, the paraclinical assessment, the treatments administered. Data were collected using a survey form and analyzed with SPSS software. Results: During the study period, 183 victims of sexual abuse were received and treated at the level of our structure out of a total of 39,760 patients, representing a frequency of 0.46%. The age of the victims varied between 2 and 36 years with an average of 13 years. The 11 to 15 age group was the most represented. Students were the most represented among victims of sexual abuse (87.4%). Workers represented 9.3% of the victims. Infants made up 3.3% of the victims;the average age of the alleged attackers was 31 when they were known to their victim. Half of the victims (50.3%) were in the pre-pubertal stage. Among those who were in genital activity (91 cases or 49.7%), 16 cases of pregnancy were reported;which represented 8.7% of cases. Only 20.2% of victims had genital trauma. Prescription of emergency contraception was carried out for 47% of the victims who were in genital activity. After the clinical examination, 17% of the victims had received antibiotic prophylaxis. Conclusion: Sexual abuse is currently a real socio-cultural drama. Preventing them involves raising public awareness. Their management must be early and adapted in order to prevent sexually transmitted infections and psychological consequences.展开更多
Objective To compare the safety, side effects and failure rates of contraception copper intrauterine device (IUDs) in the immediate postpartum period after a vaginal delivery and during a cesarean section. Patients an...Objective To compare the safety, side effects and failure rates of contraception copper intrauterine device (IUDs) in the immediate postpartum period after a vaginal delivery and during a cesarean section. Patients and methods This was a descriptive and analytical study, conducted in Gynecology and Obstetrics departments hospital Pikine and Abass Ndao hospitals. It compared two groups of women with IUDs in the immediate postpartum period after a vaginal delivery and during cesarean section. Our sample consisted of 215 patients. We had divided them into two groups: group 1 consisted of 115 patients who delivered by cesarean section;Group 2 consisted of 100 patients who delivered vaginally and whom the insertion was made in post placental or within 48 hours after birth. The variables studied were the sociodémographic characteristics, characteristics of pregnancy and childbirth, insertion procedures, follow up with the assessment of side effects and complications. Results and comments The socio-demographic characteristics were superimposed in both groups. Nine patients were lost to follow up, 4 in group 1 and 5 in group 2. The complaints such as pain (3.7% for Group 1 against 2.6% for group 2), vaginal bleeding (2.1% for group 2, and 1.8% for group 1) were rarely reported and stackable in both groups. After 6 months of follow up, the menses was observed in 42.8% of group 2 against 43.1% of group 1. The abnormal menstrual flow, evaluated by the Higham score, was noted in 29.6% of group 2 and 25% of group 1, and was dominated by excessive bleeding. They motivated IUD removal in two patients. A significant difference was found in the perception of IUD strings, it was effective in 95.4% of patients in group 2 against 50.5% for group 1. The evictions were 9 at 3-month follow-up 7 related group 2 and 2 for Group 1. It was partial (isthmic IUD) and total expulsion. At 6 months follow-up, 3 cases of partial expulsion were noted and concerned only group 2. This made a total expulsion rate of 5.3%, with 9.5% for group 2, and 1.8% for group 1. no cases of pregnancy or uterine perforation had been reported during this study. A vaginal sampling was performed in all our patients and the results were generally comparable in both groups and normal in most cases. However, we noted 17.6% of infection in group 2, and 16.2% in group 1. Conclusion From the results of our study, we can say that IUD insertion in the period of immediate postpartum remains safe and effective regardless of the way of delivery. The risk of expulsion is minimal so acceptable.展开更多
Premature rupture of membranes (PROM) complicates 3% of preterm pregnancies and occurs in 60% to 80% of term pregnancies. However, its management remains largely controversial. The objective of this study was to estab...Premature rupture of membranes (PROM) complicates 3% of preterm pregnancies and occurs in 60% to 80% of term pregnancies. However, its management remains largely controversial. The objective of this study was to establish the epidemiological profile, to study the management and the prognosis of Premature rupture of membranes (PROM) in our practice. Patients and methods: It was a prospective, descriptive and analytical study from May 1st 2016 to January 31st 2017 at the Pikine National Hospital Center. The target population consisted of all patients received at the hospital with premature rupture of membranes and who had given birth in the structure. The variables studied were: marital status, mode and reason for admission;risk factors;antecedents;prenatal care;the clinical and paraclinical examinations;support and immediate maternal and fetal neonatal complications. Results and comments: The mean maternal age was 27.34 years and the majority of women were aged between 18 and 39 years (94.4%). Fifty-one point three percent of patients were primiparous, large multiparous represented only 2.5%. The majority of patients (385 patients or 66.9%) had consulted in the first 12 hours following the onset of fluid flow. For 20.1% of them this flow was associated with uterine contractions. Hidden risk factors were dominated by the twin pregnancy. The blood count showed that 38.8% of patients had leukocytosis and CRP was positive in 18.3% of patients. An ampicillin-based antibiotics was established in 42.6% of cases, corticosteroid therapy in 5.2% and 1% in tocolysis. An expectation was adopted in 65.7% of cases, induction of labor in 7.3% and a cesarean section immediately in 27% of cases. In total, 65.7% of patients had vaginal delivery and 34.3% cesarean. The perinatal mortality rate was 3.6% or 22 newborns on 610. Two cases of endometritis were observed and one case of immediate postpartum hemorrhage. No maternal deaths were recorded. Conclusion: These results show that the prognosis of premature rupture of membranes remains favorable in our practice. To improve this prognosis, we recommend sensitization of patients during prenatal care regarding signs of danger, a systematic bacteriological sample from all pregnant at the end of their pregnancy and the health personnel to direct patients’ references to structures in case of PROM.展开更多
Objective: To assess a training approach in Emergency Obstetric and Neonatal Care (EmONC) to strengthen skills of healthcare providers and reduce maternal mortality. Materials and methods: The approach was based on th...Objective: To assess a training approach in Emergency Obstetric and Neonatal Care (EmONC) to strengthen skills of healthcare providers and reduce maternal mortality. Materials and methods: The approach was based on the skills training using the so-called “humanist” method and “life saving skills”. Simulated practice took place in the classroom through thirteen clinical stations summarizing the clinical skills on EmONC. The evaluation was done in all phases and the results were recorded in a database to document the progress of each learner. Results: We trained 432 providers in 10 months. The increase in technical achievements of each participant was documented through a database. The combination of training based on the model “learning by doing” has ensured learning and mastering all EmONC skills particularly postpartum haemorrhage management and reduced missed learning opportunities. Conclusion: The impact of training on postpartum haemorrhage management and maternal mortality is a major challenge in terms of prospects.展开更多
Objectives: To assess the quality of the obstetric evacuation system at the Youssou Mbargane Diop Hospital in Dakar. Methods: Our study was conducted at the Hospital of Youssou Mbargane DIOP in Rufisque, a district ab...Objectives: To assess the quality of the obstetric evacuation system at the Youssou Mbargane Diop Hospital in Dakar. Methods: Our study was conducted at the Hospital of Youssou Mbargane DIOP in Rufisque, a district about 26 km from downtown Dakar. This was a qualitative and evaluative descriptive study in the form of operational research aimed at improving the quality of obstetrical evacuations and resolving problems through a dynamic and team approach. It was carried out within the framework of the AQUASOU project (Improvement of Quality and Access to Emergency Obstetric Care in French). A liaison sheet was completed at the arrival of each evacuated patient, prospectively during the period from December 24 2006 to July 10 2008. The epidemiological characteristics were, origin of the evacuated, the evacuation conditions, evacuation patterns and therapeutic data. The data were collected through an Excel database developed for this purpose. The analysis was done using the Epi-Info version 6.0 software. Results: The frequency of evacuations was 23.2%. The average age of our patients was 25.3 years with extremes of 14 years and 48 years. More than half of the evacuees (59%) came from the Sanitary District of Rufisque. The majority of evacuations were made in a taxi (76.5%). An ambulance was used in 190 cases (20.6%). Seated transport was performed in 78% of cases. The transfer was medicalized in almost one-third of cases (29.3%). A liaison sheet was established during the transfer of patients in 77% of the cases. Evacuations were related to hemorrhage in 23.3%, dystocia in 22.2%, and fetal-adnexal anomaly in 17.3% of cases. No treatment was instituted before evacuation in 56% of evacuees. 48.5% of the evacuees had received treatment beyond. Conclusion: The poor quality of obstetric evacuations seems to be a brake on the decline in maternal and neonatal mortality in Senegal. Training and retraining of health personnel would improve maternal-fetal and neonatal morbidity and mortality.展开更多
Objectives: To evaluate the epidemiology of eclampsia, to assess maternal and perinatal prognosis and management. Material and method: This was a retrospective, descriptive study from January 1, 2015 to December 31, 2...Objectives: To evaluate the epidemiology of eclampsia, to assess maternal and perinatal prognosis and management. Material and method: This was a retrospective, descriptive study from January 1, 2015 to December 31, 2018. Included were all women received in the emergency department of our health facility for generalized seizures and/or disturbances of consciousness, occurring between the 20th Week of Amenorrhea (WA) and the 6th week of postpartum on a field of hypertension. The sources of the data consisted of antenatal consultation cards, delivery records, hospital records, operating theater and resuscitation records. The variables studied were sociodemographic characteristics, the course of pregnancy, childbirth and neonatal parameters. Data were captured and analyzed using SPSS 11.0 software. Results: The study focused on 190 cases with a prevalence of 3.5%. The average age of the patients was 20 years with extremes of 14 and 40 years. The average parity was 4.1 deliveries with extremes of 1 and 7. Nearly three-quarters of the patients (74.7%) of the patients were primiparous. Almost all the patients were evacuated. More than half of the seizures (53.1%) were recorded before work and more than one out of two patients had two seizures. Caesarean section was the mode of delivery in more than one out of two patients (56.8%). Maternal complications were marked by renal failure (23 cases), the HELLP syndrome (72 cases), and the retro placental hematoma (83 cases). The fetal impact was marked by prematurity in 90% of cases and 17 cases of fetal death in-utero. Nineteen maternal deaths were recorded while early neonatal mortality was 437 per 1000 live births. The average hospital stay of the survivors was 6.2 days. Conclusion: Eclampsia is still common in our regions. It occurs preferentially in young primiparas with hypertension and/or proteinuria on a poorly followed pregnancy. Magnesium sulphate and cesarean section can improve the maternal and fetal prognosis. Prevention necessarily means quality prenatal care.展开更多
Introduction: The practice of minimally invasive surgery in Senegal occupies more and more of a preponderant place in fields that previously did not allow it. Thus in our practice in gynecology we are witnessing an ex...Introduction: The practice of minimally invasive surgery in Senegal occupies more and more of a preponderant place in fields that previously did not allow it. Thus in our practice in gynecology we are witnessing an explosion of these operative indications especially for benign adnexal pathology. Patients and Method: The objective of this study was to evaluate the evolution of laparoscopic practice in terms of frequency, indication of duration and operative complications. For this reason, we have collected all the laparoscopic procedures carried out at the Gynecology and Obstetrics Department of the Pikine National Hospital since January 1st, 2012 over a period of 60 months. Endoscopic surgery accounted for 20.1% of all gynecological and breast procedures. There were 195 cases (14.9%) of laparoscopic surgery and 69 cases (5.2%) of operative hysteroscopy. The average age of our patients was 34 years with extremes of 15 and 67 years. The intervention was motivated by the exploration or management of infertility in 101 cases, or 57.1% of patients. Laparoscopy remained exploratory in 15.3% of cases (279 patients) with 55 cases of ovarian tumors presumed to be benign. The mean duration of diagnostic laparoscopy was 39 min with extremes of 20 to 150 min;while that of operative laparoscopy was 59 min with extremes of 20 to 250 min. It was noted that 4 cases of laparoconversion are 2.8% of all patients in our series. The postoperative course was 99.4% simple. Conclusion: In our practice and as in the developed countries, we are witnessing a considerable decline in the indications of laparotomy to the profile of laparoscopy, especially for benign adnexal pathology and infertility. An extension to the gynecological malignant pathology is the ultimate challenge.展开更多
文摘Objectives: This paper aims to study the epidemiology and causes of fetal deaths in utero at Regional Hospital Amath Dansokho of Kedougou (RHADK). Methodology: This was a retrospective epidemiological study conducted at the Maternity Ward of the Regional Hospital Amath Dansokho of Kedougou from June 01, 2022 to June 30, 2023, including all patients seen for delivery care. Data were analyzed using Statistical Package for Social Science (SPSS 22, Windows version). The parameters studied were the frequency of in-utero fetal death, sociodemographic characteristics, pregnancy and delivery data, neonatal data and cause-of-death classification according to the Cause of Death and Associated Conditions (CODAC) classification. Results: We recorded 1628 deliveries, with 231 cases of in-utero fetal death, a frequency of 14.2%. Fetal death occurred most frequently in multiparous women (64.5%). The majority of patients (72.3%) were transferred. 51.9% of patients with fetal death had at least 3 antenatal visits. On admission, fetal heart rate was absent in 73.2% of patients. The etiology of in-utero fetal death was dominated by maternal factors (high blood pressure, anaemia and diabetes), which accounted for 36.9% of deaths, followed by placental pathologies (retroplacental haematoma) and intrapartum pathologies (uterine rupture, abnormal presentation). Conclusion: In-utero fetal death can be prevented, and is mainly due to direct obstetric complications. The focus should be on the prevention and management of hypertensive disorders and their complications during pregnancy, the fight against anaemia and, above all, the rapid and correct management of dystocia.
文摘<strong>Objectives:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">To compare between hysterosalpingography (HSG) and laparoscopic findings in patients tested for infertility and thereby to determine the significance of the latter examination. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">This was a descriptive study performed in two Gynecology departments in the Dakar (Senegal). Included were 84 patients with suspicious tubal-infertility who underwent HSG followed by laparoscopy. The Kappa (K) statistics was used to clarify the concordance between HSG vs. laparoscopy findings. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Kappa concordance between HSG and laparoscopy showed the followings: 0.08 for proximal tubal obstructions (poor agreement), 0.40 for distal tubal obstructions (moderate agreement), and -</span></span><span style="font-family:;" "=""><span><span style="font-family:Verdana;">0.08 for peritoneal adhesions (no agreement). Laparoscopy revealed pelvic adhesions in 84% of cases, pelvic endometriosis in 12% of cases, and apparently normal tubes in 12%. According to the distal tubal operability score, 16.6% of the lesions were classified as stage 4 and 23.8% at stage 1. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">HSG and laparoscopy findings did not agree in patients with tubal infertility, and thus, laparoscopy should be employed, especially when HSG showed abnormal findings. HSG has a low diagnostic value in adhesions.</span></span></span>
文摘<strong>Objective</strong><strong>:</strong> <span><span><span style="font-family:""><span style="font-family:Verdana;">Maternal mortality remains a major concern in developing countries. This survey aims to suggest strategic plans that would help decrease maternal and perinatal mortality in the suburbs. It is a descriptive study that shows the different causes of maternal deaths during pregnancy and puerperium period. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">It is a retrospective descriptive study done between January 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> 2016 and the 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> of December 2018. We have collected information on all deaths due to mortality issues in Five (5) maternity clinics around Dakar. The record shows that teach centre have an average of 4000 deliveries per year. The data collected from the hospital records were inputted using Sphinx software (version 5). These data were analysed using Epi Info software (version 3.5). After analysing these data, recommendations were made to minimize the different causes of maternal deaths. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">We recorded 154 maternal deaths out of 32,420 live births. The direct causes of maternal deaths were a result of preeclampsia and its complications (31.2%), postpartum haemorrhage (24.7%), abruption placentae (20.8%) and obstructed labour (7.8%). The indirect causes were mainly sickle cell disease (1.3%), heart disease (1.3%) and gynaecological cancers (1.3%). Maternal deaths were also associated with fetal loss in 47.4% of 153 maternal deaths, need for blood transfusion 59% while none of the reference structures in the suburbs of Dakar has a blood bank;with a need for admission in intensive care unit was noted as 40%. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Thus, preeclampsia and its complications are the leading cause of maternal deaths in suburban settings. Timely availability of resuscitation units and liable blood products could drastically reduce maternal deaths from direct obstetric complications.</span></span></span></span>
文摘<strong>Background: </strong>Women with gestational diabetes mellitus (GDM) have a significantly increased risk for developing type 2 diabetes after delivery. The purpose of this study was to determine the postpartum glycemic status among women with GDM in an Endocrinology-Diabetology department in Sub-Saharan Area. <strong>Methods:</strong> It was a prospective cohort study conducted between January 1, 2013, and July 31, 2018 (over period of 5 years and 7 months) at Pikine National Hospital, Dakar, Senegal. Postpartum glucose status was evaluated at least 6 weeks post-partum among women with history of GDM according to IADPSG criteria. The glycemic status after delivery was pointed referring to 2006 WHO criteria. <strong>Results:</strong> Overall 53 patients were included in this study. Fasting plasma glucose was performed as a screening test in 94% of the cases. A type 2 diabetes after GDM as diagnosed in 6 patients, accounting for a prevalence of 11.32%. An Impaired Fasting Glucose (IFG) was revealed in 5 patients (9.43%). The patients underwent a screening test in the first year after delivery in 54.70% of the cases, over a half of whom during the post-partum period range from the 6<sup>th</sup> to the 12<sup>th</sup> week. Insulin usage during pregnancy was statistically correlated with the occurrence of postpartum diabetes. <strong>Conclusion:</strong> Diabetes prevention and early diagnosis require a glycemic status monitoring among women with history of GDM.
文摘The objective of this study is to characterize and assess the risk of collapse of woody plant formations in the Fathala forest. In recent years, this forest has suffered a sharp reduction in its plant cover to the point of compromising the survival of populations of certain animal species such as the Red colobuses. The methods used are respectively constituted by the transect method, the dendrometric statements method and that of establishing the red list of ecosystems of the IUCN. The specific richness comprises 56 species divided into 47 genera and 22 families. The density is higher in the unfenced area (369 ind/ha in clear forest and 53 ind/ha in gallery forest) compared to the fenced area (160 ind/ha in clear forest versus 48 ind/ha in gallery forest). A study of the plant formations shows a strong degradation of the ecosystems passing from a clear and dry Sudanese forest to a wooded savannah. The cover rate in the fenced area is 20% in gallery forests and 25% in clear forests;in the unfenced area, it is 19% and 23% in gallery forests and clear forests, respectively. The application of the IUCN criteria shows an annual rate of collapse is -<span style="font-family:Verdana;">6 ind/ha in gallery forests and </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">4 ind/ha in clear forests. The annual rate of cover collapse would be </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">3.75% and </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">2.9% for gallery forests and clear forests, respectively. These results classify the forest in the Critically Endangered category. The main factors responsible for this degradation are, among others, anthropogenic actions and climatic pejoration. These results could constitute a basic tool for undertaking an improvement in the management of this forest, which is a living environment for an animal species.</span>
文摘<strong>Introduction:</strong> <span style="font-family:""><span style="font-family:Verdana;">Maternal mortality is a public health problem of more concern to developing countries. As part of improving the maternofoetal prognosis during pregnancy and childbirth, it is essential to carry out regular follow-ups of pregnant women (FE) through antenatal consultations (ANC). In fact, the World Health Organization (WHO) recommends at least four ANC at regular intervals during pregnancy. In Senegal the completion rate varies greatly depending on the region. In the District of Kédougou it was 41% in 2017 (DHIS2). The national target was not achieved despite the interventions. Thus we studied the determinants of CPN completion in the health district of Kedougou in 2017. </span><b><span style="font-family:Verdana;">Method:</span></b><span style="font-family:Verdana;"> The study is of a descriptive and analytical cross-sectional type and concerned a sample of 884 women who gave birth between October 2017 and September 2018. They were chosen by a sample whose distribution in the district was made according to the quota method while respecting the demographic weight of each area of </span></span><span style="font-family:Verdana;">responsibility of the District.</span><span style="font-family:""> <b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The results of our study showed that the average age of women was 24 years with an average number of pregnancies equal to 3. The ANC completion rate at 37%</span></span><span style="font-family:Verdana;"> was</span><span style="font-family:""><span style="font-family:Verdana;"> lower than the administrative data rate which was 41%. The determinants with a statistically most significant link with the completion of ANC are respectively satisfaction with the care and quality of service, the level of information of women regarding PNC, marital status, affordability and distance from the location of the ANC. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Increasing women</span></span><span style="font-family:Verdana;">’</span><span style="font-family:Verdana;">s incomes, increasing communication about ANC, and bringing health services closer together are needed to improve the completion rate of antenatal care visits.</span>
文摘<strong>Introduction: </strong><span><span><span style="font-family:""><span style="font-family:Verdana;">In Senegal, according to the 2017 Demographic Health Survey, </span><span style="font-family:Verdana;">about 22% of married women have an unmet need for family planning. Globally</span><span style="font-family:Verdana;">, 61% of women do not have access to postpartum family planning. </span><b><span style="font-family:Verdana;">Material </span><span style="font-family:Verdana;">and Method: </span></b><span style="font-family:Verdana;">This is a prospective, descriptive and analytical study from March</span><span style="font-family:Verdana;"> 05, 2017 to January 31, 2018. The interrogation was done in the hospital ward with filling in the data collection form. The data collected was first coded and then entered, using the sphinx software. The data analysis was done with Epi info version 7 software and included a descriptive and analytical component. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">The average age of the patients was 26 years with extremes of 15 and </span><span style="font-family:Verdana;">48 years. Average gestation was 2.3 with extremes of 1 and 8 pregnancies. More </span><span style="font-family:Verdana;">than half of the women (64.7%) had delivered by caesarean in an emergency setting. More than half of the women (66.7%) had chosen the hormonal contraceptive method within 48 hours of delivery and the implant was the type of </span><span><span style="font-family:Verdana;">contraceptive prescribed in almost half of the cases (49.3%). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Integrating postpartum family planning into programs will ultimately help to dramat</span></span><span style="font-family:Verdana;">ically decrease high-risk pregnancies, decrease the </span><span style="font-family:Verdana;">unmet need for family plannin</span><span style="font-family:Verdana;">g (FP), and improve the health and survival of mothers and children.</span></span></span></span>
文摘<strong>Objective: </strong><span><span><span style="font-family:""><span style="font-family:Verdana;">The purpose of this study was to analyze the opinions of gynecologists, midwives, and interns/Specialist students practicing in Senegal about the use of IUD, and to assess factors that stand as obstacles to IUD prescribing. </span><b><span style="font-family:Verdana;">Patients and methods: </span></b><span style="font-family:Verdana;">An online questionnaire was developed to assess providers’ IUD practices and attitudes. The questionnaire was based on the one used in a Swiss study on the same topic. The platform used was Google forms. The questionnaire was shared in associative platforms involving gynecologists, midwives and interns/Specialist students. </span><b><span style="font-family:Verdana;">Results and comments: </span></b><span style="font-family:Verdana;">We received 292 feedbacks. Gynecologists represented 13.7% of the sample, interns and specialist students 11.3% and midwives 76%. Parity is a determining factor in IUD selection. The care-providers were concerned about the followings, which might have prevented the use of IUD, even </span><span style="font-family:Verdana;">though it </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">was</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> indicated: infections (75.7%), pelvic pain (61.3%), expulsion (48.3%), increased risk of perforation (46.9%), women’s appreciation </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">(45.2%), ectopic pregnancy (33.9%) and sexual behavior (28.4%). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Our study reveals that providers’ apprehensions and concerns severely limit the availability of IUDs. These concerns are often unfounded, based on personal experiences and not on official recommendations. Parity is a major obstacle.</span></span></span></span>
文摘<strong>Background:</strong> <span style="font-family:""><span style="font-family:Verdana;">Ovarian pregnancy is a rare entity of ectopic pregnancy, with a prevalence in the literature estimated between 1/2500 to 1/5000 births. The majority of ovarian pregnancies are diagnosed in the 1st trimester due to the noisy symptomatology. However, in small proportions, they may continue into the 2nd or 3rd trimester, making their diagnosis more difficult. </span><b><span style="font-family:Verdana;">Aim: </span></b><span style="font-family:Verdana;">We report a case of ovarian pregnancy in a 26-year-old patient, discovered intraoperatively as a large unruptured ovarian mass. </span><b><span style="font-family:Verdana;">Case report: </span></b><span style="font-family:Verdana;">A 26-year-old woman referred to the maternity ward for management of fetal death in utero at 31 weeks of amenorrhea associated with overlying placenta previa. Ultrasound performed in the department, was in favor of an abdominal pregnancy stopped at 31 SA with a placenta that seemed to adhere to the posterior wall of the uterus, which was empty. A Laparotomy was performed, on exploration, a large right ovarian mass was found, the site of the pregnancy. A right adnexectomy, after adhesiolysis, was performed. The incision of the operative part revealed a macerated female fetus. The clinical evolution was favorable. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">We report on a case of unruptured ovarian pregnancy, discovered in the 3rd trimester of pregnancy. The ultrasound diagnosis of an ovarian pregnancy beyond the 2nd trimester remains a challenge, the management remains surgical.</span></span>
文摘The counter-referral system is particularly important for care during pregnancy, childbirth and the post-partum period as it facilitates access to emergency obstetric and neonatal care. It allows people to access care that is not likely to be provided at the base and to manage certain complications arising in emergency settings. We therefore looked at the evaluation of obstetric evacuations from the Touba Ndamatou public health. Methodology: This was a retrospective study of descriptive and analytical type extending over a period of 12 months from January 1, 2020 to December 31, 2020 at the public hospital health establishment (PHHE) of Touba Ndamatou. Results: One thousand five hundred and sixty (1560) patients evacuated for obstetrical reasons were collected out of a total admission of 5560, i.e., a frequency of 28%. The average age of the patients was 25.54 years. The mean gestation was 3.24 pregnancies. The average parity was 3.04 deliveries. Almost all of our patients (99%) were married. Slightly more than one in two women (53.6%) had performed at least 2 or 3 Prenatal consultations. 80% of parturients had traveled a distance of less than 20 km. 623 patients came by their own means (54.6%). Evacuation was provided by an ambulance in 509 patients, i.e., 44.6%. Arterial hypertension and its complications were the frequent reason for evacuations with approximately one in four patients (26.2%). Only 3.6% of patients had qualified personnel on board being evacuated. In our series, 13 deaths were recorded, i.e., 1.1% of cases. The distance traveled seemed not to influence the future of the mother (p = 0.51). The non-accompaniment of the patient during the evacuation by a medical staff seemed to influence the prognosis of the mother (p = 0.031). Fetal morbidity was higher among evacuees not accompanied by medical personnel. The state of apparent death was observed in the majority of cases in patients received over a distance of more than 20 km. Conclusion: Evacuation requires a clear definition of the roles and responsibilities of each level of the health pyramid, good organization in the health structures as well as within the community, and a good information system.
文摘<strong>Background</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">: </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Molar pregnancy is a rare condition;its ectopic form is even rarer occurring in 1.5 per 1,000,000 pregnancies.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Aim</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span><span><b><span style="font-family:;" "=""> </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">We report a case of ectopic molar pregnancy located in the fallopian tube and draw attention to the importance of systematic histological examination in any ectopic pregnancy.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Case report</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">: </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">A 32-year-old primigravida woman presented with metrorrhagia in a context of about 2 months of amenorrhea. An ectopic pregnancy was diagnosed by ultrasonography. A Laparotomy was performed and a ruptured left ampullary ectopic pregnancy was found, and a total left salpingectomy was performed. The pathologic examination </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">the histological examination show an aspect of a partial molar ectopic tubal pregnancy. </span><b><span style="font-family:Verdana;">Conclusion</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span><span><b><span style="font-family:;" "=""> </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Ectopic molar pregnancy is a rare entity, its diagnosis requires histological confirmation. Beta-HCG monitoring is the essential tool for monitoring the postoperative evolution.</span></span></span>
文摘OBJECTIVES: 1) To draw up the epidemiological profile of patients who have benefited from cervical cancer screening by visual inspection after application of acetic acid (VIA) and then describe the results of the test, the colposcopy, histological and therapeutic aspects in case of dysplasia. 2) To evaluate the performance of IVA in cervical cancer screening and its feasibility in low-resource countries. MATERIALS AND METHODS: This was a prospective and descriptive study carried out from 06 June 2015 to 31 January 2016 (7 months) at the Maternity Center at Nabil Choucair health center in Dakar. The patients had been screened for cervical cancer by visual inspection, which consisted of applying 3% acetic acid after setting up a vaginal speculum. The test was considered positive if there were intense white areas in the cervix. Colposcopy was performed in case of a positive VIA result. This colposcopy included an unprepared examination, an examination after application of 3% acetic acid and an examination after application of Lugol solution. The colposcopic report is made according to the terminology of the French Society of Colposcopy and Cervico-Vaginal Pathology. Patients with major changes or unsatisfactory colposcopy had undergone diathermic loop resection. Surgical specimens were sent to pathologic anatomy and follow-up was performed according to the results of the histology. The studied parameters concerned the socio-demographic aspects, the results of the VIA test, the results of the colposcopy after a positive test, the therapeutic aspects in case atypical transformation zone grade 2 or of unsatisfactory colposcopy, the results of the histology after the conization and the followed. The collection of data was done thanks to a file and the statistical analysis thanks to the software Epi-info version 7. RESULTS: 899 patients were involved in the study. The epidemiologic profile of our patient was a multipara in a period of genital activity, aged 42.2 years with a mean gestational weight of 4.5, and a parity of 4. In our series, the patients had their first sexual intercourse with 20.8 years old. In our study, 84 patients (10.2%) had positive results after visual inspection after acetic acid applications. All patients with positive results after application of 3% acetic acid had colposcopy. In our study, 27 patients had major changes and/or unsatisfactory colposcopy and underwent diathermic loop resection for diagnostic and therapeutic purposes. Anatomo-pathological examination of the cone room revealed cervicitis in 22.2% of cases, flat condyloma in 7.4% of cases, CIN2 in 22.2% of cases, and CIN3 in 18.5% of cases. All the conizations were in sano. The postoperative course was simple. CONCLUSION: Cervical cancer is a real public health problem in developing countries. To do to human resources, developing countries like Senegal must put in place simple, inexpensive, effective strategies that must globally respond to “screen and treat”.
文摘The diagnosis and management of ovarian cystic tumor is sometimes difficult. In this manuscript, we wish to summarize this issue by showing three cases. Ultrasound and Color Doppler are very useful to diagnose the presence of this tumor but also to distinguish between benign and malignant. Pelvic MRI is also a strong tool and is sometimes mandatory. HE4 and CA125 are often useful as a serum diagnostic marker of malignancy, but not always so. Recently, laparoscopic management has gained popularity;however, great caution should be exercised during laparoscopic operative procedures, as this may lead to intraperitoneal malignant cell spreading/proliferation when the tumor is malignant. During the surgery of malignant tumor, irrespective of laparoscopic or laparotomic, intraperitoneal rupture should be avoided. Since the final diagnosis must be made by histological examination, the patient must always be informed of this possibility.
文摘Introduction: Sexual abuse or sexual assault is part of violence against women, as is physical violence, female genital mutilation and forced marriage. According to the Criminal Code, this is any sexual offense committed with violence, coercion, threat or surprise on the person of others. It is a criminal act punishable by the laws in force in almost every country in the world. Study Objectives: 1) draw up an epidemiological profile of female victims of sexual abuse;2) develop the treatment protocol. Methodology: This is a 7-year descriptive retrospective study from January 1, 2010 to December 31, 2016 at the Center Hospitalier National de Pikine (Dakar). Included in this study were all of the patients admitted during our investigation period who were the victims of suspected or certain sexual abuse, with or without requisition. For each case, the following parameters were studied: the epidemiological characteristics (age, gestation, parity and place of residence), the circumstances of the attack (time and place), the characteristics of the aggressor (age, link with the victim, number of aggressor), the type of sexual contact, the possible lesions found during the physical examination (genital and extra-genital), the mode of admission, the delay of the consultation, the attitude after the sexual abuse, the gynecological and obstetrical status of the victim, the repercussions and psychological follow-up, the paraclinical assessment, the treatments administered. Data were collected using a survey form and analyzed with SPSS software. Results: During the study period, 183 victims of sexual abuse were received and treated at the level of our structure out of a total of 39,760 patients, representing a frequency of 0.46%. The age of the victims varied between 2 and 36 years with an average of 13 years. The 11 to 15 age group was the most represented. Students were the most represented among victims of sexual abuse (87.4%). Workers represented 9.3% of the victims. Infants made up 3.3% of the victims;the average age of the alleged attackers was 31 when they were known to their victim. Half of the victims (50.3%) were in the pre-pubertal stage. Among those who were in genital activity (91 cases or 49.7%), 16 cases of pregnancy were reported;which represented 8.7% of cases. Only 20.2% of victims had genital trauma. Prescription of emergency contraception was carried out for 47% of the victims who were in genital activity. After the clinical examination, 17% of the victims had received antibiotic prophylaxis. Conclusion: Sexual abuse is currently a real socio-cultural drama. Preventing them involves raising public awareness. Their management must be early and adapted in order to prevent sexually transmitted infections and psychological consequences.
文摘Objective To compare the safety, side effects and failure rates of contraception copper intrauterine device (IUDs) in the immediate postpartum period after a vaginal delivery and during a cesarean section. Patients and methods This was a descriptive and analytical study, conducted in Gynecology and Obstetrics departments hospital Pikine and Abass Ndao hospitals. It compared two groups of women with IUDs in the immediate postpartum period after a vaginal delivery and during cesarean section. Our sample consisted of 215 patients. We had divided them into two groups: group 1 consisted of 115 patients who delivered by cesarean section;Group 2 consisted of 100 patients who delivered vaginally and whom the insertion was made in post placental or within 48 hours after birth. The variables studied were the sociodémographic characteristics, characteristics of pregnancy and childbirth, insertion procedures, follow up with the assessment of side effects and complications. Results and comments The socio-demographic characteristics were superimposed in both groups. Nine patients were lost to follow up, 4 in group 1 and 5 in group 2. The complaints such as pain (3.7% for Group 1 against 2.6% for group 2), vaginal bleeding (2.1% for group 2, and 1.8% for group 1) were rarely reported and stackable in both groups. After 6 months of follow up, the menses was observed in 42.8% of group 2 against 43.1% of group 1. The abnormal menstrual flow, evaluated by the Higham score, was noted in 29.6% of group 2 and 25% of group 1, and was dominated by excessive bleeding. They motivated IUD removal in two patients. A significant difference was found in the perception of IUD strings, it was effective in 95.4% of patients in group 2 against 50.5% for group 1. The evictions were 9 at 3-month follow-up 7 related group 2 and 2 for Group 1. It was partial (isthmic IUD) and total expulsion. At 6 months follow-up, 3 cases of partial expulsion were noted and concerned only group 2. This made a total expulsion rate of 5.3%, with 9.5% for group 2, and 1.8% for group 1. no cases of pregnancy or uterine perforation had been reported during this study. A vaginal sampling was performed in all our patients and the results were generally comparable in both groups and normal in most cases. However, we noted 17.6% of infection in group 2, and 16.2% in group 1. Conclusion From the results of our study, we can say that IUD insertion in the period of immediate postpartum remains safe and effective regardless of the way of delivery. The risk of expulsion is minimal so acceptable.
文摘Premature rupture of membranes (PROM) complicates 3% of preterm pregnancies and occurs in 60% to 80% of term pregnancies. However, its management remains largely controversial. The objective of this study was to establish the epidemiological profile, to study the management and the prognosis of Premature rupture of membranes (PROM) in our practice. Patients and methods: It was a prospective, descriptive and analytical study from May 1st 2016 to January 31st 2017 at the Pikine National Hospital Center. The target population consisted of all patients received at the hospital with premature rupture of membranes and who had given birth in the structure. The variables studied were: marital status, mode and reason for admission;risk factors;antecedents;prenatal care;the clinical and paraclinical examinations;support and immediate maternal and fetal neonatal complications. Results and comments: The mean maternal age was 27.34 years and the majority of women were aged between 18 and 39 years (94.4%). Fifty-one point three percent of patients were primiparous, large multiparous represented only 2.5%. The majority of patients (385 patients or 66.9%) had consulted in the first 12 hours following the onset of fluid flow. For 20.1% of them this flow was associated with uterine contractions. Hidden risk factors were dominated by the twin pregnancy. The blood count showed that 38.8% of patients had leukocytosis and CRP was positive in 18.3% of patients. An ampicillin-based antibiotics was established in 42.6% of cases, corticosteroid therapy in 5.2% and 1% in tocolysis. An expectation was adopted in 65.7% of cases, induction of labor in 7.3% and a cesarean section immediately in 27% of cases. In total, 65.7% of patients had vaginal delivery and 34.3% cesarean. The perinatal mortality rate was 3.6% or 22 newborns on 610. Two cases of endometritis were observed and one case of immediate postpartum hemorrhage. No maternal deaths were recorded. Conclusion: These results show that the prognosis of premature rupture of membranes remains favorable in our practice. To improve this prognosis, we recommend sensitization of patients during prenatal care regarding signs of danger, a systematic bacteriological sample from all pregnant at the end of their pregnancy and the health personnel to direct patients’ references to structures in case of PROM.
文摘Objective: To assess a training approach in Emergency Obstetric and Neonatal Care (EmONC) to strengthen skills of healthcare providers and reduce maternal mortality. Materials and methods: The approach was based on the skills training using the so-called “humanist” method and “life saving skills”. Simulated practice took place in the classroom through thirteen clinical stations summarizing the clinical skills on EmONC. The evaluation was done in all phases and the results were recorded in a database to document the progress of each learner. Results: We trained 432 providers in 10 months. The increase in technical achievements of each participant was documented through a database. The combination of training based on the model “learning by doing” has ensured learning and mastering all EmONC skills particularly postpartum haemorrhage management and reduced missed learning opportunities. Conclusion: The impact of training on postpartum haemorrhage management and maternal mortality is a major challenge in terms of prospects.
文摘Objectives: To assess the quality of the obstetric evacuation system at the Youssou Mbargane Diop Hospital in Dakar. Methods: Our study was conducted at the Hospital of Youssou Mbargane DIOP in Rufisque, a district about 26 km from downtown Dakar. This was a qualitative and evaluative descriptive study in the form of operational research aimed at improving the quality of obstetrical evacuations and resolving problems through a dynamic and team approach. It was carried out within the framework of the AQUASOU project (Improvement of Quality and Access to Emergency Obstetric Care in French). A liaison sheet was completed at the arrival of each evacuated patient, prospectively during the period from December 24 2006 to July 10 2008. The epidemiological characteristics were, origin of the evacuated, the evacuation conditions, evacuation patterns and therapeutic data. The data were collected through an Excel database developed for this purpose. The analysis was done using the Epi-Info version 6.0 software. Results: The frequency of evacuations was 23.2%. The average age of our patients was 25.3 years with extremes of 14 years and 48 years. More than half of the evacuees (59%) came from the Sanitary District of Rufisque. The majority of evacuations were made in a taxi (76.5%). An ambulance was used in 190 cases (20.6%). Seated transport was performed in 78% of cases. The transfer was medicalized in almost one-third of cases (29.3%). A liaison sheet was established during the transfer of patients in 77% of the cases. Evacuations were related to hemorrhage in 23.3%, dystocia in 22.2%, and fetal-adnexal anomaly in 17.3% of cases. No treatment was instituted before evacuation in 56% of evacuees. 48.5% of the evacuees had received treatment beyond. Conclusion: The poor quality of obstetric evacuations seems to be a brake on the decline in maternal and neonatal mortality in Senegal. Training and retraining of health personnel would improve maternal-fetal and neonatal morbidity and mortality.
文摘Objectives: To evaluate the epidemiology of eclampsia, to assess maternal and perinatal prognosis and management. Material and method: This was a retrospective, descriptive study from January 1, 2015 to December 31, 2018. Included were all women received in the emergency department of our health facility for generalized seizures and/or disturbances of consciousness, occurring between the 20th Week of Amenorrhea (WA) and the 6th week of postpartum on a field of hypertension. The sources of the data consisted of antenatal consultation cards, delivery records, hospital records, operating theater and resuscitation records. The variables studied were sociodemographic characteristics, the course of pregnancy, childbirth and neonatal parameters. Data were captured and analyzed using SPSS 11.0 software. Results: The study focused on 190 cases with a prevalence of 3.5%. The average age of the patients was 20 years with extremes of 14 and 40 years. The average parity was 4.1 deliveries with extremes of 1 and 7. Nearly three-quarters of the patients (74.7%) of the patients were primiparous. Almost all the patients were evacuated. More than half of the seizures (53.1%) were recorded before work and more than one out of two patients had two seizures. Caesarean section was the mode of delivery in more than one out of two patients (56.8%). Maternal complications were marked by renal failure (23 cases), the HELLP syndrome (72 cases), and the retro placental hematoma (83 cases). The fetal impact was marked by prematurity in 90% of cases and 17 cases of fetal death in-utero. Nineteen maternal deaths were recorded while early neonatal mortality was 437 per 1000 live births. The average hospital stay of the survivors was 6.2 days. Conclusion: Eclampsia is still common in our regions. It occurs preferentially in young primiparas with hypertension and/or proteinuria on a poorly followed pregnancy. Magnesium sulphate and cesarean section can improve the maternal and fetal prognosis. Prevention necessarily means quality prenatal care.
文摘Introduction: The practice of minimally invasive surgery in Senegal occupies more and more of a preponderant place in fields that previously did not allow it. Thus in our practice in gynecology we are witnessing an explosion of these operative indications especially for benign adnexal pathology. Patients and Method: The objective of this study was to evaluate the evolution of laparoscopic practice in terms of frequency, indication of duration and operative complications. For this reason, we have collected all the laparoscopic procedures carried out at the Gynecology and Obstetrics Department of the Pikine National Hospital since January 1st, 2012 over a period of 60 months. Endoscopic surgery accounted for 20.1% of all gynecological and breast procedures. There were 195 cases (14.9%) of laparoscopic surgery and 69 cases (5.2%) of operative hysteroscopy. The average age of our patients was 34 years with extremes of 15 and 67 years. The intervention was motivated by the exploration or management of infertility in 101 cases, or 57.1% of patients. Laparoscopy remained exploratory in 15.3% of cases (279 patients) with 55 cases of ovarian tumors presumed to be benign. The mean duration of diagnostic laparoscopy was 39 min with extremes of 20 to 150 min;while that of operative laparoscopy was 59 min with extremes of 20 to 250 min. It was noted that 4 cases of laparoconversion are 2.8% of all patients in our series. The postoperative course was 99.4% simple. Conclusion: In our practice and as in the developed countries, we are witnessing a considerable decline in the indications of laparotomy to the profile of laparoscopy, especially for benign adnexal pathology and infertility. An extension to the gynecological malignant pathology is the ultimate challenge.
