[Infections associated with the care in the department of gynecology - obstetrics of the University Hospital Center Gabriel Touré]. / Les infections associees aux soins dans le departement de gynecologie ­ obstetrique du Centre Hospitalier Universitaire Gabriel Toure de bamako, mali.

OBJECTIF: the purpose of this work was to study the infections associated with the care in the department of gynecology - obstetrics of the University Hospital Center Gabriel Touré (CHU G. Touré). PATIENTS AND METHODS: This was an epidemiological, descriptive, and analytical study carried out in the gynecology-obstetrics department of G. Touré University Hospital, from April 11, 2016 to August 29, 2016 (4 monthset 18 days), with a prospective collection of data that focused on the characteristics clinical and laboratory-based care-associated infections in patients during their hospitalization. Included in the study were all hospitalized patients (operated or not) in the gynecology obstetrics department, who agreed to participate in the study. The criteria used to diagnose the infection associated with care were those of the CDC Atlanta and making a thick drop in our context. Operative wound monitoring was performed until the 30th postoperative day. RESULTS: We recorded 200 patients, including 138 operated and 62 nonoperated patients, of which 30 patients developed a care-associated infection at a rate of 15%. The mean age of the patients who presented an infection was 32.52 years ± 13.36 years against 29.36 years ± 10.28 years for the patients who did not present the infection. Seven point five percent of the evacuees had an infection associated with care. The most common types of infections were surgical site infection with 56.60% followed by malaria with 23.30% and urinary tract infection with 20.00%. Escherichia coli and Acinetobacter baumaniiwere the most recovered germs. Isolated organisms were 100% resistant to Amoxicillin, 88.88% were resistant to Ciprofloxacin and 77.77% were resistant to Amoxicillin + Clavulanic acid. The average duration of hospitalization for patients who developed the infection was 14.70 days with extremes of 5 and 46 days. The mortality rate was 1.50%. The average cost of management of patients who developed the infection was 119837 FCFA; the extremes were 17750 and 825750 FCFA and the standard deviation of 174998 CFA francs. CONCLUSION: the infections associated with the care remain frequent in our service and dominated by the infections of the operating site. The isolated organisms were all 100% resistant to Amoxicillin in 88.88% Ciprofloxacin.

LE BUT: de ce travail était d'étudier les infections associées aux soins dans le département de gynécologie ­obstétrique du Centre Hospitalier Universitaire Gabriel Touré (CHU G. Touré). PATIENTES ET MÉTHODES: Il s'agissait d'une étude épidémiologique, descriptive, analytique réalisée dans le département de gynécologie ­obstétrique du CHU G. Touré, allant du 11 Avril 2016 au 29 Août 2016 (4 mois et 18 jours) à collecte prospective des données qui a porté sur les caractéristiques cliniques et biologiques des infections associées aux soins chez les patientes au cours de leur hospitalisation. Etaient incluses dans l'étude toutes les patientes hospitalisées (opérées ou non) dans le service de gynécologie obstétrique, et qui ont accepté de participer à l'étude.Les critères utilisés pour le diagnostic de l'infection associée aux soins étaient ceux du CDC d'Atlanta et la réalisation d'une goutte épaisse dans notre contexte. Une surveillance des plaies opératoires a été faite jusqu'au 30ème jour post-opératoire. RÉSULTATS: Nous avons enregistrés 200 patientes dont 138 opérées et 62 non opérées parmi lesquelles 30 patientes ont développé une infection associée aux soins soit un taux de 15%. L'âge moyen des patientes ayant présenté une infection a été 32,52 ans ±13,36 ans contre 29.36 ans ±10,28 ans pour les patientes n'ayant pas présenté l'infection. Sept virgule cinq pourcent des patientes évacuées ont présenté une infection associée aux soins. Les types d'infections les plus retrouvés étaient l'infection du site opératoire avec 56,60% suivie du paludisme avec 23,30% et l'infection urinaire avec 20,00%. L'Escherichia coli et l'Acinetobacterbaumanii ont été les germes les plus retrouvés. Les germes isolés étaient dans 100% des cas résistants à l'Amoxicilline, dans 88,88% des cas résistants à la Ciprofloxacine et dans 77.77% des cas résistants à l'Amoxicilline +Acide clavulanique. La durée moyenne d'hospitalisation des patientes ayant développé l'infection a été 14,70 jours avec des extrêmes de 5 et 46 jours.Le taux de mortalité a été de 1,50%. Le coût moyen de prise en charge des patientes ayant développé l'infection a été 119837 FCFA ; les extrêmes ont été 17750 et 825750 FCFA et l'écart type de 174998 francs CFA. CONCLUSION: les infections associées aux soins restent fréquentes dans notre service et dominées par les infections du site opératoire. Les germes isolés étaient tous résistants dans 100% cas à l'Amoxicilline dans 88,88% cas à la Ciprofloxacine.

[Comparative Study of Induced Pregnancies and Spontaneous Pregnancies in a Level II Hospital in Bamako District Mali]. / Etude Comparative Des Grossesses Induites Et Grossesses Spontanees Dans Un Hopital De Niveau II Du District De Bamako Mali.

The aim of this work was to compare the prognosis of induced pregnancies and spontaneous pregnancies received in the service. PATIENTS AND METHODS: We performed a retrospective study of Ca / Witnesses (1 case for 2 controls) with age and parity matching. This study was conducted at the maternity ward of the Reference Health Center of Commune V District Bamako (CSREF CV) over a period of 10 years from January 1, 2007 to December 31, 2016 for all patients meeting our criteria of 'inclusion. We called cases, induced pregnancies, and witnessed spontaneous pregnancies. The data was entered and analyzed on the Epi-Info software version 6.04 according to the formula applicable to the Case / Witness study. RESULTS: We included in this study, (due to a case for two controls), 1611 induced pregnancies (cases), and 3222 spontaneous pregnancies (controls). The average age was 35.4 years (25 years-43 years) with an average parity of 2.7 (1-5). Hypertensive disorders, preterm birth, intrauterine growth retardation (IUGR), caesarean section, poor perinatal prognosis were found with a statistically significant difference (OR> 1) in patients with induced pregnancies. CONCLUSION: Induced singleton pregnancy is a high-risk pregnancy.

L'objectif de ce travail était de comparer le pronostic des grossesses induites et des grossesses spontanées reçues dans le service. PATIENTES ET MÉTHODES: Nous avons réalisé une étude rétrospective Ca/Témoins (1 Cas pour 2 Témoins) avec appariement de l'âge et la parité. Cette étude s'est déroulée la maternité du Centre de Santé de Référence de la Commune V du District de Bamako(CSREF CV) sur une période de 10ans allant du 1er janvier 2007 au 31 Décembre 2016 portant sur toutes les patientes répondant à nos critères d'inclusion. Nous avons appelé Cas, les grossesses induites et témoins les grossesses spontanées. Les données ont été saisies et analysées sur le logiciel Epi-Info version 6.04 conformément à la formule applicable à l'étude Cas/Témoins. RÉSULTATS: Nous avons inclus dans cette étude, (en raison d'un Cas pour deux Témoins), 1611 grossesses induites (Cas), et 3222 grossesses spontanées (Témoins). L'âge moyen était de 35,4 ans (25 ans-43ans) avec une parité moyenne de 2,7 (1-5). Les troubles hypertensifs, l'accouchement prématurité, le retard de croissance intra-utérin(RCIU), la césarienne, le mauvais pronostic périnatal ont été retrouvés avec une différence statistiquement significative (OR>1) chez les patientes avec grossesses induites. CONCLUSION: La grossesse singleton induite est une grossesse à haut risque.

[Reduction Of Maternal And Neonatal Mortality Due To Free Caesarean In Segou's Nianankoro Fomba Hospital In Mali]. / Reduction De La Mortalite Maternelle Et Neonatale Par La Gratuite De La Cesarienne A L'Hopital Nianankoro Fomba De Segou Au Mali.

INTRODUCTION: Emergency obstetrical treatment influences maternal and neonatal mortality and so the government of the republic of Mali decided on June 23, 2005 to establish a free caesarean policy in public health establishments. After 3 years and half, we evaluated the impact of the policy on maternal and neonatal mortality. METHOD: A comparative transversal study was conducted. The data of women who had a caesarean performed in the Segou regional hospital covering the span of 5 years (18 months before the policy and 42 following the new law) was collected. The data was analyzed using the Info 6.4 software. We employed a Pearson's Chi-2 with significance set at p<0.05. RESULTS: Frequency of the caesarean increased following the policy to 25.48 % in 2008 versus 9.33 % in 2004 (p=0.0067). Maternal mortality rate was improved: 3.85 % in 2004 versus 0.23 % in 2008. The rate of neonatal mortality in the same period dropped from 25.39 % to 9.36 % (p=0.021). CONCLUSION: It is noted that the free caesarean policy enabled an increase in the number of caesareans performed and a significant reduction in maternal and neonatal mortality rates.

INTRODUCTION: La prise en charge rapide des urgences obstétricales influence le pronostic maternel et fœtal. C'est pourquoi le Gouvernement de la République du Mali a décidé le 23 juin 2005 d'instaurer la gratuité de la césarienne dans les établissements sanitaires publics. Après une période de 3 ans et demi, nous avons évalué l'impact de la césarienne gratuite sur la mortalité maternelle et néonatale. MÉTHODE: Il s'agissait d'une étude transversale comparative portant sur les femmes chez qui une césarienne a été réalisée dans le service. Les données de l'admission à la sortie de l'hôpital ont été collectées.L'étude s'est déroulée à l'hôpital régional de Ségou du 1er Janvier 2004 au 31 Décembre 2008 soit 18 mois avant la gratuité et 42 mois courant la gratuité. Il s'agit d'un hôpital de deuxième référence qui reçoit les évacuations des centres de 1er et de 2ème niveau relevant de sa circonscription. Les données ont été saisies et analysées sur le logiciel Epi info 6.4. Le test statistique utilisé est le Chi-2 de Pearson et le seuil de significativité est fixé à p< 0,05. RÉSULTATS: La fréquence de la césarienne était de 25,48% en 2008 versus 9,33% en 2004 (p= 0,0067). Le taux de mortalité maternelle était passé de 3,85% en 2004 à 0,23% en 2008, tandis que celui de mortinaissance était passé de 25,39% à 9,36%(p= 0,021). Quant au taux de mortalité néonatale, il était de 2,05% en 2008 versus 13,23% en 2004, 9,68% du 1er janvier au 23 Juin 2005 ; 5,98% durant le reste de l'année 2005, 2,26% en 2006 et 2,32% en 2007. CONCLUSION: Au terme de notre étude, nous avons constaté que la gratuité de césarienne a permis non seulement d'augmenter le nombre total de césarienne, mais aussi d'améliorer significativement le pronostic maternel et néonatal.

Can visual cervical screening be sustained in routine health services? Experience from Mali, Africa.

OBJECTIVE: To assess the feasibility of sustaining visual cervical screening and treatment services in Mali, and to evaluate their performance and impact in improving the provision of cervical cancer control, following an initial cross-sectional study. DESIGN: Descriptive study. SETTING: Bamako area, Mali. POPULATION: Women aged 30-59 years. METHODS: Routine visual screening and treatment services were organised through two hospitals and 14 health centres. Patients with positive visual screening tests underwent colposcopy and/or directed biopsies, and ablative or surgical excision treatment was offered to those with cervical intraepithelial neoplasia (CIN). MAIN OUTCOME MEASURES: Test positivity, detection and treatment rates for CIN and the sustainability of screening services. RESULTS: Of the 14,141 women screened, 1682 (11.9%) were positive and were referred for further investigations and treatment. Over 75% of the screen-positive women underwent colposcopy and/or biopsy. CIN 1 was detected in 383 women, CIN 2 in 88, CIN 3 in 37 and invasive cervical cancer in 497. More than 80% of women with CIN and 35% of those with invasive cancer received treatment. The test performance characteristics and treatment coverage of routine screening were similar to those observed in the preceding cross-sectional study. CONCLUSION: Visual screening and treatment services are sustainable and effective in improving cervical cancer control provision by health services in Bamako, Mali. It is essential to organise and sustain several point-of-care services in order to extend cervical cancer prevention in low-income African countries.

Clinical trials of cancer screening in the developing world and their impact on cancer healthcare.

Several research and training initiatives were organized by the International Agency for Research on Cancer (IARC) in collaboration with national institutions in countries such as Angola, Brazil, Burkina Faso, China, Republic of Congo, Guinea, India, Mali, Mauritania, Nepal, Niger, Peru, Tanzania and Thailand among others, to address feasible and effective means of early detection and prevention of cervical, breast and oral cancers. The impact of these activities, that involved over 600 000 participants and more than 1200 healthcare personnel trained on strengthening the local health services in terms of infrastructure, human resources and service delivery aspects in host countries and other regions, is addressed here. These studies, inbuilt in appropriate health services platforms, have resulted in the development and sustenance of several continuing point of care services of screening and treatment in most host countries, particularly in sub-Saharan Africa, and have catalysed regional early detection programmes in India, China and Thailand. The IARC collaborative studies have evolved into major focal points of training and extending services in many countries. The large evidence base, resulting from ours and other studies is likely, in due course, to facilitate much wider scaling up of screening and treatment services through organised programmes.

[Prevention of mother to child HIV transmission in an African hospital, Bamako-Mali]. / Prevention De La Transmission Mere Enfant Du Vih En Milieu Hospitalier Africain, Bamako-Mali.

AIM: Pregnant women HIV infection has main risk the contamination of newborn. MTCT actions permit to reduce that risk. MATERIAL AND METHODS: Our survey has been realized in Gabriel Touré teaching hospital gynecology and obstetrics and pediatric departments. It is about an observational prospective and descriptive survey that spreads on a period from January 2005 to December 2008. Has been included in the study all the HIV positive pregnant women followed in our service and their babies that had received ARV prophylaxis and 18 months of life serology. RESULTS: We recorded 211 HIV positive pregnant women on a total of 9291 childbirths (2.27%). We noted 90.52% of HIV-1 vs 7.11% of type 2. The mother treatment consisted in a tri therapy in 77.25 vs 0.47% of bi anti retroviral and 22.28% of mono anti retro viral therapy. Maternal viral load was undetectable at the moment of delivery in 78.20% of cases. We noted vaginal delivery in 84.36% vs 15.64% of caesarean section. Newborns respectively received 67.32%; 4.88% and 22.92% of bi, tri and mono therapy. They formula-fed in 98.98%. The mother to child HIV transmission rate was 1.98%. CONCLUSION: HIV prevalence in pregnant patients is relatively height. HARRT in HIV positive mothers associated to bi therapy and formula feeding to their infants permit to obtain low vertical HIV transmission rate.

[Maternal mortality at the Gynecology-Obstetrics Service of the Segou Regional Hospital Center of Mali. Retrospective study of 138 cases]. / Mortalite Maternelle au Service de Gynecologie-Obstetrique du Centre Hospitalier Regional de Segou au Mali Etude Retrospective Sur 138 Cas.

Maternal mortality remains a serious threat especially to developing countries. We proposed to determine the frequency, causes and contributing factors to maternal mortality in order to improve the quality. of care. This is a retrospective study on 138 cases from 1 January 2005 to 31 December 2008 at the Maternity Center Hospital Régional of Ségou. The maternal mortality rate was obtained in 2031 for 100000 live birth. The causes were dominated with obstetric hemorrhage (38.4%), anemia (26.8%), hypertensive complications (20.2%), infections (13.0%). Risk factors such as age, parity, without the occupation, the non-educated; associated with delayed evacuation and the lack of the technical burden contributed to the clinical picture of our patients. The issue of maternal mortality calls everyone of us, mainly health staff. Its reduction passes by a coordinated and effective action on all the levels of care in pregnancy and childbirth.

[Clinical and medico - legal aspects of sexual aggressions at Gabriel Toure teaching hospital]. / Aspects Cliniques et Medico-Legaux des Agressions Sexuelles au CHU Gabriel Toure.

AIM: The sexual aggressions pose an important medico - legal problem. The implication of several services is often indispensable to determine the future of this aggression. Our survey objectives were to determine epidemiological and clinical characteristics of sexual aggressions and to specify the judicial continuations. MATERIAL AND METHODS: We did historical cohort survey while recruiting all cases of consultation in the service for sexual aggressions. This survey spreads on a period of 60 months going from January 2004 to December 2008. A systematic health evaluation (HIV test, vaginal screeming, lever inflammatory deseases) is asked to every sexual abuse patients.Data have been recorded from patients' clinical files, cards of requisition and accounts returned of verbal suit of auditions and police custodies. khi 2 test has been used to appreciate relationship between variables, significativity doorstep P value < 5%. RESULTS: The sexual aggression frequency in relation to admissions to emergencies is 3.12%. The age group <15 years were the more represented with 59.18%. The police authority referred the patients with a requisition in 65.17% of cases (p<0,005). Presumed aggressor was known by the patient in 63.67% of cases (p<5%) and in 72.28% of cases the aggression has been made by night (p=0,001) It was about one aggressor in 65.54% of cases; they were 2 and 3 numbers in 17.23%. (p=0,002). We noted a sexual penetration notion in 80.52% of cases against 19.48% of sexual attouchements. The threat has been noted in any case: 40.82% by weapon and 30.71% by stroke of point. More of the half of the patients (60.30%) had had sexual intercourse before the aggression. The clinic exam was normal in 76.40% of cases (P<5%). The main types of lesions were: hymeneal injuries (13.48%), vulva injuries (7.87%). The judicial continuations have been marked by 10.48% of condemnations, 46.06% of acquittal and 40.06% of friendly regulation (P<5%). CONCLUSION: The number of sexual aggressions, although under valued, is raised in our country. The collaboration between the judicial, police and medical services should permit to reduce the frequency of these aggressions.

[Trauma and pregnancy: clinical and prognosis about 152 cases recorded into Gabriel Toure Teaching Hospital]. / Traumatisme et Grossesse: Aspects Cliniques et Pronostic a Propos de 152 cas Colliges au chu Gabriel Toure.

AIM: The objectives of our survey were to determine the frequency of trauma associated to pregnancy in our service, to describe types of lesions and the maternal and fetal complications. MATERIAL AND METHODS: It is about a descriptive retrospective survey that spreads on a period of 63 months going from March 2002 to Jun 2007. We recorded all cases of trauma associated to pregnancy whatever the term of pregnancy. The parameters studied have been: admission mode, circumstances of intervening, gravida, parity, pregnancy age, delivery route and materno-fetal prognosis. We have used χ² test to appreciate relationship between variables studied, the significant doorstep has been P value < 5%. RESULTS: During the period of the survey we recorded 152 cases of trauma associated to pregnancy and 8016 emergency consultations is a frequency of 1.90%. In 3 cases on 4 (115 cases, 75.66%), the age of pregnancy was at least equal to 12 weeks. We noted 13.16% of unevolutive pregnancy; 13.83% of case of abortion and 15.13% of childbirth witch 5 by cesarean section. The main lesions more associated were: bruises (41.28%), the fractures of the pelvic (25.64%), the rachis fractures (10.26%) and the cranial trauma (12.82%), 6.58% (10 cases) of patients are died. CONCLUSION: Trauma in pregnant women often generate polymorphic lesions. Their complications can be serious dragging sometimes maternal and or fetal death. Their management is always multidisciplinary.

[Socio-demographic and prognostic aspects of unfollowed pregnancies of patients admitted in the Department of Gynaecology-Obstetric of Gabriel Toure Hospital]. / Aspects socio-demographiques et pronostic des grossesses non suivies chez les patientes admises dans le Service de Gynecologie-Obstetrique de l'Hopital Gabriel Toure.

UNLABELLED: The prenatal followed up permit, on the one hand, to track down risk pregnancies, to appreciate the evolution of pregnancy and its repercussion on the maternal state, to finally make the prognosis of the childbirth and on the other hand to identify risk pregnancies and to assure a management outside emergency context. They contribute this fact to the meaningful reduction of the maternal mortality. The non followed up pregnancies are characterized by their important maternal and fetal mortality and morbidity. The aim of our survey was to determine the frequency of the unfollowed pregnancies, to describe the socio demographic profile of the women and to determine the prognosis of these pregnancies. MATERIAL AND METHODS: Our survey had for setting the service of Gynecology and obstetrics of Gabriel Touré hospital. Center of cares, research and formation, this service that is 3rd level in the sanitary pyramid in Mali, receives emergencies from other motherhoods of lower level. Were include in this survey, women who delivered in the service and hadn't done any prenatal consultation. Criterias of non inclusion were next one: women having done at least a prenatal consultation, women having delivered in another sanitary structure, all cases of non assisted childbirths, women whose gestational age is lower to 28 weeks and/or fetal weight lower than 500 grams. Every case has been matched to a witness (consistent woman who has been followed and delivered in the service) according to criterias of age and parity. The statistical tests used to study associations between variables are the chi2 with a significativity doorstep of P = 0.05 and Odd ratio (OR). RESULTS: We recorded 2173 childbirths and 286 non followed pregnancies been 13.16% of frequency. The middle age of our patient was 23 years with extremes of 16 and 44 years, nullipareses represented 25.9% of cases. The domestic helps were more numerous in the group of cases with 4.9% against 0.3% in the witness group (P = 0.0006, OR = 14.6; IC [2.01, 30.05]). The maternal prognosis is marked by 2.1% of death (P = 0.013). Fetal prognosis is bad with 10.9% of child stillborn (P = 0.0007; OR = 3.19) and 21.5% of morbid APGAR. CONCLUSION: The absence of prenatal consultation is associated to a height maternal and fetal mortality and morbidity.

[Association of extrauterine and intrauterine pregnancy: 3 cases]. / Association grossesse extra uterine et intra uterine: a propos de 3 cas.

Extra uterine pregnancy (GEU) constitutes, by its frequency a problem of public health, by its gravity an obstetric emergency and a problem of fertility for the woman. It represents the chief reason of maternal death during the first quarter of pregnancy. The association of extra-uterine and intra-uterine pregnancy is a particular case of twin pregnancy said ditopic. It is rare, but non exceptional. The authors bring three cases to remind us of its existence.

VAGINAL HYSTERECTOMY IN THE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY OF THE Point "G" HOSPITAL.

Our survey consisted in evaluating the prevalence, specifying the indications and describing per and post - operation complications of vaginal hysterectomy in the Department of Gynecology and Obstetrics of the National Hospital of "Point G ". We conducted a descriptive retrospective survey on 58 cases of vaginal hysterectomies performed in that Department from 1995 to December 2000. Vaginal hysterectomies represented 27.3% of all hysterectomies done in the Department. The mean age of the patient was of 56 +/-2 years. The mean parity was 8. In 91.4% of cases this intervention was a step of the cure of a 3rd degree genital prolapsus. Ménométrorragia represented 5.2%, myomatus delivered by the cervix represented 1.7% and high rank cervical dysplasis was 1.7%. Per and post - surgery complications were dominated by perineal infections (5.2%), hemorrhage (1.7%) and urine retention (1.7%). The mean length of hospitalization was of 7+/-2 days. Vaginal hysterectomy is praticable in our context and secondary morbidity remains within acceptable limits. Because of its advantages this technique must be popularized.