[Epidemiology and prognosis of caesarean sections in University Hospital of Dakar]. / Epidémiologie et pronostic des césariennes au CHU de Dakar.

Caesarean section is our first activity in obstetrical surgery. Due to his high frequency and the maternal and foetal prognostic, we have undertaken to do a prospective, longitudinal, exhaustive study concerning all women whose delivery necessitated a caesarean section, between 01 January and 31 December 2001 in Gynaecological and Obstetrical Clinic of University Hospital Center Le Dantec. Our objectives were: describe the epidemiological aspects, evaluate the maternal and foetal prognosis of caesarean sections performed in University Hospital Center. The study revealed that 25.1% of births necessitated a caesarean section. The average age was of 26; the mean parity of 2; the medium height of 161cm. 26.4% of patients were evacuated and coming from the health centers in majority (41.9%) with unmedicalised evacuation in 44.9% of cases. 78.7% of patients have realised at least 3 antenatal consultations. The mains indications were cephalopelvic disproportions (34.9%) and foetal distress (18.9%). The classification per indications group revealed that 37.2% were "prudence caesarean section", 40.1% were "obligator's caesarean section" and 22.7% "necessity's caesarean section". The mean Apgar's score at the birth was 6,5 at first minute. 12 maternal deaths were noted, means 0.8% of global lethality; the morbidity was at 10.5% of cases, represented mainly by postoperative infection (64.3%). The per natal mortality was estimated to 5.9% and neonatal morbidity to 32%. About the quality of caesarean sections, the temporal (24h/24) and financial(kit of caesarean section) accessibilities are more satisfying; otherwise the quality of surgical act and the postoperative follow-up was not optimal. An inflationist advancement is actually noted about the rate of caesarean section, and due to the widening of the indications to the foetal interest. Nevertheless, despite agreed efforts, the quality is still insufficient because the maternal and per natal morbidity and mortality are still high.

[Fertility after ectopic pregnancy at the University Hospital in Dakar]. / Fertilité après grossesse extra-utérine au CHU de Dakar.

The aims is to evaluate fertility and medical cost about post ectopic pregnancy follow up. It is about a retrospective and descriptive study about 337 patients who have the opportunity to get a salpingectomy for an ectopic pregnancy between 1989 and 1997 at Le Dantec Gynecological and Obstetrical Clinic. After the ectopic pregnancy cure, women are followed with contraception, just time before trying to obtain another pregnancy. The studied parameters are: age, parity, socio-economical status, level of instruction, obstetrical and gynecological antecedents, Chlamydia serology, hysterosaipingography data, fertility after ectopic pregnancy, fees related to the cost of follow up after ectopic pregnancy. Data exploitation is done through an epidemiologic programme named Epi Info version 5 The average age of the patients was 27 years and that of the parity was 2.70. 87.83% of women were married. More than the half of those patients came from the suburb of Dakar. 171 patients (50.74%) were followed regularly, the other 166 (49.26%) disappeared. A Chlamydia trachomatis infection was found among 23.4% of cases. A tubal obstruction was noted in the level of the horns at 12.5 % of women. No case of maternal death was observed. Among 59 patients who wished a pregnancy, 34 ectopic pregnancy had been obtained (57.62%) in 4 month after stopping contraception and 26 cases of a new ectopic pregnancy. The expenses of medical cure after ectopic pregnancy are about 17.814 to 71,574.65 F CFA with an average of 38,689 F CFA (389.89 FF). Medical care after ectopic pregnancy raises a lot of problems: --some patients disappeared probably because of the inaccessibility of financial cost, --the high rate of Chlamydial trachomatis infection, an hypofertility after ectopic pregnancy. To combat this, we have to insist in the prevention of sexually transmitted diseases in general and of the chlamydial infection in particular. We have also to insist in the early diagnosis of the ectopic pregnancy. At last, we must set up a registre of ectopic pregnancy at the national level.

[Uterine perforation after an illegal abortion]. / Perforation utérine après avortement provoqué.

This study focuses on problems related to the management of peritonitis following non-medically assisted abortions in developing countries. Between January 1, 1997 and December 31, 1998, four cases of peritonitis due to perforation of the uterus occurred in a consecutive series of 101 women treated following non-medically assisted abortions at the Gynecology and Obstetrics Clinic of the University Hospital Center in Dakar, Senegal. Abortions were performed by untrained persons using dangerous instruments (wood or metal probes) for prices ranging from 5000 to 30,000 CFA francs. The mean interval between abortion and hospitalization was seven days. All patients presented in poor condition with low-grade symptoms of peritonitis. In 3 of 4 cases, the site of perforation was located in the isthmus (anterior, posterior, and lateral). Extensive necrotic lesions required hysterectomy. Postoperative complications occurred in 3 cases including parietal infection in one case, repeat peritonitis requiring re-operation in one case, and fatal iliomesenteric infarction in one case. Prevention could best be achieved by reducing unwanted pregnancies by better sex education and access to contraceptive techniques.

[Sexually transmitted diseases and female sterility at the University Hospital Center of Dakar: management and prevention]. / Maladies sexuellement transmissibles et stérilité féminine au CHU de Dakar: prise en charge et moyens de prévention.

It is a retrospective study supporting 82 cases continued series of feminine sterility and which objective is to evaluate the nursing management quality of genital infection in exploration and treatment of sterility. Women mean age is 26 years old, sterility is most primary frequently (68%) and from fallopian origin (80%). Followers examinations have been asked: vaginal taking (100%), urines cytobacteriology examination (56%), syphilis serology (23%), chlamydia serology (57%), mycoplasma serology (03%). Genital infection have been diagnosed in 75% of cases, in 33% of cases positive Chlamydia serology was found. Three molecules have been used principally in treatment: cyclines 50%, imidazoles derived 47%, lactamines 15%. The upper cost of diagnostic and treatments produce a wishest of prevention which based is the tracking and the precocious treatment of STD.