[Post-partum sexuality. Living in black African couple analysis]. / La sexualité du post-partum. Analyse du vécu dans le couple noir africain.

INTRODUCTION: The period of the post-partum arouses a lot of questioning in the couple in particular regarding sexuality. OBJECTIVE: Analyze the real-life experience of the sexuality of the African black couples in the post-partum. PATIENTS AND METHOD: It was about study type attitudes and practical knowledge which took place in the department of gynecology-obstetrics and andrology of the teaching hospital of Bouaké over the period going in September 30th, 2012 on April 30th, 2013. The study took place in two stages. The first stage had consisted in a pre-test which allowed validate the questionnaire which contained 16 items. The second stage consisted submitting it directly to the patients, in postnatal consultation, who had agreed to participate in the study after an informed consent. The data were analyzed with epi-info, 2002 version. RESULTS: On 395 patients investigated, we noted the resumption of the sexual intercourse for 140 patients (34,2 %). The resumption was made on the initiative of the partner in 67,9 % of the cases, in particular after the return of menstruation (53,8 %). The reason to accept sexual intercourse was to satisfy the partner (60,7 %) and to maintain the harmony of the couple (57,1 %). However, the weekly frequency of the sexual intercourse had decreased in 75 % of the couples. This decrease was caused by the time dedicated to the child (66,7 %) and by the dyspareunia (57,1 %). We also observed a more important frequency of the anal sexual intercourse in the post-partum compared with the period before the childbirth (17,8 % vs. 3,57 %). Also, the use of subtleties, such as lubricants was observed more frequently in the post-partum (39,3 % vs. 3,6 %). Sixty-four comma three percent of the patients had found less satisfaction sexual intercourse. Dyspareunia was more frequent in case of episiotomy, perineal tear during the delivery and delivery assisted (vacuum). The patients, in 51 % of the cases, were themselves responsible for the refusal of the resumption of the sexual activity. The reasons of the refusal were of cultural and religious order and in touch with the absence of the return of menstruation in respectively 64,7 % and 54,9 % of the cases. CONCLUSION: The delivery had a negative impact on the resumption of couple sexual activity. Also, we noted a strong influence of the cultural and religious faiths on the sexual practice of the post-partum in the absence of reliable information. A particular attention should be concerned by the medical profession on the question of sexuality in the post-partum.

Bilan d'activite coelioscopique dans un hopital secondaire. cas de l'hopital general d'Ayame (Cote d'Ivoire)

Objectif. Etablir le bilan de l'activite colioscopique a l'Hopital General d'Ayame Methode. Il s'agissait d'une etude retrospective et descriptive qui s'etait realisee a l'hopital general d'Ayame et qui concernait tous les actes coelioscopiques effectues dans le service de gynecologie et d'obstetrique du 02 janvier 2013 au 30 juin 2014. Nous avions etudie les caracteristiques socio-demographiques des patientes; les indications; les actes operatoires (diagnostiques et therapeutiques) et la morbidite postoperatoire. Resultats. Il a ete realise 45 interventions percoelioscopiques; soit 21% de l'activite chirurgicale gynecologique de l'hopital. Les patientes avaient un age moyen de 33;1 ans avec des extremes de 24 et 44 ans. Il s'agissait en majorite de nulligestes et primigestes (66%); de nullipares (71%); de cadres et de niveau scolaire superieur (48;8%); residant a Abidjan (66;6%) et vivant maritalement (75%). L'infertilite et la seconde consultation post-myomectomie etaient les indications avec respectivement 67% (30 cas) et 33% (15 cas). Les constatations per operatoires pour infertilite etaient dominees par les adherences periannexielles; les kystes ovariens et les obstructions tubaires avec des frequences respectives de 33%; 27% et 23%. L'adhesiolyse et la kystectomie representaient les actes chirurgicaux les plus realises dans des proportions respectives de 53;3% (24 cas) et 13;3% (6 cas). Dans tous les cas de seconde consultation postmyomectomie; nous avions note des adherences parmi lesquelles predominaient les type II (60%). Aucune complication operatoire n'avait ete observee. Conclusion : la colioscopie est realisable en dehors des structures sanitaires de niveau tertiaire. Une mise a niveau du personnel pourrait ameliorer sa pratique

Analyse situationnelle de la mortalite perinatale au CHU de Bouake: resultats d'une etude portant sur le 1er semestre 2011

Contexte la mortalite perinatale represente une situation frequente malheureusement peu analysee; alors qu'elle constitue un parametre important dans l'evaluation de la qualite des soins. Objectif : Analyser la situation de la mortalite perinatale afin d'en preciser les facteurs favorisants. Patientes et methode : il s'agissait d'une etude retrospective descriptive exhaustive qui s'est deroulee a la maternite du CHU de Bouake; couvrant le 1er semestre de l'annee 2011. Elle a concerne tous les cas de deces feotaux enregistres directement dans le service apres accouchement et les enfants evacues en pediatrie qui y sont decedes. Nous avons analyse les caracteristiques epidemiologiques des meres; les circonstances de l'accouchement et les facteurs pouvant expliquer les deces fotaux Resultats : la mortalite perinatale representait 122 des accouchements de la periode d'etude. Cent vingt six enfants; soit 68;9; etaient morts pendant le travail. En pediatrie; vingt cinq nouveau-nes (13;70) y etaient morts. L'age moyen des patientes etait de 30 ans et la tranche d'age la plus representee etait celle des adolescentes avec un taux de 29;5. Il s'agissait aussi en majorite des femmes au foyer (86;3); primipares (26;8); avec antecedents de deces neonataux (38;8); un age variant de 25-34 ans (44;8); et provenant de la ville de Bouake (61;2). Les patientes etaient a 84;7 admises apres une evacuation dont les principaux motifs etaient la dystocie mecanique (24;6) et les metrorragies (13;66). L'accouchement des fotus morts s'etait realise par la cesarienne et par la laparotomie dans respectivement 39;3 et 14;8 des cas. Les indications de cesarienne etaient essentiellement l'epaule negligee et le syndrome de pre-rupture uterine a un taux identique de 20;83; et l'hematome retro-placentaire dans 19;4 des cas. En l'absence d'autopsie; les causes les plus probables des deces etaient le travail prolonge (38;89); l'hypertension arterielle (10;92).Conclusion : la mortalite perinatale est elevee au CHU de Bouake. Les causes sont essentiellement les dystocies mecaniques; dont la prise en charge adequate devrait permettre de reduire sa prevalence

[Reality of the impact of pregnancy on sexuality. Results about review of 200 Ivoirians pregnant women]. / Réalité de l'impact de la grossesse sur la sexualité. Résultats d'une enquête auprès de 200 gestantes ivoiriennes.

BACKGROUND: Sexuality during pregnancy is a subject little approached during the antenatal follow-up while it sometimes constitutes a source of preoccupation for pregnant women for the preservation of the harmony of the couple. OBJECTIVE: Determine the opinions and the practices of women in sexuality during pregnancy. PATIENTS AND METHOD: Prospective transverse study of type knowledge practical attitude which took place from September 1st, 2008 to February 28th, 2009 at the General Hospital of South Abobo. It concerned 200 pregnant women who agreed to answer a pre-tested questionnaire, with their confirmed pregnancy. RESULTS: It is noted that 95,5% of pregnant women consider that it is possible to have sexual relations during the pregnancy. So 89% of them continue to have sexual relations during their pregnancy. The continuation of the sexual activity aims mostly at satisfying the pleasure of the woman and her partner (34,4%). Twenty-six percent of the questioned women consider that the sexual relations can have consequences on the pregnancy and that they would be responsible, for 60,9% of them, for miscarriages. Nine of 22 patients who observe a sexual abstinence during their pregnancy are afraid of hurting their fetus. Only 21,1% of pregnant women have appealed to the medical and paramedical staff to inquire on sexuality during pregnancy. They assert in 81,6% to have a decline of the libido and 54,7% find the sexual relations less satisfactory than before the pregnancy. CONCLUSION: The pregnancy influences negatively the sexual practices during the pregnancy. Pregnant women are badly informed and convey prejudices. The medical staff should offset for this deficit of information by daring to speak about it during the antenatal visits.

[Spontaneous splenic rupture in the first trimester of pregnancy: report of a case and review of the literature]. / Rupture spontanee de la rate au 1er trimestre de la grossesse: a propos d'un cas et revue de la litterature.

The authors return a case of spontaneous rupture of the spleen occured at the first quater of pregnancy. It is a rare accident during pregnancy that often entails the maternal death. Its exact reasons are difficult to determine. Among the reasons of the hemoperitoines at the firt quarter it is necessary to know how to think about the rupture of the spleen. Its diagnosis is unsuspected. The hold in charge surgical fast in our case permitted the pursuit of pregnancy.

Rupture spontanee de la rate au 1er trimestre de la grossesse : a propos d'un cas et revue de la litterature

Les auteurs rapportent un cas de rupture spontanee de la rate au premier trimestre de la grossesse. C'est un accident rare au cours de la grossesse qui entraine le deces maternel. Ses causes exactes sont difficiles a determiner. Son diagnostic est insoupconne. La prise en charge chirurgicale rapide dans notre cas a permis la poursuite de la grossesse. Parmi les causes des hemoperitoines au premier trimestre il faut savoir penser a la rupture de la rate

[Birth of a large fetus: epidemiologic aspects and analysis of factors of a case in an southern urban public health facility (Abidjan)]. / L'accouchement du gros foetus: aspects épidémiologiques et analyse des facteurs déterminants à propos d'une étude cas-témoin à la Formation sanitaire urbaine d'Abobo sud (Abidjan).

OBJECTIVE: to highlight the factors which influence the childbirth of the large foetus in order to propose adequate conduits. MATERIALS AND METHOD: it acted of a study case--witness who had been held on May 1, 2003 to April 31, 2004. We had included 108 cases of childbirth large foetus and 229 cases of childbirth of foetus of standard weight. The appreciation of the factors which influence the childbirth in these two groups was made thanks to the statistical analysis of the Chi 2 test; it had been considered to be significant with the threshold 5%. RESULTS: the parturients who were confined of the large foetus were referred than those of the group of the witnesses (p = 0,0421). The high way was observed in the event of large foetus (p = 0,0091). When the childbirth of the macrosomes was done by low way, one had noted more dystocie shoulders (0,0091) and more episiotomy (0,00479). The Caesarean for large foetus was carried out when the parturients were allowed in room of work in phase of latency of work (p = 0,028). Among the cesarized parturients, there were more first calf cows (p = 0,00532), young people and parturients whose size was between 150 and 170 cm (p = 0,00069) in the group of study. CONCLUSION: the childbirth of the large foetus is childbirth at the risk both for the mother the foetus. However it is necessary to be patient in front of an excessive uterine height evoking a large foetus. The indication of Caesarean should be posed only in primiparous, young parturients or teenagers, first calf cows of which size lower than 170 cm.

[Prognosis of uterine rupture during labor: a 293-case series compiled at the Bouake University Hospital Center (Ivory Coast)]. / Pronostic de la rupture utérine au cours du travail: à propos de 293 cas colligés au CHU de Bouaké (Côte d'Ivoire).

The purpose of this retrospective comparative study carried out between January 1, 1996 and December 31, 2001 was to determine the incidence of uterine rupture in the maternity ward of the Bouake University Hospital Center and evaluate prognosis for the mother and child in function of transportation distance to the Center. Patients were divided into two groups, i.e., patients transported from an arbitrarily defined safety zone within a 100-kilometer radius of the city and patients from outlying areas beyond the safety zone. The overall incidence of uterine rupture was 2.44%, i.e., one of 41 deliveries. Hysterectomy was performed more often in women from outlying areas: 83.34 % versus 28.57% (p = 0.0000). Mortality secondary to uterine rupture was 411.26% overall with a higher rate in patients from outlying areas than patients from the safety zone: 29.91% versus 8.97% respectively (p = 0.0052). Fetal mortality was 100% for patients from outlying areas. The prognosis of uterine rupture is less favorable for both the mother and child in patients transported from outlying areas.

Pronostic de la rupture utérine au cours du travail : à propos de 293 cas colligés au CHU de Bouaké (Cote d'Ivoire)

L'objectif a été de préciser la fréquence de la rupture utérine au sein de la maternité du CHU de Bouaké et de déterminer le pronostic en fonction de l'éloignement du CHU de Bouaké. Il s'agit d'une étude rétrospective et comparat ive qui s'est déroulée du 1er janvier 1996 au 31 décembre 2001. Cette étude a comparé les caractéristiques et le pronostic materno-fœtal de deux types de patientes : celles issues d'un périmètre de sécurité sanitaire arbitraire défini de 100 kilomètres autour de la ville et celles issues de localités situées au-delà. La fréquence de la rupture utérine a été de 2,44 % soit une rupture utérine pour 41 accouchements. L'hystérectomie a été plus pratiquée dans la population des femmes issues de localités situées au-delà du p é ri m è t re de sécurité sanitaire : 83,34 % contre 28,57 % (p < 10- 4). La létalité de la ru p t u re utérine a été de 11,26 % pour l'ensemble des patientes avec une surmortalité pour celles venues de localités au-delà du périmètre de sécurité sanitaire : 29,91% c o n t re 8,97 % pour celles du péri m è t re de sécurité sanitaire (p = 0,0052). La mortalité fœtale a été de 100 % pour les patientes hors du périmètre de sécurité sanitaire. Les patientes présentant une rupture utérine et évacuées de localités situées au-delà du périmètre sécurité sanitaire ont un pronostic materno-fœtal beaucoup plus sombre

`aSurveillance de la grossesse chez la femme diabetique au CHU de Cocody Abidjan (Cote d'Ivoire)

L'Association diabete et grossesse constitue une grossesse a haut risque. Aussi les auteurs se sont proposes d'elaborer un protocole de surveillance de la gestante diabetique. Ce protocole de surveillance s'etablit comme suit: Hospitalisation precoce et initiale de deux semaines en moyenne; Visite medicale hebdomadaire des gestantes diabetiques; Hospitalisation au voisinage du terme. Ce protocole de surveillance leur a permis de depister et traiter precocement les comlications suivantes chez 31 gestantes diabetiques: vaginites (14;50 per cent); HTA (6;50 per cent); infections urinaires (6;50 per cent); menaces d'accouchement premature (5;50 per cent); mort-nes (2;90 per cent) et malformations foetales (1;90 per cent). Le cout financier de la surveillance est estime a 150 000 F CFA pour une gestante dabetique suivie des la 8 eme semaine d'amenorrhee. La grossesse chez la diabetique est une grossesse a risque eleve qui necessite une surveillance toute particuliere. Le protocole de surveillance que les auteurs proposent a permis d'obtenir de bons resultats mais se heurte a son cout financier qui reste encore eleve

L'accouchement chez l'adolescente au CHU de Cocody; Abidjan

Les auteurs ont realise une etude retrospective de 1989 a 1991 dans le service de gynecologie obstetrique du CHU de Cocody. L'objectif de cette etude est de determiner les caracteristiques de l'accouchement de l'adolescente dans un service de reference. Ils ont emprunte la definition de l'adolescente par l'OMS; a savoir toutes les jeunes filles agees de 12 a 19 ans. Les resultats revelent que 79 pour cent des adolescentes ont ete referees a la suite d'une complication de l'accouchement; 93 pour cent des grossesses chez ces adolescentes ont beneficie d'au moins une consultation prenatale; 84 pour cent des adolescentes ont accouche par voie basse; 84 pour cent des enfants sont nes vivants et le taux de mortalite maternelle est de 3 326 pour 100 000 accouchements. La grossesse et l'accouchement doivent etre surveilles en milieu specialise

La mortalite maternelle chez les adolescentes au CHU de Cocody-Abidjan

Les auteurs ont entrepris une etude retrospective de 1989 a 1991 dans le service de gynecologie obstetrique du CHU de Cocody. L'objectif de cette etude est de preciser l'incidence des deces maternels chez les adolescentes et de relever quelques facteurs de risque de deces. La maternite du CHU de Cocody est un service de reference qui recoit toutes les dystocies provenant des structures obstetricales situees dans un rayon de 100 km. L'etude revele que l'incidence de la mortalite maternelle chez les adolescentes est de 3 326;2 pour 100.000 accouchements durant ces 3 annees. Les principales causes medicales immediates des deces sont les infections (45;5 pour cent) et les hemorragies (30 pour cent). Les adolescentes agees de moins de 16 ans courent un risque eleve de deces. Les auteurs proposent la vulgarisation des methodes contraceptives; et la prise en charge precoce des grossesses dans des structures specialisees pour reduire la mortalite maternelle chez les adolescentes

Evaluation of the benefit of setting up a decentralised obstetric-surgical structure in order to reduce maternal mortality and transfers in the Ivory Coast.

Our purpose is to study the way to reduce maternal mortality when introducing a structured obstetric and surgical center to a community previously without such a center. The study was done in Ivory Coast, where such a structure was set up in 1982 in a rural hospital at Divo. It has been observed that with such a structure there are no more transfers of women from Divo to the teaching hospital at Cocody, and a reduction in maternal mortality at Divo. This observation regarding the value of bringing obstetric services to communities currently without them could be a way among those available to reduce maternal mortality in a developing country such as the Ivory Coast.

Decentralization of maternity care.

One of the main reasons for the high maternal mortality rates in developing countries is the need to transfer patients long distances to city hospitals when they develop complications. Local obstetric facilities would relieve this situation.

PIP: The effects of providing local center at which women can obtain essential obstetrical care and of transferring urgent cases from local maternity hospitals to teaching hospitals are also considered. The study was done in 3 maternity hospitals in the Ivory Coast: at Divo (where Cesarean sections are done and forceps used regularly); at Agboville (where Cesarean sections are not usually performed but there is always a gynecologist on duty); and at Yopougon, where no obstetrical operations have been performed. There are 2 teaching hospitals in the Ivory Coast--one in Cocody and the other in Treichville, both near Abidjan. Transfers are often decided on too late. They account for a large proportion of the maternal deaths occurring in the teaching hospitals. Reduction of long-distance transfers could be done by giving local maternity hospitals the means to deal with obstetric emergencies. In Divo, some 190 km away from Cocody, the health authorities set up a post obstetrician/gynecologist (OBGYN) at the local hospital. The OBGYN would perform Cesarean sections and do blood transfusions with the help of a blood bank. 10 midwives were working at the hospital. In Agboville, 70 km from Abidjan, the maternity hospital is mostly run by midwives. An OBGYN has been there since 1984 but he often transfers patients to Cocody. In Yopougon, a suburban "commune" 12 km from Abidjan, no OBGYN is available. All complicated cases are referred to Abidjan. Between 1980 and 1985, the number of cases transferred from Divo fell from 6.5 to 0. There was also a dramatic fall in the number transferred from Agboville. Loss of blood and sepsis are the main reasons for transfer. Of the women who died, fetal-pelvic disproportion was the main reason. There were 4097 deliveries at Divo Hospital and 23 deaths--a mortality rate of 56/100,000. Of the women who died, 22 of 23 came from the area surrounding Divo, rather than Divo itself. This is a maternal mortality rate of 2013/100,000. Among women from Divo, there was only 1 death--a mortality rate of 33/100,000. The reasons for transfer from Agboville to Cocody have changed, with greater incidence of threatened uterine rupture.

Decentralization of maternity care

One of the main reasons for the high maternal mortality rates in developing countries is the need to transfer patients long distances to city hospitals when they develop complications. Local obstetric facilities would relieve this situation

Descentralización de la atención materna / Descentralization of maternity care

Una de las principales razones de las elevadas tasas de mortalidad materna registradas en los países en desarrollo es que cuando las pacientes presentan complicaciones no queda más remedio que enviarlas a los hospitales de las ciudades, situados a grandes distancias. El establecimiento de servicios locales de obstetricia remediaría esa situación