[Clitoral reconstruction after female genital mutilation at CHU Yalgado of Ouagadougou, Burkina Faso. About 68 patients operated]. / Reconstruction clitoridienne après mutilation génitale féminine au CHU Yalgado de Ouagadougou, Burkina Faso. À propos de 68 patientes opérées.

OBJECTIVE: The objective of this survey was to assess the results of a new clitoral transposition technique in the obstetrics and gynecology department of CHUYO. MATERIALS AND METHOD: A cohort of 68 women victims of genital mutilation has received clitoral reconstruction by a new technique of transposition of the clitoris. They were operated and followed for 12 months in CHUYO gynecology ward in Ouagadougou. We evaluated the management of pain, anatomical aspect, functional and occurrence of complications. RESULTS: Anatomically have no new increase was within a neoclitoris, and a very satisfactory ratio of 100 % of women with clitoral massif visible in the 12th month assessment. Functionally, before clitoral reconstruction half of the women had mild pain or discomfort during sexual intercourse. However, clitoral reconstruction after the 6th month and 12th month this pain or mild discomfort were 3.18 % and 0 % respectively. In addition, we noted a sensitive neoclitoris in all women, after one year. Very few postoperative complications were observed in this series compared to previous series. CONCLUSION: These results are of interest in this new clitoral transposition technique in favor of women victims of genital mutilation.

[Obstetric endometritis at the UTH-Yalgado Ouedraogo of Ouagadougou (Burkina Faso): about the management of 102 cases]. / Les endométrites obstétricales au CHU-Yalgado Ouédraogo de Ouagadougou (Burkina Faso). À propos de la prise en charge d'une série de 102 cas.

This is a descriptive cross-sectional study over a nine months period conducted at the UTH-Yalgado Ouédraogo from all patients in whom the diagnosis of endometritis at obstetrical been laid. Endo-cervical and vaginal swabs were taken from all these patients. Commensal bacteria and anaerobes were investigated in the laboratory. During the study period, 102 cases of obstetric endometritis were recorded that to say a frequency of 1.4% of admissions. The average age of patients was 25.2 years [17-43]. The childbirth mean was 2.5 ± 2 [0-7]. The reason for consultation was dominated by hyperthermia in 98% of cases. The bacterial ecosystem was mainly dominated by Escherichia coli (49.2%), Staphylococcus aureus (29.5%), Streptococcus sp (4.9%). The acid + amoxicillin clavulanic showed low activity on most germs. The average hospital stay of patients was 6.30 days [1-33]. A maternal death was recorded in 3 patients that to say fatality rate of 2.9%. The lethality of endometritis at the UTH-Yalgado Ouedraogo is greater than the rate of 1% allowed by WHO. The resistance of germs is high enough with amoxicillin. The systematization of the bacteriological study is expected to guide the antibiotic to help better fight against maternal mortality.

Prognosis for term breech presentations in Africa (Bobo Dioulasso, Burkina Faso).

to describe the mode of delivery and the fetal prognosis for breech presentations in Bobo Dioulasso, Burkina Faso. this prospective, descriptive, cross-sectional study covered the entire year 2013 and included patients from the city's three principal maternity units. The sample included 184 women who gave birth at term to fetuses in breech presentation and a control group of 368 women with infants in cephalic presentation. Data were collected with standardized case report forms. The analysis was conducted with Epi-Info 3.5.1 software. We used the Chi-square test to compare percentages and the Chi-square test for trend to study the variation in frequencies. Differences were considered significant when P ≤ 0.05. during the study period, the prevalence of breech presentation at term was 1.74%. In the breech group, 55.5% of the women had vaginal deliveries versus 92% in the cephalic group (P = 0.04). The comparative analysis of fetal and neonatal morbidity in the two groups found greater morbidity in the breech group, marked by complications including uterine rupture (P = 0.0045), cord prolapse (P = 0.02), dynamic dystocia (P = 0.001), fetal distress (P = 0.0001), postpartum hemorrhage (P = 0.003), and perinatal death (P = 0.006). vaginal delivery remains the most frequent mode of delivery for breech presentations in Bobo Dioulasso, and perinatal morbidity and mortality are relatively high. Improvement of hospital protocols and staff training for breech deliveries should help to improve this situation.

[Eclampsia at the University hospital Yalgado of Ouagadougou (Burkina Faso) from 1 April 2013 to 31 March 2014]. / L'éclampsie au CHU-Yalgado de Ouagadougou (Burkina Faso) du 1er avril 2013 au 31 mars 2014.

The objective of this study was to describe the epidemiological, clinical, therapeutic and prognostic aspects of the eclampsia in the obstetrics and gynecology department at the University Teaching Hospital Yalgado Ouedraogo of Ouagadougou. It has been a descriptive crosssectional study over a period of 12 months from 1 April 2013 to 31 March 2014. The main criterion for inclusion in our sample was the occurrence of seizures in a pregnant more than 20 weeks of gestation or recently delivered with elevation of blood pressure and the presence of albumin in the urine. The patients were followed from the onset of the crisis until hospital discharge. Data were collected and analyzed using Epi Info 3.5.1. The significance level of 5% was used for data comparison. We identified 203 cases of eclampsia for 6063 deliveries that to say a frequency of 3.3%. The average age of patients was 27.5 years [14-46]. In socio-demographic terms, patients were housewives in 62.5% of cases, the average rate of the past-deliver number was 4.2 [0-11] and 47.7% of patients were living as married. Clinically, they were referred in 72.4% of cases and were initially admitted into the service for elevation of blood pressure in 40.3% of cases. The mean gestational age was 31.5 weeks [23-41]; diastolic blood pressure exceeded 110 mmHg in 63.1% of cases. Therapeutically, all the patients benefited from a treatment based in anticonvulsant by magnesium sulfate and antihypertensive therapy by nicardipine, clonidine or alpha-methyl-dopa. Maternal prognosis was marked by significant morbidity in 46 cases (22.6%) and mortality in 13 patients that to say a fatality rate of 6.4%. The fetal one was dominated by a perinatal lethality in 31.5% of the cases. Eclampsia is a major cause of maternal and perinatal mortality in the University Teaching Hospital of Ouagadougou. The adoption of strategies for screening during antenatal consultations and early management should contribute to the reduction of the mortality in the mother and child couple in Burkina Faso.

[Obstetric emergency and non-emergency transfers to the university teaching hospital Yalgado ouedraogo of Ouagadougou: A 3-year study of their epidemiologic, clinical, and prognostic aspects]. / Références et évacuations obstétricales dans le contexte de la subvention des soins obstétricaux et néonataux d'urgence : aspects épidémiologiques, cliniques et pronostiques sur une période de trente-six mois au CHU Yalgado de Ouagadougou.

OBJECTIVE: to describe the epidemiologic, clinical, and prognostic aspects of the emergency and non-emergency transfers of obstetric patients to Yalgado Ouédraogo University Hospital Center (UHC-YO) in Ouagadougou. this retrospective descriptive study looked at the outcomes of women transferred, on an emergency basis or not, to the obstetrics department of the UHC-YO. The study population comprised all women transferred to the department during 2010, 2011, and 2012. during the study period, there were 9,806 admissions for obstetric disorders: 43% were transfers. The patients' mean age was 26.11 years [(13-49]. Women transferred from health care facilities within the city of Ouagadougou accounted for 96% of the sample. The leading reason for these transfers - emergency or not - was preeclampsia and eclampsia (24.57%). We recorded a total of 161 maternal deaths, for a mortality rate of 3.9%. Approximately 26.55% of the newborns received immediate intensive care and were then transferred to the neonatology department. maternal and neonatal prognosis is always poor in cases transferred to UHC-YO, despite increased funding for emergency obstetric and neonatal care. Increased population awareness of the importance of prenatal consultation and adequate funding for health care facilities to provide equipment for emergency transfers and staff training in the management of obstetric and neonatal emergencies would probably improve these mortality and morbidity rates.

[Unsafe abortions in countries that restrict legal abortions. Epidemiologic, clinical, and prognostic aspects at the University Hospital Center Yalgado-Ouédraogo of Ouagadougou]. / L'avortement clandestin dans les pays à restriction légale sur les avortements. Aspects épidémiologiques, cliniques et pronostiques au CHU Yalgado-Ouédraogo de Ouagadougou.

OBJECTIVE: to describe the epidemiologic, clinical, and prognostic aspects of the management of the complications of women who had unsafe (illegal) abortions. MATERIAL AND METHODS: this prospective, descriptive cross-sectional study took place the Yalgado Ouédraogo University Hospital Center (UHC-YO) in Ouagadougou during the 12-month period from June 2012 to May 2013. The study included all women admitted to the obstetrics-gynecology department during the study period and diagnosed after clinical examination with complications of an unsafe abortion. Data were collected with standardized case report forms. The analysis was conducted with Epi Info 3.5.1 software and Student's, Fisher's, and Pearson's Chi-square tests to compare the data. The threshold for statistical significance was set at 5%. RESULTS: during the study period, 111 women were admitted for complications of unsafe abortions, for a rate of 1 per 47 deliveries. The women's mean age was 23.6 years and ranged from 15 to 45 years. More than half the women (n=62, 55%) were pregnant for the first time. Hemorrhage was the primary reason for admission: 78 women, or 75%. Only 18 women (16%) admitted to having had an illegal intentional abortions. Complications included endometritis in 10 women (11%), anemia in 6 (5%), and hepatonephritis, also in 6 (5%). Six women died, for a mortality rate of 24%. CONCLUSION: the epidemiologic profile of women with complications from unsafe abortions is that of a young women pregnant for the first time, who has no income-producing activity. Morbidity is dominated by infectious or hemorrhagic complications and mortality is high. Strengthening activities for prevention, health and sex education, and dissemination of knowledge of and access to contraceptive methods will help to reduce these abortions and their consequences.

[Factors associated with preterm birth in an urban African environment: A case-control study at the University Teaching Hospital of Ouagadougou and Saint Camille Medical Center]. / Les facteurs associés à l'accouchement prématuré en milieu urbain africain À propos d'une étude cas témoins au CHU-YO et au centre médical Saint-Camille de Ouagadougou.

OBJECTIVE: To study the risk factors associated with preterm delivery in two busy obstetrics centers in Ouagadougou. MATERIAL AND METHODS: This prospective case-control study included 115 women with preterm deliveries and 230 control patients, or two controls per case, recruited from January through June 2011. The study took place in the maternity and neonatology departments of the University Hospital Center Yalgado-Ouédraogo (UHC-YO) and the Saint-Camille medical center, in the same city. Stillbirths were excluded from the study. Case infants were born at gestational ages ranging from 28 to 37 weeks. RESULTS: During the study period, the preterm delivery rate was 6.1%. Multivariate analysis with logistic regression enabled us to identify the factors associated with preterm delivery. These factors were: advanced maternal age (>30 years) (OR = 0.4 [0.2-0.8]), history of intentional abortions (OR = 3.3 [1.43-7.6], high stress (OR = 4.03 [2.14-3.39]), too few prenatal care visits (OR = 4.92 [3.03-8]), fever during pregnancy (OR = 1.59 [1.01-2.5]), premature rupture of membranes (OR = 3.72 [1.11-4.34]), urinary infections (OR = 2.55 [1.55-4.19]), and threatened preterm delivery (OR = 3.3 [1.43-7.6]). CONCLUSION: Preterm delivery is very frequent at both these Ouagadougou health care facilities. Many factors are associated with preterm birth, including social and demographic as well as clinical characteristics. The effort to reduce the rate of preterm births, which are associated with neonatal morbidity, must be strengthened by refocusing on prenatal consultations.

[Cesarean deliveries in a district hospital in Ouagadougou. Epidemiological, clinical, and prognostic study of 3381 cases]. / La pratique de la césarienne dans un hôpital de district à Ouagadougou. Aspects épidémiologiques, cliniques et pronostiques à propos de 3381 cas.

OBJECTIVE: to study the epidemiologic aspects, indications, and prognosis of cesarean deliveries at the maternity ward of the Bogodogo health district hospital in Ouagadougou. METHODOLOGY: This retrospective study examined records for the years 2005 through 2008. Data were collected from the computer database of records of cesareans at the hospital. RESULTS: Of 11,142 deliveries during the study period, 3381 were cesareans, for a hospital cesarean rate of 30.3%. The epidemiological profile of these women showed that: 55% of the women had been transferred to the hospital on an emergency basis; their mean age was 26.8 years (range: 15 to 48 years), their mean parity 4 (range: 1 to 13), and 87% of the cesareans were performed in emergency situations. The principal indications for the cesareans were fetal distress (22.9%), fetopelvic disproportion (17.2%), previous cesarean delivery (12.8%), preeclampsia/eclampsia (7.9%), and pelvic abnormalities (7.8%). Maternal morbidity was reported for 1.6% of the women; 63% of these involved hemorrhages. The lethality rate of maternal complications was 0.7%. The stillbirth rate was 3.1% and the early neonatal mortality rate 0.1%. CONCLUSION: The cesarean rate at the Bogodogo district hospital is similar to international rates. Maternal and fetal morbidity are not high. The example of the Bogodogo hospital deserves to be followed by other districts in Africa in order to meet the Millennium Development Objectives.

[Improving the provision of major obstetric interventions by task delegation in Africa: An example from the Bogodogo health district hospital in Ouagadougou, Burkina Faso]. / Amélioration de l'offre des soins obstétricaux par la délégation des tâches en milieu africain Exemple de l'hôpital du district sanitaire de Bogodogo à Ouagadougou, Burkina Faso.

OBJECTIVE: To describe the role of task delegation in the practice of major obstetric procedures in the Bogodogo health district hospital. MATERIALS AND METHODS: This descriptive and analytic prospective study took place in the hospital's department of obstetrics and gynecology from February through October 2013. It included all women undergoing a major obstetric surgical intervention, performed by either by a gynecologist-obstetrician or by a nurse specializing in surgery. Data were collected from individual records and analyzed by SPSS and Epidata software. RESULTS: There were 601 major obstetric interventions during the study period. The women's mean age was 26.7 years. Cesarean deliveries accounted for 90% of these procedures, followed by laparotomy (7.7%). The Misgav-Ladach technique was used for cesareans by 86.5% of the obstetricians and 95.3% of the nurses specialized in surgery. The primary complications were anemia and postpartum hemorrhage. Maternal mortality did not differ significantly between the groups of operators, nor did maternal, fetal, and neonatal outcomes. CONCLUSION: Task delegation in obstetric surgery at the Bogodogo district hospital is effective. Its extension to the national level would make it possible to overcome the lack of highly qualified human resources to enable adequate availability of major obstetric interventions in rural hospitals.

[Epidemiology and characterization of high-risk genotypes of human Papillomavirus in a population of sexually active adolescents in Ouagadougou]. / Épidémiologie et caractérisation des génotypes à haut risque de Papillomavirus humain dans une population d'adolescentes sexuellement actives à Ouagadougou.

OBJECTIVE: This cross-sectional study was to determine the prevalence and characterization of high-risk HPV genotypes circulating among adolescents in Ouagadougou. METHODS: From September to December 2013, 200 adolescents recruited from a youth counseling center have voluntarily accepted a swab of the endocervical canal. The identification of the genotypes of the human Papillomavirus (HPV) was performed by real-time polymerase chain reaction technique. RESULTS: The mean age of adolescents was 18.7±0.7 years and 83/200 adolescents were positive for at least one high-risk genotype HPV a prevalence of 41.5%. Twelve genotypes corresponding to 136 infections were characterized: HPV 52 (22.8%), HPV 59 (14.0%), HPV 39 (13.2%), HPV 35 (10.3%), HPV 51 (10.3%), HPV 56 (8.8%), HPV 16 (5.2%), HPV 18 (5.2%), HPV 58 (4.4%), HPV 31 (3.6%), HPV 45 (1.5%), HPV 33 (0.7%). Multiple infections (2-5 virus) statistically associated with age (p=0.0318) was detected in 42.2% of infected females. If the number of sexual partners was statistically associated with the porting of HPV (OR=2.18; 95% CI=1.17 to 4.09), early sexual intercourse and the recent change of sexual partner were not (p>0,05) CONCLUSION: The prevalence of carriage of HPV in this study is high, as described in young people at the start of sexual activity. Identified genotypes are different from those targeted by prophylactic vaccines currently available. A larger study to map genotypes of high-risk HPV circulating in West Africa is necessary for a suitable vaccine.

Place de l'echographie du premier trimestre de la grossesse dans la determination du sexe foetal : experience du departement de gynecologie obstetrique du CHU-YO (a propos de 311 cas)

Objectif : Decrire l'experience du departement de gynecologie obstetrique du CHU-YO dans la determination echographique du sexe fotal au premier trimestre de la grossesse Patientes et methodes : Il s'agissait d'une etude prospective de type descriptif pendant une periode de 30 mois allant du 1er fevrier 2013 au 30 juin 2014 au sein de l'unite d'echographie gynecologique et obstetricale du CHU-YO de Ouagadougou. L'echantillon d'etude a ete constitue de 311 fotus. Ont ete incluses dans cet echantillon toute les gestantes venue pour une echographie obstetricale en dehors de toute situation d'urgence dont l'age gestationnel etait compris entre la 11eme et la 14eme semaine d'amenorrhee et ayant exprime le desir de connaitre le sexe fotal. Les methodes decrites par Mazza et par Efrat ont ete utilisees pour la determination du sexe fotal. Les patientes ont ete suivies jusqu'a leur accouchement apres verification clinique du sexe des nouveau-nes. Le recueil des donnees a ete fait sur une fiche de collecte individuelle de donnees. La participation a l'etude a ete conditionnee a la signature d'un consentement eclaire par les patientes.Resultats : La determination du sexe fotal a ete possible chez 280 des 311 fotus; soit un taux de faisabilite de 89;7%. Chez les 31 autres cas; il n'a pas ete possible de determiner le sexe fotal; la position du fotus ne permettant pas de bien voir le bourgeon genital. Au niveau de la fiabilite; des 238 fotus qui ont ete suivis; la determination du sexe fotal a ete correcte chez 204 fotus soit un taux de succes de 85;7%. L'exactitude etait meilleure lorsque la determination du sexe etait faite apres 12 semaines d'amenorrhee. Il n'y avait pas de difference significative dans les mesures selon que la grossesse etait monofoetale ou multiple. Conclusion : La determination echographique du sexe fotal au premier pourrait etre une option efficace; simple; disponible et peu couteuse dans les pays en voie de developpement

[Practice of reconstructive plastic surgery of the clitoris after genital mutilation in Burkina Faso. Report of 94 cases]. / Pratique de la chirurgie plastique reconstructrice du clitoris après mutilations génitales au Burkina Faso. À propos de 94cas.

PURPOSE OF THE STUDY: To describe and evaluate the results of reconstructive plastic surgery of the clitoris in order to promote reproductive health. PATIENTS AND METHOD: We conducted a retrospective study from 2007 to 2010. Ninety-four women were included in our study. RESULTS: The mean age was 32.3 years. The evaluation of the experience of sexuality before reconstruction showed that 41.5 % of patients had never had a sexual desire before surgery, more than half did not have a clitoral orgasm and dyspareunia was experienced by about a third of them. The main reason for consultation in our series was related to sexual dysfunction in more than half of our study population. All patients were operated using the technique of Dr Pierre Foldès. Evaluation with a decline of at least 6 months after surgery showed us a massive restoration of the clitoris at 89.7 %. There was a significant difference between sexual desire before and after surgery. A significant improvement in sexuality was observed in 83.6 % of patients. However, there was no significant difference between orgasm before and after surgery. This showed us that getting an orgasm is multifactorial and it is not enough to have a clitoris to have an orgasm, you have to use it. CONCLUSION: Regardless of the anatomical and functional results, all women were satisfied with respect to body found.

[Study of factors favouring the occurrence of Plasmodium falciparum in pregnant women in the health district of Bogodogo]. / Étude des facteurs favorisant la survenue du paludisme àPlasmodium falciparum chez les femmes enceintes dans le district sanitaire de Bogodogo à Ouagadougou, Burkina Faso.

OBJECTIVE: The behaviour of pregnant women live in towards prevention, attitude health workers, access measures prejudices and inadequate in urban design contribute to course the persistence of malaria. Objective analyse the factors leading to occurrence of malaria in women speakers in the health district Bogodogo. PATIENTS AND METHODS: He acts sectional study was place in the rainy season period high malaria transmission. The test rapid diagnosis (TDR) using soluble antigens (HRPII) of Plasmodium falciparum was the diagnostic method used in this work and carried on 810 pregnant women in the health area District Bogodogo in Ouagadougou, Burkina Faso. Results The overall prevalence of antigen HRPII P. falciparum was 18.6% with a CI [16.1-21.5] to 95%. It follows from this work that the risk of infection malaria was significantly higher among pregnant women: that were not educated, lived in outlying areas called "zones not off" of the town and villages nearby, who were not using net. For various reasons, the administration of sulfadoxine/pyrimethamine was not supervised and less than 50% of women regularly slept under a mosquito net. CONCLUSION: The fight against malaria in pregnant women should focus on communication for change of behaviour of pregnant women and also of health professionals. The fight antivector must be considered in rural areas.

[Antenatal transmission of hepatitis B virus in an area of HIV moderate prevalence, Burkina Faso]. / Transmission anténatale du virus de l'hépatite B en zone de prévalence modérée du VIH, Ouagadougou, Burkina Faso.

The aim of this study was to assess antenatal transmission of hepatitis B virus in a context of moderate prevalence of HIV in Burkina Faso. Among 360 counselled pregnant women for HIV and HBV testing, 307 were voluntarily enrolled at their last antenatal clinic at the university hospital, in Ouagadougou. Blood samples were collected from all the 307 mothers and tested for HBsAg, HBeAg and antibodies to HIV Blood samples were collected from 313 newborns in the 24 hours after birth and screened for HBV Data from mothers and newborns were collected and analysed using the EPI Info 2002 software. Values for p < 0.05 were considered statistically significant. HBsAg were found in 35 (11.4%) mothers, including 7 with HBeAg and 6 co-infected by both HIV and HBV. Seven babies born to 13 carrier mothers for HBsAg and HBeAg had HBsAg versus 6 born to 22 HBsAg carrier mothers HBeAg-negative. HBsAg was detected in 4 babies born to 6 HIV/HBV co-infected mothers versus 9 born to 29 mothers with HBsAg and HIV-negative. HIV infection, HBeAg and mothers excision were significantly associated with mother-to-child transmission (MTCT) of HBV (p < 0.02). HBV antenatal transmission was important in Ouagadougou and it occurred 2.5 folds more from HIV coinfected mothers than in HIV-negative mothers to newborns. These results showed the need of the implementation of national programme for HBV screening and immunisation in Burkina Faso.

Multicentre experience with a simple blood salvage technique in patients with ruptured ectopic pregnancy in sub-Sahelian West Africa.

BACKGROUND AND OBJECTIVE: Haemorrhage from ruptured ectopic pregnancy is a major cause of maternal death in Africa. The experience in three hospitals in salvaging intraperitoneal blood with a perforated metallic conical funnel is reported. METHOD: The blood was transfused back to the patient immediately after salvaging. Data were collected concerning the patient, her clinical state and haemoglobin levels throughout her stay in hospital, the diagnosis, the transfusion, and the complications encountered. RESULTS: Two hundred and twelve patients were reported prospectively. The preoperative haemoglobin level was 70.6 +/- 18.7 g/l (n = 132). After transfusion of 681 +/- 389 ml (n = 212) of salvaged blood, haemoglobin levels reached 84.7 +/- 10.5 g/l (n = 23) 6 days postoperatively. Twenty-two patients, half of whom had a life-threatening haemodynamic state, were also given donor blood. Twenty patients still had severe anaemia on leaving hospital (blood haemoglobin < 70 g/l). No untoward outcomes attributable to the reinfusion were seen. CONCLUSION: The surgical treatment of ruptured ectopic pregnancy with intraperitoneal haemorrhage was rendered safe and efficient with this new salvaging equipment.

[Mother to child prevention against HIV in the Health District of Kossodo (Burkina Faso)]. / Prévention de la transmission mère-enfant du VIH dans le District Sanitaire de Kossodo (Burkina Faso).

The mother to child prevention against HIV has become a major concern in the fight against the HIV/AIDS pandemic in Africa. To bring in our contribution for the improvement of this prevention work, we have carried out a descriptive retrospective study in the Health District of Kossodo over a period of two years going from September 1, 2004 through August 31, 2006. The segment of the population concerned by this study framework included HIV pregnant females having benefited from an appropriate assistance during their delivery and babies born from HIV mothers. The mother to child prevention against HIV protocole used was the monotheuraphy made from nevirapine. Most of the pregnant females delivered through the base way (88.9%). The ratio of new premature borns was not different from the one of the general population. The majority of the mothers (62.2%) chose to breast feed with an early weaning after 4 months as a feeding option for their babies. The mother to child transmission in HIV/AIDS was rated to 15.15%. As for the rate of infant mortality, it was 18.52%. The monotherapy regimes should be abandoned because they provide high levels of vertical transmission therefore creating a selection of resisting mutantes.

Is misoprostol a safe, effective and acceptable alternative to manual vacuum aspiration for postabortion care? Results from a randomised trial in Burkina Faso, West Africa.

OBJECTIVES: Previous research has demonstrated the effectiveness of misoprostol for treatment of incomplete abortion; however, few studies have systematically compared misoprostol's effectiveness with that of standard surgical care. This study documents the effectiveness of a single 600 micrograms dose of oral misoprostol versus manual vacuum aspiration (MVA) for treatment of incomplete abortion in a developing country setting. DESIGN: Open-label randomised controlled trial. SETTING: Two university teaching hospitals in Burkina Faso, West Africa. POPULATION: Women of reproductive age presenting with incomplete abortion. METHODS: From April 2004 through October 2004, 447 consenting women with incomplete abortion were randomised to either a single dose of 600 micrograms oral misoprostol or MVA for treatment of their condition. MAIN OUTCOME MEASURE: Completed abortion following initial treatment. RESULTS: Regardless of treatment assigned, nearly all participants had a complete uterine evacuation (misoprostol = 94.5%, MVA = 99.1%; relative risk [RR] = 0.95 [95% CI 0.92-0.99]). Acceptability and satisfaction ratings were similar and high for both misoprostol and MVA, with three out of four women indicating that the treatment's adverse effects were tolerable (misoprostol = 72.9%, MVA = 75.8%; RR = 0.96 [95% CI 0.86-1.07]). The majority of women were 'satisfied' or 'very satisfied' with the method they received (misoprostol = 96.8%, MVA = 97.7%; RR = 0.99 [95% CI 0.96-1.02]), expressed a desire to choose that method again (misoprostol = 94.5%, MVA = 86.6%; RR = 1.09 [95% CI 1.03-1.16]) and to recommend it to a friend (misoprostol = 94.5%, MVA = 85.2%; RR = 1.11 [95% CI 1.04-1.18]). CONCLUSION: Six hundred micrograms of oral misoprostol is as safe and acceptable as MVA for the treatment of incomplete abortion. Operations research is needed to ascertain the role of misoprostol within postabortion care programmes worldwide.

[Maternal and foetal prognostic in excised women delivery]. / Pronostic maternel et foetal au cours de l'accouchement chez la femme excisée.

INTRODUCTION: The female circumcision constitutes by their frequency and complications a real problem of public health. MATERIAL AND METHOD: Our study aims at comparing the maternal land fetal complications of the spontaneous vaginal delivery in the excised women and non-excised. We led a comparative survey case witness implying 227 excised pregnant women at the maternity in CHU YO of Ouagadougou. RESULTS: The prevalence of the excision from January 1st to July 31, 2006 was 72.86%. The distribution of female genital mutilations in this population is the following: type I=27.75%, type II=69.61%, type III=2.64%. The middle age was 25 years and 79.30% of women were aged less than 30 years. Islam appeared like a factor of exposure to the practice of the excision with 67.40% of women excised that practise it against 41.90% at the non-excised group (P<0,0001). The maternal complications were dominated by the duration of fetal expulsion prolonged and perineal tears. The duration of fetal expulsion was superior to 30 minutes for 34.56% of excised woman childbirths 9 times more frequently than women non-excised (P=0.001). The frequency of perineal tears was 10.13% in the group of women excised against 5.73% in the group of the non-excised (P=0.008). These perineal lesions were more frequent with the primiparae and women excised at the 2nd and 3rd degree. The neobirth asphyxia affected 4.4% of newborns from mother excised against 0.2% in the non-excised group (RR=5.18; P=0.006). In the group of excised them the rate of mortinatality was 22.03 for 1000 births, against 8.81 for 1000 births in the group of the non-excised (P=0.22). CONCLUSION: The prevention of these complications with the excised woman rests on the episiotomy and the instrumental extraction in the FGM of type III.

[Cervix cancer screening in a health district (Burkina Faso) by voluntary biopsies after the application of acetic acid and lugol]. / Dépistage du cancer du col utérin dans un district sanitaire (Burkina Faso) par biopsie de volontaires après application d'acide acétique et de lugol.

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

[Abruptio placentae: epidemiological, clinical and prognostic aspects with respect to a 177 case series]. / Hématome rétroplacentaire: aspects épidémiocliniques et pronostiques à propos d'une série de 177 cas.

OBJECTIVE: A retrospective study based on 177 cases of abruptio placentae, and describing the epidemiological, clinical and prognosis aspects. PATIENTS AND METHODS: A hundred and seventy-seven cases, corresponding to 185 children, were registered over a five-year period in the department of gynecology and obstetrics of the CHNYO of Ouagadougou. RESULTS: Abruptio placentae occurrence rate was about 9.6 per 1000 deliveries. In our study, this type of accident was most frequent with 30 to 34-year-old women (31.1%), with multiparous ones (56.5%), and with those suffering from arterial hypertension linked to pregnancy (31.1%). The clinical picture was most often complete, 83.1% of patients having reached grade 3 of abruptio placentae with complete symptomatology and foetal death. Vaginal delivery was preferred to cesarean section in 64.4% of the cases. Maternal death rate was about 3.9% and mainly caused by severe anemia (61.6%) and puerperal infections (7.9%). Foetal prognosis was dominated by the high rate of mortinatality (85.9%). DISCUSSION AND CONCLUSION: To reduce maternal mortality as well as morbidity due to abruptio placentae, correct prenatal follow-up, early diagnosis and prompt evacuation of the womb are required.