Les oesophagites caustiques: conduite a tenir au stade sequellaire (a propos de onze cas)

Pathologie grave en tous lieux; les brulures caustiques de l'oesophage representent un veritable fleau en Afrique; qu'elles soient d'origine accidentelle ou dues a des tentatives suicidaires. Dans les formations hospitalieres de Libreville chaque annee 40 oesophagites corrosives sont habituellement recensees. Il s'agit dans la majorite des cas d'enfants de moins de cinq ans qui ingerent un produit corrosif laisse a leur portee. Au Gabon c'est l'eau de javel qui est responsable dans 90 pour cent des cas

[Delivery in the scarred uterus. Apropos of 606 cases in 62,193 deliveries]. / L'accouchement des utérus cicatriciels. A propos de 606 cas pour 62193 accouchements.

Scarred uterus represent 1 p. cent of the deliveries in our department (n = 606). Delivery is performed vaginally in 61 p. cent of the cases and by caesarean section in 39 p. cent of the cases. During two 4-year periods (1981-1984 and 1985-1988), the rate of repeated caesarean sections increases from 36 to 41 p. cent with decrease of the number of uterine ruptures which however, persists (almost 5 p. cent of scarred uteruses). The type of scarring is the major risk factor with: segmental scarring (1.5 p. cent of ruptures), gynecological (5 p. cent), segmento-corporeal (26 p. cent) and corporeal (33 p. cent). Strict obstetrical monitoring permits to control this risk (25 p. cent of ruptures occur at home). It is the uterine rupture that determines the maternal risk (3 death scarred uteruses represent almost 40 p. cent of uterine ruptures 11) and result in 3 p. cent of the maternal mortality in the department. The perinatal mortality is 63.6 for 1,000. A dynamic test of the uterus requires an obstetrical decision taking into consideration the scar, essentially segmental transverse, the head delivery with favorable cephalo-pelvic comparison and a well-trained team. This choice is dictated by the maternal risk of caesarean section, 2 for 1,000 in Europe (14) and for 1,000 in the department and a persistent high mortality in children (97 for 1,000 in Gabon).

[Uterine rupture. Apropos of 31 cases seen at the Hospital Center of Libreville (Gabon)]. / Les ruptures utérines. A propos de 31 cas observés au Centre Hospitalier de Libreville (Gabon).

The authors report 31 cases of rupture of the uterus at the Hospital of Libreville-Gabon. The frequency is 1.4/1,000 deliveries. The usual etiological factors are found: malformations of the uterus, obstetrical maneuvers, mechanical dystocias, use of oxytocics, scars of caesarean section. The clinical characteristics are those previously described. There were two maternal deaths and 17 fetal deaths. These figures emphasize the progress accomplished and to come.