[Chlamydia infection and female low fertility in Morocco]. / Chilamydiose et hypofertilité féminine au Maroc.

Chlamydia trachomatis infection is recognised as the most common asymptomatic sexually transmitted disease, and this may lead to severe complication including infertility. The purpose of this study was to evaluate the part that this pathology takes in the female hypofertility, using serologic, cell culture, and histopathologic tests. Some of the women had undergone biopsies during coelioscopic exam, the others during salpingectomy. Cervical specimens were carried from other women. They had as clinical signs: primary or secondary infertility, ectopic pregnancy, syndrome of synechie, hydrosalpinx, or pelvic pains. 128 of these women had undergone serologic exam, 57 a cell culture, and 47 an histopathologic test. The results showed that 26% had anti Chlamydia trachomatis antibodies and 46% from them with tubal problems confirmed, had anti Chlamydia trachomatis antibodies as well, only 7% had cell culture positive from cervix specimens, none from the biopsies, and 73% of them had inflammatory responses. All women with inflammatory responses had a serologic and/or cell culture positive tests. Our results allow us to conclude that this infection takes a good part in female hypofertility, there is a correlation between a previous Chlamydia trachomatis infection and a tubal histopathology. In front of the difficulties of isolation by cell culture the detection of the microorganism by molecular biology assays may resolve a lot of problems.

[Chlamydial infections and male infertility in Morocco]. / Chlamydiose et infertilité masculine au Maroc.

Chlamydia trachomatis infection of the lower genital is recognised as the most common sexually transmitted disease, is role in male infertility is controversial, the objective of this study was to evaluate the part that this pathogen agent takes in male infertility among maroccan population, to compare serological tests, sperm abnormalities, antisperm-antibodies and DNA research in semen. Microimmunofluorescence (MIF) was done for 139 patients, 124 were checked for sperm abnormalities, 87 for antisperm-antibodies and 92 for DNA research in sperm. The results showed that MIF is positive in 24,5%, 11% of the subjects in antisperm antibodies, 8% of them simultaneously in anti-Chlamydia and antisperm antibodies and 5 of them had sperm abnormalities. Azoospermy was more observed in positives subjects in Chlamydia trachomatis antibodies. C. trachomatis DNA was found in 7,6% and there was no association between the detection of C. trachomatis in semen specimens and the presence of anti-Chlamydia trachomatis, antibodies in serum. We conclude that, because of the complexity of the Chlamydia's physiopathology, association between several tests is necessary in male infertility workup.

[Reccurent abortions: unpublished syndrome suggesting the explanation of fetal death]. / Avortements à répétition: un syndrome inédit suggérant l'explication de la mort foetale.

A report is given of 8 cases of recurrent "idiopathic" abortions sharing in common the following features, unreported so far: (1) high uterine arterial impedance; (2) decrease in endometrial thickness, in spite of normal hormonal and endometrial cycle at biopsy; (3) a history of previous curettages. Such a syndrome could be consistent with the existence of a narrow peripheral symphysis of the uterine cavity, unaffecting its shape at hysterography.

[Abdominal pregnancy. Apropos of 7 cases collected between 1978 and 1986]. / La grossesse abdominale. A propos de 7 cas colligés de 1978 à 1986.

The authors point out, following a study of 7 cases of abdominal pregnancy, how necessary it is to make a diagnosis early and to use ultrasonography routinely whenever there is the slightest abnormality in the progress of the pregnancy, such as absence of strong fetal movements or failure of the abdominal contents to grow rapidly. The treatment is surgical and the placenta should as far as possible be removed completely because serious complications both of infection and haemorrhage can occur if the placenta is only partially removed. These complications can pose a great threat to the mother.

[Hemorrhagic hepatic lesions in toxemia of pregnancy]. / Les lésions hépatiques hémorragiques de la toxémie gravidique.

One case of hepatic hemorrhage during toxemia of pregnancy is reported. This complication occurs in the last trimester of the pregnancy or immediately after labor. The diagnosis is usually made per-operatively. The anatomical lesions are subcapsular hematomes or spontaneous rupture of the liver. Surgery is only treatment and must be conservative. The very high mortality rate has generally been attributable not only to uncontrolled hemorrhage but also to disorders of hemostasis associated and to multiple organe failure.

[Maternal mortality and perinatal mortality]. / Mortalité maternelle et mortalité périnatale.

PIP: 94 maternal deaths and 1546 fetal and neonatal deaths were registered among 28,706 births at the CHU Averroes in Casablanca between 1978-80. 45% of women who deliver at the clinic are very poor and only 10% are relatively well off. Obstetrical antecedents were noted in 27% of the fetal deaths. 70% of the maternal deaths occurred in women aged 20-34. 32 maternal deaths occurred among 16,232 women with 1-2 children, 30 among 6514 women with 3-5 children, and 32 among 5960 women with 6-14 children. 11,027 of the 28,706 were primaparas. Perinatal mortality was 4.46% among primaparas, 8.24% among grand multiparas, and 4.1% among secondiparas. In 58 of the 94 cases of maternal mortality the woman was hospitalized after attempting delivery at home or in a village clinic. Among women with 1 or 2 children, hemorrhage was the cause of death in 8 cases, infection in 7 cases, eclampsia in 3 cases, thromboembolism in 2 cases, uterine inversion in 2 cases, pulmonary tuberculosis in 1 case, embolism in 5 cases, and other causes 1 case each. Among women with 3-5 children hemorrhage was the cause of death in 10 cases, septicemia in 3 cases, uterine rupture in 3 cases, eclampsia in 3 cases, uterine inversion in 2 cases, viral hepatitis in 2 cases, emboli in 2 cases, and other reasons 1 case each. Among grand multiparas hemorrhage was the cause of death in 11 cases, uterine rupture in 12 cases, peritonitis in 2 cases, eclampsia in 2 cases, emboli in 2 cases, and other causes 1 case each. 19 of the maternal deaths were judged to have been avoidable with better management. Prematurity and birth weight of 1000-2500 g associated or not with other pathology were found in 714 of 1546 perinatal deaths. Of 390 cases of death in utero with retention and maceration, 68 were caused by reno-vascular syndromes, 76 by maternal infections, 33 by maternal syphilis, 26 by fetal malformation, 18 by maternal diabetes, 10 by Rh incompatability, and 159 by indeterminate causes. In 795 cases of intrapartum mortality without maceration, 114 were caused by retroplacental hematomas, 61 by placenta previa, 74 by uterine rupture, 119 by prolapse of the cord, 51 by fetal malformation, 45 by dystochia, 53 by twin pregnancies, 104 by fetal distress, 44 by obstetrical trauma, 55 by prematurity, and 75 by undetermined causes. In 361 cases of early neonatal mortality, 88 were caused by renovascular syndromes, 24 by diabetes, 13 by Rh incompatibility, 34 by placenta previa, 94 by prematurity, 28 by fetal malformation, 35 by fetal infections, 31 by fetal distress, and 14 by obstetrical trauma. The rates of maternal and perinatal mortality are very high compared to those of European countries.^ieng

[Birth weight in an African country]. / Le poids de naissance dans un pays Africain.

PIP: 2900 records of deliveries occurring at a clinic in Casablanca between January and April 1979 were analyzed to identify factors influencing birth weight. Of the 2575 newborns with healthy mothers, 2353 were full term and weighed over 2500 g, 94 were full term and weighed less than 2500 g, and 128 were premature. 253 of the 2900 mothers suffered from toxemia of pregnancy, 30 had diabetes, 21 had pulmonary tuberculosis, 12 had cardiac problems, and 9 had other ailments; 30 of their babies were premature. Average birth weight was 3392 g for mothers of higher socioeconomic level, 3280 g for middle level, and 3070 g for lower level. Average weights were 3230 g for 1st births, 3426 g for 2nd births, 3494 g for 3rd-5th births, and 3620 g for subsequent births. Babies of women under 20 weighed the least; birth weights increased with maternal age and stabilized after 30. Babies of married women weighed on average 257 g more than those of single women. Babies of mothers having at least 1 prenatal consultation were 102 g heavier. Babies of women with no previous abortion, stillbirth, or premature birth were 70 g heavier. Male babies weighed 138 g more than female. Lowest birth weights were among babies with mothers weighing under 50 kg and under 145 cm tall. Babies born at 28 weeks weighed 1081 g, at 32 weeks 1814 g, and at 36 weeks 2472 g. 47.64% of premature births occurred to primaparas. 303 infants weighed more than 4000 g. Newborns of mothers with toxemia but no other illness weighed 3247 g. Over 20% of babies carried to term by mothers with toxemia weighed less than 3000 g. Birth weight decreased with increasing severity of toxemia. Average weight for mothers with diabetes was 3864 g. Of 50 babies weighing under 3000 g at birth, 2 had deficient Apgar scores, 15 weighed less than 2500 g and 5 less than 2000 g, and 17 died, of which 9 weighed less than 2500 g and 4 less than 2000 g. Regional studies disclosed that average birth weight in a maternity center in El Jadida was 3408 g, with males weighing 107 g more, and with weights generally increasing by parity and maternal age, height, and weight. Average birth weights in Fez were 3350 with males weighing 140 g more. Birth weights were correlated with parity and maternal weight but not maternal height. Average birth weights in the studies were higher than expected, and the number of low birth weight infants was less than expected.^ieng