[Is there a relationship between a history of spontaneous abortion and low birthweight in Cotonou (West Africa)?]. / Existe-t-il une relation entre l'antécédent de fausse couche spontanée et les naissances de petit poids à Cotonou (Afrique de l'Ouest)?

In Benin, as in other African countries, low birthweight infants is a major health problem with poorly understood causes. In a case-control study of 2114 mothers recruited before discharge from the "Lagune" maternity ward at Cotonou, we examined the relationship between spontaneous abortion and low birthweight infants in women who delivered between 15 June 1990 and 20 July 1991. Information was obtained by interview then on the basis of hospital files. The results indicated that there was no association between spontaneous abortion and premature birth: OR = 1.00 (95% CI = 0.61-1.56). Likewise, the relationship between a past history of spontaneous abortion and intrauterine growth retardation was not significant: OR = 1.19 (95% CI = 0.83-1.71). Adjustment with characteristics of the mothers did not improve the correlations. It is concluded that there is no relationship between a past history of spontaneous abortion and low birthweight.

PIP: Researchers analyzed data on 2114 mothers who delivered at Lagune Maternity Hospital in Cotonou, Benin, to examine the relationship between premature birth, intrauterine growth retardation (IUGR), and history of spontaneous abortion. There was no statistically significant correlation between premature birth and history of spontaneous abortion (odds ratio [OR] = 1). Initiation of prenatal care after the first trimester was significantly associated with an increased risk of premature birth (OR = 1.27). There was no statistically significant correlation between term IUGR births and history of spontaneous abortion (OR = 1.19), even if a woman had a history of habitual abortion (OR = 1.22). Maternal weight less than 50 kg and initiation of prenatal care beyond the first trimester were associated with an increased risk of a term IUGR birth (OR = 1.75 and 1.27, respectively). These results indicate that a history of spontaneous abortion does not increase the risk of low birth weight whether it be caused by premature birth or IUGR.

[Version by internal maneuvers: alternative to cesarean section under precarious conditions. The experience of the University Clinic of Gynecology and Obstetrics]. / La version par manoeuvres internes: alternative à une opération césarienne dans des conditions précaires. Expérience de la CUGO.

Obstetrics practised in African University Hospitals is beset with specific constraints. The emergency admission of a woman whose fetus is dead or severely compromised, after an extended labor and an obvious ovular infection, leads to fear an hysterotomy as well as an hysterectomy. The authors specify, under their work conditions, the indications of internal version maneuvers, from 50 cases collected in one year. The fetal prognosis is not taken into account since it concerns dead or very threatened children. As for the maternal prognosis, it is excellent since the average stay is of 48 hours and no severe infection developed, which is not the case for caesarean sections performed under the same circumstances. If a maternal death must be deplored, it concerned a placenta praevia in a distressing conjunction of circumstances since the blood bank was out of blood.

La pratique de l'amniocentese tardive sans echographie prelable dans la prise de decision concernant les grossesses a risque a Cotonou : a propos de 68 cas

Cette etude rappelle la technique de l'amniocentese tardive realisee sans localisation placentaire echographique prealable. Cette technique realisable dans n'importe quel service de gynecologie ne disposant pas d'un echographe; constitue un element de prise de decision dans les cas de grossesse a risque eleve. Sur un total de 68 amniocenteses le taux d'echec a ete de 14;7 pour cent avec 4 ponctions blanches et 6 ponctions sanglantes. Cette amniocentese a ete determinante dans 10 cas sur 16 grossesses d'age gestationnel compris entre 34 et 36 S.A

Interêt de la détermination du rapport lecithine sur sphingomyeline (L/S), du pourcentage des cellules orangées et du test de Clements dans la surveillance des grossesses à haut risque à Cotonou

55 gestantes ont une amniocentese tardive sans echographie prealable. Parmi elles 30 portent une grossesse a risque et 25; une grossesse normale sans pathologie associee. Le liquide amniotique (LA) obtenu a permis la determination du rapport de la lecithine sur la sphingomyeline (L/S); du pour centage des cellules orangees et la realisation du test de Clements. On note une assez bonne concordance des resultats pour les trois tests. La positivite de l'un ou de deux de ces tests est un bon indicateur d'extraction prematuree du foetus

Les hémorragies de la délivrance: étude statistique et étiologie (à propos de 151 cas recenses en 5 ans)

Dans une etude portant sur les complications de la delivrance observees a la Clinique Universitaire de Gynecologie et d'Obstetrique du C.N.H.U. de Cotonou; les auteurs relevent un taux de 0;89 pour cent de cas d'hemorragies de la delivrance sur un total de 16 979 accouchements. Sur les 151 cas recenses le taux de mortalite est de 21;85 pour cent. L'etude des facteurs de risque realisee permet de proposer une attitude preventive plus active afin de reduire l'importance de ce fleau