[The histological aspect of the uterine vein wall according to age and parity]. / Effets de l'age et de la grossesse sur les veines uterines de la femme Senegalaise.

Veinous pathology is increasingly involved in numerous gynecological and obstetrical conditions. This study describes the histological aspects of uterine vein wall according to age and parity. Uterine vein were taken during autopsy of 50 black women of various age and parity. Necroscopic samples of uterine veins were taken from 50 black women of various and diverse age and parity. Microscopic stains were used to assess histological modifications of veinous walls according to age and parity. The disorganization of elastic fibers, collagen fibers of the media, the muscular wall and elastic fibers of the adventice increased with age. The main histological modifications associated with increasing parity were the increase of collagen tissue and the disorganization of the veinous wall. This study provides useful information for other studies regarding the histological analysis of pelvic veins removed during caesarian section for vascular pathology such eclampsia, abruption.

[Sonographic features of gestational choriocarcinoma]. / Aspects echographiques du choriocarcinome gestationnel. Résultats préliminaires a propos 13 cas.

PURPOSE: To describe the sonographic morphological features of gestational choriocarcinoma. MATERIALS AND METHODS: Retrospective evaluation of 13 cases of gestational choriocarcinoma diagnosed by clinical and laboratory (BHCG) criteria in all cases and confirmed by histological data in 8 cases. RESULTS: The tumor presented multiple features (nodular, submucosal, macrocystic, multicystic, compact and microcystic) often with involvement of surrounding tissues. All cases showed myometrial involvement. The size of the ovaries was normal with small corpus luteum cysts noted in only 5 cases. In 2 cases, ultrasound modified the clinical staging. CONCLUSION: Sonographic features of gestational choriocarcinoma are variable, and may mimic other diseases of the endometrium or myometrium. The involvement of multiple layers of the uterus suggests a malignant disease.

Risk factors for HIV-1 and HIV-2 infection in pregnant women in Dakar, Senegal.

This study examines the prevalence and risk factors for Human Immunodeficiency Virus type 1 (HIV-1) and type 2 (HIV-2) infection in pregnant women in Dakar, Senegal. From April 1991 to January 1993, 9,518 pregnant women were interviewed and serologically tested for antibodies to HIV-1 and HIV-2; 26 (0.3%) were HIV-1 seropositive, 44 (0.5%) were HIV-2 seropositive, two (0.02%) were dually seropositive, and 9,448 (99.3%) were seronegative. Guinea-Bissau nationality and age > 25 years were associated with HIV-2 infection, whereas parity < or = 2 was associated with HIV-1 infection. Among women who gave birth to live infants, shorter length of union with the partner and having been married more than once were associated with HIV-2 infection, whereas age < or = 25 years was associated with HIV-1 infection. Information gained by this study may help target intervention strategies for preventing maternal HIV infection and understanding biological differences between the two viruses.

In vitro production of immunoglobulins of various classes and subclasses by cord blood B cells in African neonates: modeling and assessment of determination.

Cord blood B cells obtained from neonates of healthy Senegalese mothers were assayed in vitro for their capacity to fully differentiate and secrete immunoglobulins (Ig) of various classes and subclasses. Stimulation of mononuclear cells with SAC particles or anti-micro antibodies in the presence of IL-4, or with IL-2 and IL-10 induced a strong production of IgG, provided that an additional CD40/CD40L signal was present, in contrast to adult cell cultures. Cord blood mononuclear cells differentially stimulated with various cytokines in order to lead to Ig heavy chain switching and production of the various classes/subclasses consistently produced IgG1, IgG3, IgG4, IgE and IgA. This system has been applied to immune cells from African neonates that have not been extensively studied previously. Estimation of Ig production as OD ratios could be applied to cultures where cord blood B cells are stimulated with defined antigens of human pathogens to which the fetus immune system was primed in utero.

Perinatal transmission of hepatitis B virus in Senegal, west Africa.

We studied 152 healthy pregnant women and their 156 newborns for markers of hepatitis B virus (HBV) infection in Dakar, Senegal. Of these, 120 mothers (79%) had antibodies to the hepatitis B core antigen (anti-HBc), 21 (13.8%) were hepatitis B surface antigen (HBs Ag) positive, including 2/21 (9.5%) hepatitis B core-associated antigen (HBe Ag) positive and 1/21 (4.7%) HBV DNA positive. At birth, 11 (7%) infants were HBs Ag positive; 9/11 had an HBs Ag positive mother. Ten of these HBs Ag positive-born infants were investigated at 6-7 months: 5 were strongly HBs Ag positive and developed antibodies to HBs Ag, HBc Ag or HBe Ag; these 5 (3.2% of the total) probably became chronic carriers of HBV. The 5 others were HBs Ag negative and 4/5 did not develop antibodies against HBV Ag; HBs Ag positivity at birth was likely due to contamination of the mother's blood. Thirty-one of the 145 HBs Ag negative-born infants were studied at 6-7 months and remained HBs Ag negative. However, 5 (16%) showed evidence of HBV infection occurring between 0 and 6 months, as shown by the development of antibodies to HBs Ag, HBc Ag, and/or HBe Ag. Despite the low prevalence of HBV DNA and HBe Ag in HBs Ag positive African mothers, this study shows the occurrence of perinatal transmission of HBV in West Africa, in contrast with previous studies. Perinatal HBV transmission could explain the HBV vaccination failure recently reported in children in Senegal.

A 5-year clinical evaluation of Norplant implants in Senegal.

The principal objective of this 5-year clinical study of Norplant implants was to introduce these implants into the family planning program in Senegal and to determine their overall acceptability and safety in Senegalese acceptors. A total of 300 subjects were enrolled into the trial from August 1986 to July 1991. All the women were followed-up for 5 years or until the implants were removed. The pooled cumulative discontinuation rate was 40.8 +/- 2.91 per 100 women resulting in a continuation rate of 59.2 +/- 2.91 per 100 women. Thirteen subjects (4.3%) were lost during the follow-up. Seven pregnancies were reported throughout the 5 years leading to a cumulative pregnancy rate of 3.3 +/- 1.25 per 100 women. Menstrual problems were the reason most often given for early removal during the first 2 years. After year 2, desire for another pregnancy was the main reason for implant removal. The results presented in this study show that the Norplant implant system is a safe, effective, and acceptable method that meets the needs of the Senegalese family planning program.

PIP: A 5-year prospective, noncomparative clinical evaluation of Norplant implants was conducted to introduce these implants into the family planning program and to determine the acceptability among women users in Senegal from August 1986 to July 1991. Findings showed that the pooled discontinuation rate was 40.8 +or- 2.91 per 100 women, resulting in a continuation rate of 59.2 +or- 2.91 per 100 women. During follow-up, 13 (4.3%) subjects were lost. Throughout the 5 years, 7 pregnancies were reported leading to a cumulative pregnancy rate of 3.3 +or- 1.25 per 100 women. The most common reason for early removal during the first 2 years was menstrual problems, while the main reason for removal in the second year was the desire to have a child. Overall, the Norplant implant system is a safe, effective, and acceptable method that is suitable for the Senegalese family planning program.

[The role of Hühner's direct post-coital test in the evaluation of conjugal sterility in the African environment in Senegal. (Apropos of 2593 post-coital tests performed by the clinical cytology, cytogenetic and reproduction biology laboratory at the University Hospital Center in Dakar, Senegal) 1983-1993]. / Place du test post-coïtal direct de Hühner dans le bilan de la stérilité conjugale en milieu africain au Sénégal. (A propos de 2593 tests post-coïtaux réalisés par le laboratoire de cytologie clinique, cyto-génétique et biologie de la reproduction du CHU de Dakar, Sénégal) 1983-1993.

About 2593 post-coïtal tests (PCT) or Hühner direct tests were realised in the laboratory of clinical cytology, cytogenetics and reproductive biology of the University medical Centre of Dakar, Senegal from 1983 to 1993. Analysing the results, the authors showed the importance of the infectious factor in women and also the role of male deficiency in conjugal sterility in black African environment. These realities have been confirmed cytospermiologic test deficient results. These sperm exams have shown among other things, the prevailing number of azoospermia (25%) and of oligo-asthénotératozoospermia (44%) in husbands of sterile women in the black African environment of Senegal. Pap's Tests have been jointly realised at the same time as 1902 PCT. The results have enabled us to track down 120 cervix with precancerous and cancerous cell alterations; 81 condylomas (HPV), 25 CIN1, 11 CIN2 and 3 CIN3 (CIN: cervical intra-epithelial Neoplasia). These facts suggest a cautious technics, and a prudent interpretation of the results and taking into account the competence and the subjectivity of the practitioner. We have learnt from the study that we must give as much as possible to biologists of Reproduction in southern countries, where conjugal sterility and cervix precancerous and cancerous cell alterations are high, a polyvalent training so that they can practise jointly the post-coïtal or Hühner direct test (PCT) and the Papanicolaou Colpocytologic Test (TP), provided that one owes a microscope.

[Phenotypic differences of nosocomial bacterial strains isolated in the obstetric-gynecology service of the University Hospital Center of Dakar]. / Caractères phénotypiques de différentes souches bactériennes nosocomiales isolées au service de gynécologie-obstétrique du CHU de Dakar.

A study on nosocomial infections was conducted in the Laboratory of Bacteriology-Virology of Aristide Le Dantec's Hospital, in collaboration with the Gynecology Obstetrics clinic located both in the same Dakar's hospital, during May 1995. The aim of the study was to define the phenotypical characteristics of various bacterial strains isolated from the atmosphere health care staff's hands, medical equipment (material, antiseptics) and patients (hospitalized pregnant and newborns in day Nursery). A total of 133 strains were collected and the most frequent isolates were Staphylococcus aureus (27 strains) and Klebsiella pneumoniae (10 strains) encountered mainly in the atmosphere. Otherwise, Escherichia coli (11 strains) and Enterococcus faecalis (11 strains) were more present in hospitalized patients. Results obtained after antimicrobial agents susceptibility (Antibiotics and Heavy metal salts) by Antibiogramm and Minimal inhibitory concentrations (MIC) and also data from biotyping of Klebsiella strains have allowed us to say there's a probable contamination of hospitalized patients by the bacteria from the atmosphere but manuportage too.

[3 cases of vulvar epidermal cysts after female genital mutilation]. / Trois cas de kystes épidermiques de la vulve après mutilations génitales féminines.

We report three cases of tumors of the vulva following an excision during childhood, in patients aged 22 to 25. The achieved surgical removal gave correct aesthetic and functional results. Histological examination of these tumors revealed epidermal cyst containing keratin. Because of clinical, psychological and social impact of female excision, steps should be taken against such traditional practices.

[Choriocarcinoma in Senegal: epidemiology, prognosis and prevention]. / Choriocarcinome au Sénégal: épidémiologie, pronostic et prévention.

OBJECTIVE: The objective of this study was to define the epidemiological profile of choriocarcinoma in Senegal, to evaluate its prognosis and to submit a better way of prevention of this pathology in an area with poor medical care. MATERIAL AND METHOD: It was a retrospective case-control study of all choriocarcinomas diagnosed from January 1st to December 31st 2000 at Dakar university teaching hospital. The witnesses were chosen among patients who had had molar abortion at the same time as the cases at study and had not developed the pathology after at least 12 months of aftercare. The stability of association was checked by calculating the confidence interval in 95% by Miettinen method and using Chi 2 test of Pearson with a risk factor alpha under 5% or Fischer test; the prognosis survival factors were compared by using logrank test. RESULTS: Among the 1098 patients in follow-up treatment after molar abortion, 61 choriocarcinomas were diagnosed with an incidence of 5.5%. The epidemiological profile was a great multiparous (40 years old or more) with low socio-economical level, 51% of the diagnosed cases are made in the metastasis stage. The prognosis was marked by a complete remission in 37.7% and by global lethality in 49.2%; the average survival was about 48 months. DISCUSSION AND CONCLUSION: The risk factors of choriocarcinoma among patients who had a molar abortion were represented by an age superior or equal to 40 years old, high multiparity and preservation of the uterus after molar abortion. To improve the prognosis in a country with low medical care, we recommend to widen preventive hysterectomy indications after molar abortion among patients with risk factors of choriocarcinoma.

[Neonatal bacterial infections at the CUH of Dakar]. / Infections bactériennes néonatales au CHU de Dakar.

OBJECTIVES: It's a retrospective study in order to determine the epidemiology of neonatal bacterial infection and to evaluate the efficiency of the antibiotic protocol in University Teaching Hospital in Dakar. MATERIAL AND METHODES: From January 1st 1997 to December 31st 1998 we have registered 7461 live births, samples of blood are taken from 2312 new-born baby and they received antibiotherapy (beta-lactamine + gentamycin) at the first day based on infections risk evaluated by anamnestic criterias. The treatment is seven to one days long, the antibiotic was adapted according to the antibiogram result. RESULTS: The neonatal infection diagnosis is confirmed in 246 cases, about 33 per 1000 live births or 10.6% of newborn babies having on antibiotherapy. Most current risk factors are premature rupture of membranes (85%) and neonatal suffering (87.8%). Isolated gerras are: Klebsiella pneumoniae (61.5%), Enterobacteria (11.5 Staphylococcus (8.7%), colibacille (6%), Streptococcus (5.5%), Enterococcus (4.1%) and Pseudomonas (2.7%). Most of these germs are resistant to antibiotics currently used in first intention (ampicillin, cefotaxim, gentamycin), in particularly 95% of Klebsiella. Most efficient antibiotics are amikacin, colistin, ceftriaxon and ciprofloxacine. Deaths occurs in 48 cases with 36 in early neonatal period, 79% of mortality rate related to infection by Klebsiella. CONCLUSION: First intention antibiotherapy must be always adapted to the bacterial ecology evolution and must be more selective by using major infections risk factors. We promote early infection diagnosis by using biologic markers which reference is represented by C Reactive Protein.

[Tolerance and acceptability of Norplant contraceptive devices]. / Tolérance et acceptabilité des implants contraceptifs Norplant: expérience au CHU A. Le Dantec de Dakar (Sénégal).

OBJECTIVES: Norplant implants have been used for long-lasting contraception in Senegal since 1986. The purpose of this work was to assess tolerance and acceptability of the method among Senegalese women. MATERIAL AND METHODS: A prospective non-comparative study including 300 women was undertaken in the Obstetrics and Gynecology Clinic at the University Teaching Hospital A Le Dantec of Dakar between December 1986 and July 1991. Women meeting inclusion criteria were seen at 1 month, 3 months, and 6 months after insertion then every 6-month until device removal. RESULTS: The mean age of women was 31.3+/-5.45 years and mean parity was 4.7+/-2.45. Almost half of the women no longer desired pregnancy and 67.6% of the women who had not used contraceptive method the month before admission decided to use Norplant. During follow-up visits, 45.2% had menstrual side effects mainly amenorrhea 23.4% and irregular bleeding 12.5%. Non-menstrual side effects were local reactions at the implant site (19.9%). The other side effects were dizziness, asthenia, insomnia, anemia, and high blood pressure and weight change. Overall, 58.8% of the women kept their implants and had them removed after 5 years of use. The failure rate was 3.3+/-1.25. At the end of five years of use, satisfaction was 84.8% and nearly two-thirds of the women decided to recommend Norplant to a friend or relative or to use it again. CONCLUSION: Norplant is a method of choice among the range of contraceptive methods available in Senegal. Because of its advantages and its ease of use, Norplant could be a widely used method in Senegal.

[Norplant contraceptive implant]. / Les implants contraceptifs Norplant: évaluation des effects secondaires, du poids et de la tension artérielle dans les cliniques de planification familiale à Dakar (Sénégal).

OBJECTIVE: Norplant is a long lasting contraceptive method which protect again pregnancy for five years. We studied the side effects and the variations related to weight and blood pressure. MATERIAL AND METHODS: The study was carried out in three family planning clinics in Dakar with 450 women who have had their implants for at least six months. Data collection was based on patient interviews and review of medical files. RESULTS: The side effects reported were mainly menstrual problems with 54.7% of the women reporting menstrual spotting. The other non-menstruel side effects were headaches (64.2%) and dizziness (59.1%). The side effects at the insertion site were pruritus (16%) and pain (3.1%). Regarding weight and blood pressure, an increase in weight was observed up to three years of Norplant use and a decrease to the initial weight was seen during the fifth year of use. No variation was noted regarding blood pressure. CONCLUSION: Norplant is a contraceptive method widely used in Senegal. Most of the side effects involve menstrual problems. A slight increase of weight was observed in general with no variation in blood pressure.

[Delivery after scarred uterus at the University Hospital Center of Dakar]. / Accouchement sur utérus cicatriciel au CHU de Dakar.

The objective of this retrospective study was to analyze the prognosis of delivery after previous cesarean section in Dakar University Hospital from January 1, 1996 to December 31, 1997. For 9,068 registered deliveries, 134 were on scarred uterus (1.5% of all deliveries). Average age of these women was 29 years. Prophylactic cesarean was performed in 61 cases (45.5%). The main indications were multi-scarred uterus, breach presentation and macrosomy. A trial of labor was undertaken in the 73 other patients (54.5%), 85% were successful. Vaginal delivery rate was 46.3% on scarred uterus. There were no maternal deaths. Only one case of uterin rupture occurred in the prophylactic cesarean group. There were no perinatal deaths caused by trial of labor. These results confirm that trial of labor on scarred uterus should be the rule whenever possible, even when electronic cardiotocographic monitoring is not available.

[Some exceptional evolution of the abdominal pregnancy (author's transl)]. / Evolutions exceptionnelles de la grossesse abdominale.

The authors have reported 5 exceptional cases of abdominal pregnancy observed at the clinic of obstetrics and gynecology of the university of Dakar. This pathology remains important and shows various clinical aspects in these counties presenting insufficient medical development. In a review of the literature the authors have studied the frequency and the etiopathogenic aspects of this "dystocical" pregnancies.

[Indications and prognosis of cesarean sections at the Dakar University Hospital Center]. / Indications et pronostic de l'opération césarienne au CHU de Dakar.

From 1st January 1992 to 30 June 1994, 8489 delivered at the Dakar University Hospital. Among them, there were 953 cesarean sections, i.e. 11.2%. Epidemiological analysis revealed that mean parity was 2 for a mean age of 26 years. 22% of the women had a clinically perceptible pelvic problem. The indications for cesarean section were divided into 3 groups: mandatory operations (feto-pelvic disproportion, haemorrhagic placenta praevia, dystocia): 41.4%; prudent operations (long-awaited infant, fetal suffering, breech presentation, cicatricial uterus): 50%; and necessary operations (maternal disease, especially hypertension): 8.6%. There was a high postoperative mortality (1.4%) and major morbidity, especially infection (10%). Neonatal prognosis was also poor with a 14% early neonatal mortality. These findings reflect the major problems facing obstetricians in Senegal and Subsaharian Africa. Improved prognosis necessarily will involve better organization of our health systems allowing easier access to life-saving cesarean section for our rural populations.

[HIV infection in pregnant women in Dakar (Senegal)]. / L'infection par le VIH chez la femme enceinte á Dakar (Sénégal).

The epidemiologic and sociodemographic characteristics of human deficiency virus (HIV) infection vary from one country to another. The objective of this study was to determine the prevalence of HIV infection in pregnant women in Dakar and associated factors. Systematic anonymous screening was performed in pregnant women admitted to the maternity ward. Women whose seropositivity was confirmed by Western blot retroviral serology were included. One woman out of four was assigned by simple random selection to the case control group. Over a 24 month period, 12,498 women were tested. 104 were seropositive (44 HIV1, 58HIV2, and 2 HIV1-HIV2 giving a prevalence of 0.8%. Factors associated with HIV1 and HIV2 were different: mean age 21.7 years for HIV1 versus 30.6 for HIV 2 (p = 0.05); origin in Guinea-Bissau for HIV2 (p = 0.001); mean number of pregnancies 2.6 for HIV1 versus 5.9 for HIV2 (p = 0.001); mean parity 1.5 for HIV1 versus 4.5 for HIV2 (p < 0.01); vitality of the conception product in 85.1% for HIV2 versus 67.5% for HIV1 (p = 0.0001). These data confirm the low prevalence of HIV infection in pregnant women, with a predominance for HIV2. The factors identified in associated with virus type suggest a different mode of transmission and/or reduced virulence or HIV2 compared with HIV1. Knowledge of these factors helps orient management strategies, especially in pregnant women.

[Term abdominal pregnancy with delivery of a living child. Two case reports]. / La grossesse abdominale à terme avec enfant vivant. A propos de 2 observations.

The lack of antenatal care and the growing number of genital infections make ectopic pregnancy a current unrecognized pathology in areas with few physicians. Such pregnancies exceptionally reach term but delivery of a live infant is rare. We report two cases in which echographic diagnosis of abdominal pregnancy was followed by the delivery of a live child. In both cases, fetal hypotrophy led to neonatal death. Maternal outcome was however favorable with surgery to reduce the risk of hemorrhage. Safe childbearing requires improved preventive measures and better maternal sanitary conditions and education, particularly important for subjects living in areas poorly provided with health facilities.

[Obstetric complications of the first trimester in Western Africa]. / Complications obstétricales du premier trimestre en Afrique de l'Ouest.

The obstetrical complications affecting women in Benin, Senegal and Ivory Coast during the first trimester of pregnancy were studied. Information about the 345 women included in the study was collected from registers maintained by the eight participating maternity units. The most frequent complications observed were spontaneous abortions (50% of admissions), complications of induced abortions (34%), and ectopic pregnancy (8%). Overall, the patients appear to have gained rapid access to care: two thirds of the women underwent interventions on the day of admission. Nevertheless, there were three maternal deaths, two of which followed induced abortion complications.

[Uterine rupture in Senegal. Results of 2 surveys taken in 1992 and 1996]. / Ruptures utérines au Sénégal. Résultats de deux enquêtes effectuées en 1992 et 1996.

OBJECTIVES: National prospective descriptive study on dystocia were conducted in Senegal in 1992 and 1996. We examined more closely the data on uterine rupture to determine trends between these two surveys. METHODS: Data were collected for all patients undergoing an obstetrical intervention between January 1st and December 31st in 1992 and in 1996 in one of the referral maternity-obstetrical surgery units in each of the 10 regions in Senegal. RESULTS: The rate of uterine rupture was 1 per 51 interventions in 1992 (1.87%) versus 1 per 53 interventions in 1996 (1.94%). This dramatic event was recurrent in 7 of the 10 regions. The patients involved were aged 25-35 years (68% in 1992 versus 70% in 1996), multiparous or grand multiparous (52% in 1992 versus 70% in 1996), illiterate (90%), with poor follow-up (less than 3 prenatal consultations in 56% of the cases), and were generally evacuated to the unit (80% in 1992 versus 97% in 1996) without medical care (55%). Maternal mortality was high (28% in 1992 versus 12% in 1996). Infant mortality was also very high (98% in 1992 versus 86.6% in 1996). Conservative treatment of uterine rupture was used increasingly: the rate of conservative suture rose from 3.3% in 1992 to 22% in 1996. CONCLUSION: Prevention is a challenge for healthcare workers, public authorities and the population in general. Health policy should be directed towards forming general practitioners in obstetrical surgery. Emergency surgery kits should be made available to improve the quality of care in all maternity units throughout the country.