Accuracy of syndromic management in targeting vaginal and cervical infections among symptomatic women of reproductive age attending primary care clinics in Dakar, Senegal.

OBJECTIVE: To assess the effectiveness of the WHO syndromic algorithm in the management of vaginal discharge among women of reproductive age in Dakar. METHODS: Cross-sectional study of consecutive female patients (aged 18-49 years) presenting with vaginal symptoms at six selected study sites in Dakar; of these, 276 patients were included in the analysis. Vaginal and cervical swab samples were collected and analysed to establish an aetiological diagnosis of any infection. Syndrome-based diagnosis was compared with the laboratory results to evaluate its accuracy based on sensitivity, specificity and positive and negative predictive values. The degree of agreement between the two approaches was assessed using the Cohen's kappa concordance analysis. RESULTS: Overall prevalence of vaginal infections was 56.9% (157/276); 5.4% (15/276) of the patients had cervical infection. Using the syndromic approach, 51% of patients were correctly managed for Trichomonas vaginalis (TV)/Gardnerella vaginalis (GV); 61% for Candida albicans (CA) and 54% for Chlamydia trachomatis (CT)/Neisseria gonorrhoea (NG) infections. Consequently, 31% of patients with TV/GV, 51% with CA and 53% with CT/NG infections would have missed treatment. Further, the kappa value was <0.20, indicating that there was no agreement or only slight agreement between the syndromic approach and laboratory-based diagnosis. CONCLUSION: This study highlights the limitations of the applicability of the WHO syndromic approach in settings with low prevalence of sexually transmitted infections (STIs) and calls for affordable and accurate rapid tests for STIs.

[Sexual abuse in Ziguinchor, Senegal: epidemiology and management]. / Abus sexuels dans une zone reculée du seud du Sénégal: épidemiologie et prise en charge.

AIMS: To determine the frequency of sexual abuse, establish the demographic profile and to evaluate the care of victims of sexual abuse in Ziguinchor. METHODS: That is a retrospective, descriptive study from February 1, 2008 to August 31, 2010, including all patients received in the Department of Gynecology and Obstetrics, Ziguinchor Regional hospital for sexual abuse. For each patient, data analyzed were sociodemographic data, characteristics of aggression, clinical implications and psychological support. The data were entered and analyzed using the Excel 2003 version. RESULTS: 50 cases of sexual abuse were collected on 4950 patients, a prevalence of 1%. The average age of victims was 13 years (range: 3 to 23 years). The abuse took place in the day in 60% of cases. The location was familiar to victims in 70% of cases. The notion of penetrative genital contact was reported in 74% of victims. Physical force or a weapon was used in 34% of cases. The offender was 30 years old in 86% and operated alone in 92% of cases. Half of the victims had consulted in the first 24 hours. Genital trauma was found in 82% of victims. Feelings of fear, shame, or anger was observed in 64% of patients. Antibiotic was prescribed in two-thirds of the victims as postexposure prophylaxis for HIV was performed in only five patients. Emergency contraception was prescribed in 34% of victims. Six pregnancies were recorded. Six patients had developed complications such as depressive syndrome, hysteria with severe epileptiform seizures, mood disorder and psychosis. A proportion of 26% of victims did not consider it necessary to have recourse to justice. CONCLUSION: The management of a victim of sexual abuse should not stop at a forensic evaluation. We must therefore endeavor to provide a solution to three important consultation which are medical care, legal and emotional.

[Impact of AQUASOU: a practice-based research program at the Rufisque Health Centre, Senegal]. / Impact d'AQUASOU: un programme de recherche-action au Centre de Santé de Rufisque, Sénégal.

INTRODUCTION: Due to the inadequacy of preventive strategies to reduce maternal and neonatal mortality, the current priority concerns emergency obstetric and neonatal care, as defined in the Improvement of the Quality and Access to Emergency Obstetric Healthcare programme (AQUASOU). The objective of this study was to assess the impact of the AQUASOU programme on improved availability and quality of healthcare in the Rufisque Health District in Senegal. METHODOLOGY: We conducted a qualitative and operational descriptive study evaluating the activities of the AQUASOU programme between May 2004 and December 2007: observation of Prenatal Consultations, supervision of emergency care, organization of "mirror meetings" and medical evacuation audits. The periods before and after setting-up of the programme were compared. RESULTS: These various activities had a real impact on indicators of accessibility and availability of healthcare. A consultation framework based on the principle of feedback control and a "practice review" approach allowed an improvement of the quality of care. The number of deliveries increased by 60%. The annual surgical activity was increased sevenfold and the number of evacuations to more specialised structures was decreased (0.4% versus 9.6%), while evacuations admitted to the local structure increased. The maternal mortality rate decreased from 656 to 435 per 100,000 live births. The stillbirth rate decreased from 51 to 56 per thousand. The leading causes of death were bleeding complications (mortality of 3.7%) and paroxysmal complications of hypertension (mortality of 2.7%).

[Unadjusted and customized fetal growth curves: a comparative study in a sub-Saharan population]. / Courbes de croissance fœtale non ajustées et personnalisées: une étude comparative dans une population du Sud du Sahara.

The purpose of this study was to compare the unadjusted EPOPé M0 curve with the customized Gardosi curve in the diagnosis of small-for-gestational-age (SGA) fetuses in a sub-Saharan population. We compared the Gardosi et al. and EPOPé M0 classifications. Classification differences were analyzed according to patient characteristics and obstetric conditions. Data collected from FileMaker software were analyzed using SPSS 20.0 and R Studio software. The statistical tests were carried out according to applicability conditions. Alpha risk was set at 0.05. The Gardosi curve showed that the rate of SGA newborns was higher (31.4% versus 28.9%) and did not differ between overweight and normal-weight women. The rate of severe SGA in preterm infants was also higher (23.6 versus 19.7%). Diseases were more frequent in newborns classified as severe SGA by the customized growth curve. The customized curve is recommended for the sub-Saharan Africa population.

[Sexuality in postmenopausal women in sub-Saharan Africa: example from Senegal]. / Sexualité des femmes ménopausées en Afrique sub-saharienne: exemple du Sénégal.

INTRODUCTION: In Africa, sex life after menopause remains an under-explored topic due to the fact that it is a taboo. This study aims to evaluate the quality of couple's sex life during menopause. METHODS: We conducted a cross-sectional survey of a representative sample of 320 postmenopausal women. The inclusion criteria were natural menopause. Patients who had experienced early or iatrogenic menopause were excluded. Investigation form was divided into 4 sections: social and cultural characteristics, clinical data, psycho-sexual data and therapeutic data. Comparison of proportions and chi-squared test with a significance threshold of less than 0.05 were used. RESULTS: The average age of women was 60 years; the average age of onset of menopause was 48 years and the age of the menopause was 11.3 years. All woman suffered from climacteric syndrome. Hot flushes occured in 85.9% of women, vaginal dryness in 62.8% and urinary disorders in 52.5%. Only married women reported having sex with their partner (62.1%). Women had sex occasionally in 68.9% of cases, while 18.1% of women reported no sexual activity. Decreased sexual activity was due to partner's erectile dysfunction (62% of couples) and the lack of sexual desire (83.5% of women). Lack of sexual appetite and orgasm were also reported in 92% and 100% of cases. However, 93.5% of married women thought their life was bearable. CONCLUSION: Marital status, dyspareunia, vaginal dryness and partner's erectile dysfunction have a significant impact on sexuality of menopausal women in Senegal.

Prevalence and Risk Factors of Lower Reproductive Tract Infections in Symptomatic Women in Dakar, Senegal.

BACKGROUND: Lower reproductive tract infections in women are important causes of morbidity but can also lead to complications and sequelae. This study aimed to establish the prevalence and risk factors of lower genital tract infections among women of reproductive age in Dakar (Senegal). METHODS: This was a prospective study conducted in 6 maternity hospitals from July to November 2015. Participants ranged in age from 18 to 49 years and presented at health facilities with signs and symptoms of genital infection. Consenting individuals who met the inclusion criteria were recruited for the study. RESULTS: During the reporting period, 276 patients were enrolled. According to the laboratory results, the prevalence of any genital infection was 69.6% (192 of 276). The most common vaginal infections were bacterial vaginosis (39.5%) and vaginal candidiasis (29%), with the third most common cause, trichomoniasis, trailing behind in terms of prevalence (2.5%). Among the microorganisms responsible for cervical infections, Ureaplasma urealyticum was the most frequent (27.5%), followed by Mycoplasma hominis (14.5%), Chlamydia trachomatis (4.7%), and Neisseria gonorrhoeae (1.1%). Multivariate analysis showed that young women and women with low levels of education were at increased risk for vaginal/cervical infections. CONCLUSIONS: This study revealed a high prevalence of bacterial vaginosis and vaginal candidiasis and suggests that health care providers should increase awareness and communication to improve vaginal hygiene practices. If infection with Trichomonas vaginalis, C trachomatis or N gonorrhoeae is suspected, we also recommend systematically performing laboratory diagnostic confirmation.

[Pregnancy and delivery in patients with a personal history of cesarean section in Dakar: epidemiological, clinical, therapeutic and prognostic aspects]. / Grossesse et accouchement des patientes ayant un antécédent de césarienne à Dakar: aspects épidémio-cliniques thérapeutiques et pronostiques.

The aim of our study was to determine hospitalization rate for vaginal birth after cesarean section in Pikine, to evaluate the quality of the management of pregnant women with previous cesarean section and to determine prognostic factors of the outcome of a trial of scar. We conducted a retrospective study based on medical records and operational protocols of patients who underwent vaginal birth after cesarean section over the period 1 January 2010 - 31 December 2011. We analyzed socio-demographic data, pregnancy follow-up, therapeutic modalities and prognosis. Data were collected and analyzed using Microsoft Office Excel 2007 software and SPSS software 17.0. The frequency of vaginal births after cesarean section was 9.6%. The average age of our patients was 29.4 years. Primiparous women accounted for 54%. Short spacing interval between births was found in 52.6% of cases. Based on the number of cesarean sections, the breakdown was as follows: patients with a history of one previous cesarean section (79.8%), patients with a history of two previous caesarean sections (17.9%) and patients with a history of three previous caesarean sections (2.3%). The number of antenatal consultations performed was greater than or equal to 3 in 79.8% of cases. Patients undergoing evacuation accounted for 54.2% and they were already in labor at the time of admission in 81.7% of cases. Trial of scar was authorized in 177 patients (34.3%) and, at the end of this test, 147 patients (83%) had vaginal birth, of whom 21.7% by vacuum extraction. Cesarean section was performed in 71.4% of cases with 245 emergency cesarean sections and 93 scheduled cesarean sections. A history of vaginal birth was a determining factor in normal delivery (p = 0.0001). There was also a significant relationship between mode of admission and decision to perform a cesarean section (p = 0.0001). Maternal mortality was 0.4%. Perinatal mortality rate was 28.2‰ of live births. We are witnessing a dramatic increase of deliveries after cesarean section in our SONUC Health Centre. The quality of management should be enhanced through a better strategy in preparation for delivery. Trial of scar is a procedure to encourage in order to reduce the rate of iterative cesarean sections.

[Benign tumors of the breast in the department of senology at the University Hospital Aristide Le Dantec, Dakar (Senegal)]. / Tumeurs bénignes du sein à l'unité de sénologie du Centre Hospitalier Universitaire Aristide Le Dantec de Dakar (Sénégal).

INTRODUCTION: This study aimed to identify the epidemiological, clinical and therapeutic features of benign tumors of the breast treated in the department of senology at the university hospital Aristide Le Dantec, Dakar. METHODS: We conducted a cross-sectional, descriptive and analytical study of 220 patients treated in the Department of Senology at the University Hospital Aristide Le Dantec, Dakar over the period from 1 January 2008 to 31 December 2013. RESULTS: 220 patients out of 984 consultants had benign tumor of the breast (22.5%). Benign tumors of the breast accounted for 58.2% of tumor pathologies. The average age was 24 years. The age group 11-30 years was the most represented (70%). The quasi-totality of patients were women of childbearing age (95%), 58.6% were nulliparous women. The main reason for consultation was a breast mass in 94.5% of cases. The left side was most often affected (49.5%), especially the upper outer quadrant (41.6%). 145 patients (65.9% of cases) underwent ultrasound. Cytologic examination showed conjunctival epithelial hyperplasia in almost all cases (96.1%). 44 women underwent histologic examination, which confirmed the histologic nature of the lesions. Fibroadenoma and fibrocystic changes were the most retained diagnoses, accounting for 86.3% and 5.9% respectively. 28 patients (12.7%) underwent lumpectomy, all tumor types were taken together. The majority of patients had follow-up appointments within 3 months, with favorable outcome. CONCLUSION: Benign tumors are very frequent in senology consultations. The recommended diagnostic approach combines the clinico-radio-cytological triad and, in case of doubt or discrepancy, biopsy or surgical resection are essential. Surgery is not always the treatment of choice. This is based on the nature of the tumor.

[Issues involving breast cancer management in Senegal: a cross-sectional study]. / Problématique de la prise en charge des cancers du sein au Sénégal: une approche transversale.

At a time when innovative therapies in breast cancer multiply, poorer countries such as Senegal are still lag far behind in the overall management of this type of cancer. In Senegal, although the treatment of advanced breast cancer is now well codified, survival and morbidity outcomes are still mediocre in view of diagnostic delays and of sometimes expensive and poorly tolerated mutilating treatments become necessary. With respect to advanced cancers, the challenges will lie in building of palliative care centres and in developing multidisciplinary approaches to improve quality of life and to support patients. On the other hand, with respect to preclinical or potentially curable cancers, the challenges are immense given the importance of early detection, localisation and diagnosis (stereotactic or ultrasound guided biopsy) but also of precision surgery and of complete resection (indexing - excision ensuring a margin of healthy tissue and specimen radiograph) while minimizing complications such as those of classic dissection (sentinel lymph node biopsy). Our health structures are not always prepared to achieve these goals. This is a situational analysis of the contextual obstacles that still exist and add a burden on the overall management of breast cancer in Senegal.

Fatal Cases of Gestational Trophoblastic Neoplasia in a National Trophoblastic Disease Reference Center in Dakar Senegal.

OBJECTIVES: The objectives of this study were to analyze deaths after gestational trophoblastic neoplasia and to determine the factors of treatment failure. METHODS: This is a retrospective study in Aristide Le Dantec teaching Hospital in Dakar, Senegal, between 1 January 2006 and 31 December 2014. We took into account socio-epidemiological characteristics of patients, initial diagnosis, time between uterine evacuation and admission, time to onset of gestational trophoblastic neoplasia (GTN), treatment received (deadlines, protocols), difficulties experienced in the diagnosis and the initiation of treatment and survival. RESULTS: In total, 1044 patients were admitted during the study period; 164 cases of GTN were diagnosed (15.7%); and 21 deaths occurred leading to a specific lethality of 12.8%. The average age was 30 years. Almost all patients (n = 18; 85.7%) had low income or no income. Eight out of 21 patients (38.1%) were seen in our department after GTN onset. The mean time to onset of GTN of all patients was 22.1 weeks. For 66.6%, histology was not available; the diagnosis of hydatidiform mole was made on the clinical history and sonographic features and GTN on human chorionic gonadotrophin (hCG) evolution and ultrasound findings. None of the patients had regular chemotherapy due to financial reasons. Patients who died within 3 months after diagnosis had metastatic tumors (7 of 21). All these women had resistance to treatment or progressed after three courses of chemotherapy. Ten of the 12 women with high-risk GTN were not treated with multi-agent chemotherapy (EMA-CO) for purely financial reasons. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: The high incidence and mortality require a profound reorganization of our health system and a high awareness of practitioners to refer to time or to declare all suspected cases of hydatidiform mole or gestational trophoblastic neoplasia.

Distribution of causes of maternal mortality during delivery and post-partum: results of an African multicentre hospital-based study.

OBJECTIVE: To assess the maternal mortality ratio in maternity units of reference hospitals in large west African cities, and to describe the distribution of complications and causes of maternal deaths. STUDY DESIGN: Prospective descriptive study in twelve reference maternities located in three African countries (Benin, Ivory Coast, Senegal). Data (clinical findings at hospital entry, medical history, complications, type of surgery, vital status of the women at discharge) were collected from obstetrical and surgical files and from admission hospital registers. All cases of maternal deaths were systematically reviewed by African and European staff. RESULTS: Of a total of 10,515 women, 1495 presented a major obstetric complication with dystocia or inappropriate management of the labour phase as the leading cause. Eighty-five maternal deaths were reported, giving a global hospital-based maternal mortality ratio of 800/100,000. Hypertensive disorders were involved in 25/85 cases (29%) and post-partum haemorrhage in 13/85 cases (15%). Relatively few cases (14) of major sepsis were reported, leading to three maternal deaths. CONCLUSION: The results of this multicentre study confirm the high rates of maternal mortality in maternity units of reference hospitals in large African cities, and in addition to dystocia the contribution of hypertensive disorders and post-partum haemorrhage to maternal deaths.

[Minilaparotomy with a mini-pfannenstiel incision for the early diagnosis of ectopic pregnancy in Africa]. / Intérêt du mini-pfannenstiel dans le diagnostic précoce de la grossesse extra-utérine en milieu africain.

OBJECTIVE: to evaluate the usefulness of an exploratory minilaparotomy under local anaesthesia in cases of suspected ectopic pregnancy. PATIENTS AND METHODS: Prospective study of the management of all cases of unruptured suspected ectopic pregnancy at the Gynaecological and Obstetrical Clinic at the Dakar University teaching hospital from 1 January, 2000, to 31 December, 2002. RESULTS: 44 unruptured ectopic pregnancies were recorded. The typical patient had no or few previous deliveries and was 30 years old; 27% of the patients presented risk factors for ectopic pregnancy. The principal motive for consultation was abnormal menstruation and pelvic pain; however, these symptoms together with a lateral uterine mass appeared in only 29.5% of the cases. Ultrasound examination was performed systematically and beta-HCG assessed for 36.8% of patients. The diagnostic was considered certain in 13.6% of the cases, probable in 36.3% and possible in 50%. Laparotomy was performed when the diagnosis was sure or probable, and an exploratory minilaparotomy was undertaken when the ectopic diagnosis was possible but uncertain. The diagnosis was confirmed in 79. 5% of the cases. The laparotomy failure rate was 18.7%, compared with 27.2% for the exploratory minilaparotomy, but the difference observed was not statistically significant (p=0.80). CONCLUSION: In view of the equipment problems that make beta-HCG assays and laparoscopy difficult to perform in Africa, the minilaparotomy under local anaesthesia is a useful alternative.

[Maternal Mortality At The Centre De Sante Roi Baudouin (Dakar - Senegal): About 308 Cases]. / Mortalite Maternelle au Centre de Sante Roi Baudouin de (Dakar ­ Senegal): à propos de 308 cas.

OBJECTIVES: - To determine the epidemiologic profile and private clinics of the cases of maternal mortality at the centre de santé Roi Baudouin.- To identify the etiologies of the cases of maternal death at the centre de santé Roi Baudouin; - To determine the assumption of responsibility of the cases of maternal death at the centre de santé Roi Baudouin. MATERIAL AND METHODS: It was about a longitudinal descriptive retrospective study relating to 308 cases of maternal death from January 1998 to December 2005 at the centre de santé Roi Baudouin; de Guédiawaye, in suburbs of Dakar. We had included in the study all the patients died during the time of the gravido-puerperality during the study period. The studied parameters related to the socio-epidemiologic data, the clinical data on the pregnancy and the childbirth, the quality of the assumption of responsibility, the causes of maternal death and the forecast neonatal. The data were analyzed with the software Epi information-version 6. RESULTS: The ratio of maternal death was of 615.8 per 100.000 live births. The Middle Age of the deaths was 28.4 years with extremes of 14 and 52 years. The average gestity was of 4 with extremes of 1 and 25. As for the parity, it was of 3.9 with extremes of 1 and 22. The multipares were the section most concerned, followed first calf cows. A woman on four had made more than 3 antenatal consultations. The majority of our patients were evacuated (53.6%), but only 18.2% of the patients had profited from a medicalized transport. The reasons for evacuation were dominated by the vasculo-renal haemorrhages (49%) and syndromes (19%). The majority of the patients (n=234) had been confined, that is to say 76% of the cases; by natural way (45%) and Caesarean (32%). The patients had died of direct obstetrical causes in 80%, the indirect causes accounted for only 17,5%. The obstetrical causes death were dominated by the abrupto placentae, the haemorrhage of the postpartum and the uterine rupture. The maternal death was associated in more half of the cases of a fetal death (51.3%). The maternal age, the parity, the quality of the antenatal consultations, the hemorrhagic pathology coupled with the way of childbirth influenced occurred of maternal death. CONCLUSION: Maternal mortality remains a major concern at the centre de santé Roi Baudouin. The reduction of this mortality passes by operation correct 24 hours a day hours of the other ONEC centers of the area of Dakar, the availability of blood and its derivatives and the creation of a functional service of intensive care.

OBJECTIFS: - Déterminer le profil épidémiologique et clinique des cas de décès maternel au centre de santé Roi Baudouin.- Identifier les étiologies des cas de décès maternel au centre de santé Roi Baudouin.- Déterminer la prise en charge des cas de décès maternel au centre de santé Roi Baudouin. MATERIEL ET METHODES: Il s'agissait d'une étude rétrospective descriptive longitudinale portant sur 308 cas de décès maternel de janvier 1998 à décembre 2005 au centre de santé Roi Baudouin de Guédiawaye, en banlieue Dakaroise. Nous avions inclus dans l'étude toutes les patientes décédées dans la période de la gravido-puerpéralité durant la période d'étude. Les paramètres étudiés sont co les données socio-épidémiologiques, les données cliniques sur la grossesse et sur l'accouchement, la qualité de la prise en charge, les causes de décès maternel et le pronostic néonatal. Les données ont été analysées avec le logiciel Epi info-version 6. RESULTATS: Le ratio de mortalité maternelle est de 615,8 pour 100.000 naissances vivantes. L'âge moyen des décès est de 28,4 ans avec des extrêmes de 14 et 52 ans. La gestité moyenne est de 4 avec des extrêmes de 1 et 25. Quant à la parité, elle est de 3,9 avec des extrêmes de 1 et 22. Les multipares constituent la tranche la plus concernée, suivies des primipares. Une femme sur quatre a fait plus de 3 consultations prénatales.La majorité de nos patientes ont été évacuée (53 ,6%), mais seules 18,2% des patientes ont bénéficié d'un transport médicalisé. Les motifs d'évacuation sont, les hémorragies (49%) et les syndromes vasculo-rénaux (19%). La majorité des patientes (n=234) ont accouché, soit 76% des cas; par voie naturelle (45%) et par césarienne (32%). 80% des patientes sont décédées de causes obstétricales directes , les causes indirectes ne représentaient que 17,5%. Les causes obstétricales décès étaient dominées par l'hématome rétroplacentaire, l'hémorragie du post-partum et la rupture utérine. Le décès maternel est associé dans plus de la moitié des cas d'une mort fœtale (51,3%). L'âge maternel, la parité, la qualité des consultations prénatales, la pathologie hémorragique couplée à la voie d'accouchement ont influencé influençaient la survenue de décès maternel. CONCLUSION: La mortalité maternelle reste une préoccupation majeure au centre de santé Roi Baudouin. La réduction de cette mortalité passe par le fonctionnement correcte 24 heures sur 24 heures des autres centres de Soins Obstétricaux Néonatals d'Urgence de la région de Dakar, la disponibilité du sang et de ses dérivés et la création d'un service de soins intensifs fonctionnel.

Spontaneous Uterine Rupture of an Unscarred Uterus before Labour.

Uterine rupture is a public health problem in developing countries. When it is spontaneous, it occurs most often during labor in a context of scarred uterus. Uterine rupture during pregnancy is a rare situation. The diagnosis is not always obvious and morbidity and maternal and fetal mortality is still high. We report a case of spontaneous uterine rupture during pregnancy at 35 weeks of an unscarred uterus before labour. This is an exceptional case that we observe for the first time in our unit.

Apport de l'echographie dans le diagnostic de l'engagement de la tete foetale au cours du travail

Objectifs : Evaluer la sensibilite et la specificite de l'echographie transperineale par rapport au toucher vaginal dans le diagnostic d'engagement de la tete foetale au cours du travail.Patientes et Methodes : Etude pilote prospective et descriptive menee a la maternite du CHN de Pikine; durant la periode allant du 01 Mars au 30 Juin 2012. Toute parturiente admise respectant les criteres d'inclusion avait beneficie a la fois d'un examen vaginal et d'une echographie transperineale afin de definir la notion d'engagement. Une distance seuil inferieure ou egale a 60 mm entre le perinee et la tete foetale avait ete retenue comme signe echographique de l'engagement Resultats : L'evaluation conjointe etait realisee chez 55 parturientes. L'age moyen etait de 26 ans; la parite moyenne de 1;47. L'echographie avait permis de poser le diagnostic d'engagement de la presentation avec une sensibilite de 93;1% et une valeur predictive positive de 81;25%. La specificite de cette exploration etait de 76;92% avec une valeur predictive negative de 90;91%. Le toucher vaginal permettait de predire l'accouchement par voie basse dans 96;4% des cas contre 77;2% pour l'echographie. Conclusion : Le toucher vaginal est un parametre subjectif et peut etre limite dans certaines situations (bosse sero-sanguine; oedeme vulvaire) et l'echographie peut s'averer interessante. L'echographie transperineale parait simple et reproductible. Une valeur seuil de 60 mm revet une bonne sensibilite et une bonne valeur predictive negative pour le diagnostic d'engagement. La diffusion de la technique doit aller de pair avec la vulgarisation de l'echographie en salle de travail dans les maternites de notre pays afin de valider cette technique sur un echantillon beaucoup plus significatif

Mortalite maternelle au centre de sante Roi Baudouin de (Dakar - Senegal) : a propos de 308 cas

Objectifs Determiner le profil epidemiologique et clinique des cas de deces maternel au centre de sante Roi Baudouin -Identifier les etiologies des cas de deces maternel au centre de sante Roi Baudouin ; Determiner la prise en charge des cas de deces maternel au centre de sante Roi Baudouin. Materiel et methodes : Il s'agissait d'une etude retrospective descriptive longitudinale portant sur 308 cas de deces maternel de janvier 1998 a decembre 2005 au centre de sante Roi Baudouin de Guediawaye; en banlieue Dakaroise. Nous avions inclus dans l'etude toutes les patientes decedees dans la periode de la gravido puerperalite durant la periode d'etude. Les parametres etudies sont co les donnees socio epidemiologiques; les donnees cli niques sur la grossesse et sur l'accouchement; la qualite de la prise en charge; les causes de deces maternel et le pronostic neonatal. Les donnees ont ete analysees avec le logiciel Epi info version 6. Resultats: Le ratio de mortalite maternelle est de 615;8 pour 100.000 naissances vivantes. L'age moyen des deces est de 28;4 ans avec des extremes de 14 et 52 ans. La gestite moyenne est de 4 avec des extremes de 1 et 25. Quant a la parite; elle est de 3;9 avec des extremes de 1 et 22. Les multipares constituent la tranche la plus concernee; suivies des primipares. Une femme sur quatre a fait plus de 3 consultations prenatales. La majorite de nos patientes ont ete evacuee (53 ;6 ); mais seules 18;2 des patientes ont beneficie d'un transport medicalise. Les motifs d'evacuation sont; les hemorragies (49) et les syndromes vasculo renaux (19). La majorite des patientes (n= 234) ont accouche; soit 76 des cas ; par voie naturelle (45) et par cesarienne (32). 80 des patientes sont decedees de causes obstetricales directes; les causes indirectes ne representaient que 17;5. Les causes obstetricales deces etaient dominees par l'hematome retroplacentaire; l'hemorragie du post partum et la rupture uterine. Le deces maternel est associe dans plus de la moitie des cas d'une mort fotale (51;3 des patientes sont decedees de causes obstetricales directes; les causes indirectes ne representaient que 17;5). L'age maternel; la parite; la qualite des consultations prenatales; la pathologie hemorragique couplee a la voie d'accouchement ont influence influencaient la survenue de deces maternel. Conclusion : La mortalite maternelle reste une preoccupation majeure au centre de sante Roi Baudouin. La reduction de cette mortalite passe par le fonctionnement correcte 24 heures sur 24 heures des autres centres de Soins Obstetricaux Neonatals d'Urgence de la region de Dakar; la disponibilite du sang et de ses derives et la creation d'un service de soins intensifs fonctionne

Decrease of lymphoid dendritic cells in blood from malaria-infected pregnant women.

Activation of dendritic cells (DCs) during malaria is poorly documented and has mainly been studied in rodent models. We conducted studies in Senegal to better understand the relationship between DC subset activation and susceptibility of pregnant women to malaria. For each woman, samples were collected at delivery from peripheral (WB), placental (PB) and cord blood (CB). The ex vivo phenotypes of DCs were assessed using flow cytometry on whole blood. The percentage of total DCs was the same for malaria-infected or non-infected pregnant women, except for PB where a decrease in DCs was observed during infection. Lymphoid dendritic cells (LDC) also decreased in the three blood compartments of infected pregnant women and less differentiated DCs (ldDCs) increased. During infection, Human Leucocyte Antigen DR (HLA-DR) expression decreased on LDCs, myeloid DCs (MDCs) and ldDCs. IL-10 increased in the three blood compartments. These data demonstrate a modulation of DC sub-populations during placental malaria. A decrease in LDCs during placental malaria could trigger major alterations in the immune response and a change in the Th1/Th2 balance. However, elevated IL-10 observed during infection substantiates a normal micro-environment triggering normal production of DCs. The decrease in LDCs could thus be due to their migration towards spleen or other lymphoid organs.