Clinical outcomes of two early postpartum IUD insertion programs in Africa.

Postpartum IUD insertion programs are new to Africa and few have been carefully evaluated. Also, data on the clinical outcomes of postpartum IUD insertions using the Copper T 380A IUD are sparse. Therefore, we conducted a study to evaluate introductory postpartum IUD programs using the Copper T 380A IUD in Kenya and Mali. Postpartum IUD acceptors in Kenya (n = 224) and Mali (n = 110) were interviewed at baseline and at 1, 3, amd 6 months after delivery. We compared expulsion, medical removal, and discontinuation rates by insertion characteristics in each country. Six-month cumulative expulsion rates were lower for immediate insertions (those within 10 minutes of placental delivery) than for late insertions (generally between 10 minutes and 72 hours after placental delivery) in both Kenya (0.01 vs 0.05) and Mali (0.15 vs 0.27). Medical removals occurred in 1% and 7% of Kenyan and Malian acceptors, respectively, while pelvic infections were rare in both countries (< or = 2%). Differences in 6-month cumulative discontinuation rates between immediate and late insertions were not significant in either Kenya (0.05 vs 0.07) or in Mali (0.24 vs 0.32). This study suggests that postpartum IUD insertions can be performed safely with acceptable expulsion rates in African settings. Previous studies of other IUDs showed that expulsion rates are lower for immediate insertions compared with late postpartum insertions. This study suggests that these findings can be extended to the Copper T 380A IUD.

[Apropos of 77 cases of cervical cerclage in pregnant patients. Prospective study over a period of 1 year]. / A propos de 77 cas de cerclage du col effectué chez des patientes enceintes. Etude prospective sur une période d'un an.

This report covers cercling 77 cervices because of cervico-isthmic stretching. The frequency of this pathology is about 1%, 25% of cervico-isthmic stretching is of traumatic origin (above all I.V.G.). Over 72% of deliveries took place when due: 19.4% were premature and about 8% aborted. Six (6) deliveries were by caesarean, 3 of them because of cervical dystocy.

[Apropos of 507 pregnancies and twin deliveries in the district of Bamako]. / A propos de 507 grossesses et accouchements gémellaires dans le district de Bamako.

This report covers study on pregnancy and delivery of 507 sets of twins: pregnancy involving twins accounts for 1.52%. in over 60% of cases, twins are diagnosed during the last 3 months, 34% by the clinic, 38% by echography and 26% by X-ray over 55% of these patients have undergone no prenatal examination over 91% of these patients had normal deliveries: over 8% had caesarean operations over 41% of deliveries were premature perinatal mortality was 150%, that of the second twin (J2) being 3 times higher than that of the first (JI) 25% of the deliveries were accompanied by haemorrhage of which 8 cases resulted in the mother's death.

[Uterine rupture during labor. Apropos of 21 cases observed at the gynecology-obstetric department of the National Hospital of Point-G]. / Les ruptures utérines au cours du travail. A propos de 21 cas observés au service de gynécologie-obstétrique de l'Hôpital National du Point-G.

Among accidents likely to complicate pregnancy, and in particular delivery, a ruptured uterus is considered serious. The foetus often dies, and the life of the mother is threatened: treatment has serious after effects on fecundity. This study covers certain aspects of uterus rupture crisis in a highly risk delivery specialization unit. The special purpose of the unit explains the high proportion of ruptures. The special purpose of the unit explains the high proportion of ruptures (11.5%). High multiparity and the lack of insufficiency of supervision during pregnancy and delivery constitute the greatest factors of risk.

[Socio-demographic and prognostic aspects of unfollowed pregnancies of patients admitted in the Department of Gynaecology-Obstetric of Gabriel Toure Hospital]. / Aspects socio-demographiques et pronostic des grossesses non suivies chez les patientes admises dans le Service de Gynecologie-Obstetrique de l'Hopital Gabriel Toure.

UNLABELLED: The prenatal followed up permit, on the one hand, to track down risk pregnancies, to appreciate the evolution of pregnancy and its repercussion on the maternal state, to finally make the prognosis of the childbirth and on the other hand to identify risk pregnancies and to assure a management outside emergency context. They contribute this fact to the meaningful reduction of the maternal mortality. The non followed up pregnancies are characterized by their important maternal and fetal mortality and morbidity. The aim of our survey was to determine the frequency of the unfollowed pregnancies, to describe the socio demographic profile of the women and to determine the prognosis of these pregnancies. MATERIAL AND METHODS: Our survey had for setting the service of Gynecology and obstetrics of Gabriel Touré hospital. Center of cares, research and formation, this service that is 3rd level in the sanitary pyramid in Mali, receives emergencies from other motherhoods of lower level. Were include in this survey, women who delivered in the service and hadn't done any prenatal consultation. Criterias of non inclusion were next one: women having done at least a prenatal consultation, women having delivered in another sanitary structure, all cases of non assisted childbirths, women whose gestational age is lower to 28 weeks and/or fetal weight lower than 500 grams. Every case has been matched to a witness (consistent woman who has been followed and delivered in the service) according to criterias of age and parity. The statistical tests used to study associations between variables are the chi2 with a significativity doorstep of P = 0.05 and Odd ratio (OR). RESULTS: We recorded 2173 childbirths and 286 non followed pregnancies been 13.16% of frequency. The middle age of our patient was 23 years with extremes of 16 and 44 years, nullipareses represented 25.9% of cases. The domestic helps were more numerous in the group of cases with 4.9% against 0.3% in the witness group (P = 0.0006, OR = 14.6; IC [2.01, 30.05]). The maternal prognosis is marked by 2.1% of death (P = 0.013). Fetal prognosis is bad with 10.9% of child stillborn (P = 0.0007; OR = 3.19) and 21.5% of morbid APGAR. CONCLUSION: The absence of prenatal consultation is associated to a height maternal and fetal mortality and morbidity.

[Association of extrauterine and intrauterine pregnancy: 3 cases]. / Association grossesse extra uterine et intra uterine: a propos de 3 cas.

Extra uterine pregnancy (GEU) constitutes, by its frequency a problem of public health, by its gravity an obstetric emergency and a problem of fertility for the woman. It represents the chief reason of maternal death during the first quarter of pregnancy. The association of extra-uterine and intra-uterine pregnancy is a particular case of twin pregnancy said ditopic. It is rare, but non exceptional. The authors bring three cases to remind us of its existence.