Research
Rupture Prematuree Des Membranes Sur Grossesse A Terme : Prise En Charge, Au Centre Hospitalier Universitaire De Brazzaville
Objective: To describe the management of pregnant woman with premature rupture of membranes at term. Patients and methods: A Cross sectional study conducted during two months. Were included, pregnant women with a gestational age greater than or equal to 37 weeks who presented a Premature Rupture of Membranes (PROM). Those with associated fetal death in utero, were excluded. Results: The frequency of PROM was 4.25% of deliveries; the pregnant mean age was 29.5 years, ranging from 16 to 46 years. Thirty-seven pregnant or 80.4% have performed more than 4 prenatal consultations. Etiological research was unsuccessful in 42 cases (91.3%) At admission, we observed 13 pregnant (28.3%) not in labor. 23 pregnant in labor transition stage. Sixteen pregnant women (34.8%) had meconium. The duration PROM was 1 to 6 hours, with over a third of pregnant women. The Caesarean delivery was the mode of delivery the most common with 27 cases (58.7%). Thirty-two infants (69.6%) born from mothers who experienced rupture of membranes had a rating Apgar in the first minute of 7 to 10; this score was between 4 and 6 in 14 newborns (30.4%). When the Apgar was between 4 and 6 in the first minute, the Fisher test indicates no significant difference between mode of delivery and the color of the amniotic fluid. By cons when the Apgar was between 7 and 10, the difference was significant, and there are 68.2% of vaginal deliveries when the amniotic fluid is clear. For the Apgar score between 7 and10, 100% of vaginal deliveries. Conclusion: In case of PROM in term pregnancy with a favorable Bishop score, we practice a systematic labor induction. If local conditions are unfavorable, a wait of 24 hours is allowed, after which cervix maturation for a labor induction is performed.
Qualite De Vie Et Vcu De La Maladie, Avant Et Apres Hystrectomie Vaginale, Chez Les Femmes Admises Au Centre Hospitalier Universitaire De Brazzaville
Introduction: The disease is a trouble that must be eradicated; vaginal hysterectomy is beneficial to patients for this purpose but can also have a detrimental impact on the quality of life of women. Objective: To explore the impact of the disease on the quality of life before vaginal hysterectomy (VH) of women before and after surgery. Methods: This is a qualitative study, with clinical method during a 12-month period which involved women who underwent vaginal hysterectomy. Women who didn’t consent to participate and had no phone contact were not included. Results: During illness, women's experience was: sexual discomfort 26/40 (65%); genital bleeding 12/40 (30%); 13/40 pelvic pain (32.5%) After surgery, we noted transient dyspareunia 30/40 (75%); secondary headache due to anesthesia 4/40 (10%). The psychological experience before HV, has been dominated by the fear of surgery in all patients, sleep disorders38/40(95%), anxiety 30/40 (75%), shame and difficulty with the sexual intercourse because of prolapsed 26/40 (65%) even impossibility because of the genital bleeding 14/40(35%). The loss of femininity was reported by 26/40 women with uterine prolapsed (65%), the modification of selfesteem 26/40 (65%). If these items have been improved with the HV, by cons, they all lost the reproductive organ. No information was given by women to their families and members of the company prior to surgery. The cessation of symptoms was observed in all cases, although we noted one case of rectal injury (1.25%). as for sexual activity, all couples declared their satisfaction after therapy. Conclusion: The experience of the disease and the tragic perception of vaginal hysterectomy before, were improved significantly after surgery.
Impact Du JeAne Chez Les Parturientes Au Centre Hospitalier Universitaire De Brazzaville
Objective: To seek the impact of fasting on the outcome of labour. Methods: This was a cross-sectional study carried out in consenting parturients who had a singleton pregnancy at term, and who had been fasting for at least 10hours. The fasting was confirmed by appositive ketonuria test. The impact of fasting (attributable risk) was calculated using the Open Epi software. Results: No case of Mendelson syndrome was observed, vomiting in the non fasting parturients was not abundant, (4% of cases RR=0.3); fasting exposes the women 3.75 times more to risk of dynamic dystocia (40% of cases) and 3.5 times more to risk o f acute fe tal distress (18.6% of ca ses). Instrumental vaginal delivery was not significantly more frequent in fasting women (RR=1.5 ; p=0.12) and spontaneous vaginal delivery had a protective effect (RR=0.66 ; p=0.001). On the contrary, cesarean deliveries were significantly more frequent in these parturients (RR=3.7 ; p =0.0006). The impact of fasting on parturients is as follows: for every 100 fasting parturients, 73.3% may present with dynamic dystocia, 71.4% with acute foetal distress and 73.3% stand the risk of having a cesarean delivery. Conclusion: Fasting is detrimental to the outcome of labour and delivery, it is advisable to encourage feeding in parturients.
Algies Pelviennes Aigues De La Femme, Au Centre Hospitalier Universitaire De Brazzaville: Orientation Diagnostique.
The objective of this work was to give a working diagnosis if pelvic pains acute, the woman at University Hospital of Brazzaville. Methods: We carried out a descriptive and prospective study over a period of five months, from 2nd June to 2nd October 2015 in the Obstetrics and Gynecology Unit at CHU Brazzaville. Patients who presented with Acute Pelvic Pain and who gave their consent were included in the study. All those in the third trimester of pregnancy and in the post partum period were excluded. Data was analyzed using Epi info version 3.5.4. software Results: We registered a total of 410 cases of pelvic pain out of the 6345 patients representing 6.4%. Of these, 285 were cases of acute pelvic pain, representing 4.5% of the total consultations in the service. Acute Pelvic Pain was found to occur more often in women who were unemployed 31.5%(26.3-37.1); single 56.1% (50.3-61 .8) ; under educated 61.4%(55.6-66.9) ;had only one current sexual partner 68.8%(62.8-73.6) ; had no notion of contraception 64.2%(58.1-69.7) ; had no past history of dysmenorrhoea 94.3%(91.2-96.6) nor abortion 69.8%(64.3- 74.9) ; whose HIV status was unknown 80.7%(75.8-84.9) ; and who had previously suffered from a genital tract infection. The acute pelvic pain; evolved over 5 days; was of insidious onset 56.6% (52-64.2) ; diffuse 54.3% (48.5-60.1) ; not related to the menstrual cycle 86.6% ( 82.3-90.2); had no irradiations 78.9% (73.9-83.3); was crampy in nature 31.9% (26.7-37.5) ; associated to bleeding 52.6% (46.8-58.3) ; and severe 60%, with a tender abdomen 83.5% and tenderness on mobilization of the uterus 70.5%.A complete blood count 57.5% (51.1-63.1) and pelvic ultrasound 70%, were the tests usually carried out. The etiologies registered were mostly complications of pregnancy 60.6% and upper genital tract infections 13.9%. Conclusion: Acute Pelvic pain is a common presenting complaint in gynecology. The clinical and paraclinical characteristics are related to the etiologies. The most
Prise En Charge Des Hmorragies Du TroisiAme Trimestre De La Grossesse Au Centre Hospitalier Et Universitaire De Brazzaville.
Objective: to Identify différent problems encountered in the Management of bleeding the last trimester of pregnancy Methods: This is a retrospective descriptive study over a period of 12 months. This study involved pregnant women with a minimum term of 28 weeks of gestation, with an antepartum haemorrhage of pregnancy. Those with incomplete data, and none obstetric genital bleeding were not included. Results: The frequency was 1.27% of deliveries of 98 patients, 3% had a poor condition upon admission; they consulted for bleeding (57.1%) and / or to the lumbosacral pelvic pain (33.7%); the birthing work was initiated in 47.9% of cases, 63.3% of fetuses were alive at admission. Bleeding causes were placenta previa (56.1%); the retro-placental hematoma (37.5%), uterine rupture (5.1%), and undetermined causes 3%. Blood transfusion was performed in 16.3% of patients; 80.6% received caesarean section; the hystérorraphie was performed in 5.1% of patients. Maternal prognosis was satisfactory in 83.6% of cases; despite a residual anemia in 73.4% of cases and 11% of infectious complications. The fetal prognosis was grim: Prematurity has affected 39.8% of newborns, with 45.9% of low birth weight and 28.7% of stillbirths costs. Conclusion: The Management of the third trimester bleeding is still mixed, if maternal prognosis seems satisfactory, fetal prognosis is uncertain.
