Socio-Epidemiological Aspects and Prognosis of Unassisted Deliveries Arriving at Fousseyni Daou Hospital in Kayes

Introduction: The World Health Organization estimates that each year more than 20 million women suffer from the after-effects of unattended childbirth, of which 800 women die every day as a result of obstetric complications. Objective: Study the socio-epidemiological aspects and prognosis of unassisted deliveries arriving at the Fousseyni Daou De Kayes hospital. Materials and Methods: This was a descriptive, cross-sectional study with prospective collection, case-control that took place at the maternity ward of the Fousseyni Daou hospital in Kayes, from 1 January to 31 December 2021. Results: The frequency of unattended birth was 4.1%. The 30 - 35 age group was the most represented with 32.5%. In our study 58.1% of cases were out of school, 19.4% were primigestes and 39.4% were multiparous. In our series 60.6% of cases had given birth at home and 39.4% along the way. The majority of cases regretted having given birth without the assistance of qualified personnel in 45.6%. Maternal complications were dominated by perineal lesions in 14.4% of cases, haemorrhage of delivery in 25% of cases, severe anaemia in 30% of cases;16.7% of newborns were in poor condition, 13.6% were fresh stillbirths, 15.6% of newborns had obstetric trauma. The maternal death rate on arrival was 3%. Conclusion: The frequency of unassisted childbirth is high in the Kayes region. Its complications can be serious for both the mother and the newborn.

Vaginal Caesarean Section: A Review of Indications in Mali

Introduction: The vaginal caesarean described since the 19th century remains unknown to many practitioners. The publications available on the subject are rare. The objective of this review is to report the experience of our team in Mali on vaginal cesarean section. Materials and Methods: This is a documentary review of a series of 5 cases on the practice of vaginal caesarean section at the Sominé Dolo Hospital and Reference Health Center of the Sanitary District of Bla in Mali between 2005 and 2022. Results: We performed a vaginal caesarean section on 5 patients in this series. The indications were retroplacental hematoma in 2/5 cases including 1 with a live fetus, eclampsia crisis in 1/5 cases, dystocia on uterine prolapse in 1/5 cases and beating cord prolapse in 1/5 cases. In the 5 cases, the pregnancy was not at term. In 3/5 cases, cesarean section was indicated to save the non-term fetus with a very low possibility of success by classic cesarean section and in 2/5 cases for maternal rescue with fetal death in utero. 2 live newborns were released in satisfactory condition, 1 died after 6 hours of life. Antibiotic therapy was not necessary in the majority of cases. The average length of hospitalization was 3 days. Conclusion: The circumstances of the realization of the vaginal cesarean section in our series of studies remain frequent in the practice of modern obstetrics. The short duration of hospitalization and the low use of antibiotics can contribute to the reduction of the medical cost of caesarean section in low-income countries, such as Mali.

Maternal Deaths in Patients Evacuated to the Fousseyni Daou Hospital in Kayes over a Decade

Introduction: Evacuation refers to the rapid transfer of a patient in an emergency, from one health center to another more equipped and better specialized. The objective of this study was to study maternal mortality in patients evacuated to the gynecology and obstetrics department at the Fousseyni Daou Hospital in Kayes over a period of 10 years. Materials and Methods: This was a descriptive, cross-sectional, retrospective study over nine years from January 1, 2011 to December 31, 2019 and prospective over one year from January 1, 2020 to December 31, 2020 involving all patients or parturients evacuated for obstetrical causes and died in the gynecology-obstetrics department of the Fousseyni Daou Hospital. Confidentiality and anonymity were respected. The processing and analysis of the statistical data was carried out using SPSS 20.0 software. Results: during our study period we identified 38,854 obstetric admissions including 6758 evacuations or 17.4%, among the 6758 cases of obstetric evacuations 284 died, a frequency of 4.2%. The maternal death audit committee of the Fousseyni Daou hospital in Kayes audited 101/284 cases (files) or 35.5% of which 64 maternal deaths (63.4%) were considered inevitable. In our study the 20 - 29 age group was more represented with 38%. 85% of the deceased patients lived in rural areas. In our series, 63.7% of the deceased patients had not had antenatal consultations (NPC). Eclampsia accounted for 26.8% of admissions diagnoses and 30.9% of causes of death. Seventy-two (72%) of deaths occurred postpartum, 15% perpartum and 13% prepartum. Direct obstetric causes were predominant at 65.1%. Conclusion: Indicators of maternal deaths among evacuated patients remain poor in our work. Maternal deaths were driven by socio-economic and cultural factors, but also by factors related to the health system.

Epidemiological Clinical Aspects and Medical Management of Sexual Assault in the Region of Ségou in Mali

Introduction: Sexual assault is an act of a sexual nature perpetrated on another person without their consent. Goal: To describe the epidemio-clinical aspects and the medical management of sexual assault in the Segou region. Methodology: This was a retro-prospective descriptive study from September 2010 to September 2018 on the alleged female victims of sexual assault registered in the Gynecology and Obstetrics departments of the hospital and the sanitary quarters of Ségou. Results: We recorded 107 cases of sexual assault out of 47,729 gynecological consultations, representing a hospital prevalence of 0.22%. The victims were between 10 and 15 years old in 48.59% of the cases. Students were the most represented with 53.27% (57/107) of cases. Genito-genital contact was recorded in 90.65% (97/107) of cases. Vulvo-perineal lesions were present in 44.86% (48/107) of survivors. Hymenial deflowering was the most frequent traumatic genital lesion accounting for 43.70% (21/48) of old cases and 27.00% (13/48) of recent cases. Sexual assault was committed by a single individual in 60.75% (65/107) of cases and by a friend of the victim in 21.5% (23/107) of cases. The survivors had consulted within 24 hours of the sexual assault in 53.27% (57/107) of the cases, the treatment was medical in 68.22% (73/107) and medical-surgical in 4.7% (5/107), post-exposure prophylaxis to the Human Immunodeficiency Virus (HIV) was performed in only 26.16% (28/107) of survivors. Conclusion: Sexual assault remains a concern although its frequency is low. This scourge mainly affects children and adolescents, and the lesions are mainly genitals.