The Place of Blood Transfusion in the Management of Obstetric Emergencies in the Gynaecology and Obstetrics Department of the Reference Health Center of Fana (Mali)

This is a prospective and descriptive study carried out at the gynecology and obstetrics department of the reference health center of Fana from 01 May 2019 to 30 November or 7 months. The main objective was to study the role of blood transfusion in the management of obstetric emergencies. During the study period we recorded 434 cases of obstetric emergencies of which 116 cases required an emergency blood transfusion or 26.73%. The most frequently found indications for blood transfusion are hemorrhages of the immediate postpartum 46.6% followed by severe malaria on pregnancy 27.6%. Blood remains the most prescribed and available Labile blood product in the department. Maternal prognosis was improved in 92.2%.

The Effect of Human Immunodeficiency Virus-1 Infection on Low Birth Weight, Mother to Child HIV Transmission and Infants’ Death in African Area

Background: It is yet a controversy subject whether low birth weight and infant death are associated to human immunodeficiency virus-1 infection. Objective: To appreciate association between low birth weights, mother to child HIV transmission and infant mortality in HIV-1 infected pregnant women delivering between 2011 and 2016. Materials: We conducted 6 years cohort study in urban Mali. Outcome included preterm delivery, small for gestational age, infant survival status and HIV transmission. Comparison concerned women clinical WHO stage, mother viro-immunological status, and newborn anthropometric parameters. Results: HIV-1 infected women who delivered low birth weight newborn were 20.9% (111/531) versus 16.5% (1910/11.546) in HIV negative patients (p = 0.016). CD4 T cell counts low than 350 T cells count were strongly associated to LBW (p = 0.000;RR = 3.03;95% CI [1.89 - 3.16]). There is no significant association between ART that was initiated during pregnancy (p = 0.061, RR = 0.02;CI 95% (1.02 - 1.99)) or during delivery (p = 0.571;RR = 1.01;CI 95% (0.10 - 3.02)) and LBW delivery. In multivariate analysis ART regimens containing protease inhibitor (PI) were lone regimens associated with LBW ((p = 0.030;RR = 1.001;95% confidence interval [1.28 - 3.80]). Very low birth weight was statistically associated to women HIV infection (adjusted relative risk, 2.02;p = 0.000;95% confidence interval (2.17 - 4.10)). There is no significant difference between mother to child HIV transmission rate in the two HIV-infected pregnant women (10 infected children in group 2: MTCT rate 4.5%) and 3 infected children in group 1 (MTCT rate: 2.7%) (p = 0.56;RR, 0.59;CI 95% (0.18 - 4.39)). In multivariate analysis, LBW was associated with infant death (p = 0.001;RR = 2.04;CI 95% [1.04 - 5.05]). The median weight of infant at the moment of death in group 1 was 851 g (IQR: 520 - 1833 g). Significant relationship was found between infant death among LBW newborn with mother WHO stage 2 (p = 0.004;adjusted RR = 3.22;CI 95% [2.25 - 6.00]), CD4 T cells count 3 (p = 0.005;RR = 2.81;CI 95% [1.20 - 4.11]), PI regimens (p = 0.030;RR = 1.00;CI 95% [1.28 - 3.80]). Conclusion: We confirm increased risk of low birth weight and mother HIV-1 infection and we identified strongest association between mortality in infant born to HIV-1 infected mother and LBW.

Pregnancies without Prenatal Care in the Health District of Commune V in Bamako: Obstetrical Prognosis

Summary: We attempted to determine the obstetric prognosis of women without antenatal care in the Health District of Commune V of Bamako, Mali. Materials and Methods: We undertook this retrospective case-control study from January 1 to March 31, 2017. Of all women having given birth to during this period in this district, we compared characteristics and obstetric outcomes between women without antenatal care (study group) vs. those with antenatal care (age/parity matched control). Results: 13.8% of women were without antenatal care (23.45 ± 9.56 years of age: 13 - 42). Study group (without antenatal care), compared with control, was significantly more likely to be household helpers (OR = 2.5 [2.0 - 3.4]) and single (OR = 2.3 [1.8 - 2.8]). Study group women were more significantly likely to have the following poor obstetric outcomes: premature rupture of the membranes, post-maturity, low birth weight, hypertensive disorders of pregnancy, uterine rupture, fetal death, anemia, fetal malposition, cesarean section, postpartum hemorrhage, puerperal infection and maternal death. Study group showed a higher risk of early neonatal death, low Apgar score, and transfer to Neonatology institute. Conclusion: In accordance with the previous reports in any other countries, no prenatal checkup causes higher poor outcome of both mothers and infants/neonates also in this area.

Prognosis of Pregnancy and Childbirth in Heart Operated Patients: Experience in a 3 Referral Hospital in Mali, Case of the Gabriel University Hospital in Bamako

Introduction: In sub-Saharan Africa and Mali, young women who have had heart surgery want to become pregnant. The occurrence of pregnancy in these women who have had heart surgery is becoming more and more frequent in our country because of the persistence of acute rheumatoid arthritis (RAA) and especially the increasingly easy access to heart surgery. General Objective: To study the evolution of pregnancy and the prognosis of childbirth in women who have undergone heart surgery. Methodology: This was a retrospective and descriptive study that took place over a period of five (5) years in the gynecology-obstetrics department of University Teaching Hospital (UTH) Gabriel Touré and the cardiology department of UTH Luxembourg. Was included in the study any pregnant woman admitted to the gynecology-obstetrics department of UTH Gabriel Touré and having a history of heart surgery. The variables studied were the socio-demographic characteristics, the type of heart disease, the management, the evolution of the pregnancy and the prognosis. Data was typed on word processor, Excel and analyzed on Epi info and SPSS. The Chi square or Fisher exact test (for the number < to 5) and the relative risk (RR) with confidence interval (CI) to 95% were calculated. P was considered as significant if <0.05. Results: Of the 13,388 pregnant women admitted to the gynecology/obstetrics department of UTH Gabriel Touré, 20 pregnant women had a history of heart surgery (1.49‰). The average age was 26 years old. The main cardiac pathology was valvular heart disease supported in 80.00% by the placement of a prosthesis. During pregnancy follow-up, 55% of pregnant women were on Anti-Vitamin K (AVK). In 95.00% of cases, heart disease was asymptomatic. We reported a case (5.00%) of iterative cardiac decompensation, in which cardiac ultrasound found a very arrhythmic heart, grade III mitral leak, and massive aortic leak. We did not find any case of prosthetic thrombosis. The abortion rate was 5.00%. The caesarean section rate was 31.60% and the instrumental extraction rate (forceps) was 23.10%. Newborns had a normal birth weight (68.40%), and were hypotrophic (15.80%) and premature (15.80%). In pregnant women on AVK, we reported 2 cases of fetal deaths in utero (10.00%). Conclusion: Surgical treatment of operable heart disease is a real prophylaxis for gravidocardiac accidents. Pregnancy can be well tolerated in patients who underwent heart surgery with artificial heart valves.

Menstrual Hygiene Management in School Setting in Two Secondary Schools in the Bamako District, Case of the School “La Chaine Grise” and the School Cheick Modibo Diarra

This study on Menstrual Hygiene Management (MHM) was carried out in two secondary schools in the Bamako district, “Chaine Grise” and “Cheick Modibo Diarra” located respectively on the right bank and the left bank depending on the geographic position of the Niger river. This work took place over a period of 6 months from January 2019 to June 2019. The objective of this study was to study menstrual hygiene management in school?setting for girls aged 16 to 18 in two secondary schools in Bamako. It was a transversal and qualitative description. The study population consists of girls aged 16 to 18 years enrolled in one of the selected secondary schools.?At the end of this study, we arrived at the following results:?*50% of the girls in our study have poor knowledge about menstruation;?*10% of girls miss school at least one day a month during menstruation;?*90% of girls use hygienic cotton to absorb menstrual blood;?*90% of the sources of supply for hygienic products are?mothers.?The unsanitary conditions of the toilets, lack of light and the non-separation of the toilets according to gender guidelines were found in 99% of the cases: *99% of girls say that the poor state of health infrastructures was one of the causes of genital infections linked to poor management of menstrual hygiene;?*lack of water in the toilets (99%). Through these results, we conclude that,?in our context,?menstruation remains a taboo and shameful subject for girls. In addition, some of their menstrual hygiene practices are a real danger to their health.

Study of Cofactors Associated with Precancerous High-Grade Cervical Lesions at the Teaching Hospital Gabriel Touré, 2010 to 2015

Introduction: High grade dysplasia of the cervix has a high incidence and can progress to cervical cancer. The aim was to study cofactors associated with high-grade cervical dysplasia. Methodology: This was a retrospective case-control study without matching. Women with high grade dysplasia were the cases while those with a normal screening test represented the controls. The study took place at the Gabriel Touré University Hospital Center in Bamako. We included 351 cases and 420 controls. The capture and analysis were performed using the SPSS 20 software. A univariate and multivariate logistic regression analysis was performed for the analysis of risk cofactors. The statistical tests used were the odds ratio and its confidence interval and the statistical significance threshold was set at p Results: In univariate analysis, the co-factors statistically significantly associated with the occurrence of high-grade dysplasia were parity 0.6 (0.5 - 0.9), gestational 0.7 (0.5 - 0.9), smoking of the spouse 3.4 (1.1 - 11.3), the non-schooling 1.4 (1.2 - 2.1). In multivariate analysis after adjusting for confounding factors, two co-factors have significantly increased the risk of high-grade dysplasia: lack of schooling 1.4 (1.2 - 2.0) and polygamy 1.5 (1.4 - 2.5). Conclusion: At the end of this study, polygamy and lack of schooling were the main risk factors. The prevention of cervical cancer will go through the education of girls and women as well as communication for behavioral change and social change.