Trauma in Pregnancy at the Yalgado Ouedraogo Teaching Hospital in Ouagadougou,Burkina Faso:Epidemiological,Clinical,Therapeutic and Prognostic Aspect

Objective: To study the epidemiological, clinical, therapeutic and prognostic aspects of trauma in pregnancy at the Yalgado Ouedraogo teaching hospital in Ouagadougou. Patients and Methods: A descriptive retrospective study was done over a period of three years from 1st January 2010 to 31st December 2012. We included in our sample, all pregnant women admitted for trauma in pregnancy and eligible in three clinics: obstetrics/gynecology, orthopedics, general and visceral surgery. Anonymity and confidentiality of collected data were respected. Results: We recorded 224 emergency consultations for trauma in pregnancy out of 26,735 obstetric and gynecological consultations which gave a frequency of 0.8%. The mean age of our patients was 25.9 ± 5 years and mean parity was 1. Housewives accounted for 50% of patients and referrals were the mode of admission in 74.6% of cases. The causes of injury were dominated by road traffic accidents in 82.6% of cases, falls in 9.8% and assault in 7.6%. The mean gestational age of onset of trauma was 26.3 ± 7 weeks amenorrhea. The management was multidisciplinary with a medical component in 99.1% of cases, obstetric component in 13% of cases, a visceral surgery component in 6.7% of cases and an orthopedic component in 4.2% case. Multiple traumas were found in 4 patients. The fetal prognosis showed in the 1st trimester 3 cases of abortion in the 2nd trimester 5 cases of intrauterine fetal death and in the 3rd trimester 10 cases of preterm labor. Conclusion: Traumas during pregnancy are beyond emergencies within multiple causes and requiring a multidisciplinary management. Seen the limited means of support, establishment of a national strategy to prevent trauma in pregnancy will improve the prognosis for mother and child.

Integration of Post Abortion Care Package in the Activity of 56 Health Facilities by the Burkina Faso Society of Obstetricians and Gynecologists (SOGOB)

Introduction: This article is an analysis of post-abortion care in 56 health facilities after their capacity building by the Burkina Faso Society of Obstetricians and Gynecologists (SOGOB). Patients and Methods: In 2012, with funds from Safe Abortion Action Fund, the SOGOB trained care providers and equipped 56 health facilities for post abortion care. Statistical data on the management of incomplete abortions after the capacity building were analyzed. The significance level was set at 0.05. Results: There were 6316 cases of abortion that have been managed in 56 health facilities. The evacuation of the uterine contents for incomplete abortion has been provided to 6167 patients. Manual vacuum aspiration (MVA) and misoprostol were used respectively in 69.4% and 26.9% of cases to evacuate uterine content. Post-treatment complications were 1.8% for MVA and 0.9% for misoprostol (p = 0.004). MVA’s complication rate in the health facilities of the 1st level of care (1.7%) was not different from the third level of care (1.2%) with p = 0.21. A modern method of contraception was provided after abortion to 65.7% of the patients. In addition to the post abortion care, 7.3% of the patients received other reproductive health services. The community was involved in the development process of post abortion care in the facilities of the first level of care. Conclusion: The support of health facilities by SOGOB has provided post abortion care to thousands of women with little complications. Given the good results, an extension to other health facilities is desirable.

Hormonal Contraception and Hypertension at the Department of Obstetrics and Gynecology, Yalgado Ouédraogo Teaching Hospital: Epidemiological, Clinical and Therapeutic Patterns

Context: The use of hormonal contraceptives could lead to a rise in blood pressure with an onset of hypertension. The objective of the study was to describe the epidemiological, clinical and therapeutic patterns of hypertension occurring in women on hormonal contraception. Patients and Methods: A retrospective study was carried out over a period of 5 years. It involved clients on hormonal contraception who developed hypertension during follow-up at the Family Planning Unit of the Yalgado Ouedraogo Teaching Hospital in Burkina Faso. Results: The global frequency of hypertension in clients on hormonal contraception was 1.8%;it varied depending on the type of methods of contraception used;it was 4.2% for clients on oral combined pills, 1% for implant users and 0.97% for women on injectable. The mean age of patients was 35.6 ± 8.4 years. Sixty-seven patients (84.8%) had mild to moderate hypertension. The mean time to onset of hypertension was respectively seventeen (17), thirty six (36) and thirty eight (38) months for patients on OCPs, CIP, and implants. After the discovery of hypertension, the contraception methods have been changed in 75.9% of cases, stopped in 5.2% of cases and the same contraception method was continued in 8.9% of cases. None of the patients who continued the same contraceptive method had obtained a normalization of blood pressure. Blood pressure was normalized in 48.6% of patients who have changed contraceptive methods. The average time of normalization of the blood pressure varied from three to five months, depending on the method that induces the hypertension. Conclusion: Hypertension on hormonal contraception is not uncommon. It is important to assess the risk factors for its occurrence at the initiation of contraception.

Preventive Exchange Blood Transfusion in Pregnant Women with Sickle Cell Disease: Maternal and Perinatal Prognosis in a Country with Limited Resources, Burkina Faso

Context: In pregnant women with sickle cell disease, the management with exchange transfusion could be useful in improving the prognosis of mother and child by reducing the level of hemoglobin S less than 40%. Objective: To analyze the maternal and perinatal outcome during the program of the exchange transfusion in pregnant women with sickle cell disease. Patients and Methods: We conducted a prospective study over a period of 18 months. Pregnant women with a major form of sickle cell disease were included. A manual blood exchange transfusion was performed monthly. We monitored the occurrence of maternal and perinatal morbidity during the follow-up. Results: A total of 42 pregnant women with sickle cell disease were monitored. The frequency of infectious episodes and vaso-occlusive crisis was significantly reduced, respectively from 47.6% and 83.3% before the beginning of the blood exchanges transfusion to 11.9% and 16.7% during blood exchanges transfusion program. All newborns were alive at birth with an Apgar score higher or equal to 7 at the 5th minute. The rate of admission of the newborns at neonatal intensive care unit was 9.3%. Maternal mortality was estimated at 7.1% and there was no early neonatal mortality. Conclusion: Prophylactic exchange transfusion reduces infections and the reoccurrence of vaso-occlusive crisis, which has an impact on perinatal prognosis.