HIV/AIDS Screening in the African Birthplace (Hospital in Kayes, Mali)

Purpose: The purpose of this study was to determine HIV prevalence among participants admitted to the delivery room and recent birth attendants. Materials and Methods: This was a descriptive, cross-sectional, analytical study, with a prospective collection from February 1, 2018 to January 31, 2019 at fousseyni Daou Hospital in Kayes, Mali. Results: During our study period, we recorded 4269 deliveries. HIV-positive patients known before labour accounted for 0.21%. Four hundred and six participants received counselling/testing in the delivery room;of which 36 refused the test: 8.87% and 370 accepted or 91.13%. Thirteen patients tested positive or 3.51%. The 20 - 35 age group was the most represented at 76.92%. Positive patients tested received ARV treatment in the delivery room in 92.31% of cases;and 1 patient or 7.69% did not receive treatment for refusal. Vaginal delivery was the most common at 77%, with caesarean section 23%. Newborns had a good prognosis in their first weeks of life in 85%;fetal lethality was observed in 15% of newborns including 1 case of fresh stillbirth and 1 case of pediatric deaths for neonatal suffering. Conclusion: Counselling and voluntary HIV/AIDS testing during labour and immediate postpartum can detect many pregnant women who escape screening during antenatal consultations.

Maternal-Fetal Prognosis of Delivery in the Presentation of the Seat at the Kayes Hospital (Mali)

Objective: The purpose of this study was to assess the risk factors associated with seat presentation and to determine the maternal-fetal prognosis of delivery in the presentation of the seat. Materials and methods: This was a descriptive, cross-sectional and analytical case-control study with prospective data collection, from January 1, 2018 to December 31, 2019, a 12-month period at Kayes Hospital, Mali. Results: During our study period we recorded 3820 deliveries, including 120 breos;a frequency of 3.14% of all deliveries. The 20 - 35 age group was the most represented in cases 61.7%. Of the cases 66.7% (n-80) were out of school, we note 75.8% (n-182) of out-of-school controls. Primiparaes were the majority among cases 39.2% (n-47), as were 39.1% of the controls (n-118). The cases had a history of caesarean section at 15% (n-18);13, 3% (n-32). The most common mode of presentation was the 70% decomplete seat. It was mainly the anterior left sacro iliac variety (85.8%). The low pathway was preferred during these deliveries to 70% against 30% of caesarean section of which 28.3% of cases were carried out in an emergency. Several factors such as delivery pathway, mode of presentation, length of expulsion and obstetric manoeuvres used influenced fetal prognosis. Fetal complications were dominated by acute fetal suffering (15.8%), followed by dislocation of the shoulder (0.8%). The most common morbid maternal complications were soft part tears (15 cases or 12.5%) and parietal suppuration (1 case or 0.8%). We did not record any maternal deaths. Conclusion: Our results confirm that childbirth is a risky delivery, and must require careful selection of eligible cases and rigorous management of labour with trained teams. In these circumstances, it seems totally abusive to advocate as a single mode of delivery caesarean section in all presentations of the chair in the primigestes.

Bacteriology of Healthcare-Associated Infections in the Gynecology and Obstetrics Department of CHU Gabriel Touré

Introduction: Healthcare-associated infections (HAIs) are a public health issue. An infection is said to be associated with the care if it occurs during or after the care of a patient, and if it was neither present nor incubation at the beginning of the care. Objective: The purpose of this work was to study the bacteriology of infections associated with obstetric care in the gynecology-obstetrics department of CHU Gabriel Touré. Patients and Methods: This is an epidemiological, descriptive, analytical study conducted in the gynecology-obstetrics department of the CHU Gabriel Touré, from April 11th, 2016 to August 29th, 2016 (5 months). Data collection focused on the clinical and laboratory characteristics of healthcare-associated infections in patients during their hospitalization. Included in the study were any patients hospitalized in the Gynecology and Obstetrics Department who agreed to participate in the study. The criteria used to diagnose the associated infection were those of the Atlanta CDC. Operative wound monitoring was done up to the 30th postoperative day. Results: We have recorded 200 patients, out of whom 138 were operated on and 23 cases of bacterial infection associated with care (11.50%). The average age of the patients was 32.52 years ± 13.36 years against 29.36 years ± 10.28 years for the patients who did not present the infection. Seven point five percent of the evacuated patients had an infection associated with care. The most common types of infection were surgical site infection (60.86%), urinary tract infection (26.08%), endometritis and sepsis with 13.04% each. The isolated organisms were all resistant to Amoxicillin, to Amoxicillin + Clavulanic acid (88.88%) and to Ciprofloxacin (77.77%). The average duration of hospitalization for patients who developed the infection was 14.70 days. The lethality was 1.50%. The average cost of management of patients who developed the surgical site infection was 119,837 FCFA. Conclusion: The bacterial infections associated with the care remain frequent in our service and dominated by the infections of the operating site. Isolated organisms were all resistant to amoxicillin in 88.88% case ciprofloxacin.

The Complications of Cesarean Section at Teaching Hospital Gabriel TOURE, Bamako Mali

Cesarean operation permits to save the mother and fetus. However, in developing countries as ours, complications related to this cesarean are not to be neglected. It constitutes an important cause of maternal and fetal morbidity and mortality. Here we rapport the experience of our structure about the complications of cesarean. Objectives: The objectives of this study were to study the complications the complications of cesarean section at teaching hospital Gabriel TOURE, Bamako Mali. Materials and methods: We have carried out a cross sectional analytic study from January 1st?2003 to December 31st?2013. All the patients who gave birth by cesarean operation in gynecology-obstetric service of teaching hospital Gabriel TOURE were included during this period of study. Descriptive statistics were used, Chi-square test Pearson, and?Cochran Armitage test have?been used to calculate the P-value of trend. We performed multivariate analyses with a high alpha threshold of 10%, and then logistic regression multivariate. Results: We have registered 28,376 deliveries with 9509 cases of cesarean (33.5%) and a complication cesarean rate of 32% (3049/9509). The main risk factors for cesarean operation completions were adolescence primiparity, obesity, the non-realization of antenatal care, evacuations and co-morbidities. Intraoperative complications were dominated by hemorrhage 8.3% and bladder lesion 1.1%, whereas anemia (58.8%) and parietal infection (21.1%) dominated the postoperative complications table. The evacuation (Odds Ratio adjusted (ORa) = 1.96) as well pre-eclampsia/eclampsia?(ORa = 2.34) and the sicle cell disease (ORa = 9.99) were the main influencing factors of material death. Praevia placenta (ORa = 1.75) abruption placenta (ORa = 11.08) and fetal malformation (ORa = 2.21) dominated the influencing factors of perinatal death. Conclusion:?The cesarean complications rates were high in our improvement of the quality of antenatal care.?The reorganization and revitalization of the reference and against reference system will permit to program some cesarean operation to reduce the morbidity related to caesarean.