Serum Calcium Ionised Rate and Materno-Perinatal Prognosis in Arterial Hypertension in Pregnancy at the Reference General Hospital of Panzi

Hypertensive disorders of pregnancy are among the leading causes of severe maternal morbidity and mortality, particularly in developing countries. Hypertensive disorders of pregnancy are among the leading causes of severe maternal morbidity and mortality, particularly in developing countries, maternal hypocalcaemia being a factor favouring the onset of arterial hypertension during pregnancy. The aim was to determine the maternal and perinatal prognosis of patients with hypertensive disorders of pregnancy as a function of serum ionised calcium levels. Material and Methods: A cross-sectional analytical study of 114 patients with arterial hypertension during pregnancy or during pregnancy or in the postpartum period at the HGR/Panzi from 1 January 2021 to 30 June 2022, text was entered using Microsoft Office Word 2010 and the tables were analysed using Excel 2010. The data was analysed using SPSS version 20.0 and Stata 14.0. The associations of the variables were calculated using Pearson's chi-square test, with a significance threshold set at a value of p < 0.05. Study of risk factors, Odds ratios and their confidence intervals were estimated in a univariate analysis. The most determining factors were identified by multivariate analysis using the Forward conditional logistic regression model. Results: The mean gestational age was 34.43 ± 4.327 amenorheas weeks, 46.6% of patients had a vaginal delivery, 66.65% of which were indicated for maternal prognosis, maternal complications were associated with maternal hypocalcaemia in 81, 82% (P = 0.043) and an OR = 3.255 (P = 0.0158) threefold risk that the patient presenting with a complication is likely to be in a state of hypocalcaemia at 95% confidence index, and fetal prognosis was not significantly related to maternal calcaemia. Conclusion: Maternal hypocalcaemia is one of the factors that can influence maternal-foetal complications maternal-fetal complications, early management and prevention of this pathology is pathology is important to reduce maternal-fetal morbidity and mortality.

Circadian Rhythm of Childbirths and Maternal and Neonatal Prognosis at the YaoundéCentral Hospital

Background: The circadian variation of childbirths has been described by several authors around the globe. De Graaf showed that hospital childbirths at night were associated with increased perinatal mortality and adverse perinatal outcome. To improve obstetric care, we carried out this study to evaluate the circadian rhythm of childbirths and to assess the outcome following variations in the time of childbirths during the day. Methods: It was a cross-sectional descriptive study at the Yaoundé Central Hospital (YCH), over a two years period. We collected data from files of women who delivered from the 1st of January 2017 to 31st December 2018. We included files of women who delivered at least at 28 weeks of pregnancy. We excluded files of those who delivered by elective caesarean section, those whose hour of delivery was not noted and those who delivered before reaching the hospital. Sociodemographic, obstetrical characteristics, and immediate prognosis were recorded. Data were entered into excel, then analysed with SPSS v23 software. Tools used to appreciate our results were means, median, number, percentage, P, and OR with its 95% confidence interval. The difference in p is significant if p is less than 5%. Results: We analyzed 6041 files bearing the time of birth. Childbirths took place at all hours of the day, but the times of the day where the highest numbers of births were recorded were 10, 11, 12, 13 (that’s 1pm), 14 (that’s 2 pm), 15 (that’s 3 pm), 16 (that’s 4 pm), 17 (that’s 5 pm) and 23 (that’s 11 pm) hours, with respectively 224 (3.7%), 277 (4.6%), 256 (4.2%), 265 (4.4%), 207 (3.4%), 255 (4.2%), 228 (3.8%), 216 (3.6%) and 226 (3.7%) births. The peak of births was at 11 am while the time of day where the lowest number of births was recorded was 6 pm, with 175 (2.9%) births. The mean age of participants was 27.34 ± 6.03 years with extremes of 13 and 49, with 87.6% between 20 to 39 years. Sociodemographic characteristics of participants, prematurity and bleeding during delivery, had no dependence on the time of delivery. Perineal tear, duration of observation, Apgar score of the newborn, birthweight, delivery mode, health personnel who performed the delivery, and episiotomyseemed to be influenced by the time of delivery. Daily shifts were not independently associated with the poor Apgar score (0 - 6) at 5 mins, when adjusted for all other factors (p = 0.109). Conclusion: Childbirths were more frequent between 10 am and 5 pm. The period where episiotomy was most performed is the same as when there was macrosomia childbirth. Tears of the perineum are more frequent between 2 pm and 10 pm. There was no independent association between Daily shifts and poor Apgar score. The poor APGAR score would be more related to low birth weight.

Practice of Obstetrical Hysterectomy at the Sylvanus Olympio University Hospital Center: Indications and Maternal Prognosis

Obstetric hysterectomy is a surgical procedure most often performed in a context of extreme emergency in an obstetric environment. The incidence of obstetric hysterectomy is differently expressed around the world. In the CHU-SO maternity ward, hemorrhagic obstetric emergencies are common. The extreme urgency in which patients are admitted, the insufficiency of the technical platform, associated with the challenge of the availability of blood products, often leads to performing an obstetric hysterectomy for hemostasis. It is responsible for high maternal morbidity and mortality. Since 2000 no study has been carried out on this practice in the service. Objective was to describe the practice of obstetric hysterectomy at the CHU-SO and specifically to determine the prevalence, the prognostic factors to be able to act to reduce maternal mortality. Method: A descriptive, cross-sectional, and analytical study was carried out at the Gynecology-Obstetrics clinic of the CHU-SO;from January 1, 2021, to June 30, 2022. All hysterectomies performed in an obstetric emergency context (during pregnancy, perpartum or postpartum) in the department were included in our study. We did not include cases of obstetric hysterectomies outside the SO hospital or planned non-obstetric hysterectomies. Results: We recorded 75 cases of obstetric hysterectomy and 15,625 deliveries (0.48%). The average age was 32.89 ± 5.93. The age group between 30 and 35 years old was the most affected with a rate of 37.33%. Labor and third trimester hemorrhage were the main reasons for admission, patients were referred in 80% of cases. The average parity was 3.25 ± 1.92 with utmost of 0 and 11. The pauciparous (41.67%) and multiparous (32%) were the most affected. The indications frequently found were uterine atony (44%);uterine rupture (33.33%). Subtotal inter adnexal hysterectomy was performed in 94.67%. General anesthesia practiced in 69%. They were all polytransfuses. Three poor prognostic factors were observed during our study, namely: uterine atony;the state of hemodynamic shock before the operation;lack of blood transfusion. The maternal death rate was 21.33%. Conclusion: Obstetric hysterectomy is a very mutilating and complicated surgical procedure and is still common practice in Africa. The maternal prognosis is still reserved with a very high mortality rate in Togo.

Eclampsia: Epidemiological Aspects and Maternal and Foetal Prognosis at the University Teaching Hospital Centre (Uth) of Bouake

Objective: To determine the epidemiology and maternal-fetal prognosis of eclampsia at Bouaké University Teaching Hospital. Material and Methods: This was a prospective study with descriptive and analytical aims over a period from 01 January 2019 to 31 December 2021. It took place in the obstetrics and gynaecology department of the Bouaké University Teaching Hospital. The inclusion criterion was any seizure in the gravid-puerperal period in the context of preeclampsia. Data were entered and analysed using EPI INFO software version 7.2.2.6. Results: We performed 20,958 deliveries and recorded 241 cases of eclampsia, representing a prevalence of 1.14%. The ages of the participants ranged from 13 to 47 years with a mean age ± SD of 22 ± 7 years. The age group ≤ 19 years represented 45.64% of participants. Housewives accounted for 46.47%, and single women accounted for 54.77% of participants. The average parity ± SD was 1 ± 1.6 with range of 0 to 10, and nulliparous women accounted for 49.8% of participants. Patients who were evacuated accounted for 74.27% of our study population. The majority of eclampsia attacks occurred in the antepartum period (56.84%). The mean gestational age ± SD was 36 ± 3.6 weeks with a range of 24 to 42 weeks. The mode of delivery was caesarean section in 64.7% of cases. Maternal lethality was 7.88%. The factors associated with maternal mortality due to eclampsia were evacuation and parity of less than 3. Maternal morbidity was 16.6%. Neonatal lethality was 18.95%. The factor associated with neonatal death in eclampsia was prematurity. Conclusion: We need to detect and manage preeclampsia early and effectively to reduce the frequency of eclampsia and improve its maternal-foetal prognosis in our context.

Socio-Demographic Factors, Clinical Characteristics and Maternal Prognosis of Hypertensive Disorders in Pregnancy at Panzi General Referral Hospital

Background: Hypertensive disease in pregnancy is an important cause of morbidity, long-term disability, and maternal and neonatal mortality. The aim is to determine the socio-demographic characteristics and maternal prognosis of these women with Hypertension during pregnancy. Material and Method: We conducted a cross-sectional study, we interview patients and after discussion we transcripts in a database in Excel software before analysis with SPSS version 20.0 and Stata 14.0 The qualitative variables have been summarised by the Percentage and the quantitative variables will be summarised by Means and Standard Deviation. The associations of the variables were calculated by Pearson’s chi-square test with a significance level set at a p-value Result: The average age of the patients was 30.33 ± 7.020 years, 92.1% were married, 79.8% lived in urban areas, most of the patients were overweight (43%), 92.1% of them had monofetal pregnancies, 36% were multiparous, 34.2% had a previous history of preeclampsia in pregnancy and 14% were known to have hypertension. Pre-eclampsia was the most frequent form of hypertension in pregnancy with 73.68% of cases and represents 84.8% of severe forms of hypertension in pregnancy, 53.4% of the patients delivered vaginally. Eclampsia was the most frequent complication in our patients with 31.7% frequency and among the socio-demographic parameters, age and body mass index were significantly associated with maternal complications. Conclusion: Maternal age and body mass index are important socio-demographic factors associated with the occurrence of maternal complications in women with hypertensive disorders in pregnancy.

A Case Study on the Impact of Mother-to-Mother Support Groups on Maternal, Infant and Young Child Nutrition and Care Practices in Habaswein and Wajir South Districts of North Eastern Kenya

Only about 25% of babies are exclusively breast fed until six months of age in developing countries though they are at a greater risk of infection and infant mortality. The Global Strategy for Maternal, Infant and Young Child Feeding (MI- YCF) Strategy developed by WHO/UNICEF in 2002 was to revitalize world attention to the impact of feeding practices on the nutritional status, growth, development, health and survival of infants and children. The data for this case study was collected through key informant interviews, observations and review of Save the Children nutrition programme reports and surveys. This information was then organized to produce a detailed description of the maternal, infant and young child nutrition programme in Habaswein and Wajir South districts or sub-counties. The maternal and infant young child nutrition (MIYCN) programme was launched in Habaswein and Wajir South districts in January 2012. The MIYCN programme followed recommendations of a Knowledge, Practice and Coverage (KPC) survey report in July 2012. To date, the programme has formed 48 Mother-to-mother Support Groups (MTMSGs), which are actively promoting the uptake of the recommended MIYCN practices in the community. MIYCN indicators have been markedly improved between July 2011 and February 2013 when surveys were conducted. The uptake of kitchen gardening has picked up significantly at Meri site and some mothers now have a changed attitude towards unskilled home deliveries and are conducting referrals for skilled births. The marked improvements in the performance of MIYCN indicators between July 2011 and February 2013 inWajir South and Habaswein districts can be partly attributed to the MIYCN programme established in January 2012. However, a randomized community trial is still required to provide conclusive results on the impact of care support groups on maternal, infant and young child feeding in this region.

Maternal and infant health in urban and rural areas in Morocco: Analysis of the preliminary results of the National Survey on Population and Family Health (EPSF 2011)

Background: The last Moroccan population and family health survey (EPSF 2011) was carried out between November 2010 and March 2011. The final report and the whole database are not yet accessible while a preliminary report was released early March 2012. The information given so far does not allow for a complete evaluation of the present health situation in Morocco. However, a partial equity analysis can be devoted to the comparison of health indicators in terms of gender and urban-rural gaps. Method: 1) Questionnaires: a household questionnaire dealt with household characteristics, general health, housing condition and anthropometric data for children less than six years of age. A second questionnaire was devoted specifically to ever married women and dealt with their resources, marriage, reproductive health, family planning, AIDS/SIDA, healthcare and nutrition. 2) Data collection: data were collected through the national survey using a three-stage stratified sampling design to select 640 clusters covering the 16 Moroccan regions. A total of 15,577 households were randomly drawn, providing a sample of 75,061 individuals (51.1% females and 48.9% males) for investigation. 3) Analysis: in this short report, we relied only on partial data released by the Ministry of Health in a preliminary report. We used absolute differences and relative ratios to study the evolution of gender and urban-rural gaps on the basis of socioeconomic indicators. Results and Discussion: The Moroccan population seems to be in the last phase of its demographic transition. The total fertility rate decreased from 5.6 children per woman in 1980 to 2.5 in 2011. The mean age of first marriage went from 24 years for men and 17.5 years for women in 1960 to 31.5 years and 26.3 in 2011 for men and women respectively. The age structure is showing a trend of ageing population. Generally, health indicators related to reproductive and women’s health improved noticeably and consequently, maternal and infant mortality also decreased. However, while these achievements are praiseworthy as national averages, they remain insufficient in terms of equitable healthcare and access to health services since there is still a long way to go in order to reduce the huge gender gaps and rural-urban disparities. Conclusion: In this short report, we showed that, as averages, health indicators improved noticeably during the last decade but gender inequality and urban-rural disparities are still challenging health decision makers. Moroccan health decision makers are urged to adopt an equitable health strategy, starting by giving access to data for analysis, monitoring and evaluation.

Artificial Induction of Labor with Misoprostol: Maternal and Fetal Prognosis at the Referral Health Center of Commune I of the District of Bamako

Artificial induction of labor (AIL) is the set of techniques intended to induce childbirth in order to reduce maternal-fetal mortality. The aim of this paper was to study the maternal and fetal prognosis after the artificial induction of labor with misoprostol. It was a descriptive prospective study conducted from September 1, 2018 to February 28, 2019 at the maternity unit of the Referral Health Center (RHC) in commune I of Bamako. It was about any pregnant woman at term who had received misoprostol as part of the artificial induction of labor. 102 cases of artificial induction with misoprostol 200 μg were collected out of 3641 deliveries, or a frequency of 2.8%. The age group 28 - 32 years accounted for 56.86% with an average age of 28.8 years. Multiparous represented 54.90% of the number. The history of diabetes and hypertension involved 37.25% of the pregnant women. The main indication was premature rupture of membranes (PRM) (40.2%). Induction was performed between the 37th and 41st week of amenorrhea (69.6%). The trigger index according to BISHOP was greater than 7 (50.98%). Induction was done only with 3/4 of misoprostol tablet 200 μg (43.14%). The average labor time was 7 hours (89.22%). The vaginal birth concerned 92.16% of pregnant women. An APGAR10 was noted in 97.85% of newborns after 05 minutes. AIL with misoprostol was practiced at the Center. The main indication was the premature rupture of the membranes. It improves the maternal and fetal prognosis.

Maternal and Fetal Prognosis of Evacuated Parturients in N’Djamena Mother and Child Hospital (Chad)

Introduction: All pregnant women are at risk of obstetric complications leading to high fetal-maternal mortality and morbidity. The aim of this work was to evaluate the maternal and fetal prognosis of evacuated parturients. Patient and Method: we conducted a prospective analytical survey for four months, from April 1st to July 31st, 2018 in the Maternity of N’Djamena Mother and Child Hospital about the maternal and fetal prognosis of evacuated parturients. Any parturient evacuated or referred for obstetric complications was included. Study parameters were epidemiological, clinical, para-clinical, therapeutic and prognosis order. These parameters were analyzed in the SPSS 18 French version software. Results: Evacuated parturients represented 20% of maternity admissions. The average age was 23.9 years, with extremes ranging from 15 and 43 years. They were uneducated in 72.9%, primiparous in 46.8% of cases. The three delays were dominated by the 1st delay, which represented 34.1% of cases. In this series, 26.3% parturients had presented obstetric complications. Preruptive syndrome was the most common complication with 29.3% cases. Predisposing factors to maternal-fetal complications were low attendance antenatal care, late evacuation and distance travelled. The maternal mortality rate was 3%. Fetal complications were observed in 28.3% of cases and the neonatal mortality rate was 24.6%. Conclusion: The maternal and fetal complications of evacuated parturients are a real public health problem in our regions. The suppression of delays, capacity reinforcement of peripheral maternity and the periodic recycling peripheral centers to recognize obstetric emergencies will contribute to improve the maternal and fetal prognosis of evacuated parturients.

Maternal and Fetal Prognosis of Uterine Rupture in the Health District of Koutiala

Introduction: Uterine rupture is a complete or incomplete non-surgical continuity solution of the wall of the gravid uterus. Indeed, it is a Affection obstetrical condition whose maternal-fetal prognosis is poor in terms of morbidity and mortality. Objectives: To assess the risk factors for uterine rupture in the Koutiala Health District. Methods: This was a descriptive and analytical cross-sectional prospective collection study from January 1, 2019 to December 31, 2019, a 12-month period. In our study, all patients admitted to the maternity ward were included during the study period for which the diagnosis of uterine rupture was made. Results: Out of a total of deliveries, we recorded 27 cases of uterine rupture, a frequency of 1.04%. The average age of our patients was 32 years with extremes of 19 and 45 years. We notice 92.6% of uterine ruptures during the transfer. Almost 3/4 of our parturients were out of school 70.4% versus 11.1% in primary school and 18.5% in secondary school. The majority of patients affected by uterine rupture came from rural areas 85.2%. Only 14.8% were from Koutiala city. The admission time to the Koutiala Reference Health Centre was 2 hours 30 minutes in 50.85% of our patients with extremes of 15 minutes and 4 hours 30 min. The average parity was 6.30 - 3036;large multiparous accounted for 63% in our sample followed by multiparous 18.5%. As for pregnancy follow-up, 100% of the patients had not performed any prenatal consultations. In 85.2% hysterrhaphy was performed intervention and hysterectomy in 14.8%. Maternal prognosis was satisfactory in 96.30% of cases. From the point of view of morbidity: 1 case of bladder-vaginal fistula was recorded and corrected by the bladder survey at home for 15 days. Late complications were the occurrence of anemia in 16 patients who were transfused and 1 case of phlebitis. We recorded 1 maternal death and 25 stillbirths. Conclusion: Uterine rupture is one of the leading causes of maternal and fetal mortality in Mali.

Maternal and Perinatal Prognosis of the Cesarean at Chu Point G, Bamako, Mali

Objective: In light of numerous obstetric evacuations to the Point G University Hospital and taking into account the practice of cesarean section for many years in the service, it seemed necessary to us to make our contribution to the study of cesarean section by putting emphasis on maternal and perinatal prognosis in the Obstetric Gynecology Department of the Point G university hospital. Method and materials: We conducted a retrospective cross-sectional study in the Gynecology and Obstetrics Department of the Point G University Hospital, from January 01, 2018 to December 31, 2018. The Point G University Hospital is a 3rd level center of reference in the field of obstetrics in Mali. There is no neonatal ward. The study included all women who gave birth in the gynecology and obstetrics department during the study period. All prophylactic and emergency Caesarean section records during the period in which management took place in the ward were included. The records of patients who had a prophylactic or emergency cesarean section in other health facilities and non-usable records were not included. Data were collected using a pre-established survey form. The variables analyzed were socio-epidemiological, clinical and prognostic. Data were analyzed using IBM SPSS software version 16.00. The Chi2 test and Fischer’s exact test were used to highlight risk factors. The significance level retained was p < 0.05. Operational definition: Nulliparous: A woman who has never given birth;Primipara: A woman who gave birth once;Pauciparous: A woman who has a number of deliveries between two and three;Multiparous: A woman who has a delivery count of between four and six pregnancies; Large multipara: A woman who has given birth more than six times. Results: We recorded 608 deliveries by cesarean section out of a total of 1573 deliveries, i.e. a rate of 38.6%. The majority of caesarized patients were between 20 and 29 years old or 41.94%, the average age was 26 years old. Out-of-school patients were the most represented, or 44.41%. They were pauciparous in 34.4% of cases. The pregnant majority had performed at least 04 antenatal consultations, or 68.91%. In 74, 51% of the cases the patients carried a pregnancy estimated to term. Cesarean section was performed urgently in 85.36% of cases and eclampsia crisis was the most common maternal indication, or 27.97% among the 379 cases. We recorded 10 maternal deaths or 1.64%. The bleeding disorder was responsible for half of our deaths, or 50%, from retro-placental hematoma. The fetal prognosis was dominated by neonatal distress with 19.08% of cases. We recorded 101 cases of stillbirths, or 16.61%, and 23 cases of early neonatal death, or 3.78%. Our study found a statistically significant relationship between the type of cesarean section and neonatal death with Fisher’s exact test = 27.772, P < 0.0001.

Effect of insulin in combined with Chinese medicine formulae on the serum Mg2+ and visfatin levels, maternal and infant outcome in pregnant women with gestational diabetes mellitus

Objective:To explore the effect of insulin in combined with Chinese medicine formulae on the serum Mg2+ and visfatin levels, maternal and infant outcome in pregnant women with gestational diabetes mellitus (GDM).Methods:A total of 108 pregnant women with GDM who were admitted in our hospital were included in the study and randomized into the observation group (n=55) and the control group (n=53). The patients in the two groups were given diet control, exercise therapy, and subcutaneous injection of insulin. On this basis, the patients in the observation group were given self-made Chinese medicine formulae, continuously for 2 weeks. The blood sugar level, and serum Mg2+ and visfatin (VF) levels before treatment and before delivery in the two groups were detected. The maternal and infant outcome in the two groups was evaluated.Results:The serum HbA1c, FPG, 1 h PBG, 2 h PBG, and VF levels before delivery in the two groups were significantly reduced when compared with before treatment (P<0.05), while the serum Mg2+ level was significantly elevated when compared with before treatment (P<0.05). The improvement of the above indicators before delivery in the observation group was more significant when compared with the control group (P<0.05). The occurrence rate of cesarean section, premature delivery, gestational hypertension, fetal distress, and macrosomia in the observation group was significantly lower than that in the control group (P<0.05).Conclusions:Insulin in combined with self-made Chinese medicine formulae can effectively control the blood sugar level in pregnant women with GDM, and improve the maternal and infant outcome.

The relationship between the electroencephalogram(EEG),head computerized tomography and the prognosis of spasm in infants

Objective To investigate relationship between prognosis of infant spasm and electroencephalogram(EEG) and head CT.Method 47 infants underwent EEG and head CT.Follow up was performed to compare the prognosis during different periods.Result Among 31 infants with abnormal head CT,2 infants were cured,17 were improved and effective rate was 61.3%. Among 16 patients with normal head CT,6 were cured,8 were improved,and effective rate was 87.5%. Among 34 infants with high rhythm disorder,8 were cured,21 were improved,effective rate was 85.29%. For 13 infants with abnormal EEG of other types,no infants were cured,4 were improved,and effective rate was 30.8%.Conclusion Changed head CT not various EEG has no significant effect on prognosis of infant spasm(P >0.05).Prognosis is favorable in infants with high rhythm disorder(P<0.01).

Mental health of mothers and their premature infants for the prevention of child abuse and maltreatment

Birth of preterm infants is a stressful event for their parents, particularly for mothers. The mothers of preterm infants often feel hard to relate their infants because they have separated since their first days after delivery. Long term separation and less attractive, less responsive appearance of preterm infants also make it difficult to build mother-child relationships. In addition, the mothers of preterm infants are likely to have mood disorders such as depression, anxiety, and stress-related disorders. The mothers’ psychiatric illnesses affect the psychosocial development of preterm infants and are often regarded as a risk factor for child abuse and maltreatment in later life. Child abuse and maltreatment are also prevalent among preterm infants than the full term infants. Intervention from the early period of preterm birth is an important issue for both preterm infants and their mothers. Medical and co-medical professionals should pay attention to developmental outcome of preterm as well as psychosocial conditions of their mothers for the improvement of their mental health.

Comparison of three different recombinant hepatitis B vaccines:GeneVac-B,Engerix B and Shanvac B in high risk infants born to HBsAg positive mothers in India

AIM: To evaluate a low cost Indian recombinant hepatitis B vaccine GeneVac-B for its immunogenicity and safety in comparison to Engerix B and Shanvac B vaccine in high risk newborn infants born to hepatitis B surface antigen (HBsAg) positive mothers. METHODS: A total of 158 infants were enrolled in the study. Fifty eight infants were enrolled in the GeneVac-B group while 50 each were included for Engerix B and Shanvac B groups. A three-dose regimen of vaccination; at birth (within 24 h of birth), 1st mo and 6 mo. were adopted with 10 μg dosage administered uniformly in all the three groups. Clinical and immunological parameters were assessed for safety and immunogenicity of the vaccines, in all the enrolled infants. RESULTS: Successful follow up until seven months of age was achieved in 83/ (48/58) for GeneVac-B, 76/ (38/50) and 64/ (32/50) for Engerix B and Shanvac B groups respectively. 100/ seroconversion and seroprotection was achieved in all the three groups of infants. The geometric mean titers of anti-HBs one month after the completion of three dose of vaccination were 90.5, 80.9 and 72.5 mIU/mL in GeneVac-B, Engerix B and Shanvac B vaccine group respectively. Furthermore the level of anti-HBs increases with age ofbabies who were born to HBsAg positive mothers. The GMT values of anti-HBs were 226.7, 193.9 and 173.6 mIU/mL respectively in GeneVac-B, Engerix B and Shanvac B groups one year after the completion of the three doses of vaccine. No systemic reactions were reported in infants during the entire vaccination process of GeneVac-B and the other two vaccines. Clinical safety parameters remained within the normal limits throughout the study period.CONCLUSION: The study concludes that there is no significant difference between the three recombinant hepatitis B vaccines. Administration of these vaccines within 24 h of birth to babies, born to HBsAg positive mothers will reduce the incidence of HBV infection.

Maternal mental disorders in pregnancy and the puerperium and risks to infant health

Prenatal and postnatal period presents the highest prevalence of mental disorders in women's lives and depression is the most frequent one,affecting approximately one in every five mothers.The aggravating factor here is that during this period psychiatric symptoms affect not only women's health and well-being but may also interfere in the infant's intra and extra-uterine development.Although the causes of the relationship between maternal mental disorders and possible risks to a child's health and development remain unknown,it is suspected that these risks may be related to the use of psychotropic drugs during pregnancy,to substance abuse and the mother's lifestyle.Moreover,after delivery,maternal mental disorders may also impair the ties of affection(bonding) with the newborn and the ma-ternal capacity of caring in the post-partum period thus increasing the risk for infant infection and malnutrition,impaired child growth that is expressed in low weight and height for age,and even behavioral problems and vulnerability to presenting mental disorders in adulthood.Generally speaking,research on this theme can be divided into the type of mental disorder analyzed: studies that research minor mental disorders during pregnancy such as depression and anxiety find an association between these maternal disorders and obstetric complications such as prematurity and low birth weight,whereas studies that evaluate severe maternal mental disorders such as schizophrenia and bipolar disorder have found not only an association with general obstetric complications as well as with congenital malformations and perinatal mortality.Therefore,the success of infant growth care programs also depends on the mother's mental well being.Such findings have led to the need for new public policies in the field of maternal-infant care geared toward the population of mothers.However,more research is necessary so as to confirm the association between all factors with greater scientific rigor.

Maternal-Fetal Prognosis of the Prophylactic Cesaarian versus Emergency Cesaarian at the Reference Health Center of Commune V of Bamako District, Mali

Objectives: The goal was to assess the risk factors for emergency cesarean section versus prophylactic caesarean section. Materials and Methods: This was a descriptive analytical cross-sectional study of the Type Cas/Witnesses at the Reference Health Centre of Commune V of the District of Bamako in Mali. The sample consisted of 100 cases for 200 controls (1 case for 2 controls) with retrospective collection of data for the period from January 1 to July 11, 2011 (6 months and 11 days). Results: During the study period, out of a total of 3559 deliveries, we recorded 2,794 vaginal deliveries, 78.50% and 765 caesarean sections or 21.50%. Of the 765ceras, we performed 353 emergency caesarean sections or 46.15% and 412 prophylactic caesarean sections 53.85%. We have selected 100 prophylactic caesarean section files and 200 emergency caesarean section files. The average age of the patients was 27.41 years-5.84 with extreme ages of 14 to 40 years. 100% of our patients (Cas) had performed at least one antenatal consultation compared to 83.5% of the parturients evacuated (Witnesses). The most frequently cited reasons for evacuation were: acute fetal suffering, non-cephalic presentation and excessive uterine height with 30%, 17.5% and 12% respectively. The bulk of the caesarean section indications were dominated by dystocies with 90% in cases compared to 65% in Witnesses, followed by acute fetal suffering with 30% in Witnesses. We recorded 30% perinatal deaths among Witnesses compared to 1% in Cases. We recorded 16 uterine ruptures in the Witnesses among which 2 hysterectomies and 14 hystererraphia. Conclusion: Prophylactic caesarean section improves maternal and perinatal prognosis more than emergency caesarean section.

Relationship between maternal pathology and infant social withdrawal: Analysis of a 268-outpatient population

Objective: Sustained withdrawal is a sign of infant distress and may be determined by extreme conditions like organic pathology or relationship problems. The Alarm Distress Baby Scale is the best instrument to identify withdrawal in infants between 2 and 24 months of age. The aim of this study was to assess the association between infant social withdrawal behavior and maternal pathology in the perinatal period. Method: The target sample of the study was 134 mother-child couples examined at the Policlinico Agostino Gemelli General Pediatric Outpatient Clinic and Psychiatric Outpatient Clinic, in Rome. We analyzed the relationship between withdrawal behavior and psychological and organic prenatal/postnatal pathology, using the Chi Square exact test. Results: When the mother suffers from both organic and psychological pathologies in the perinatal period, the risk of withdrawal is increased: the probability of infant withdrawal behavior is increased by maternal organic postnatal pathology by 14 times, by maternal psychological postnatal pathology by 9 times, and by maternal psychological postnatal depression, measured by Edinburgh Postnatal Depression Scale, by almost 4 times. Conclusion: Increased or sustained withdrawal reactions can be observed in unsatisfactory mother-child interaction. Maternal risk factors should be strictly considered in the pediatric clinical evaluation.

Obstetrical Complications of Female Genital Mutilation: Management Maternal-Fetal Medical Care and Prognosis, Obstetrical Gynecology Regional Hospital, Unit of N'zérékoré

Introduction: Female Genital Mutilation (FGM) is a public health problem. There are 100 to 140 million girls and women who suffer every year in the world [1]. The aim of this study is to improve the medical care and reduce complications of FGM at the Regionalhospital of N’zérékoré, to determine their frequency, and to evaluate the maternal-fetalprognosis. Methods: The study was conducted at the Regional Hospital of N’zérékoré. This was a cross-sectional, descriptive and analytic study of 6 months, from 1 September 2016 to 28 February 2017, including all pregnant women admitted for childbirth who had a complication of female genital mutilation. Results: A total of 1295 women gave birth in the service, of which 1204 women were women with female genital mutilation. Given a frequency of 92.97%, of these 1204 mutilated women, 223 presented obstetrical complications during their delivery, a proportion of 17.22%. They were mostly young patients, mostly housewives who were not in school. Type II FGM was the most common (53.06%). Obstetric complications were dominated by complicated perinatal tears (54.08%), and hemorrhages (40.81%). The catch was dominated by perineorrhaphy. Conclusion: The frequency of FGM was 92.97% and that of their obstetric complications 17.22%. Most were house-wives, not in school. There was FGM type II. The abandonment of FGM would reduce maternal and perinatal morbidity and mortality.

Efficacy of Danshen Injection Combined with Phosphocreatine Disodium in Treating Frequent Premature Contractions during Pregnancy and Its Effects on Maternal and Infant Outcomes

[Objectives]To explore the efficacy of Danshen Injection combined with phosphocreatine disodium in treating frequent premature contractions during pregnancy and its effect on maternal and infant outcomes.[Methods]A total of 200 pregnant women with normal pregnancy and frequent premature contractions who were treated in the outpatient department of internal medicine in Women and Children's Hospital of Hubei Province and Xinzhou District People's Hospital of Wuhan Central Hospital during September 2015 and October 2018 were selected and randomly divided into the control group and observation group,100 cases for each group.The observation group was treated with Danshen Injection combined with phosphocreatine disodium,and the control group was treated with phosphocreatine disodium alone.The course of treatment in both groups was one week.During the treatment,the changes of heart rate,heart rhythm,electrocardiogram and 24-h dynamic electrocardiogram(DCG)of both groups were observed.[Results]After treatment,the clinical efficacy of the observation group was better than that of the control group,and the difference was statistically significant(P<0.01).There were no adverse drug reactions in both groups.However,in the control group,non-sustained ventricular tachycardia(NSVT)was found in 24-h dynamic electrocardiogram(DCG)of 2 pregnant women with premature ventricular contraction.The pregnancy process was smooth,with full-term natural delivery and no fetal malformation.There was no significant difference in gestational age and neonatal weight between the two groups(P>0.05).However,there was a statistically significant difference in Apgar score between the two groups(P<0.05).During the 6-month postpartum follow-up,the mother and child were unharmed,and examination of repeated electrocardiograms showed that the conditions were normal.[Conclusions]Danshen Injection combined with phosphocreatine disodium has better efficacy in the treatment of frequent premature contractions during pregnancy and the maternal and infant outcomes than the treatment with phosphocreatine disodium alone,and it has good safety and can prevent premature contractions from progressing to tachyarrhythmias.