Uterine Rupture: Epidemiological Aspects, Etiologies and Maternal-Fetal Prognosis in the Obstetric Gynecology Department of the Donka CHU Conakry National Hospital, Guinea

Objectives: The objectives of this work were to calculate the frequency of the uterine rupture, to describe the epidemiological profile, to identify the etiologies and to establish the maternal prognosis and foetal. Methodology: It was about a descriptive survey with compilation of the data in two phases: a retrospective spreading on one period of 6 years and the other forecasting of 1 one year achieved to the service of Obstetric Gynecology of the hospital National Donka, Fallen from Conakry, Guinea. Results: We recorded 24.030 childbirths of which 188 cases of uterine rupture either a frequency of 0.78, which represents an uterine rupture for 128 childbirths. The epidemiological profile was the one of a woman of 24 to 28 years (31.91%), housewives (69.14%), without prenatal follow-up (47.87%), big multipare (37.76%) and évacuées (78.78%). The motives of consultation have been dominated by the hémorragie (95.74%). The rupture was of transverse type in the majority of the case (63.82%). The hysterorraphy was the most performed surgical procedure which is 85.10% followed by the total sub hysterectomy in 10.63%. The newborns of birth weight superior or equal to 4000 g represent 25.53%. The maternal morbidity has been dominated by the anemia of the postpartum (60%). We recorded a rate of maternal létalité of 12.76%. The maternal deaths were due to the hemorrhage in 78.57%. The living newborns endured a respiratory distress in 9.57% and those stillborn represent 87.23%. The etiologies of uterine rupture were dominated by fetal-pelvic disproportions 48.93% followed by an iatrogenic uterine rupture 22.33%. Conclusion: The reduction of this uterine rupture rate would pass by the recentered prenatal consultation offered, the one of obstetric cares and complete néonataux of emergency, the discount to level of the beneficiaries of the basic structures so that they can discover the cases in time susceptible to drag a rupture to evacuate better in time and the promptness in the hold in charge since the admission of the emergencies in the structures of superior level.

Dead Fœtale in Utéro: Hospitable Frequency, Etiologies and Maternal Prognosis to the Service of Obstetric Gynecology of the Hospital National Donka, CHU of Conakry, Guinea

Objectives: The objectives of this work were to calculate the frequency of MFIU, to describe the epidemiological profile, to identify the étiologies and to establish the maternal prognosis. Methodology: It was about a prospective survey of analytic type spreading on one period of twelve (12) month achieved to the service of Obstetric Gynecology of the hospital National Donka, FALLEN from Conakry. Results: On 5226 childbirths, we recorded 208 cases of MFIU, either a frequency of 3.98%. The epidemiological profile was the one of a teenager or aged woman (more of 35 ans) with respectively (8.17%) and (7.20%), sans follow-up prénatal (10.41%), nullipare (6.02%), célibataire (7.80%), ménagère (5.02%) and non scolarisée (5.16%). The MFIU occurred in the age group of 32 - 36 SA. L’absence of the MAF was the main motive of consultation 94.23%. All cases of MFIU benefitted from a confirmation scan. The vasculo-renal syndromes and their complications were the main étiologie 43.75%;follow-up of the malaria is 13.94%. The majority of the gestantes were delivered by low way 98.08%. The induction of work has been made mainly to the misoprostol (Cytotec 200 μg) either 81.86% against 10.78% of Syntocinon in drip. The maternal morbidity has especially been dominated especially by the hemorrhages in the case of long length retention and the infections when the membranes are broken either 1.44% against 98.56% of case of good maternal prognosis. No maternal death has been recorded. Conclusion: The prenatal consultation offer recentered and the one of medical correct cares of the vasculo-renal syndromes and the malaria could reduce the cases of death fœtale efficiently in utero.

Aetiological factors of Budd-Chiari syndrome in Algeria

AIM: To study the clinical presentation of Budd-Chiari syndrome(BCS) and identify the aetiologies of this disease in Algeria. METHODS: Patients with BCS, hospitalised in our unit from January 2004 until June 2010 were included and the aetiological factors were assessed. Patients presenting a BCS in the setting of advanced-stage cirrhosis or a liver transplantation were excluded from the study. The diagnosis was established when an obstruction of hepatic venous outflow(thrombosis, stenosis or compression) was demonstrated. We diagnosed myeloproliferative disease(MPD) by bone marrow biopsy and V617 F JAK2 mutation. Anti-phospholipid syndrome(APLS) was detected by the presence of anticardiolipin antibodies, anti-β2 glycoprotein antibodies and Lupus anticoagulant. We also detected paroxysmal nocturnal haemoglobinuria(PNH) by flow cytometry. Celiac disease and Behcet disease were systematically investigated in our patients. Hereditary anticoagulant protein deficiencies were also assessed. We tested our patients for the G20210 A mutation at Beaujon Hospital. Imaging procedures were performed to determine a local cause of BCS, such as a hydatid cyst or a liver tumour.RESULTS: One hundred and fifteen patients were included. Mean follow up: 32.12 mo. Mean age: 34.41 years, M/F = 0.64. Chronic presentation was frequent:63.5%. The revealing symptoms for the BCS were ascites(74.8%) and abdominal pain(42.6%). The most common site of thrombosis was the hepatic veins(72.2%). Involvement of the inferior vena cava alone was observed in 3 patients. According to the radiological investigations, BCS was primary in 94.7% of the cases(n = 109) and secondary in 5.2%(n = 6). An aetiology was identified in 77.4% of the patients(n = 89); it was multifactorial in 27%(n = 31). The predominant aetiology of BCS in our patients was a myeloproliferative disease, observed in 34.6% of cases. APLS was found in 21.7% and celiac disease in 11.4%. Other acquired conditions were: PNH(n = 4), systemic disease(n = 6) and inflammatory bowel disease(n = 5). Anticoagulant protein deficiency was diagnosed in 28% of the patients(n = 18), dominated by protein C deficiency(n = 13). Secondary BCS was caused by a compressing hydatic cyst(n = 5) and hepatocellular carcinoma(n = 1). CONCLUSION: The main aetiologic factor of BCS in Algeria is MPD. The frequency of celiac disease justifies its consideration when BCS is diagnosed in our region.