Jean Charles Moreau

Spontaneous Uterine Rupture of an Unscarred Uterus before Labour

Uterine rupture is a public health problem in developing countries. When it is spontaneous, it occurs most often during labor in a context of scarred uterus. Uterine rupture during pregnancy is a rare situation. The diagnosis is not always obvious and morbidity and maternal and fetal mortality is still high. We report a case of spontaneous uterine rupture during pregnancy at 35 weeks of an unscarred uterus before labour. This is an exceptional case that we observe for the first time in our unit.

Évolution de la mortalité néonatale précoce entre 1994 et 2003 au CHU de Dakar

Resume Objectifs Evaluer l’evolution des taux et des etiologies de la mortalite neonatale precoce au CHU de Dakar au cours des 10 dernieres annees. Materiel et methodes Il s’agit d’une etude retrospective de tous les deces neonatals enregistres au cours de l’annee 2003. Pour eliminer la part du hasard dans les variations observees pour les differentes periodes etudiees, nous avons utilise comme test statistique la comparaison des proportions avec un seuil de signification inferieur a 5 %. Resultats Nous avons enregistre 364 deces repartis de la maniere suivante : 243 parmi les 4 853 nouveau-nes accouches au niveau de la maternite (221 en periode neonatale precoce et 23 en periode neonatale tardive) et 121 parmi les 213 nouveau-nes transferes des maternites peripheriques. Le taux de mortalite neonatale precoce est de 45 deces pour 1 000 naissances vivantes. Cette mortalite concernait surtout les nouveau-nes pesant moins de 2 500 grammes a la naissance (66 %) et/ou ayant un score d’Apgar inferieur ou egal a 6 a la premiere minute de vie (83 %). La mortalite neonatale precoce a connu une baisse significative depuis 1994, mais la mortalite specifique observee chez les nouveau-nes transferes ne cesse d’augmenter (568 pour 1 000). Les principales causes de deces sont la prematurite (49 % des cas), la souffrance neonatale (23 %) et l’infection neonatale (18 %). L’analyse a montre une baisse significative de la part de la prematurite et de la souffrance neonatale mais une hausse significative de l’infection neonatale. Conclusion La mortalite neonatale precoce a sensiblement baisse, mais elle reste a un niveau encore trop eleve. Pour consolider cette tendance il faut reduire davantage l’incidence de la prematurite, de la souffrance neonatale et de l’infection et parallelement organiser un reseau de perinatalite a Dakar.

Gestational trophoblastic neoplasia after achieving a nondetectable serum human chorionic gonadotrophin level.

To determine the risk of recurrent trophoblastic disease after normalisation of human chorionic gonadotrophin (hCG) levels in women with hydatidiform mole.

Épreuve du travail dans les dystocies osseuses modérées au CHU de Dakar

Resume Objectifs Determiner la frequence des bassins moderement retrecis, apprecier la valeur diagnostique de la pelvimetrie clinique par rapport a la scano-pelvimetrie et evaluer le pronostic de l’epreuve du travail avec une gestion exclusivement clinique. Materiel et methodes Il s’agit d’une etude prospective longitudinale de type exposees non exposees concernant 296 patientes porteuses d’un bassin moderement retreci et ayant accouche a la maternite du CHU de Dakar entre le 1er fevrier 2001 et le 31 juillet 2002. La capacite du bassin est evaluee par la pelvimetrie clinique et la scano-pelvimetrie. Le bassin est considere comme moderement retreci sur la base d’un des elements suivants : un diametre promonto-retropubien compris entre 9,5 et 10,4 cm ou un indice de Magnin compris entre 20 et 22 ou un diametre transverse median mesurant entre 9,5 et 11,5 cm ou une reduction d’un des diametres sacro-cotyloide de moins de 2 cm. Au total, 148 patientes ont ete exposees a l’epreuve du travail ; pour le groupe temoin, 148 non exposees ont ete selectionnees de maniere raisonnee parmi celles qui ont fait l’objet d’une cesarienne prophylactique et qui n’ont pas presente une pathologie surajoutee pouvant interferer avec le pronostic maternel et perinatal. Les differentes variables sont etudiees en utilisant les tests du Chi 2 de Pearson et de Kappa. Resultats Les retrecissements moderes du bassin representent 5,3 % des accouchements. La moyenne d’âge est de 24 ans, la parite moyenne de 1, la taille moyenne de 161 cm et l’âge gestationnel moyen de 38 semaines d’amenorrhee. L’examen clinique du bassin possede une bonne valeur predictive positive par rapport a la pelvimetrie radiologique (entre 76,5 et 100 % selon le type de bassin). L’epreuve du travail a permis d’obtenir un accouchement par voie basse dans 109 cas (73,6 %), soit un taux global d’accouchements par voie basse de 27 % chez l’ensemble des parturientes presentant un bassin moderement retreci. Cette epreuve du travail n’a pas induit un risque significativement plus important que celui lie a la cesarienne prophylactique. En effet, la mortalite maternelle est nulle dans les deux groupes. La morbidite maternelle est faible, essentiellement d’ordre infectieuse, 4 % des epreuves du travail contre 2,7 % des cesariennes prophylactiques (p = 0,318). La mortalite post-natale est de 7,4 % chez les nouveau-nes apres une epreuve du travail contre 4,1 % chez les nouveau-nes par cesarienne prophylactique (p = 0,579). Conclusion Malgre les contraintes de la pratique obstetricale en Afrique Noire, l’epreuve du travail dans les bassins moderement retrecis doit etre la regle a chaque fois que cela est possible, meme avec une surveillance du travail exclusivement clinique.

Traitement chirurgical des kystes clitoridiens compliquant des mutilations génitales féminines

We report the surgical management of eight vulvar tumors occurred at the waning of female genital mutilation practiced in childhood. Patients were aged 19 to 38 years. It was essentially excision type 2. Surgical excision of the labia minora with a refund without clitoral plasty gave satisfactory aesthetic and functional results. Histological examination of these tumors showed a single cyst containing keratin without inflammatory reaction.

Premiers résultats de la cœlioscopie gynécologique au Centre hospitalier universitaire (CHU) de Dakar : série prospective de 128 cas

OBJECTIVES To analyze the results of, and to evaluate, gynaecologic laparoscopy in Dakar Teaching Hospital. METHODS This exploratory and descriptive study deals with a continuous series of 128 gynaecologic laparoscopies carried out between January 1, 2006, and December 31, 2009. In each operative case, sociodemographic and clinical parameters,operative data, and outcomes were studied. RESULTS Laparoscopies represented 14.37% of the programmed operative activities. The average age of the patients was 32 years,and the average parity was 1.2. The interventions were most frequently undertaken because of infertility (78.9%). A history of pelvic infections was found in 39.8% of the cases. The most frequent pathologies were tubal anomalies (70% of infertility cases) followed by ovarian cysts (10.1%) and endometriosis. The operative interventions included adhesiolysis in 35.1% of cases,and tubal surgery in 30.4%. A conversion, necessary in 7% of cases, was necessitated by the extent of adhesions (3 cases),the treatment of an associated pathology (4 cases), or a technical difficulty (2 cases).The main complications were vascular wounds and uterine perforations. The average operating times for diagnostic and operative laparoscopies were 56 minutes and 107 minutes,respectively. Outcomes were simple in 91.8% of cases. During the immediate postoperative period, a death occurred due to an acute pneumopathy. The average length of hospital stay was 3 days. We observed a pregnancy rate of 4.6%. Assisted reproduction was indicated in 28.7% of infertility cases. CONCLUSION Given its many advantages, diagnostic and operative laparoscopy must be integrated and developed by gynaecology departments in developing countries. This necessity is emphasized by the prevalence of tubal infertility of infectious origins, which, if diagnosed and treated early by laparoscopy,could have a better prognosis.

Dispositif intra-utérin mis en place en cours de césarienne. Étude pilote réalisée au centre hospitalier universitaire de Dakar

OBJECTIVES To demonstrate the feasibility of copper IUD insertion following cesarean deliveries and assess its safety. PATIENTS AND METHODS This is a prospective pilot study at Pikine national hospital from February 15 to November 15, 2012. Were evaluated the efficacy, incidence and spectrum of complications and continuation rates. RESULTS Fifty-nine subjects were enrolled and 46 received an IUD. The average age of patients was 28 years. No patient had previously used IUDs. Forty-four patients (97.5%) were returned to the first follow-up visit at the first month, 41 patients (89.1%) at the second visit and 39 patients (86.9%) at the third visit. The rate of lost sight was 8.7%. Pain and bleeding were reported rarely: 2.3% at the first month, 4.9% at the third month and 7.7% at the sixth month for the bleeding and 6.8% at the first month, 2.4% at the third month and 2% at the sixth month for pain. The rate of expulsion was 2.2%. CONCLUSION The insertion of the IUD following cesarean delivery has an acceptable rate of expulsion and no increased rate of adverse effects. This technique should be popularized.

Prothèse valvulaire cardiaque et grossesse au CHU de Dakar : aspects épidémiologiques, cliniques, pronostiques et modalités thérapeutiques

OBJECTIVE The persistence of the rheumatic valvular cardiopathie and the access to cardiac surgery make this association frequent. This work will deal with a description of the epidemiological and clinic profile and the evaluation of the cares to the pregnancies with cardiac valvular prostheses. METHODOLOGY We took a retrospective study beginning from 1987 to 2006 about 14 cases, which had benefited from collaboration between the Gynaecologic and Obstetric Clinic and the Cardiological Clinic of the University Hospital Center of Dakar. RESULTS The frequency of pregnancies with valvular prosthesis was of 0.12 per thousand. The average age of our patients was of 27.7 years. The average pregnancy was of 2.3 gestures with extremes of 1st to 12th gestures. The pregnancies were not, in any case, planned. An auricular fibrillation was noticed in four patients. The fraction of ejection of the left ventricle was superior or equal to 60% in 10 cases, the prosthesis was lightly blocked in two cases. Despite the use of anti-vitamin K during the first trimester with 42.86% of the patients, the anticoagulation was effective with the entire cases excepted one who died by lung embolism. The delivery was, in seven cases, realized by caesarean and in two cases by natural way. Two cases of premature and foetal hypotrophy have been noticed. There was no case of malformed children. CONCLUSION With a multidisciplinary care, the carry of valvular prosthesis can be compatible with pregnancy. The lack of embryopathy and malformed children could incite to propose the oral anticoagulation during the whole sequence of pregnancy.

Accuracy of syndromic management in targeting vaginal and cervical infections among symptomatic women of reproductive age attending primary care clinics in Dakar, Senegal

To assess the effectiveness of the WHO syndromic algorithm in the management of vaginal discharge among women of reproductive age in Dakar.

Tumeurs bénignes du sein à l’unité de sénologie du Centre Hospitalier Universitaire Aristide Le Dantec de Dakar (Sénégal)

Introduction This study aimed to identify the epidemiological, clinical and therapeutic features of benign tumors of the breast treated in the department of senology at the university hospital Aristide Le Dantec, Dakar. Methods We conducted a cross-sectional, descriptive and analytical study of 220 patients treated in the Department of Senology at the University Hospital Aristide Le Dantec, Dakar over the period from 1 January 2008 to 31 December 2013. Results 220 patients out of 984 consultants had benign tumor of the breast (22.5%). Benign tumors of the breast accounted for 58.2% of tumor pathologies. The average age was 24 years. The age group 11-30 years was the most represented (70%). The quasi-totality of patients were women of childbearing age (95%), 58.6% were nulliparous women. The main reason for consultation was a breast mass in 94.5% of cases. The left side was most often affected (49.5%), especially the upper outer quadrant (41.6%). 145 patients (65.9% of cases) underwent ultrasound. Cytologic examination showed conjunctival epithelial hyperplasia in almost all cases (96.1%). 44 women underwent histologic examination, which confirmed the histologic nature of the lesions. Fibroadenoma and fibrocystic changes were the most retained diagnoses, accounting for 86.3% and 5.9% respectively. 28 patients (12.7%) underwent lumpectomy, all tumor types were taken together. The majority of patients had follow-up appointments within 3 months, with favorable outcome. Conclusion Benign tumors are very frequent in senology consultations. The recommended diagnostic approach combines the clinico-radio-cytological triad and, in case of doubt or discrepancy, biopsy or surgical resection are essential. Surgery is not always the treatment of choice. This is based on the nature of the tumor.