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Introduction: An instrumental extraction is performed in order to shorten the phase of expulsion of the fetus outside the maternal pelvic pathway, when there is a suspected fetal state or a defect in progression of the fetal mobile. It can be responsible for immediate or late maternal complications, which are not specific because they can occur after a normal delivery. The objectives of this work are to describe the epidemiological-clinical and prognosis aspects of deliveries assisted by instrumental extractions in a reference maternity unit in Dakar. Materials and Methods: This was a retrospective, descriptive and analytical study between January 1, 2017 and December 31, 2017, a period of 12 months at the maternity ward of the Nabil Choucair Health Center. The collection was carried out using the survey form completed on the basis of the analysis of the files, the delivery register and the anaesthesia register of the operating room. The parameters studied were about socio-demographic characteristics, indications and prognosis. The data entry was carried out using the Sphinx version 5 software and the data analysis using the Epi info version 3.5 software. Results: During the period of our study, we collected 94 instrumental extractions. The frequency of instrumental extractions was 1.7%. The average age of the patients was 25 years with extremes of 16 to 43 years old. The average parity was 1 with extremes 1 to 6. Among parturient women, 12 patients (12.8%) had a history of suction cup, two (2.1%) had received forceps and three (3.2%) had a cesarean section. The average gestational age was 39 Weeks of Amenorrhea (WA), the average uterine height was 32 cm, fetal heart sounds were normal in 98% parturient’ cases. The vaginal touch had found a fully dilated cervix, a rupture of the amniotic sac with clear amniotic fluid in 98% of parturient women and a fetus with an anterior left iliac occipito topin 69.4% of cases. The pelvis was clinically normal in all parturient women. The indications were dominated by maternal fatigue (65.9%). The spatula was the most commonly used instrument (82.7%). Episiotomy was performed in 97.3% of cases. The average weight of the newborn was 3058 grams and an Apgar score of 8/10 was noted in 96% of newborns. We noted 3 cases of maternal complications with perineal tear type (3.2%) and 1 case of perineal tear associated with postpartum hemorrhage (1.06%). The neonatal prognosis was dominated by 2 caput succedaneum cases (2.1%). Newborns were alive and well in 97.8%. We noted 2 cases of death, i.e. 2.1% in unsolved circumstances. All the mothers were alive and well at (100%). Conclusion: Instrumental extractions must be integrated into our structures to significantly reduce the number of abusive cesarean sections. The perfect mastery of extraction techniques and indications makes it possible to reduce fetal suffering while avoiding the morbidity associated with instrumental extractions.

Introduction: Maternal mortality is a public health problem of more concern to developing countries. As part of improving the maternofoetal prognosis during pregnancy and childbirth, it is essential to carry out regular follow-ups of pregnant women (FE) through antenatal consultations (ANC). In fact, the World Health Organization (WHO) recommends at least four ANC at regular intervals during pregnancy. In Senegal the completion rate varies greatly depending on the region. In the District of Kedougou it was 41% in 2017 (DHIS2). The national target was not achieved despite the interventions. Thus we studied the determinants of CPN completion in the health district of Kedougou in 2017. Method: The study is of a descriptive and analytical cross-sectional type and concerned a sample of 884 women who gave birth between October 2017 and September 2018. They were chosen by a sample whose distribution in the district was made according to the quota method while respecting the demographic weight of each area of responsibility of the District. Results: The results of our study showed that the average age of women was 24 years with an average number of pregnancies equal to 3. The ANC completion rate at 37% was lower than the administrative data rate which was 41%. The determinants with a statistically most significant link with the completion of ANC are respectively satisfaction with the care and quality of service, the level of information of women regarding PNC, marital status, affordability and distance from the location of the ANC. Conclusion: Increasing women’s incomes, increasing communication about ANC, and bringing health services closer together are needed to improve the completion rate of antenatal care visits.

Introduction: In Senegal, according to the 2017 Demographic Health Survey, about 22% of married women have an unmet need for family planning. Globally, 61% of women do not have access to postpartum family planning. Material and Method: This is a prospective, descriptive and analytical study from March 05, 2017 to January 31, 2018. The interrogation was done in the hospital ward with filling in the data collection form. The data collected was first coded and then entered, using the sphinx software. The data analysis was done with Epi info version 7 software and included a descriptive and analytical component. Results: The average age of the patients was 26 years with extremes of 15 and 48 years. Average gestation was 2.3 with extremes of 1 and 8 pregnancies. More than half of the women (64.7%) had delivered by caesarean in an emergency setting. More than half of the women (66.7%) had chosen the hormonal contraceptive method within 48 hours of delivery and the implant was the type of contraceptive prescribed in almost half of the cases (49.3%). Conclusion: Integrating postpartum family planning into programs will ultimately help to dramatically decrease high-risk pregnancies, decrease the unmet need for family planning (FP), and improve the health and survival of mothers and children.

Le but de notre étude était de comparer la courbe non ajustée EPOPé M0 à la courbe personnalisée de Gardosi, dans le diagnostic des fœtus petits pour l´âge gestationnel (PAG) au sein d´une population du Sud du Sahara. Les classements des courbes de Gardosi et al. et EPOPé M0 étaient comparée. Les différences de classement ont été analysées selon les caractéristiques des patientes et des pathologies obstétricales. Les données recueillies à partir d´un logiciel Filemaker étaient analysées à l´aide des logiciels SPSS 20.0 et R Studio. Les tests statistiques étaient réalisés selon les conditions d´applicabilité. Le risque d´erreur alpha était fixé à 0,05. Avec la courbe de Gardosi, le taux de nouveau-nés PAG était plus élevé (31,4% contre 28,9%) et le taux de PAG ne différait pas entre les femmes en surpoids et celles de poids normal. Le taux de PAG sévères chez les prématurés était aussi plus élevé (23,6 versus 19,7%). Les pathologies étaient plus fréquentes chez les nouveau-nés classés PAG sévères par la courbe personnalisée. La courbe personnalisée est plus adaptée dans la population d´Afrique Sub-saharienne.

The objective of this study was to analyze the indications of cesarean sections performed in a Level II clinic and to evaluate early maternal and neonatal outcome in the context of decentralization of obstetric and emergency newborn care. Material and Method: This was a retrospective descriptive and analytical study conducted at the maternity CSNC over a period of 12 months from 1 July 2010 to 30 June 2011. It included all women in childbirth by caesarean section and excluded patients admitted for management of complications of cesarean section performed in another structure. Results: During the study period, 595 caesarean sections were performed on a total of 4410 births, a rate of 13.5%. The average age of patients was 27 years. The mean parity was 2. The patients came from them even 55%. They were admitted with a single uterine scar in 28.40% of cases and bi-scar in 25.4% of cases. A pathology was associated with pregnancy in 31.6% of cases. These pathologies were dominated by vascular and renal syndromes (75.5%), anemia (13.8%) and the obstacles previa (10.1%). Caesarean sections were performed in 517 patients in emergency. The technique of Misgav Ladach was the most common 75.1%. The average hospital stay was 4.2 days with extremes of 0 and 15 days. Postoperative maternal mortality was 0.34%. Operative follow-up was simple in 98.3% of patients. Two patients (0.34%) died after surgery. In 92.4% of the cases, the newborns were alive. The Apgar score in the first minute was favorable (greater than or equal to 7/10) in 503 newborns (95.1%) and unfavorable (less than 7/10) in 47 cases (8.55%). At the fifth minute, he was favorable in 98.5% of the cases. Overall stillbirth was 72.26‰ with a total of 43 stillbirths including 3 macerated stillbirths. Conclusion: Cesarean section is by far the most accomplished action in gynecology and obstetrics. Its ease of implementation and low cost, and of course his results in terms of reduction of maternal-fetal morbidity and mortality make a key intervention and allowed its extension.

Objectives: To evaluate the epidemiology of eclampsia, to assess maternal and perinatal prognosis and management. Material and method: This was a retrospective, descriptive study from January 1, 2015 to December 31, 2018. Included were all women received in the emergency department of our health facility for generalized seizures and/or disturbances of consciousness, occurring between the 20th Week of Amenorrhea (WA) and the 6th week of postpartum on a field of hypertension. The sources of the data consisted of antenatal consultation cards, delivery records, hospital records, operating theater and resuscitation records. The variables studied were sociodemographic characteristics, the course of pregnancy, childbirth and neonatal parameters. Data were captured and analyzed using SPSS 11.0 software. Results: The study focused on 190 cases with a prevalence of 3.5%. The average age of the patients was 20 years with extremes of 14 and 40 years. The average parity was 4.1 deliveries with extremes of 1 and 7. Nearly three-quarters of the patients (74.7%) of the patients were primiparous. Almost all the patients were evacuated. More than half of the seizures (53.1%) were recorded before work and more than one out of two patients had two seizures. Caesarean section was the mode of delivery in more than one out of two patients (56.8%). Maternal complications were marked by renal failure (23 cases), the HELLP syndrome (72 cases), and the retro placental hematoma (83 cases). The fetal impact was marked by prematurity in 90% of cases and 17 cases of fetal death in-utero. Nineteen maternal deaths were recorded while early neonatal mortality was 437 per 1000 live births. The average hospital stay of the survivors was 6.2 days. Conclusion: Eclampsia is still common in our regions. It occurs preferentially in young primiparas with hypertension and/or proteinuria on a poorly followed pregnancy. Magnesium sulphate and cesarean section can improve the maternal and fetal prognosis. Prevention necessarily means quality prenatal care.

OBJECTIVES: 1) To draw up the epidemiological profile of patients who have benefited from cervical cancer screening by visual inspection after application of acetic acid (VIA) and then describe the results of the test, the colposcopy, histological and therapeutic aspects in case of dysplasia. 2) To evaluate the performance of IVA in cervical cancer screening and its feasibility in low-resource countries. MATERIALS AND METHODS: This was a prospective and descriptive study carried out from 06 June 2015 to 31 January 2016 (7 months) at the Maternity Center at Nabil Choucair health center in Dakar. The patients had been screened for cervical cancer by visual inspection, which consisted of applying 3% acetic acid after setting up a vaginal speculum. The test was considered positive if there were intense white areas in the cervix. Colposcopy was performed in case of a positive VIA result. This colposcopy included an unprepared examination, an examination after application of 3% acetic acid and an examination after application of Lugol solution. The colposcopic report is made according to the terminology of the French Society of Colposcopy and Cervico-Vaginal Pathology. Patients with major changes or unsatisfactory colposcopy had undergone diathermic loop resection. Surgical specimens were sent to pathologic anatomy and follow-up was performed according to the results of the histology. The studied parameters concerned the socio-demographic aspects, the results of the VIA test, the results of the colposcopy after a positive test, the therapeutic aspects in case atypical transformation zone grade 2 or of unsatisfactory colposcopy, the results of the histology after the conization and the followed. The collection of data was done thanks to a file and the statistical analysis thanks to the software Epi-info version 7. RESULTS: 899 patients were involved in the study. The epidemiologic profile of our patient was a multipara in a period of genital activity, aged 42.2 years with a mean gestational weight of 4.5, and a parity of 4. In our series, the patients had their first sexual intercourse with 20.8 years old. In our study, 84 patients (10.2%) had positive results after visual inspection after acetic acid applications. All patients with positive results after application of 3% acetic acid had colposcopy. In our study, 27 patients had major changes and/or unsatisfactory colposcopy and underwent diathermic loop resection for diagnostic and therapeutic purposes. Anatomo-pathological examination of the cone room revealed cervicitis in 22.2% of cases, flat condyloma in 7.4% of cases, CIN2 in 22.2% of cases, and CIN3 in 18.5% of cases. All the conizations were in sano. The postoperative course was simple. CONCLUSION: Cervical cancer is a real public health problem in developing countries. To do to human resources, developing countries like Senegal must put in place simple, inexpensive, effective strategies that must globally respond to “screen and treat”.

Objectives: To study the epidemiological profile and the prognosis of the retro-placental hematoma (HRP) at the maternity ward at Kolda Regional Hospital Center. Materials and methods: This was a retrospective descriptive cross-sectional study conducted over a period of 11 years: from January 1st, 2006 to December 31st, 2016, at Kolda Regional Hospital Center. It included all patients admitted for HRP during this period. The studied parameters concerned sociodemographic characteristics, gynecological obstetrical history; clinical, therapeutic and prognostic data (non-inclusion or exclusion criteria). The data were collected from medical records, the delivery room and the surgery room registers using a collection sheet developed for this purpose. The statistical analysis of the variables studied was done with the software Epi-info 3.5. For the qualitative variables, we calculated the frequencies and for the quantitative variables, we studied the distributions. Results: During the study period, 15,343 were recorded deliveries and we carried out the diagnosis of HRP in 301 patients (1.97%). The average age of the patients was 24 years with an average parity of 4.8 deliveries. Almost all the patients (87.5%) were evacuated and half had delivered by caesarean section. Maternal and fetal deaths were 7% and 72.1%, respectively. Uterine atony accounted for 21.2% of complications. One third of the cases of uterine atony had resulted in a hysterectomy. The average duration of hospitalization was 6 days. Conclusion: The retro-placental hematoma is a serious medico-obstetric emergency. It is burdened with high maternal and fetal morbidity and mortality in developing countries.

We share our experience on reconstructive for surgery female genital mutilation. This is a retrospective study of all cases of female genital mutilation surgery performed in Pikine National Hospital. We have reviewed the various indications and surgical techniques used. We collected 8 cases of clitoral cyst and 6 cases of closed vaginal opening. The surgery of clitoral cysts was to perform cystectomy followed by nymphoplasty. The closing of the vaginal opening required defibulation together with clitoroplasty according to the wishes of the patient. The anatomical and functional outcomes were satisfactory. Female genital mutilation surgery requires a good knowledge of vulvar anatomy. The various surgical indications must meet the expectations of patients to guarantee their satisfaction.

Objectives: The aim of this study was to analyse key factors and main indications of primary caesarean sections and find out ways to reduce the rising rates. Patients and method: This was a longitudinal and retrospective study carried out from 1 January 2012 to 31 December 2016. The study included all patients in whom a primary CS was performed. A previous uterine scar was a non-inclusion criterion. We analysed the main indications and their trends during these five years, Apgar score at the 5th minute according to the course of caesarean section rate and the impact of daily audit. Data were collected retrospectively from 2012 to 2015, then prospectively in 2016 using a Filemaker database. Data were analysed with SPSS 21 software, Mac version. Averages were calculated for quantitative data and percentage for qualitative ones. The statistical tests used were the Pearson Chi2 test. The differences observed were considered significant when the p value was less than 0.05. Results: During the study period, we registered 21.308 deliveries and 6.292 caesarean sections (29.5%). Primary CS concerned 72.5% of overall CS. The main indications were suspicious of fetal distress (29.1%), obstructed or prolonged labour (21.7%), breech and twin delivery with respectively 8.2% and 5.2%. We registered more vaginal deliveries with induction of labour: 81.4% versus 75.2%. An obstetrical audit allowed better management of labour and decrease of CS rate. Conclusion: We need to focus on diagnosis of fetal distress, management of breech presentation in twin delivery and singleton. The induction of labour can be an effective alternative in some indications. An obstetrical audit is necessary to reverse caesarean section rate.

Objectives: The aim of our study was to investigate the relation of some sociodemographic factors and delays presentation in breast cancer. Patients and method: This was an observational study in Breast Unit of Aristide Le Dantec Teaching Hospital in Dakar. Were included in the study all patients followed for breast cancer from January 2008 to December 2014. The following variables were selected and stratified: age, place of living, educational attainment, menopausal status, socioeconomic status and family history of breast cancer. For each variable, an association with the stage and presentation delay was assessed. Results: Two hundred and fifty nine (259) patients met the inclusion criteria. No correlation was found between the studied socio-demographic factors and delay. Negative history of family breast cancer was associated with presentation delay. The only factor associated with locally advanced breast cancer after adjusting confounding factors was low level of income. Conclusion: A significant percentage of women with breast cancer in Senegal are experiencing presentation delay. Coordinated efforts with public health department are needed to educate the focused groups and mitigate the barriers.

Objective: To assess a training approach in Emergency Obstetric and Neonatal Care (EmONC) to strengthen skills of healthcare providers and reduce maternal mortality. Materials and methods: The approach was based on the skills training using the so-called “humanist” method and “life saving skills”. Simulated practice took place in the classroom through thirteen clinical stations summarizing the clinical skills on EmONC. The evaluation was done in all phases and the results were recorded in a database to document the progress of each learner. Results: We trained 432 providers in 10 months. The increase in technical achievements of each participant was documented through a database. The combination of training based on the model “learning by doing” has ensured learning and mastering all EmONC skills particularly postpartum haemorrhage management and reduced missed learning opportunities. Conclusion: The impact of training on postpartum haemorrhage management and maternal mortality is a major challenge in terms of prospects.

In Senegal, maternal mortality is 222.9 per 100,000 live births. Acute postpartum hemorrhage (PPH) complicates 3.1 % of all births, 44.2 % of direct causes of maternal deaths, and 33.6 % of all maternal deaths. Major causes include uterine atony, trauma, coagulation disorders, and total or partial retention of the placenta. A newer technique to address acute postpartum hemorrhage is the use of the condom balloon catheter. In Senegal, prevention means following the World Health Organization (WHO) recommendation of active management of the third stage of labor for all women in labor. This practice necessitates close collaboration of a multidisciplinary team comprising obstetricians, midwives, anesthetists, radiologists, and biologists. Obstetric care should be conducted simultaneously with resuscitation.

The objective of our study was to report 2 cases of hepatocellular carcinomas associated with pregnancy followed in our structure and to review the literature. Our patients were 30 and 37-year-old multi-gesture females with chronic unattended viral hepatitis B in whom the diagnosis of hepatocellular carcinoma was made in the third trimester of pregnancy at 31 weeks of amenorrhea and 4 days and at 32 weeks of amenorrhea after the incidental finding of tumor hepatomegaly on abdominal-pelvic ultrasound. The main clinical signs were jaundice and hepatomegaly and paraclinical signs were dominated by hepatic cytolysis and anemia in addition to ultrasound images. Follow-up of pregnancies revealed no particularities. A caesarean section was scheduled at 32 weeks of amenorrhea and 32 weeks of amenorrhea and 3 days allowing the birth of two preterm newborns weighing 1210 and 1500 gm with Apgar scores of 8-10/10 and 7-9/10 respectively at the fifth minute. The immediate post-operative follow-up was simple. However, the maternal-fetal prognosis was poor with the death of both patients in a multi-visceral failure table occurring respectively at 6 weeks and 3 weeks after caesarean section. The newborns had died 8 days after birth. Although rare, these two cases challenge any obstetrician to think about liver cancer in pregnant women, especially those with chronic hepatitis B. Ultrasound examination of the liver, or even better, the MRI, which is more efficient, in order to suspect early on a possible liver cancer. Indeed, early diagnosis and a thorough medical approach are essential for the treatment of HCC in pregnant patients.

INTRODUCTION: en Afrique, la vie sexuelle apres la menopause reste un domaine mal explore du fait de son caractere tabou. L'objectif de cette etude etait d'apprecier la qualite de la sexualite du couple au cours de la menopause. METHODES: il s'agissait d'une une enquete transversale concernant un echantillon representatif de 320 femmes menopausees. Les criteres d'inclusion etaient la menopause naturelle. N'etaient pas incluses de l'etude les patientes ayant fait l'objet d'une menopause precoce ou iatrogene. La fiche d'enquete etait divisee en 4 chapitres : les caracteristiques socio-culturelles de la femme, les donnees cliniques, les donnees psycho-sexuelles et les donnees therapeutiques. Nous avons utilise la comparaison des proportions et le test du Chi 2 avec un seuil de signification inferieur a 0,05. RESULTATS: l'âge moyen des femmes etait de 60 ans. L'âge moyen de survenue de la menopause etait de 48 ans et l'anciennete de la menopause etait de 11,3 ans. Aucune femme de notre etude n'etait epargnee par les manifestations du syndrome climaterique. Les bouffees de chaleur etaient presentes dans 85,9%, la secheresse vaginale dans 62,8% et les troubles urinaires dans 52,5%. Seules les femmes mariees declaraient avoir des rapports sexuels avec leurs conjoints (62,1%). Ces rapports sexuels etaient occasionnels dans 68,9% des cas alors que 18,1% des femmes n'avaient plus d'activite sexuelle. La diminution de l'activite sexuelle etait due aux troubles de l'erection du conjoint (62% des couples) et au manque de desir sexuel (83,5% des femmes). Une absence d'excitation sexuelle et d'orgasme etaient egalement retrouvee respectivement dans 92% et 100%. Cependant, 93,5 % des femmes mariees jugeaient supportable leur vecu. CONCLUSION: le statut marital, la dyspareunie, la secheresse vaginale et les troubles erectiles du conjoint ont un impact reel sur la sexualite de la femme menopausee au Senegal.

To determine the epidemiologic profile and private clinics of the cases of maternal mortality at the centre de santé Roi Baudouin.- To identify the etiologies of the cases of maternal death at the centre de santé Roi Baudouin; - To determine the assumption of responsibility of the cases of maternal death at the centre de santé Roi Baudouin.It was about a longitudinal descriptive retrospective study relating to 308 cases of maternal death from January 1998 to December 2005 at the centre de santé Roi Baudouin; de Guédiawaye, in suburbs of Dakar. We had included in the study all the patients died during the time of the gravido-puerperality during the study period. The studied parameters related to the socio-epidemiologic data, the clinical data on the pregnancy and the childbirth, the quality of the assumption of responsibility, the causes of maternal death and the forecast neonatal. The data were analyzed with the software Epi information-version 6.The ratio of maternal death was of 615.8 per 100.000 live births. The Middle Age of the deaths was 28.4 years with extremes of 14 and 52 years. The average gestity was of 4 with extremes of 1 and 25. As for the parity, it was of 3.9 with extremes of 1 and 22. The multipares were the section most concerned, followed first calf cows. A woman on four had made more than 3 antenatal consultations. The majority of our patients were evacuated (53.6%), but only 18.2% of the patients had profited from a medicalized transport. The reasons for evacuation were dominated by the vasculo-renal haemorrhages (49%) and syndromes (19%). The majority of the patients (n=234) had been confined, that is to say 76% of the cases; by natural way (45%) and Caesarean (32%). The patients had died of direct obstetrical causes in 80%, the indirect causes accounted for only 17,5%. The obstetrical causes death were dominated by the abrupto placentae, the haemorrhage of the postpartum and the uterine rupture. The maternal death was associated in more half of the cases of a fetal death (51.3%). The maternal age, the parity, the quality of the antenatal consultations, the hemorrhagic pathology coupled with the way of childbirth influenced occurred of maternal death.Maternal mortality remains a major concern at the centre de santé Roi Baudouin. The reduction of this mortality passes by operation correct 24 hours a day hours of the other ONEC centers of the area of Dakar, the availability of blood and its derivatives and the creation of a functional service of intensive care.- Déterminer le profil épidémiologique et clinique des cas de décès maternel au centre de santé Roi Baudouin.- Identifier les étiologies des cas de décès maternel au centre de santé Roi Baudouin.- Déterminer la prise en charge des cas de décès maternel au centre de santé Roi Baudouin.Il s'agissait d'une étude rétrospective descriptive longitudinale portant sur 308 cas de décès maternel de janvier 1998 à décembre 2005 au centre de santé Roi Baudouin de Guédiawaye, en banlieue Dakaroise. Nous avions inclus dans l'étude toutes les patientes décédées dans la période de la gravido-puerpéralité durant la période d'étude. Les paramètres étudiés sont co les données socio-épidémiologiques, les données cliniques sur la grossesse et sur l'accouchement, la qualité de la prise en charge, les causes de décès maternel et le pronostic néonatal. Les données ont été analysées avec le logiciel Epi info-version 6.Le ratio de mortalité maternelle est de 615,8 pour 100.000 naissances vivantes. L'âge moyen des décès est de 28,4 ans avec des extrêmes de 14 et 52 ans. La gestité moyenne est de 4 avec des extrêmes de 1 et 25. Quant à la parité, elle est de 3,9 avec des extrêmes de 1 et 22. Les multipares constituent la tranche la plus concernée, suivies des primipares. Une femme sur quatre a fait plus de 3 consultations prénatales.La majorité de nos patientes ont été évacuée (53 ,6%), mais seules 18,2% des patientes ont bénéficié d'un transport médicalisé. Les motifs d'évacuation sont, les hémorragies (49%) et les syndromes vasculo-rénaux (19%). La majorité des patientes (n=234) ont accouché, soit 76% des cas; par voie naturelle (45%) et par césarienne (32%). 80% des patientes sont décédées de causes obstétricales directes , les causes indirectes ne représentaient que 17,5%. Les causes obstétricales décès étaient dominées par l'hématome rétroplacentaire, l'hémorragie du post-partum et la rupture utérine. Le décès maternel est associé dans plus de la moitié des cas d'une mort fœtale (51,3%). L'âge maternel, la parité, la qualité des consultations prénatales, la pathologie hémorragique couplée à la voie d'accouchement ont influencé influençaient la survenue de décès maternel.La mortalité maternelle reste une préoccupation majeure au centre de santé Roi Baudouin. La réduction de cette mortalité passe par le fonctionnement correcte 24 heures sur 24 heures des autres centres de Soins Obstétricaux Néonatals d'Urgence de la région de Dakar, la disponibilité du sang et de ses dérivés et la création d'un service de soins intensifs fonctionnel.

Objectives: To report our experience in using an electronic database for management of breast diseases in a developing country. Materials and methods: E-Breast is a database developed on FileMaker Pro Advanced to serve as patient file and breast diseases registry. The development of the platform, its usage and advantages on a manual filing system are described. Results: For 6 years, we use this database, which accounts more than 2000 patients and includes data from more than 10 years. An overview of the activity is easily generated by E-Breast. The generated reports are used to the routine care of patients, statistics and clinical research. Data entered are immediately useful in addition to simultaneously implement the database for clinical research. Many custom features are integrated. For research purposes, the system has the ability to perform detailed analyses on subsets defined by the user as breast cancer, breast benign diseases, etc. Conclusion: E-Breast has proven to be a useful way of documentation that has become an integral and essential part of the daily activity and also a valuable research tool.

Background: The aim of this study was to determine clinical features and outcomes of patients with inflammatory breast cancer (IBC) treated in our breast unit. Methods: This study was performed at Gynaecologic and Obstetric Clinic of Dakar Teaching Hospital, in which a breast unit was created since 2007. All women with diagnosis of inflammatory breast cancer in our Breast Unit between January 2010 and December 2013 were included in this study. The diagnosis of IBC was made clinically using the American Joint Committee on Cancer (AJCC) and confirmed histologically. The follow-up cut-off for this data set was December 31 st , 2014. All analyses for this study were performed using SPSS software (version 20.0). Results: Between 2010 and 2013, 22 women with breast cancer who met eligibility criteria were included out of 161 patients followed for breast cancer leading to a frequency of 13.6%. The median age at diagnosis was 43.4 years (26-79 years). Mean time to diagnosis was 4 months. The mean time to recurrence was 11.2 months. This recurrence was observed in 45.5% of cases. The median overall survival was 13.3 months (CI 95% 8.576-18.526), the survival rate was 31.8%. Conclusions: This series shows a high frequency of inflammatory breast cancer. These tumours are very aggressive with a very poor prognosis.

Background: Breast cancer is the most common cancer diagnosed in women worldwide with over 1.3 million new cases per year. There is a wide variation in the geographical burden of the disease with the highest incidences seen in the developed regions of the world and the lowest incidences observed in the least developed regions. The objective of this study was to understand further the risks for breast cancer in Senegalese population which can then inform public health strategies to try and reduce the burden of breast cancer. Methods: This matched case control study was conducted in 2015 in Aristide Le Dantec Teaching Hospital in Dakar. All women with pathologically confirmed primary breast cancer were considered as cases. For each case, 2 age-matched women were recruited. We collected and compared demographic factors, family history of breast cancer, socioeconomic variables, reproductive variables (age at menarche, age at first pregnancy and first live birth, parity, menopausal status, duration of breastfeeding), and exogenous hormone use up to 6 months. Odds ratios from univariate logistic regression were used to estimate the relative risk of breast cancer associated with the various factors, and their predictive effects. Results: In all, 212 women with breast cancer who were diagnosed as having breast cancer and 424 control women were involved in the study. The mean±SD age of cases and controls was 43.37±11.94 years (range 18-83 years) and 42.04±11.08 years (range 18-84 years), respectively. There were no significant differences between cases and controls with regards to marital status, parity, age at menarche, past oral contraceptive use, age at first last full-term pregnancy and history of breastfeeding. Breast cancer risk was significantly greater in women with a family history of the disease (OR 2.12, 95% confidence interval [CI] 1.35-3.31). A significant increase in breast cancer was observed among illiterate women compared to educated women (OR 1.27, CI 1.02-1.58), in premenopausal women and those without occupation. Conclusions: In this study, reproductive factors as early menarche or menopausal status were not associative to the risk of breast cancer and the early age at diagnosis and the positive history of breast cancer suggest a genetic pattern of this disease in Senegalese woman. But this fact is difficult to confirm for financial reasons.

Background: The current strategy to fight maternal and perinatal mortalities is mainly based on three pillars: family planning, skilled delivery and emergency obstetric and neonatal cares. The objective of the study was to assess the quality of the management of low-risk deliveries in 5 reference maternity clinics in the region of Dakar. Methods: This is an observation-based multicentric, prospective and descriptive study, carried out over a four-month period, from September 1 st to December 31 st , 2012, in 5 reference maternity hospitals in the region of Dakar. For each delivery, the focus was put on parturient socio-demographic features, the surveillance techniques of the labour, the handling of the exit and delivery phases, materno-fetal complications but also on the new-born care. To assess the quality of childbirth management, a comparison between the practices was made and observed on the field and the World Health Organization's recommendations which fall into 4 categories (A, B, C and D) depending on the appropriateness or not of their use. For data input and analysis, we used the 13.0 version of the SPSS software. Results: During the study period, 200 childbirths were observed. The epidemiologic profile used for this study was that of a literate woman with a low record of childbirth who was 27 on average with a mean parity of 3. Forty seven percent of childbirth deliveries were observed in Roi Baudouin hospital centre. The A-category recommendations of the World Health Organization, such as the consumption of drinks, mobility during labour, the use of a partograph, the active management of the third stage of labour (AMTSL) and the examination of the placenta were applied in 22.5%, 86.2%, 23.4%, 100% and 23.4% of cases respectively. As for the B-category recommendations, which recommend the removal of those practices deemed harmful such as the back position during labour, the placement of an intravenous line and the oxytocin infusion, they were carried out in 91.84%, 98.08% and 7.28% of cases respectively. C and D categories which deal with non-recommended practices such as the use of abdominal expressions during labour and episiotomy were used in 47.6% and 39.7% of cases respectively. Conclusions: In our study, the most followed A-category recommendations from the WHO are: encouraged mobility, the use of single-use equipment, AMTSL and skin-on-skin contact. However, some B, C and D-category practices are still widely used in our maternity hospitals. The health authorities should make sure that the WHO recommendations are followed.

Objectives: This study aimed to assess efficacy of intramuscular methotrexate 8-day protocol in the treatment of low-risk gestational trophoblastic neoplasia and also identify prognostic factors associated with treatment failure, necessitating second line chemotherapy. Methods: This study was performed at Gynaecologic and Obstetric Clinic of Dakar Teaching Hospital, the reference Centre of Gestational Trophoblastic Disease in Senegal. At the beginning of 2011, patients were followed according to FIGO’s recommendations. From 2011 to 2014, we diagnosed 88 low-risk gestational trophoblastic neoplasia (GTN) patients (WHO score < 7). Low-risk patients started their treatment with methotrexate (MTX) based on the 8-day protocol consisting of 1 mg/kg MTX in combination with 0.1 mg/kg folinic acid (FA) every other day. Resistance to treatment was the main outcome. We studied the association of different prognostic factors included in the World Health Organisation (WHO) scoring system and resistance to the initial single agent chemotherapy. Results: Eighty-eight patients were diagnosed for GTN during the study period. Average age was 31 years. The antecedent pregnancy was molar in 98.1% of cases. Seventy-four patients underwent remission after single agent-chemotherapy. Resistance rate to single-agent chemotherapy was 15.9% (14 patients). Nine of them achieved remission after second line chemotherapy. WHO score was significantly associated with the risk of resistance to single-agent chemotherapy. Other variables included in the WHO as age, antecedent pregnancy, pre-treatment hCG, tumour size and FIGO stage were not significantly associated with resistance. We report five fatal cases. Conclusion: The 8-day protocol consisting of 1 mg/kg MTX in combination with 0.1 mg/kg folinic acid (FA) every other day is effective for women with LRGTN. The only significant prognostic factor for failure is pretreatment WHO score. We highly recommend the use of this protocol particularly in developing countries where methotrexate is available, affordable and relatively safe.

Tuberculosis is still common in developing countries and particularly in sub-Saharan Africa since the advent of the HIV/AIDS. Genital tuberculosis usually affects young women in genital activity period. The most frequent locations are tubal, endometrial and ovarian. The cervical location is rare. We report on the case of a 36 years old patient with eight pregnancies and eight deliveries who lives in a rural area and has got in her history 8 vaginal deliveries with four living children and 4 dead children and who was referred by a colleague for a "tumor of the uterine cervix". In her medical history, there was a BCG vaccination during childhood and she had never received Pap smear. The colposcopy revealed an ulcerating budding tumor of the cervix with necrotic areas. The colposcopy biopsy revealed fibrocaseous tuberculosis of the uterine cervix. Tuberculosis is still a common disease in developing countries. The cervical localization is rare but should be considered in case of an ulcerating tumor budding of the cervix.

OBJECTIVES: Specify epidemioclinical and legal aspects of sexual abuse among minors and evaluate the cost of care in Dakar. MATERIALS AND METHODS: This is a retrospective multicenter cross-sectional study on sexual abuse among minors over a period of four years from 1st January 2006 to 31st December 2009. Four maternities were targeted: the Social Hygiene Institute of Medina, health center Roi-Baudouin Guediawaye, the Pikine hospital and health center Youssou-Mbargane-Diop of Rufisque. RESULTS: During the study period, 252 child victims of sexual abuse were supported at four health facilities on a total of 272 sexual abuses of all ages, a frequency of 92.64%. The epidemiological profile of our patients was a child of 11 years old on average, female (100%) and living in the suburbs of Dakar (68.1%). Children were often abused during working hours (31.7%), outside the family environment and often by someone known to the victim (72.6%). Genito-genital contact was the most common mode of sexual contact (80.9%) with vaginal penetration in 61% of cases. Almost all of the victims (92.1%) came to consult, accompanied by their parents, between the 1st and 4th day after the sexual abuse (70%). The examination usually revealed a hymenal trauma (59.9%) of which nearly half (49%) consisted of old lesions. 56.9% of victims had a post-traumatic stress disorder and 31.1%, mutism. We recorded six (6) pregnancies, 2% of our sample. A case of HIV infection was recorded on a sample taken 72hours after sexual abuse. Control of three months HIV serology was requested in 7.1% of cases and only 20% of children had received antiretroviral prophylaxis. Antibiotic prophylaxis had been performed in 13.7% of cases using doxycycline as drug of choice (75%). Only 29% of our patients had received emergency contraception progestin and psychological care concerned only 22% of children. On the legal aspects, 46% of our patients had filed a complaint. Prosecutions were 38%, 45% of which were convicted and 21% were acquitted. The rate of out-of-court settlement was 35% and the time limit for settlement by the justice was on average 6 months with extremes of one month and 24 months. The average cost of care was estimated at 17,010 CFA francs (26 euros) taking into account the consumables used for clinical examination (sterile gloves, catheter, syringe), analysis and prescription drugs. CONCLUSION: The sexual abuse of minors is a disturbing reality that raises rightly universal reprobation. In Senegal, this mainly affects children and its magnitude is increasing over the years. Improved support for victims necessarily involves raising public awareness through the media and the development of specialized structures in the management of sexual abuse. Language: fr

Objectives To identify factors mismatch between magnetic resonance imaging (MRI) findings and postoperative histology in determining myometrial invasion, lymph node and cervical stroma involvement in endometrium cancer.

OBJECTIVE To assess the effectiveness of the WHO syndromic algorithm in the management of vaginal discharge among women of reproductive age in Dakar. METHODS Cross-sectional study of consecutive female patients (aged 18-49 years) presenting with vaginal symptoms at six selected study sites in Dakar; of these, 276 patients were included in the analysis. Vaginal and cervical swab samples were collected and analysed to establish an aetiological diagnosis of any infection. Syndrome-based diagnosis was compared with the laboratory results to evaluate its accuracy based on sensitivity, specificity and positive and negative predictive values. The degree of agreement between the two approaches was assessed using the Cohen's kappa concordance analysis. RESULTS Overall prevalence of vaginal infections was 56.9% (157/276); 5.4% (15/276) of the patients had cervical infection. Using the syndromic approach, 51% of patients were correctly managed for Trichomonas vaginalis (TV)/Gardnerella vaginalis (GV); 61% for Candida albicans (CA) and 54% for Chlamydia trachomatis (CT)/Neisseria gonorrhoea (NG) infections. Consequently, 31% of patients with TV/GV, 51% with CA and 53% with CT/NG infections would have missed treatment. Further, the kappa value was

Il s’agissait de déterminer la fréquence hospitalière de l’accouchement sur utérus cicatriciel à Pikine, d’évaluer la qualité de la prise en charge anténatale des grossesses sur utérus cicatriciel et de rechercher les facteurs pronostiques de l’issue d’une épreuve utérine. Nous avons procédé à une étude rétrospective à partir de dossiers médicaux et des protocoles opératoires des patientes ayant accouché sur utérus cicatriciel durant la période du 1er Janvier 2010 au 31 Décembre 2011. Ont été analysés les données socio-démographiques, le suivi de la grossesse, les modalités thérapeutiques et le pronostic. Les données étaient saisies et analysées à l’aide du logiciel Microsoft Office Excel 2007 et du logiciel SPSS version 17.0. La fréquence des accouchements sur utérus cicatriciel était de 9,6%. L’âge moyen des patientes était de 29,4 ans. Les primipares représentaient 54%. Un espace inter-génésique court était retrouvé dans 52,6% des cas. En fonction du nombre de césarienne, la répartition était la suivante: 79,8% des cas d’utérus unicicatriciels, 17,9% pour les bicicatriciels et 2,3% pour les tricicatriciels. Le nombre de consultations prénatales effectuées était supérieur ou égal à 3 dans 79,8% des cas. Les patientes évacuées représentaient 54,2% et elles étaient déjà en travail à l’admission dans 81,7% des cas. Une épreuve utérine était autorisée chez 177 patientes (34,3%), et à l’issue de cette épreuve, 147 patientes avaient accouché par voie basse, soit 83% dont 21,7% par ventouse obstétricale. L’accouchement par césarienne était réalisé dans 71,4% des cas avec 245 césariennes en urgence et 93 césariennes programmées. Un antécédent d’accouchement par voie basse était un facteur déterminant d’un accouchement normal (p = 0,0001). Il existait également un lien significatif entre le mode d’admission et la décision de césarienne (p = 0,0001). La mortalité maternelle était de 0,4%. La mortalité périnatale était de 28,2‰ naissances vivantes. Nous assistons à une augmentation fulgurante des accouchements sur utérus cicatriciel dans nos centres de SONUC. La qualité de la prise en charge doit être rehaussée par une meilleure stratégie de préparation à l’accouchement. L’épreuve utérine est une procédure à encourager pour réduire le taux de césarienne itérative.Mots clés: Grossesse, utérus cicatriciel, accouchement, SénégalEnglish Title: Pregnancy and delivery in patients with a personal history of cesarean section in Dakar: epidemiological, clinical, therapeutic and prognostic aspectsEnglish AbstractThe aim of our study was to determine hospitalization rate for vaginal birth after cesarean section in Pikine, to evaluate the quality of the management of pregnant women with previous cesarean section and to determine prognostic factors of the outcome of a trial of scar. We conducted a retrospective study based on medical records and operational protocols of patients who underwent vaginal birth after cesarean section over the period 1 January 2010 - 31 December 2011. We analyzed socio-demographic data, pregnancy follow-up, therapeutic modalities and prognosis. Data were collected and analyzed using Microsoft Office Excel 2007 software and SPSS software 17.0. The frequency of vaginal births after cesarean section was 9.6%. The average age of our patients was 29.4 years. Primiparous women accounted for 54%. Short spacing interval between births was found in 52.6% of cases. Based on the number of cesarean sections, the breakdown was as follows: patients with a history of one previous cesarean section (79.8%), patients with a history of two previous caesarean sections (17.9%) and patients with a history of three previous caesarean sections (2.3%). The number of antenatal consultations performed was greater than or equal to 3 in 79.8% of cases. Patients undergoing evacuation accounted for 54.2% and they were already in labor at the time of admission in 81.7% of cases. Trial of scar was authorized in 177 patients (34.3%) and, at the end of this test, 147 patients (83%) had vaginal birth, of whom 21.7% by vacuum extraction. Cesarean section was performed in 71.4% of cases with 245 emergency cesarean sections and 93 scheduled cesarean sections. A history of vaginal birth was a determining factor in normal delivery (p = 0.0001). There was also a significant relationship between mode of admission and decision to perform a cesarean section (p = 0.0001). Maternal mortality was 0.4%. Perinatal mortality rate was 28.2‰ of live births. We are witnessing a dramatic increase of deliveries after cesarean section in our SONUC Health Centre. The quality of management should be enhanced through a better strategy in preparation for delivery. Trial of scar is a procedure to encourage in order to reduce the rate of iterative cesarean sections.Keywords: Pregnancy, trial of scar, delivery, Senegal

Background: The caesarean section rate remains relatively high in the surgical maternity hospitals in Dakar and the indications for scarred uterus are still high. The management of induced prematurity for maternal pathologies still poses real problems in Dakar. The aim of our study is to compare the Caesarean section rate in the different surgical facilities in Dakar. We used the ROBSON's classification to evaluate the indications for Caesarean section in surgical maternity hospitals in Dakar. Methods: This was a descriptive and analytical prospective study which took place from January 1st to December 31st 2019 in 10 surgical maternity hospitals in Dakar (University hospital Aristide Le Dantec, National Hospital Center of Pikine, Municipal Hospital Center Abass NDAO, Principal Hospital of Dakar, Youssou Mbargane DIOP Hospital in Rufisque, Ouakam Military Hospital, Grand Yoff General Hospital, Gaspard Kamara Health Center, Nabil Choucair Health Center, Roi Baudoin Hospital Center) and which included all patients who delivered by caesarean section. Indications for Caesarean section were classified according to ROBSON's 10 group classification. The parameters studied were age, frequency, indications for Caesarean section in these surgical maternity hospitals and, Apgar score at five minutes and, birth weight. Data collection was done through birth records and registers, on-call diaries and integrated into a database developed with Sphinx software. Statistical analysis was done using SPSS software. Results: During the period of the study we recorded 35287 deliveries with 9185 Caesarean sections, i.e. a frequency of 26%. The average age of the patients was 29 years. Indications for Caesarean section in Dakar surgical maternity hospitals were dominated by group 5 (28.4%) according to Robson's classification. Group 10 in Robson's classification was predominant in the maternity hospitals of University hospital Aristide Le Dantec (23.3%) and Municipal Hospital Center Abass NDAO (22.5%). Group 5 was found in the maternity units of the Gaspard Kamara Health Center (32.3%), Nabil Choucair Health Center (39%), Principal Hospital of Dakar (26.4%), Youssou Mbargane Hospital Diop Hospital in Rufisque (31.4%), Roi Baudoin Hospital Center (29.8%), Grand Yoff General Hospital (32%), Ouakam Military Hospital (34.2%), and, National Hospital Center of Pikine (27.9%). 4 facilities had a caesarean section rate higher than 30% (University hospital Aristide Le Dantec 35.6%, Youssou Mbargane Diop Hospital in Rufisque 32.03%, Municipal Hospital Center Abass Ndao 32.01% and, National Hospital Center of Pikine 30.45%). The average birth weight of new-borns was 2943 grams, with an average Apgar score of 8 at the fifth minute. The post-op care was simple. Conclusion: The caesarean section rate remains relatively high in the surgical maternity hospitals in Dakar and the indications for scarred uterus are still high.

The objective of this study was to take stock of instrumental extractions using an obstetric suction cup at the Nabil Choucair Health Center in Dakar. It was a retrospective, descriptive study on instrumental extractions by vacuum cup from January 1, 2010 to December 31, 2017 (144 months) at the maternity unit of the Nabil Choucair Health Center. This study included all patients who had experienced vacuum assisted delivery. The parameters studied concerned socio-demographic, clinical characteristics, indications and maternal-foetal complications. The collection was carried out using the fact sheet completed on the basis of the analysis of the files, the delivery register, and the anaesthesia register of the operating room. Data entry was carried out using Sphinx version 5 software and data analysis by Epi info version 3.5 software and descriptive analysis was carried out by studying the frequency, the mean and the standard deviation. During the study period 66,000 women gave birth and we collected 360 instrumental extractions. The frequency of the vacuum cup was 0.5% for instrumental extractions. The average age of the patients was 24.5 years, parity was 1.6. The average gestational age was 39.4 Weeks of Amenorrhea (SA), the average uterine height was 33 cm, the noises of the foetal heart were normal in 98% of parturients. The indications were dominated by a stop in the progression of foetal mobile (39%). The mean average birth weight was 2994 g and 97% of new-borns had an Apgar score of 9. Maternal complications were dominated by simple perineal tears (7%) and 3 cervical tears (1.2%). The neonatal prognosis was dominated by 13 caput succedaneum (chignon) (7%). The obstetrics suction cup is still decisive for the foetal outcome in our maternities. The mastery of the technique and the right indications help to avoid complications.

Objectives: To assess the quality of prenatal monitoring of pregnant women with a previous cesarean delivery and determine the maternal and neonatal prognosis in an African setting. Patients and methods: This prospective, descriptive, and analytical study took place at Roi Baudouin Health Center in Dakar (Senegal) and examined the records of women giving birth from November 1, 2009 to August 31, 2010. It included all women admitted for delivery at 22 weeks of gestation or more, with at least one previous cesarean, and a prenatal consultation record booklet. Women with uterine scars from a gynecological intervention were excluded. The study included a qualitative analysis of the record booklets and an interview of patients. Results: Women with previous cesareans accounted for 12.5% of all women giving birth during the study period. The average age of the women in our study was 28 years, their mean parity was 3, and their mean number of prenatal examinations 3 (range: 1 to 5). Most prenatal care was provided by midwives (95.1%). The clinical characteristics were rarely completed. Not all women had undergone the laboratory tests required, and fewer than half (40.7%) had had a third-trimester ultrasound. In all, 109 (28.1%) had been referred to the hospital as an appropriate structure for their delivery. Complications of labor were observed in 28.3% of the cases. In 73% of these cases, women had repeat cesareans; 26% had vaginal deliveries. The performance of the recommended prenatal check-up was significantly correlated to how early prenatal care began (p = 0.001) and the level of the structure providing prenatal care (p = 0.027). Conclusion: Reducing maternal and fetal morbidity and mortality due to uterine scars requires that women be made aware of the relevant issues and that healthcare providers refer them appropriately and early.

Resume Nous rapportons la prise en charge chirurgicale de huit tumeurs clitoridiennes survenues au decours d’une mutilation genitale feminine pratiquee dans l’enfance. Les patientes etaient âgees de 19 a 38 ans. Il s’agissait essentiellement d’excision de type 2. L’exerese chirurgicale avec restitution des petites levres sans plastie clitoridienne a donne des resultats esthetiques et fonctionnels satisfaisants. L’examen histologique de ces tumeurs a montre une cavite kystique unique contenant de la keratine sans reaction inflammatoire.

Extra-uterine leiomyomas are rare, benign, and may arise in any anatomic sites. Extra-uterine leiomyomas are diagnostic challenge due to their rare unusual locations. We present a case of pelvic leiomyoma mimicking ovarian mass in a 34-year-old woman who was suffering for right pelvic pain. Clinical and imaging findings revealed an ovarian leimyoma. A laparotomy using Pfannenstiel incision was performed. Pelvic organs and both ovaries appeared normal. There was a firm mass about 5 cm in size distinct from the left ovary and attached to uterus with some fine adhesions that were cut allowing removal of the mass. Pathologic examination concluded to a benign leiomyoma. The recovery was uneventful and pelvic pain disappeared. Leiomyomas occur infrequently outside the uterus. Although they are histologically benign, extra-uterine leiomyomas may mimic malignant tumours at imaging and may present a diagnostic challenge. Surgical excision is the most common treatment.