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Retro Placental Hematoma: Maternal and Fetal Prognosis at the Maternity of the University Hospital of Bouake

Open Journal of Obstetrics and Gynecology 2024年第1期14卷 44-56页

作者： samake yaya Djanhan Lydie Estelle Menin-Messou Benie Michele Kouadio Kouadio Narcisse Akanji Iburaima Alamun M’bro Clausen Georgie Boko Dagoun Dagbesse Elysee Camara Sokhona N’guessan Kouadio Ismael Foua Bi Paul Hyacinthe Keita Ismael Vaho Magnificat Marina Kone Minzata Yasmine Doumbia Yacouba Gynaecology-Obstetrics Department Centre Hospitalier Universitaire de Bouaké Bouake Ivory Coast Mother and Child Department Alassane Ouattara University Bouake Ivory Coast

Introduction: Retroplacental haematoma (RPH) is a very serious complication of pregnancy, with life-threatening consequences for both the mother and foetus. The aim of this study is to determine the incidence and epidemiological characteristics of patients with retroplacental haematoma (RPH) and describe the maternal-foetal complications at Bouaké University Hospital. Methods: This was a cross-sectional prospective, descriptive and analytical study carried out at Bouaké University Hospital over a period of 3 years, from January 1, 2019 to December 31, 2021. All parturients with RPH whose delivery took place at the hospital were included in the study. Data were entered and analysed using EPI INFO software version 7.***.2.6. Results: We recorded 2,0959 deliveries, including 202 cases of RPH, representing an incidence of 0.96%. The 21 to 35 age group accounted for 64.4%, multigestas and large multigestas accounted for 58.5% and multiparas accounted for 41.6%. The main signs on clinical examination were metrorrhagia (100%), arterial hypertension (84.6%) and cervical cerclage (79.7%). Preeclampsia accounted for 50% of per-gestational pathologies. Maternal mortality was 12.9%. Morbidity was dominated by anaemia in 64.1%, followed by disseminated intravascular coagulation (DIC) in 21.8%, and the factors associated with this maternal prognosis were multiple gestations, multiparity, Sher grade IIIb and the occurrence of complications such as DIC, shock, renal complications and HELLP syndrome. Neonatal mortality was 79.2%, and the factors associated with these fetal prognoses were cup size ≥ 5 cm and hematoma weight ≥ 500 g. Conclusion: Better screening of at-risk populations, early diagnosis and treatment in an organised and equipped medical and surgical facility would improve prognosis.

关键词： Retroplacental Haematoma Lethality Bouaké and Prognosis

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Anesthesiological Management of Eclampsia in Tropical Africa: Experience of the University Hospital Center of Bouake

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Open Journal of Anesthesiology 2018年第3期8卷 93-99页

作者： Kouadio Konan Stéphanie Irié Bi Gohi Serge Pete Yaich Koffi N’Guessan Yao Kouassi Christian Ogondon Bernard Nda-Koffi Cinthia samake yaya Kouame Konan Edmond Brouh Yapo Anesthesia-Intensive Care Unit Bouake Hospital Bouake Ivory Coast Pediatric Department Bouake Teaching Hospital Bouake Ivory Coast Obstetrics and Gynecology Department Bouake Teaching Hospital Bouake Ivory Coast

Introduction: Eclampsia is a common cause of maternal mortality in developing countries. The objective of this study is to evaluate the practice of anesthesia for eclampsia in tropical Africa. Patients and Methods: Retrospective descriptive study on the parturients who benefited from eclampsia anesthesia in the operating theaters of the gynecology and obstetrics department, the University Hospital Center (CHU) of Bouake over a two-year period (January 2015 to December 2016). The parameters studied were: anesthetic risk assessment, anesthetic management, immediate anesthetic and post-anesthetic accidents and incidents. Results: Out of a total of 3831 emergency cesarean sections, 65 were for eclampsia, or 1.69% of obstetrical surgical activity. The mean age of the patients was 20.30 ± 3.34 years (range: 14 years and 39 years). Prenatal consultation was not performed in 70% of cases and 85% of patients were primiparous. Patients classified as ASA IIIU accounted for 75% of the population and in 62% of cases, the Glasgow score was between 9 and 12. Induction was achieved with thiopental in 98% of patients and vecuronium was the only muscle relaxant used. The most common fetal complications were hypotrophy (50%), prematurity (30%) and respiratory distress (40%). Postoperative anesthetic complications were agitation (70%) and wake delay (15%). Maternal mortality was 5% and the neonatal death rate was around 7.69%. The elements of poor maternal prognosis were the ASA IVU class (P = 0.015) and the Aldrete awakening score between 3 and 5 awakening (P = 0.001). Conclusion: Anesthesia for eclampsia at CHU of Bouake is difficult. It needs to be improved thanks to better equipment of the health structures.

关键词： Eclampsia Emergency Anesthesiology Ivory Coast

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Digestive Surgical Emergencies at the “Mother Child”Hospital Center Luxembourg in Mali

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Surgical Science 2024年第5期15卷 299-310页

作者： Cheickna Tounkara Amara Coulibaly yaya Ongoiba Aboubakrine Sylla Abdoul Karim Simaga Bréhima B. Coulibaly Aminata Dabo Souleymane Dembele samake Hamidou Sidiki Keita Sékou Bréhima Koumare Soumaïla Keita Bakary Tientigui Dembele Zimogo Zié Sanogo Djibril Sangare Department of General Surgery and Anesthesia-Resuscitation of the “ Mother Child&#8221 Hospital Center Luxembourg Bamako Mali Social Health Service of the Armed Forces of Mali Bamako Mali Department of General Surgery “ A&#8221 and Cardiovascular of Point G University Hospital Bamako Mali Department of General Surgery of CHU Gabriel TOURE Bamako Mali

Digestive surgical emergencies concern all patients admitted urgently, for whom a decision for surgical intervention may be necessary within 24 hours. They are on guard duty day and night. To carry out this work, we set ourselves the objectives of: 1) Studying digestive surgical emergencies in the general surgery department of the “Mother Child” Le Luxembourg hospital in Bamako, Mali;2) Determine the frequency of digestive surgical emergencies, 3) Describe the clinical and therapeutic aspects, and 4) Analyze the results of treatment. From November 1, 2022 to October 31, 2023, the general surgery department of the “Mother Child” Luxembourg Hospital Center in Bamako, Mali, carried out 139 digestive surgical emergencies whose files were usable;75 men and 64 women, a sex ratio of 1.2. The 20 - 40 years old age group was the most represented, at 40.29%. The average age was 39 years;the extremes 16 years and 93 years with a standard deviation of 21.65 years. The reference concerned 51.08% of our patients. Abdominal pain was the main reason for consultation (100% of cases). In the majority of cases, the physical examination made it possible to make the diagnosis. Faced with certain clinical cases, we requested ultrasound (109/139), ASP (46/139) and CT (15/139). The main etiology was acute appendicitis with 42.45% of cases. The frequency of digestive surgical emergencies was 10.71% of all activities in the general surgery department of the “Mère Enfant” Le Luxembourg hospital center in Bamako. All our patients were seen in consultation by an anesthesiologist before entering the operating room. The surgical consequences were complicated in 11.51% of cases with 7.91% deaths. Surgical site infections accounted for 12.5% of postoperative complications. Eleven deaths were noted, representing 68.75% of complications and 7.91% of our sample. Acute peritonitis was the cause of death in 100% of cases. The average cost of care was 329,000 FCFA.

关键词： Emergency Digestive Surgery Post-Operative Complication

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Review of Two Years of Surgical Activities of the General Surgery Department of the Reference Health Center of Commune I of Bamako Mali

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Surgical Science 2024年第4期15卷 195-206页

作者： Tounkara Cheickna Cisse Amadou Beydi samake Hamidou Diarra Issaka Sanogo Modibo Diarra Bogoba Doumbia Seydou Yena Sadio Department of General Surgery of the Reference Health Center of Commune I Bamako Mali Directorate of Social and Health Services of the Armed Forces of Mali Department of Public Health of the Faculty of Medicine and Odontology-Stomatology Bamako Mali Department of Surgery Mali Hospital Bamako Mali

The objectives of this work were to evaluate the surgical activities carried out in the general surgery department of the Reference Health Center of Commune I of Bamako, to describe the sociodemographic characteristics of the operated patients, to determine the main pathologies encountered and to evaluate qualitatively the result of the treatment. In order to improve performance, and the quality of care, and to identify common pathologies in the surgical department, we undertook a retrospective study on surgical activities from January 2009 to December 2010. At the end of this study, out of 474 men and 187 women (equal sex ratio 2.53);we were able to determine the frequency of surgical pathologies. Farmers, housewives and pupils/students were the most represented with 25.9% respectively;20% and 13.3%. The most frequently observed pathologies were wall hernia (44.8%), prostate adenoma (12%) and acute appendicitis (10.5%). The average length of hospitalization was 3.43 days. Infectious complications affected 25 patients (3.8% of cases) and a death rate of 0.45% (i.e. 3 patients). The average cost of care was 53,500 FCFA. Indeed, the reality of surgical practice in health centers was not the same because of the level of skills of practicing surgeons.

关键词： Assessment Surgical Activities 2 Years Reference Health Center of Commune I Bamako

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Postoperative Complications in the General Surgery Department of the Cs Ref of Commune I of the District of Bamako Mali

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Surgical Science 2024年第6期15卷 409-419页

作者： Tounkara Cheickna samake Hamidou Dembele Lamine Diarra Issaka Togola Modibo Sanogo Modibo Dembele Bakary Tientigui Traore Alhassane Togo Adégné Pierre Kante Lassana Department of General Surgery Reference Health Center of Commune I of Bamako Bamako Mali Directorate of Social and Health Services of the Armies Bamako Mali Department of General Surgery CHU Gabriel Tour Bamako Mali

Postoperative complications represent important indicators for the quality of surgical care. The objectives of this work were to study post-operative complications in the general surgery department of the Cs ref of commune I in Mali, to determine the frequency of post-operative complications, to identify the factors of occurrence, to describe the clinical aspects, diagnostic and therapeutic in order to assess the additional cost linked to post-operative complications. This study was prospective, carried out in the general surgery department on 300 cases of surgical interventions. It covered all patients aged at least 15 years, operated on and hospitalized or not, and who presented complications during the 30 days postoperatively. Patients under the age of 15 were not included (our general surgery department is not a pediatric surgery department). We collected 300 patients among whom 199 (66.33%) were men and 101 (33.66%) women, i.e. a sex ratio = 1.9. The average age was 38 years with extremes of 15 and 87 years. The main initial diagnoses were: acute appendicitis, peritonitis, occlusions, wall hernias, hemorrhoids, uterine prolapse, uterine myomas, ovarian cysts and acute cholecystitis. Emergencies represented 43% (N = 129) of interventions with 6.98% post-operative complications (POC). Postoperative complications were dominated by surgical site infections, 75% of cases (N = 20), wall hemorrhage 5% (N = 1), testicular necrosis 5% (N = 1) and testicular calcification 5% (N = 1), wire rejection 5% (N = 1) and death 5% (N = 1). The management of postoperative complications was surgical in 95% and medical in 100%. Their occurrence extended the hospital stay by 3.65 days and increased the average cost of care by 60541.85 CFA francs. The mortality index lowered by efficient management of complications (IMAGE) calculated in relation to deaths was 95% of cases. Anemia, ASA score ≥ III, Alteimeir II and IV classes, duration of surgery and post-operative hospitalization were

关键词： Complications Post Opératoires Chirurgie Cs Ref CI Bamako Mali

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Clinical and Therapeutic Aspects of Inguinal Hernia in Children in the General Surgery Department of Reference Health Center in Commune I of Bamako Mali

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Surgical Science 2024年第2期15卷 54-63页

作者： Tounkara Cheickna samake Hamidou Simpara Mama Diarra Issaka Sanogo Modibo Sidibe Souleymane Togola Modibo Dembele Bakary Tientigui Coulibaly Yacaria Togo Pierre Adégné Kante Lassana Department of General Surgery the Reference Health Center of Commune I Bamako Mali Directorate of Social Health Service the Armed Forces of Mali Bamako Mali Department of Pediatric Surgery Mali Hospital Bamako Mali Department of General Surgery the Gabriel TOURE University Hospital Bamako Mali Department of Pediatric Surgery Gabriel TOURE University Hospital Bamako Mali

Inguinal hernia in children is a congenital pathology in children linked to the persistence of the peritoneo-vaginal canal in children and the NüCK canal in girls;persisting into adulthood. This work aimed to study inguinal hernia in children in the general surgery department of the Reference Health Center of Commune I of the Bamako District;to determine the frequency of inguinal hernia;describe the epidemiological, clinical and therapeutic aspects of inguinal hernias and in order to evaluate the cost of treatment. This was a prospective study from April 2017 to March 2018 during which 60 children with an inguinal hernia were collected. Inguinal hernias in children represented 9.23% of patients operated on in the department. The average age was 59.23 months with extremes of one month and 180 months and a standard deviation of 49.23 years. The male sex was dominant with a sex ratio equal to 9:1. The notion of prematurity was found in 11.7% and was associated with a testicle not in place in 1.7% of cases. 41.7% of our patients were referred by a doctor and 66.7% of patients presented with painless, intermittent inguino-scrotal swelling (83.3% of cases). The hernia was discovered before one week of life in 50% of cases. Inguinal swelling was absent in 11.7% but observed intraoperatively. The inguinal hernia was unilateral in 91.7% of cases and 70% of hernias were discovered by the parents during pushing efforts. The inguinal hernia was located on the right in 61.7% of cases. The hernia swelling was soft, painless, impulsive and reducible in 78.3% of cases. The swelling was inguino-scrotal in 58.3% of cases. The hernia was simple in 95% of patients and hernial strangulation was observed in 3 cases or 5% of cases. 98.3% of patients were ASA I. The treatment was carried out openly in all our patients including closure of the vaginal peritoneal canal in 95% of cases under general anesthesia in 98.3% of cases. The morbidity rate was 8.4% (surgical site infection: 6.7% of ca

关键词： Inguinal Hernia Child Surgery Cs Ref C I Bamako Mali

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Nephroblastoma in Adults about a Clinical Case

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Surgical Science 2024年第2期15卷 81-88页

作者： Tounkara Cheickna Coulibaly Amara Malle Oumar Amadou Bréhima Bolo Coulibaly Bagoyoko Kaloga Daye samake Hamidou Berthe Honoré Jean-Baptiste Gabriel Diakite Mamadou Lamine Department of General Surgery Hospital Center “Mother Child” Luxembourg Bamako Mali Directorate of Army Health Services Kati Mali Department of Urology and Andrology Point G University Hospital Bamako Mali

Nephroblastoma is the most common malignant renal tumor in children and is related to an abnormal proliferation of cells resembling those of the embryonic kidney (metanephroma), hence the terminology;embryonal tumor. These are tumors that remain and remain unstudied in Mali because they are common in adults in our context. Its annual incidence is estimated at approximately 1/10,000 births. Nephroblastoma is a rare or even exceptional tumor in adults. The clinical manifestation was a large swelling of the right hypochondrium;abdominal pain for a year;unquantified fever, hypertension, initial hematuria associated with burning during urination and anemia. The main clinical manifestation remained fever and abdominal pain. This renal tumor posed a diagnostic problem which was previously labeled as a mesenteric tumor in our general surgery department. The diagnosis was made by imaging: CT and magnetic resonance imaging. The treatment is multidisciplinary and combines chemotherapy, surgery with or without radiotherapy. The prognosis is poor due to late diagnosis and less effectiveness of chemotherapy compared to the child. Survival did not exceed a year and a half because the renal tumor in our patient was surgically overcome. We report a case of nephroblastoma in an 86-year-old patient with unfavorable histology (hematogenous metastases), operated on in the general surgery department and whose postoperative course was simple and who was referred to oncology for treatment.

关键词： Nephroblastoma Malignant Kidney Tumor Treatment Adult Mali

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Evaluation of the Integrated Management Program for Acute Malnutrition in the Douentza Health District, Mopti Region, Mali

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Food and Nutrition Sciences 2024年第8期15卷 790-806页

作者： Abdoul Salam Diarra Lamine Traore Mohamed Diarra Tawfiq Abu Mamadou Traore Yacouba Guindo Sidi Sangare Seydou Kante Intimbeye Tembine Dramane Coulibaly Mamadou Fodé Diarra Salia Keita Sadio Sambala Diallo Mamadou samake Hamadoun Sangho National Center for Scientific and Technological Research Bamako Mali Division of Nutrition Regional Directorate of Health and Public Hygiene Mopti Mali Department of Pediatric Health Referral Center of Kalaban Coro Koulikoro Mali Private Practice for Family and Emergency Medicine Casablanca Morocco Division of Nutrition General Directorate of Health and Public Hygiene Bamako Mali Administration Department Health Referral Center of Djenne Mopti Mali Administration Department Health Referral Center of Douentza Mopti Mali Administration and Planning Department Regional Health Directorate Mopti Mali Division of Health Department Regional Health Directorate of Mopti Mopti Mali Golden Life American Hospital Bamako Mali Department of Public Health Faculty of Medicine and Odontostomatology University of Sciences Techniques and Technologies of Bamako Bamako Mali

Introduction: Malnutrition is a major public health problem in Mali, despite the efforts of the government, its technical and financial partners. The aim of this study was to evaluate the integrated management program for acute malnutrition (IMPAM). Methodology: This was a descriptive cross-sectional study that took place from January to December 2020 in the Douentza health district. The study included anyone with at least one malnourished child aged 6 to 59 months in their care who agreed to take part in the study, community health center staff who had given their consent, and the URENI manager at the Douentza reference health center. Data collected via questionnaires were entered into Excel and then analyzed using Epi-Info version 7 software. Results: A total of 138 acutely malnourished children aged 6 - 59 months, including 71 girls (51.45%), 138 accompanying mothers and 11 health workers, were included in our case study. Among the malnourished, 54.34% were in the 12 - 23 months age group and 69.57% had the severe form. 93% of the mothers interviewed were satisfied with the care provided, and all the health staff interviewed stated that community conflicts had an impact on IMPAM’s activities. Cure rates were 81% in Moderate Outpatient Nutritional Recovery and Education Unit (URENAM), 84% in Severe Ambulatory Nutritional Recovery and Education Unit (URENAS) and 92% in Recovery and Intensive Nutritional Education Unit (URENI). Drop-out rates were 19% in URENAM, 16% in URENAS and 0% in URENI. The death rate was 8% in URENI and 0% in URENAM and URENAS. Conclusion: This study confirms the high prevalence of malnutrition in the district (10.54%). It also reveals that factors such as inter-community conflict and insecurity have seriously affected the IMPAM program.

关键词： Care Acute Malnutrition Children Aged 6 - 59 Months IMPAM Douentza

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Maternal Fetal Prognosis: Pregnancy and Delivery in Women of 40 Years Old and Over in a Second Reference Hospital in Bamako

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Open Journal of Obstetrics and Gynecology 2024年第4期14卷 509-519页

作者： Samaké Alou Diarra Lasseny Keita Mamadou Haidara Dramane Haidara Mamadou Diallo Mamadou Konaté Moussa Maiga Mariam Mohamed Saydi Ag Med Elmehdi Elansari Kassogue Djibril Seydou Zana Dao samake Hawa Konate Karim Dembele Bertin Coulibaly Moussa Mariko Seydou Collarete Dohino Reference Health Center of Commune VI of the Bamako District Bamako Mali Bamako Dermatology Hospital (BDH) Bamako Mali Kalaban Coro Reference Health Center Bamako Mali Timbuktu Hospital Timbuktu Mali Reference Health Center of Commune II of the Bamako District Bamako Mali Reference Health Center in Commune V of the Bamako District Bamako Mali National Institute for Training in Health Sciences Bamako Mali Mali Hospital Bamako Mali

Introduction: Late pregnancies are considered a public health problem linked to maternal mortality due to their complications. These risks, which worsen with maternal age, should be better known and taken into account in monitoring these pregnancies. Objective: To evaluate the impact of age on the prevalence of obstetric and neonatal complications among parturients of 40 years old and over. Methodology: This was an 11-year retrospective analytical case control study from January 1, 2007 to December 31, 2017. The study population was female patients of 40 years old or older for cases and female patients younger than 40 years of control case. Results: In total, we collected 640 cases of parturients of 40 years old and over out of a total of 84,234 deliveries during the study period;i.e. a frequency of 0.76%. Spontaneous abortion increased in patients of 40 and over with 8.28%. Hypertension and diabetes were higher of women of 40 and over, 52.65%. Concerning the method of admission: 55% of parturients of 40 and over were referrals. Incidents occurring among women of 40 and over were more pronounced than in control cases. Complications during vaginal delivery, cervical tear, perineal tear, uterine dehiscence and uterine rupture are high in our cases, i.e. 11.88%;3.59%;2.19%;2.66. During our study, depending on the type of delivery, the cesarean rate was much higher among women of 40 and over than among control cases, i.e. 54.22% versus 12.24%. Hemorrhages in the 3rd trimester were the main indications for cesarean section. Hemorrhages in the 3rd trimester were more frequent with women of 40 and over, i.e. 10.47%;5.94% versus 1.74% and 0.42%. As for the different types of malformations in parturients, women under 40 years old fetal malformations were absent in 92.29%, on the other hand they were more frequent in patients with 40 years and over, i.e. a normal frequency of 36.72%. Conclusion: Pregnancy at a late age exposes the elderly patient and the newborn to several ri

关键词： Advanced Maternal Age Childbirth Risk Mali

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Maternal and Perinatal Prognosis of Arterial Hypertension and Pregnancy in a Peripheral Health Center in Mali

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Open Journal of Obstetrics and Gynecology 2024年第5期14卷 855-867页

作者： Samaké Alou Diarra Lasseny Keita Mamadou Haidara Dramane Haidara Mamadou Diallo Mamadou Konaté Moussa Maiga Mariam MS Ag Med Elméhdi Elansari Kassogue Djibril Dao Seydou Zana samake Hawa Konate Karim Dembele Bertin Coulibaly Moussa Mariko Seydou Colette Dohinnon Reference Health Center in Commune VI of the Bamako District Bamako Mali Bamako Dermatology Hospital (HDB) Bamako Mali Kalaban Coro Reference Health Center Bamako Mali Timbuktu Hospital Timbuktu Mali Reference Health Center of Commune II of the Bamako district Bamako Mali Reference Health Center in Commune V of the Bamako district Bamako Mali National Institute for Training in Health Sciences Bamako Mali Mali Hospital Bamako Mali

Introduction: Maternal mortality constitutes a public health problem and its rate is an indicator of a country’s development. Among the causes of maternal and perinatal death, high blood pressure associated with pregnancy occupies a significant part. It represents 5% of direct maternal deaths. Objective: to study the maternal and perinatal prognosis of high blood pressure during pregnancy in the Tenenkou reference health center in Mali. Methodology: This was a descriptive, analytical and retrospective cross-sectional study over a period of twelve months from January 1, 2021 to December 31, 2021 and involving 144 cases of high blood pressure associated with pregnancy. Results: We obtained a frequency of 11.75%. The majority of patients 70.9% were aged between 20 - 35 years. The important risk factor found was young age. During our study, 46.5% of patients had performed at least one CPN and only 13.9% performed 04 CPN. Pre-eclampsia was the most common type of high blood pressure during pregnancy, i.e. 61.1%. Eclampsia and retroplacental hematoma were the most common maternal complications, respectively 27.8% and 11.1%. The most common fetal complications were premature births and fetal distress with 20.9% and 17.4% respectively. Conclusion: Hypertension associated with pregnancy still remains a major cause of maternal-fetal morbidity and mortality in our context where diagnosis is often late. The main clinical form was preeclampsia. Eclampsia and retroplacental hematoma were the most frequent maternal complications. Fetal complications were mainly prematurity and fetal distress.

关键词： Pregnancy High Blood Pressure Prognosis

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