Background: Postpartum hemorrhage (PPH) remains the main cause of maternal death throughout the world. present goal was to determine the associated factors to maternal death in postpartum hemorrhage.Methods: This was a retrospective case-control study; carried out within Befelatanana maternity, in Antananarivo, from January 1st, 2013 to December 31st, 2015, on parturients who presented PPH. The cases were represented by the parturients who died despite well-managed care, and the control, by the living parturients.Results: Authors recorded 181 cases of PPH from 20,888 deliveries, with a prevalence of 0.86%; 47 of them died and 134 were alive; the mortality rate by PPH is 25.96%. Factors associated with death were low education (p=0.00 OR:3.2), non-working (p=0.01, OR:2.4), multiparity ( p:2.2 OR:0.01), absence of prenatal care (p:0.01 OR:2.2), cesarean section (p:0.00 OR:5.5); Intrauterine Fetal Death (p= 0.02, OR:2.2); uterine atony (p=0.03, OR 2.1); the state of shock (p=0.00 OR:57.8), sanitary evacuation (p=0.01 OR: 2.4), the need for blood transfusion (p=0.00 OR: 3, 7), use of catecholamines (p=0.00, OR:17.5); delayed management (p=0.01, OR:2.2), hemostasis hysterectomy (p=0.00 OR: 8.67).Conclusions: The decrease of maternal mortality related to PPH requires better monitoring of pregnancy, delivery and postpartum. Speed care management, improvement of technical platform and establishment of a powerful health system are also needed. Thus, the global reduction of poverty is indispensable.
L a procidence du cordon ombilical réalise un accident obstétrical grave de la période du travail, et constitue une cause importante de mortalité périnatale sans grever le pronostic de la mère. Définie comme la chute d'une anse du cordon ombilical au-devant de la présentation au moment de la rupture des membranes ou après celle-ci, elle expose le cordon à la compression, à la dessiccation ou à la mort réflexe, menaçant ainsi le pronostic foetal [1]. Il s'agit d'une extrême urgence d'extraction foetale. À Madagascar, qui est un pays en développement, sur 1 000 naissances vivantes, vingt-quatre décèdent entre zéro et un mois et vingt-quatre entre un et douze mois [2]. Des progrès ont été réalisés dans notre centre, depuis quelques années, en matière de prise en charge obstétricale et néonatale, par exemple pour ce qui est des possibilités d'extraction foetale dans les Résumé. La procidence du cordon ombilical est une urgence obstétricale majeure, menaçant le pronostic foetal. Nous avons réalisé une étude rétrospective transversale sur trois ans des procidences du cordon ombilical pulsatile dans notre centre, qui est une maternité de niveau 3, afin d'évaluer le pronostic néonatal de la procidence du cordon ombilical pulsatile. La procidence du cordon ombilical pulsatile se rencontrait dans 0,27 % des accouchements. La moyenne d'âge des parturientes était de 28 ans, et 51 % étaient des multipares. Une césarienne était pratiquée dans 96 % des cas. Les facteurs agissant sur le pronostic néonatal étaient le degré de procidence (p = 0,0002981) et l'aspect du liquide amniotique (p = 0,004078). Les complications néonatales étaient représentées par l'admission en réanimation néonatale (33 %), l'asphyxie périnatale (31 %), la prématurité (29 %), l'infection néonatale (4 %) et la mortalité néonatale (10 %). Conclusion : l'extraction foetale doit se faire dans les plus brefs délais, notamment lorsque le cordon ombilical est extériorisé et que le liquide amniotique est méconial.Abstract. Umbilical cord prolapse is an obstetrical emergency that is life-threatening for the fetus. This retrospective cross-sectional study examined cases of pulsating umbilical cord prolapses at our level-3 maternity unit over the past three years and sought to assess their prognosis. Cord prolapse occurred in 0.27% of deliveries. The women's mean age was 28 years, and 51% of the women were multiparous. Cesarean deliveries were performed in 96% of cases. Factors affecting neonatal outcome were the degree of cord prolapse (p = 0.0002981) and the appearance of amniotic fluid (p = 0.004078). The neonatal complications included admission to neonatal intensive care (33%), perinatal asphyxia (31%), prematurity (29%), neonatal infection (4%), and neonatal mortality (10%). Conclusion: The fetus must be delivered rapidly, especially when the umbilical cord drops outside the mother's body and the amniotic fluid is meconial.
Lymphoepithelioma-like carcinoma (LELC), which is commonly reported in the nasopharynx and occasionally in other organs, remains a rare condition in gynecology. It is morphologically defined as a poorly differentiated carcinoma with prominent lymphoplasmacytic infiltrate. We present a case of an 82-year-old woman with a 10 cm LELC of the ovary shown by inguinal lymph nodes. There was no peritoneal carcinomatosis. Cytoreductive surgery was performed to remove a left ovarian neoplasm and multiple involved lymph nodes. Cytoreduction was complete. The tumor was a mixed poorly undifferentiated ovarian carcinoma consisting of 95% LELC and 5% moderately differentiated serous adenocarcinoma. Immunohistochemistry showed a large infiltration of T lymphocytes and plasma cells. Epstein-Barr virus was not detected by immunolabeling and polymerase chain reaction. The patient was still alive at 24 months of follow-up. To our knowledge, this is the second case of ovarian LELC and the first description of the native tumor before chemotherapy. In conclusion, this rare tumor of the ovary is difficult to diagnose both preoperatively and perioperatively. However, clinicians and pathologists should be aware that ovarian tumors with massive involvement of lymph nodes and no peritoneal carcinomatosis are suggestive of such a diagnosis and that prognosis is relatively good.
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