Abstract:Introduction: Chlamydia trachomatis is a bacteria responsible of the most prevalent sexually transmitted disease worldwide, causing severe tubal damage responsible of ectopic pregnancy. This study was conducted to determine the incidence of chlamydia in women with ectopic pregnancy ruptured in a reference hospital of capital town of Madagascar. Patients and methods: This is a transversal and descriptive study of screening for Chlamydia trachomatis IgG cases among ectopic pregnancy seen at the University Hospital of Obstetrics Gynecology Befelatanana (CHUGOB) from 01 February to 30 May 2015. Results: During the study period, we recorded 41 cases with a overall rate of ectopic pregnancy of 2.04% when reported to the total number of deliveries. (n: 2347) The average age of patients was 30.50 years with predominance in primiparous (66%). More than half of the patients had at least one risk factor and 90% had a history of abortion induced and spontaneous miscarriage. The frequency of positive Chlamydia trachomatis IgG is 20.83% (n: 10) among which 7 presented pathological fallopian tube. Conclusion: The best way to avoid complications is precocious screening, but the cost of the screening tests remains an obstacle in developing countries like Madagascar.
Objective: Pregnancy after age 40 remains a concern as it exposes to particular obstetrical complications. Our study aims to determine the risks of complications related to pregnancy and childbirth of women aged 40 and over. Study design: We carried out a cross-sectional analytical study of a historical cohort comparing the progress and the outcome of pregnancy in women 40 years of age and over to those aged 20 and 35 who gave birth at the University Hospital of Obstetrics and Gynecology in Befelatanana, from 1 st January 2010 to 31 December 2013. Results: The prevalence of childbirth among 40 years old and over was 0.61%. They were multiparous and large multiparous in 88% of the cases. The analysis showed that parturients aged 40 years and older were at signifi cant risk for caesarean section, with three times the risk of emergency caesarean section. The frequency of this emergency caesarean section increased with parity (RR = 3.04 [2.15-4.30], p = 10-10). Among their neonates, 23.42% were hypotrophic, 22.86% premature, 12% asphyxiated at birth, 13.14% admitted to neonatal resuscitation and 5.71% died in utero, but without signifi cant difference with the group unexposed. Perinatal death was 7.43% in women aged 40 and over vs. 4% in 20 to 35 year olds (RR = 1.85 [0,89-3,86]; p = 0.052). Conclusion: We found that pregnancies after 40 years were not exposed to pregnancy-related pathologies or specifi c fetal complications. The use of an emergency cesarean is, however, frequent.
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