[How far do clandestine abortion providers go in Africa?]

A 28-year-old, gravida 2, para 2 was admitted to undergo abortion in the third quarter. The procedure consisting of mechanical induction of labor using plastic catheters was performed by a male nurse. The day after placement of the catheters the patient began labor and gave uneventful birth to female infant weighing 2900 grams. The procedure undertaken to destroy the fetus led to the birth of a normal healthy child. Mechanical induction after full-term pregnancy (rarely performed in our areas) is unwarranted if pregnancy is ongoing. Due to his ignorance of the late stage of pregnancy and of the potential consequences of the procedure, the male nurse had exposed the patient to risk of severe trauma. Although the outcome was favorable for the patient, action must be taken to control intermediate level health care workers whose practices can endanger the population.

[Analysis of abortions at a community maternity hospital in Bangui]

Abortion, i.e., early termination of pregnancy, has few complications when it occurs spontaneously. However self-inflicted abortion (SIA) often leads to more or less serious complications. In view of the increasing number of abortion cases in our department, we undertook this yearlong transversal study to evaluate the incidence of SIA in the department, determine the demographic characteristics of the women that practiced SIA, and identify the complications of SIA. Only ongoing or incomplete abortions were studied. Amenorrhea not related to pregnancy or associated with ectopic pregnancy was excluded from study. Clinical and demographic data were noted on forms specially designed by the research team. Data analysis yielded the following findings. Abortion accounted for 719 of the 5292 hospitalizations (13.6%) in gynecology unit, including 43.4% of SIA. Mean patient age was 24.7 years (range, 13 to 39). Spontaneous abortion was more likely to be observed in married women than in students who usually presented SIA. Wanted pregnancy was more likely to be reported by married women than by single woman who posed the problem of unwanted pregnancy. Students had more SIA. The main reasons for practicing SIA were financial (61.5%). The most common methods used for SIA were drug combinations (39.1%) and mechanical tools (26.0%). All severe complications such as infection and death were observed in women who practiced SIA. The high incidence of SIA in the department was especially disturbing due to the young age of the women involved and the severity of the complications. More action is needed to spread information on contraceptive methods in schools and universities to avoid unintended pregnancies that drive young people to practice SIA.

[Student sexual behavior at the University of Bangui in the Central African Republic]

Encouraging responsible sexual behavior has become an important issue in recent years mainly due to the worldwide human immunodeficiency virus (HIV) epidemic and to the high number of unwanted pregnancies that often end in high-risk abortions. Young people and in particular students in higher education are high-risk groups for both unwanted pregnancy and HIV. The purpose of this report is to describe the findings of a month-long survey conducted among students at the University of Bangui (UB) in 1998-1999. Individual students were asked to give immediate responses to semi-open questions. The Chi test was used to assess correlation between a number of variables. A total of 422 UB students including 218 males (51.7%) and 204 females (483%) were included in the survey. Mean age was 24.9 years for females and 26.1 years for males. Over half of the students of both sexes reported having their first sexual relation between the ages of 15 and 19 years. Males were more satisfied by their first experience than females. The percent of married students (male or female) was 5.9%. Most students (62.1%) had at least 2 sex partners and 58.3% had at least one child. The preferred contraceptive method was condom use for males and the Ogino technique for females. The percent of female students expressing fear of HIV infection was 27.4%. The results of this study show that information and education campaigns are needed to encourage UB students to practice sexual behavior to avoid both unwanted pregnancies and sexually transmitted diseases such as HIV infection.

[Uterine rupture in the maternity ward of the Bangui Community Hospital (Central Africa)]

Although now uncommon in developed countries, uterine rupture is among the major obstetrical emergencies dealt on a daily bases in the maternity ward of the Bangui Community Hospital in Central African Republic, which is the national reference facility. Uterine rupture is life-threatening for both the fetus and mother. In view of the relatively high rate of rupture observed in our department in previous years, this cross-sectional study was undertaken in order to determine incidence, identify predisposing factors, evaluate prognosis for the mother and newborn, and propose solutions. From January 1997 to December 1997, all deliveries by the vaginal route or cesarean section including cases involving uterine rupture were recorded. The length of time elapsed between the decision to perform cesarean section and actual performance of the procedure was determined. Risk factors associated with uterine rupture in our department were noted. The outcome of uterine rupture was evaluated in both the mother and fetus. Of a total of 5763 deliveries during the study period, 299 required cesarean section (5.9%). Uterine rupture occurred in 35 cases of the 299 women (11.7%). In 10 cases of uterine rupture, the time lapse for performance of cesarean section was at least 2 hours. The main cause of delay was the lack of funding for cesarean section. Six women died due to irreversible shock (0.1% of deliveries, 2% of cesarean sections and 17.1% of uterine ruptures). The perinatal mortality rate was 80%. In our department, uterine rupture is a common emergency causing high mortality in mothers and newborns. Most of these patients could have been saved.

[Value of fetal pulmonary maturity determination with the Clements test in high risk pregnancies]

To extract a foetus which presents chronic suffering in high risk pregnancy, the determination of pulmonary maturity leads to take the decision. Among the complementary analysis to determine the pulmonary maturity, we used of Clements test (CT) which realization is easy and the results rapid. The objectives of this paper were to evaluate the pulmonary maturity with CT, to establish correlation between CT and breathing distress syndrome at birth and to determine the validity of CT about new born vitals parameters. During a two years prospection in "Hopital Communautaire" maternity and "Complexe Pédiatrique", we have recruited 390 laboring women with high risk pregnancy who attained six months. We have leaved out the search cases of prematureness membrane rupture or tinted amniotic fluid. The fluid amniotic to be analyzed was taken with syringe and was subjected to different techniques allowing to conclude pulmonary maturity or not. Statistical tests has permitted to establish correlation between CT and new born vitals parameters. The means of laboring women age was 25 years old. In 59.3%, the women have between 1 and 3 children. The caesarians decided in 21.4% of cases were related to generally restricted pelvis with bi-scared uterus. The prematurity confinement had concerned 37.4% of new born. The CT result was positive in 61% of cases. The Apgar score under 7 had been more observed among children who had positive CT. The respiratory distress was significantly more frequent among children born by caesarian. The stillbirths rates of was more exalted with cases of negative CT. The results of this search have permitted to identify new born correlative parameters with pulmonary maturity. This one might be determined by CT, in high risk new born, the vulgarization of this test would improve their management.

[Report of a case of ovarian pregnancy observed at the Gynecolgy-Obstetrics Service in Bangui (Central African Republic)]

The case report was the first observed in Central African Republic. The patient was a thirty years woman who comes from a small-townish for dead fetus retained. She had not point out abdominal pain or bleeding and had presented a satisfied clinical state. The investigations had confirm a dead abdominal pregnancy. During the laparotomy, it was uncovered a regular mass developed on the right annex. Those annex mass hasn't presented adherences with other abdominal organs. The ablation of the mass and the right annex had been done without difficulty. The holing of operated mass had permit to uncover a macerated dead male fetus weighted 1650 grams. The following of operation was normal The histological analysis had determined the nature of that ovarian pregnancy. Hour attention was be retain by that case who had prolonged development and almost non-existence complications.

[Prenatal care in a semiurban area of Central African Republic: frequency, influential factors, maternal and neonatal prognosis]

This 9-month longitudinal study was carried out in a cohort of 287 women hospitalized for various obstetrical reasons in Bouar, the third largest city in Central Africa. A total of 225 of these women gave birth to 229 children. The purpose of study was to evaluate attendance at prenatal examinations, risk factors for obstetrical morbidity, and maternal and neonatal prognosis. Results showed an overall absence rate at scheduled examinations of 38 p. 100. Only 8.4 p. 100 of women enrolled for prenatal care complied fully with the examination schedule. The factors associated poor attendance were age older than 19 years, distance greater than 5 kilometers between the woman's home and care facility, and illiteracy. The incidence of complicated pregnancy was significantly higher in refractory women. Reported complications included eclampsia, extrauterine pregnancy, and death of the mother. A total of 43.5 p. 100 of home deliveries involved women that did not attend prenatal care clinics. A total of 23.1 p. 100 of newborns without prenatal care presented complications requiring intensive neonatal care with an Apgar score below 7. Overall the perinatal death rate was 12.7 p. 100 (n = 29). The stillbirth rate was 10.1 p. 100 (n = 16). The findings of this study demonstrate the favorable impact of prenatal care on pregnancy outcome for both mother and child. Prenatal care should be made available to all pregnant women.

[Giant anovulvar condyloma acuminata revealing hiv-1 seropositivity in a Centrafrican patient]

As a general rule, genital condylomas present as localized lesions and large masses of warts are observed only during pregnancy. In this report we describe a giant anogenital condyloma in a non-pregnant 18-year-old Centrafrican woman. Soft papillomas completely covered the anterior and posterior perineum and obstructed the vagina. Clinical findings were suggestive of vulvar Buschke and Loewenstein tumor. The extent of the lesions and a history of unprotected relations with several sex partners raised suspicion of HIV infection which was subsequently confirmed. The CD4+ lymphocyte count was 540/min3. Surgical removal led to complete cure after healing of the surgical wound. Histological findings showed that the lesions were benign and ruled out malignant vulvar tumor. This case documents the link between florid genital condylomas and HIV infection with no change in immune status.