Background Methotrexate is an anticancer drug from the antimetabolite class. It is also used in gynecology and obstetrics and is the molecule of choice for the medical treatment of ectopic pregnancies. We report a case of toxidermia associated with severe pancytopenia induced by methotrexate for ectopic pregnancy. Case presentation A 30-year-old Malagasy (African) woman was admitted to the Emergency and Intensive Care Department for probable toxidermia following injection of 75 mg of methotrexate for an ectopic pregnancy. She had developed generalized erythema, which started 48 hours after the injection. The secondary onset of phlyctenular maculopapular skin lesions, generalized purpura, and erosions of the oral mucosa in a context of febrile jaundice prompted her hospitalization. On admission, the patient presented with febrile neutropenia, pancytopenia, renal failure, and hepatic cytolysis. She received transfusions of fresh whole blood, erythromycin, and amphotericin B. The course was fatal within 2 days of hospitalization. The patient died of multiple organ failure. Conclusions Our case is mainly distinguished by the lack of use of granulocyte growth factors and folinic acid. In the event of severe reactions to methotrexate, the management should be multidisciplinary and as much as possible within an intensive care unit.

Background: Umbilical cord prolapse is a major obstetrical emergency that threatens the fetal prognosis during labor. The objective of this study was to describe the epidemiologic and clinical profile of pulsatile cord prolapse at the Befelatanana University Hospital of Obstetric Gynecology.Methods: It is about a retrospective cross-sectional study conducted at the Befelatanana University Hospital of Obstetrics and Gynecology in Antananarivo over a period of 3 years, from January 1st, 2012 to December 31st, 2014. We have identified all cases of umbilical cord prolapse. We studied obstetric, neonatal and maternal parameters.Results: We found 70 cases of pulsatile umbilical cord prolapse, a prevalence of 0.28% of deliveries. The average age of the patients was 28 ± 3.2 years with extremes ranging from 18 to 43 years. Multiparous women predominated with (51.43%) Pregnancy was long term, with 71.43% of cases associated with placenta praevia, lateral prolapse of the limb, long cord and contracted pelvis. The prolapse of the cord was 1st degree with 44.29% of cases. All patients had received (100%) of oxygen therapy. Almost all patients were caesarized (95.71%). Neonatal complications were represented by admission to neonatal intensive care unit (32.86%), perinatal asphyxia (31.43%), prematurity (28.57%), neonatal infection (4.29%) and neonatal death (10%).Conclusions: The umbilical cord prolapse is relatively rare. Fetal extraction in the shortest possible time, especially when the cord is externalized, which is the main determining factor of neonatal prognosis.

Background: Uterine rupture is an obstetric emergency. It involves the life of the mother and the fetus. The main objective of this study was to describe the epidemiological-clinical profile of uterine rupture in Befelatanana Obstetrics and Gynecology University Hospital from January 2016 to April 2018.Methods: This is a retrospective and descriptive study conducted from January 1, 2016 to April 30, 2018 at the Befelatanana Hospital Centre of Gynecology-Obstetrics. All pregnant patients with uterine rupture were included.Results: We recorded 35 cases of uterine rupture in 13184 deliveries with a prevalence of 2.65%. The average age was 27.69±6.21 years old. More than half of the pregnant women attended at least four prenatal care consultations. Uterine rupture occurred after a vaginal delivery attempt outside the centre in 62.86%. There were 77.14% cases occurring on non-scarred uterus and 14.29% on mechanical dystocia. A case of fetal macrosomia has been reported. There were 28.57% maternal deaths and 51.43% perinatal deaths, half of which were fetal deaths in utero and the other half were early neonatal deaths.Conclusions: Uterine rupture remains high in Madagascar. Quality antenatal care and training of the personal would be needed.

Ectopic pregnancy is a life-threatening condition occurring in 1-2% of all pregnancies. The most common site of implantation for an ectopic pregnancy is the fallopian tube. Authors report a case of recurrent ipsilateral ectopic pregnancy following right partial salpingectomy of a 29-Year-Old woman that led to tubal rupture. The pregnancy was conceived spontaneously. Diagnostic of ruptured ectopic pregnancy was done after clinical and ultrasonography examination. The presence of a massive hemoperitoneum with a positive pregnancy urinary test that lead us to the diagnosis of ectopic pregnancy. She underwent a laparotomy for a suspicion of ruptured ectopic pregnancy. The ectopic pregnancy was identified in the left remnant fallopian tube. Partial salpingectomy, removal of tubal stump, and resection of the uterine cornua, was performed. The postoperative recovery was uneventful. She has stayed for five days at the Hospital. All patients, even though they have already received a definitive contraception by tubal section and ligature or unilateral or by bilateral salpingectomy for any reason, must seek an ectopic pregnancy in case of pelvic pain, vaginal bleeding and/ or amenorrhea. Authors propose to carry a total salpingectomy after a chosen surgical treatment.