Objective: Anemia during childbirth remains a concern for reproductive health personnel, both in terms of frequency and the risks involved in all periods of pregnancy and childbirth. This work aims to analyze the epidemiological profile of anemic parturient and the outcome of their pregnancy. Methods: A multicenter case-control study conducted from February 1st to July 31st, 2017, in three Brazzaville maternity clinics, comparing the ratio of one case for two controls, the anemic parturient (n = 67) to those without anemia (n = 134). Any parturient with a hemoglobin level < 11 g / dl was considered anemic. The variables studied were sociodemographic and reproductive, related to anemia, per and postpartum. Results: Sixty-seven anemic parturient were recorded among 10,106 deliveries, a frequency of 0.7%. Anemic female parturient were older (30.1 ± 1.6 years vs 27.5 ± 1.9 years, p < 0.05), out of school (OR = 13.1 [1.5-111], p < 0.05) and unemployed (OR = 3.8 [2.1-7.2], p < 0.05). The mean hemoglobin level was 8.1 ± 0.1g / dl vs 12.1 ± 0.8g / dl. Anemia was microcytic hypochromic (28.4%) and normochromic normocytic (71.6%). Anemia was mild (40.3%), moderate (44.7%) and severe (15%). Delivery was more by caesarean section in cases (97% vs 1.5%, p < 0.05) with a higher recourse to blood transfusion (55.4% vs 3.8%, OR = 29.9 [10.8-82.6], p < 0.05). Maternal lethality was 13-fold higher in case of anemia (OR = 13 [1.5-111], p < 0.05). Neonatal morbidity was represented by poor adaptation to extrauterine life (OR = 40.7 [9.1-180.7), p < 0.05), hypotrophy (OR = 21.9 [7.2-67.1], p < 0.05), prematurity (OR = 6.6 [2.6-16.9], p < 0.05), neonatal resuscitation (OR = 35.4 [10.2-122.5), p < 0.05) and neonatal transfer (OR = 2.8 [2-4], p < 0.05). Neonatal lethality was three times higher in case of anemia (OR = 3.3 [2.6-4.8], p < 0.05). Conclusion: Maternal and neonatal prognosis is poor in anemic female parturient. Reducing the maternal and fetal impact of anemia during childbirth requires early detection and case management during prenatal contact.

Objective. To analyze the determinants of the delivery route and the neonatal prognosis in case of breech presentation at the University Hospital Center of Brazzaville. Method. Monocentric analytical cross-sectional study conducted from January 1 to December 31, 2019 in the Obstetrics Gynecology Department of the University Hospital Center of Brazzaville, comparing 54 women who gave birth by cesarean section and 23 women who gave birth vaginally. Were included all women who gave birth to a fetus in breech presentation whose chronological age was greater than or equal to 28 weeks of amenorrhea or a birth weight greater than 1000 g and their newborn. The variables studied were pre, per and post partal. The pvalue of the probability was considered significant for a value less than 0.05. Results. Breech delivery represented 1.6% of deliveries, i.e. 97 out of 6075. The women delivered were not different in age [29 (24-34) vs 29 (26-33), p>0.05] nor in parity [1 (0-3) vs 2 (0-3), p>0.05]. Most of them gave birth by caesarean section (63.9% vs 36.1%). The determinants of the delivery route were: level of education (48.1% vs 73.9%; OR=3.1 [1.04-8.9]; p<0.05), gestational age less than 34 WA (0% vs 13%; p<0.05), the existence of a uterine scar (22.2% vs 0%; p<0.05) and insufficient fundal height (3.7% vs 26.1%; OR=0.12 [0.02 -0.7]; p<0.05). Neonatal morbidity was not influenced by the route of delivery. Newborns from the vaginal route were the most transferred to neonatology (5.6% vs 34.8%; OR=0.11 [0.3 -0.47]; p<0.05) and died (0% vs. 17.4%; p<0.05). Conclusion. The decision of the way of delivery in case of breech presentation at the University Hospital of Brazzaville depends on both maternal and obstetrical factors. Identifying the determinants requires careful questioning and rigorous obstetrical examination.

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Objective: In December 2018, new recommendations from the National College of French Obstetrician Gynaecologists restricted obstetric indications for episiotomy to only instrumental delivery, to avoid the occurrence of obstetric lesions of the anus sphincter. In our maternity wards, episiotomy is still performed liberally in the face of high-risk perineal situations, without significant reduction in perineal tears. This is how the present study set itself the objective of evaluating the impact of a restrictive practice of episiotomy on the perineum. Methods: Before-after non-experimental evaluative study, conducted from March 1 to August 30, 2019, in two maternity hospitals in Brazzaville, comparing according to a 1/1 ratio, after matching age and parity, 300 parturient with a high situation perineal risk of episiotomy having benefited from a procedure restricting episiotomy to 300 others who did not benefit. The two groups were evaluated: the percentage of episiotomy, the percentage, and the degree of perineal tears. The effect of the restriction was assessed by calculations of the difference in absolute risk (DR), reduction in relative risk (RRR) and the number of subjects required to treat (NST). Results: Parturient with high perineal risk had a median age of 23 years (18-28) and were primiparous (0-1.5). The high perineal risk situations were dominated in the two groups by the maternal indications concerning parity (nulliparity: 40% vs 63%) and the perineum (scar: 51% vs 60%); followed by macrosomia (25% vs 38%) and prematurity (25% vs 16%) as fetal indications. The episiotomy was performed in all cases of instrumental forceps extraction (1.3% vs 5%). The restrictive practice of episiotomy was effective in 96% of cases with 69.8% of intact perineum vs 19%. It had a protective effect on the perineum, making it possible to avoid the occurrence of 82 episiotomies (DR=-82% [-93, -70]; RRR=95%) and 50 perineal tears (DR=-50% [-66, -34]; RRR=63%) for 100 parturient. To avoid an episiotomy and a perineal tear, the restriction procedure must be applied to an average of 1.2 parturient (NST=-1.2) and two parturient (NST=-2), respectively. Conclusion: It is entirely possible to opt for a restrictive practice of episiotomy in our maternities by rigorously and meticulously evaluating the perineal risks and by respecting the procedures for protecting the perineum during childbirth.

Introduction. Clandestine abortion, performed under unfavorable conditions, is fraught with complications that can affect both the genitals and extra genitals. Illegal in some developing countries, abortion is responsible for high maternal mortality, of which it is the third cause. Clinical observation. We report the case of a 16-year-old adolescent girl admitted for pelvic pain and genital bleeding with extragenital exteriorization of an intestinal loop following an abortive endo-uterine maneuver, at the end of 16 weeks of amenorrhea depending on the date of the last period. After laparotomy, there was a uterine perforation of the antero-inferior surface with ileo-jejunal evisceration, requiring the performance of an intestinal resection with end-to-end anastomosis and hysterorrhaphy. Conclusion. The complications of clandestine abortions are still relevant in our country, despite the awareness of family planning and contraceptive measures. The lack of a legal framework governing the medical care of abortion leaves free rein to unqualified personnel on the one hand or to artisanal practice on the other, thus exposing them to the risk of high maternal morbidity and mortality.