Background: Postpartum hemorrhage is the leading cause of maternal death in developing countries. Uterine atony is the cause in 80% of cases. Through this study, we want to determine risk factors for uterine atony after vaginal delivery route with oxytocin-mediated delivery.Methods: This is a retrospective case-control study ranging from January 1st 2017 to June 31st 2018 at the Befelatanana University Hospital Centre of Gynecology-Obstetrics. The cases consisted of patients who had spontaneous vaginal delivery in the centre and had uterine atony. Authors studied maternal, obstetrical, neonatal parameters. Authors used the R software for the statistical analysis of the results.Results: We found 40 cases of uterine atony out of 5421 deliveries with a prevalence of 0,73%. The average age was 27.73 years old±6.46 years old (p=0.113). The average parity was 2.67±1.62 (p=0.22). The total duration of labor was 6.88±2.95 hours (p=0.0187). The average duration of rupture of the membrane was 5.80±11.90 hours (0.003376). We found as risk factor of uterine atony the increase in oxytocin infusion rate during labor (OR=18.67, 95% CI 2.21-157.57), the artificial rupture of membranes (OR=5, 27, 95% CI 2.11-13.19), artificial induction of labor (OR=7.08, 95% CI 2.06-24.28) and labor over six hours (OR=2.53, 95% CI) % 1.18-5.47). In univariate analysis, premature delivery and a hypotrophic fetus were a factor risk of uterine atony (OR=3.07, 95% CI 1.27-7.44 and OR=3.43 95% CI 1.48-8.09 respectively) but this risk is not statistically significant in multivariate analysis with logistic regression (OR=1.27, 95% CI 0.40-3.84 and OR=2.19 95% CI 0.77-6.22). The main treatment was uterotonic drug use (72.5%). Authors identified seven cases of haemostasis hysterectomy and two cases of maternal death.Conclusions: Present study confirms risk factors for uterine atony already known as prolonged labor and increased oxytocic infusion rate. Unrecognized factors have been identified as a risk factor for uterine atony such as the duration of rupture of the membranes and artificial rupture of the membranes. A minimal inflammation hypothesis that reduces susceptibility to oxytocin may explain this association. Knowing these factors would reduce the occurrence of uterine atony to reduce maternal mortality.

Background: Postpartum hemorrhage is one of the leading causes of maternal death in the entire world. It affects 10% of deliveries. Emergency peripartum hysterectomy (EPH)defined as a lifesaving procedure involving the removal of the uterus to treat severe postpartum hemorrhage is one of the last-resort treatments for severe postpartum hemorrhage in case of failure of other techniques. Through this study, we aimed both to describe the epidemiological profile, to determine the etiologies, and maternal complications of EPH.Methods: It is about a descriptive retrospective study from January 1st, 2016 to January 1st, 2017 at the Befelatanana University Hospital of Obstetrics and Gynecology. We included all patients who underwent Emergency peripartum hysterectomy after 22 weeks of Amenorrhea (WA) regardless of the delivery route in the centre. We used the R software for the statistical analysis of the results.Results: We had 31 cases of EPH during this period with a prevalence of 0.44%. The average age was 26.38±5.61 years. Mean gestational age was 37±3.59 weeks of amenorrhea. In the 83.87% of cases, the patient received less than four prenatal consultations. Patients were referred in 45.16% of the cases. The delivery route was by cesarean section in 48.39% of cases. Eleven patients (35.48%) received a blood transfusion. Hysterectomy was subtotal in 96.77% of the cases. We had five (16.13%) maternal deaths during the study period. The leading cause of death was hemorrhagic shock (80%). The etiology of hysterectomy was dominated by uterine atony complicated by hemorrhage (48.39%), followed by retroplacental hematoma (25.81%) and uterine rupture (22.58%).Conclusions: EPH still holds its place in the management of postpartum hemorrhage in Madagascar. Maternal mortality remains high. Uterine atony was the most common indication for EPH. The prevention of postpartum hemorrhage by management of the third stage of labour should be carried out by any health actor.

Background: Leiomyomas or fibromyomas more commonly referred as uterine fibroids are the most common tumors of the female genital tract. They affect 20 to 25% of women in genital activity. The objective of present study is to describe the epidemiological and therapeutic profile of uterine fibroids at the UHCOBG.Methods: Retrospective and descriptive cross-sectional study of patients with uterine fibroids hospitalized in the department of gynecology of the UHCOBG between January 2015 and December 2016.Results: In total, 101 cases of uterine fibroids have been identified with a prevalence of 3.92%. The average age is 42.75±3.6 years old. The most affected age group varies from 35 to 45 years old. Thirty-eight-point six percent of the patients were pauciparous. The medical history of irregular menstrual cycle disorders was present in 17.8% of the cases. The symptomatology was dominated by menometrorrhagia (78.2%) and in 67.3% of the cases, patients had anemia. The majority of patients (64.4%) had poly-myomatous uterus which fibroid location was predominantly corporeal (92.1%), isthmic (21.8%), and three quarters of the mapping was interstitial. Complications were dominated by aseptic necrobiosis (7.9%) and conservative treatment in 68.3% of the cases. Laparotomy is the pillar of a surgical treatment. The duration of hospitalization was short in 77.2% of the cases, 91.1% had a good progress and no death was noticed during 2 years.Conclusions: This is the first operative indication of all gynecological pathologies in present UHC and proves to be a real public health problem. The development of operative laparoscopy is necessary to reduce the morbidity associated with treatment.

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.

Background: The chorioamnionitis corresponds to an infection of the ovular cavity. She puts game neonatal and maternal forecast. This study had as objectives to describe the epidemiological aspects, the taking care and the forecast of the chorioamnionitis to the gynecology teaching hospital and obstetrics Befelatanana, Madagascar.Methods: It is about a descriptive, retrospective and transverse study, during a period of 6 months going from January, 2016 till July 2016. The pregnant women introducing a premature break of membranes (RPM) complicated with chorioamnionitis hospitalized in CHU-GOB during this period had been included.Results: Authors found 35 cases of chorioamnionitis, that is 38.1% premature breaks of membranes. The medium age of the patients was 20±5, 16 years old (extreme from 17 to 36 years). Primiparous was found in 82.9%. The chorioamnionitis had happened in 68.5% cases after 37 weeks of amenorrhea. The delay between RPM and happened of chorioamnionitis was of 6 hours. The picture of chorioamnionitis was complete in 54.3%. Delivery was by low way in 33.3%. Authors had found 88.60% case of endometritis, 8.6% case of parietal suppuration post caesarian section but without any maternal decease. Neonatal complications were marked by a score of Apgar <7 - five minutes in 74.3%, neonatal infection in 25.7% and precocious neonatal decease in 11.4%.Conclusions: The chorioamniotite concerned primiparous especially young urgent. The application of the protocol of taking care of the premature break of membranes is necessary for the reduction of the happening of the chorioamniotitis.