Postpartum hematoma, rare among several causes of postpartum hemorrhage, is exceptionally reported in the etiologies of obstetrical near miss. The authors reported a case of large vulvo-vaginal hematoma after home delivery in a 26 year old patient of Franco-Indian descent. The patient was admitted in a state of hemorrhagic shock combined with an impregnable blood pressure, a significant skin-muquauses pallor and conscience disorder. Its management required a good coordination between the anesthesia team and the obstetrical team as it was based on the hemostasis results after surgical evacuation of the hematoma for more than 1000 ml blood and corrections of blood crass disorders.

Introduction: Few hospital practice enhanced recovery after caesarian section. Our aims is to evaluate the application of enhanced recovery after caesarian section after implementation in our service. Materials and Methods : An observational audit prospective was conducted, from November 2018 to January 2019, in the complex mother-child Military Hospital, Antsiranana. Patients between 18 to 35 years, ASA 1 or 2 before surgery were included. General anesthesia procedures are excluded. Results: Thirty-one patients were identified. Each received antiotic prophylaxis and prevention of postoperative nausea/ vomiting and intratechal morphine. Fluid infusion was optimized in 18 patients. In post-interventional recovery room, multimodal analgesia were given orally after the intervention in 15 patients (48%), Sixteen (52%) cases drunk. Forty-four patients (45%) ate food four hour after intervention. Stop infusion performed in 13 cases (42%). The bladder catheter removed in 13 patients (42%). The median length of stay was 3.5 days. Conclusion : Early food, removal of the bladder catheter and the infusion stop have low compliance to the protocol. An audit and formation were needed.

INTRODUCTION & AIM: Malaria is a major health problem in our country. Our aim is to determine the poor prognosis factors of this pathology.MATERIALS AND METHOD: A retrospective descriptive, analytical study was conducted in the intensive care unit of University Hospital Center of Joseph Raseta Befelatanana, during 24 months (June 2015 to May 2017). The severity was defined according to the recommendations for clinical practice (2007). We compared surviving and non-surviving patients.RESULTS: Fifty-six (56) cases were studied. The average age was 30 ± 11 years with a sex ratio of 6. Six cases had pulmonary disease. Neurological failure was present in 29 cases. Forty-seven cases were treated with quinine and 07 cases received norepinephrine. The length of stay was 3.55 ± 2.06 days. Eighteen subjects (32%) died. In multivariate analysis, neurological failure (p = 0.0001), jaundice (p = 0.0016), renal insufficiency (p <0.0001) and use of catecholamine (p = 0.0139) were associated with poor prognosis.CONCLUSION: The mortality of malaria was high. Neurological failure, jaundice, renal insufficiency and use of catecholamine were poor prognostic factors.