Background: Postpartum hemorrhage (PPH) remains the main cause of maternal death throughout the world. present goal was to determine the associated factors to maternal death in postpartum hemorrhage.Methods: This was a retrospective case-control study; carried out within Befelatanana maternity, in Antananarivo, from January 1st, 2013 to December 31st, 2015, on parturients who presented PPH. The cases were represented by the parturients who died despite well-managed care, and the control, by the living parturients.Results: Authors recorded 181 cases of PPH from 20,888 deliveries, with a prevalence of 0.86%; 47 of them died and 134 were alive; the mortality rate by PPH is 25.96%. Factors associated with death were low education (p=0.00 OR:3.2), non-working (p=0.01, OR:2.4), multiparity ( p:2.2 OR:0.01), absence of prenatal care (p:0.01 OR:2.2), cesarean section (p:0.00 OR:5.5); Intrauterine Fetal Death (p= 0.02, OR:2.2); uterine atony (p=0.03, OR 2.1); the state of shock (p=0.00 OR:57.8), sanitary evacuation (p=0.01 OR: 2.4), the need for blood transfusion (p=0.00 OR: 3, 7), use of catecholamines (p=0.00, OR:17.5); delayed management (p=0.01, OR:2.2), hemostasis hysterectomy (p=0.00 OR: 8.67).Conclusions: The decrease of maternal mortality related to PPH requires better monitoring of pregnancy, delivery and postpartum. Speed care management, improvement of technical platform and establishment of a powerful health system are also needed. Thus, the global reduction of poverty is indispensable.

Birth defects in the uterus result from abnormal fusion of the miler ducts and / or failure. Uterine malformations are a common cause of infertility, but if pregnancy occurs absorption from the septum. They are relatively frequent and concern 0.1-3% of the female population, such a situation is potentially high risk obstetric. We report here, 11 cases of uterine malformations during pregnancy seen at the CHUGOB from May 01, 2017 to May 01, 2018. We observed 11 cases of uterine malformations during pregnancy, including 3 cases of didelphus uterus, 3 cases of pseudo-unicornuate uterus, 3 cases of bicornuate uterus, 1 case of septate uterus and 1 case of true unicornuate uterus. The age of the parturients ranged from 22 to 26 with a mean of 23.63 years. Regarding pregnancy, 5 women were primigest, 4 were paucigest and 2 were multiparous. For gestational age, 09 cases came to term and 2 cases pregnancy stopped at 17 weeks. The average birth weight was 2215g. The diagnosis of the malformation was made before the caesarean section in 2 out of 10 cases. Eight out of 10 cases of the fetuses were alive. Congenital uterine malformations are often asymptomatic. The occurrence of pregnancy in a malformed uterus is a rare but potentially serious situation. The diagnosis of these abnormalities is based on new advanced imaging means such as 3D ultrasound.

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: Pulmonary edema is defined as the as the ultrafiltration of plasma through the capillary wall to the interstitium and pulmonary alveoli. It is a rare pathology and difficult diagnosis. Through this study, we wanted to know the etiologies and maternofetal issue of acute pulmonary edema manifesting in prepartum. It is a rare pathology and difficult diagnosis. Through this study, we wanted to know the causes and maternofetal issue of acute pulmonary edema manifested in prepartum.Methods: It is about a descriptive retrospective study from January 1st, 2014 to April 30th, 2018 at the Befelatanana University Hospital of Obstetrics and Gynecology. We included all pregnant patients of 20 weeks and above with acute antepartum pulmonary edema. We excluded postpartum APE. Data collection and analysis was performed on the Excel Stat 2007 Software.Results: We had 36 cases of acute pulmonary edema during this period with an incidence of 0.001%. The average age was 28.75±8.72 years. Mean gestational age was 32 ± 7.82SA. Pregnancy was poorly followed in more than half of the cases. 15% did not perform prenatal follow-up. Caesarean section was the chosen delivery route in 82% of cases. Among the childbirth, 73% were premature, 63% asphyxiated and 56% hypotrophic. We had 52% of maternal death and 44, 44% of fetal loss. The main etiology was dominated by preeclampsia and its complications (63.88%) followed by cardiopathy (25%). A case of malaria during pregnancy was identified as the cause of APE.Conclusions: Acute pulmonary edema during pregnancy is a serious pathology because the maternal prognosis is catastrophic with 50% maternal and foetal mortality in our context. The identification of patients at risk, the monitoring of pregnancy, the effective management of the pathology involved are necessary to reduce the incidence and maternal mortality secondary to pulmonary edema.

The rectovaginal fistulas are a pathological epithelialized communication between the vagina and the rectum, its frequency is 10 to 30%, and it is a disabling pathology because of the social repercussion. Many flap techniques have been described but the aim is to present a simple procedure according to a particular technique called Martius. This is a case of woman presenting a low rectovaginal fistula on obstetrical trauma. The surgical technique consists of a repair according to the technique of Martius. The operative follow-up was simple and the patient was able to resume sexual activity and normal anal sphincter function. It is a simple technique, easy to achieve for the technical platform in Madagascar whose evaluation of the results for a larger population should be considered. This technique therefore deserves to be known and widely used.