Accouchement gémellaire en milieu africain: une analyse de 10 ans dans le District de Bamako au Mali

Abstract

IntroductionLe but de cette étude était de déterminer les facteurs influençant le pronostic de l'accouchement du deuxième jumeau.MéthodesL'étude était rétrospective et a porté sur tous les cas d'accouchements gémellaires enregistrés à la maternité du Centre de Santé de Référence de la commune V du District de Bamako du 1erJanvier 2007 au 31 Décembre 2016 soit sur une période de dix ans.RésultatsNous avons enregistré 34.899 accouchements dont 1374 accouchements gémellaires soit une fréquence de 2,54%; près de 15% étaient des primipares; 39,16% étaient référées; 69,10% et 15,5% autres sans aucun suivi prénatal. Les facteurs influençant négativement pronostic du deuxième jumeau étaient: un délai ≥ 15minutes entre les jumeaux, le recours tardif à la césarienne, la non qualification de l'accoucheur, la grossesse monochoréale, le faible poids de naissance. Par contre la parité, la réalisation de manœuvres obstétricales n'avaient aucune influence sur le pronostic du deuxième jumeau.ConclusionLe pronostic du deuxième jumeau est fortement influencé par un délai de naissance de plus de 15 minutes entre les jumeaux, les autres facteurs agissant comme des cofacteurs.

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“…Twinning was more frequently spontaneous in our series with 86.6% versus 13.4% of pregnancies occurring after infertility treatment. Our observation is similar to those of several African series [5,7,8]; on the other hand, it is contrary to those of the European series where twin pregnancy was often consecutive to ART techniques [12].…”

“…This result joins that of Moreira [8] in Senegal reporting a predominance of pauciparas in his series with 26.6%; observation contrary to that of Vaast et al, [13] who estimate that twins, especially dizigote, increase with parity. Observation also contrary to that of Tiounkani et al, [5] in Mali reporting in its series a predominance of multiparas (55.61%). The history of multiple pregnancy was found in 85 of our patients, i.e., 33.6% (76 twin pregnancies, 7 triple pregnancies and 2 quadruple pregnancies).…”

“…Prematurity is the pathology that comes at the top of the obstetric complications in twin pregnancy, however fetal complications such as bradycardia, Placental abruption or cord procidence may occur after the birth of the first twin exposing the second to increased morbidity and mortality [3,4]. For some authors, these risks are especially present when delivery takes place vaginally and this depending on several parameters: presentation, mode of delivery, term, fetal weight, the difference in weight between the first and second twin [5]. The prevalence of twin pregnancy varies from region to region, country to country.…”

“…The frequency of twin pregnancies has increased considerably in recent years since the advent of Assisted Reproduction (ART) techniques in developed countries. This increase is felt slightly today in Africa south of the Sahara, certainly because of an improvement in health coverage in certain areas [5]. In France, as in other so-called developed countries such as the United States and the United Kingdom, the number of twin deliveries increased by around 62% between 1970 and 1998 due to an increase in maternal age and increasing use of medically assisted procreation techniques, so that in France twins represented 3.5% of births during the last national perinatal survey [4,6].…”

Comparative Study of Early Neonatal Complications between the First and Second Twin during Twin Vaginal Deliveries at the Yaounde Gynaeco-Obstetric and Pediatric Hospital, and the Yaounde Central Hospital

“…It is a high-risk pregnancy and requires special attention [1]. The frequency of twin birth varies according to regions and studies: 0.01% of births in France [2], 0.82% in Tunisia [3], 2.54% in Bamako [4] and 1.8% in Yaounde, Cameroon [5]. In twin births, maternal and fetal complications are high [6] [7].…”