[Current aspects of extrauterine pregnancy in Nosy Be (Madagascar), from November 1993 to February 1995]

We present the current aspects of ectopic pregnancies in Nosy Be, Madagascar, and possible solutions. Ectopic pregnancies are problems of public health here as in many developing countries. Nosy Be is a small island northwest of Madagascar and is part of Madagascar's territory. This was a prospective, continuous, nonrandom, open study of 27 ectopic pregnancies observed on this island; all were confirmed by laparotomy during 16 months from November 1993 to February 1995 in the department of general surgery in the hospital. The selected criteria of diagnosis were epidemiological, clinical and histological. Aside from the antecedent of genital infections, apparently the clinical lists of illnesses on the island are distinct from those in industrialized countries. In Nosy Be, the majority of these patients were young women having a history of genital infections. The diseases were later diagnosed at the stage of an intraperitoneal hemorrhage with shock. The diagnoses were exclusively clinical, because the hospital of Nosy Be is lacking materials and does not have equipment for measuring human chorionic gonadotrophin, or performing ultrasonography and celioscopy. Also, there is no blood bank. Thus we suggest the following. First, a blood bank should be established. Secondly the conditions of early diagnosis of the disease should be improved by providing information and education and an early examination of pregnant women. Yet these measures will be adequate only with the acquisition of complementary equipment for measuring human chorionic gonadotrophin, and performing ultrasonography and celioscopy. Thirdly, to decrease the frequency of the disease, the public needs to be informed and educated about the dangers of genital infections, their primary and secondary prevention and the necessity of their appropriate treatment.