[Internal version maneuvers at the maternity hospital of Befelatanana--Antananarivo University Hospital Center (Madagascar): 177 cases].

Version by internal manipulations (VIM) cause high fetal and maternal morbidity and mortality rates. A retrospective study was carried out in 1998 at at the Maternity Hospital of Befelatanana, Antananarivo in order to assess VIM frequency, to specify their indications and technical difficulties by performing them. 177 VIM were registered for the period study: 85 on singleton pregnancies, 91 on the second twin and 1 on the third infant of a triplet pregnancy. VIM annual incidence was of 2.1 per cent. The average age of parturient women was 27 years old. Risk factors and determinative causes are gyneco-obstetrical history as abortion, preterm delivery, urogenital infections; high blood pressure; poor prenatal visits; poor cares during labor; untimely and inappropriate drug prescriptions; low standard of living. Maternal complications were hemorrhages of the afterbirth (73.0 per cent), uterine rupture (8.0 per cent), cervix tearing (5.0 per cent). 19 maternal deaths were noted. Infant perinatal mortality was of 68.0 per cent. The authors conclude that VIM is the only alternative to cesarotomy provided it is properly performed by a competent and experienced practitioner. VIM must be kept for the second twin in unengaged transverse lie.