Facteurs associés à l'infertilité féminine liée aux adhérences à Mbujimayi (RDC) / Factors associated with female infertility due to adherences in Mbujimayi (DRC)

Dans une société pro-nataliste, l'infertilité féminine est considérée comme un drame. Cette étude avait pour objectif d'identifier les facteurs associés à l'infertilité mécanique féminine liée aux adhérences pelviennes à Mbujimayi. MéthodologieIl s'agissait d'une étude cas-témoins, réalisée dans les Hôpitaux Généraux de Référence Dipumba et Saint Sauveur à Mbujimayi (RDC), durant une période allant du premier janvier 2006 au 31 décembre 2020. Nous avons colligé un total de 354 cas RésultatsLes facteurs associés à l'infertilité mécanique féminine étaient: l'âge inférieur à 20 ans qui multipliait par 4 le risque de développer des adhérences pelviennes (OR=4,01[1,19-13,49]); l'antécédent des infections sexuellement transmises (IST) (OR=1,77[1,06-2,96]) et l'antécédent de chirurgie abdomino-pelvienne (OR=1,76[1,07-2,88] qui multipliaient respectivement de presque par 2 le risque d'avoir les adhérences pelviennes. Ces associations étaient statistiquement significatives. ConclusionLes IST et la chirurgie abdomino-pelvienne exposent au développement des adhérences pelviennes et/ou aux altérations tubaires conduisant à l'infertilité féminine. Leur prévention doit se baser sur la prise en charge préventive des IST par la sensibilisation pour une sexualité responsable surtout chez les adolescentes, la rationalisation dans les indications et la bonne pratique de la chirurgie abdomino-pelvienne par les médecins.

Introduction: In a pro-natalist society, female infertility is considered a tragedy. This study aimed to identify the factors associated with female mechanical infertility related to pelvic adhesions in Mbujimayi. Methodology This was a case-control study, carried out in Dipumba and Saint Sauveur General Reference Hospitals in Mbujimayi (DRC), during a period from January 1, 2006 until December 31, 2020. We collected a total of 354 cases ResultsThe factors associated with female mechanical infertility were: age below 20 years, which multiplied by 4 the risk of developing pelvic adhesions (OR=4.01 [1.19-13.49]); history of sexually transmitted infections (STI) (OR=1.77[1.06-2.96]) and history of abdomino-pelvic surgery (OR=1.76[1.07-2.88] which respectively increased the risk of having pelvic adhesions by almost 2. These associations were statistically significant. Conclusion: Sexually transmitted infections (STI) and abdomino-pelvic surgery expose the patient to the development of pelvic adhesions and/or tubal alterations leading to female infertility. Their prevention must be based on the preventive management of STI by raising awareness for responsible sexuality, especially among adolescents, the rationalization of the indications and the good practice of abdomino-pelvic surgery by doctors

Severity of intrauterine adhesions and pregnancy success rates after treatment: Comparison of adhesions obtained from open myomectomy versus uterine curettage

Intrauterine adhesions (IUA) are rare. A retrospective comparative study was conducted between January 1, 2015, and December 31, 2018. Group A comprised 117 women who developed IUAs after open myomectomy, while Group B comprised 113 women who developed IUAs following uterine trauma caused by uterine instrumentation after a termination of pregnancy (TOP) or spontaneous miscarriage. The IUA grade and pregnancy rates and outcomes were compared using the March classification system. All patients underwent hysteroscopic adhesiolysis. The adhesions tended to be more severe (45/117, 38.5%) in Group A than in Group B (29/113, 25.7%); however, this difference was not statistically significant (Chi-Suare 5.047; p = .080). The period of observation was 24 months from the last hysteroscopy. The pregnancy rate in Group A (26, 22.2%) was significantly lower than in Group B (46, 40.7%) (OR: 2.403, 95% CI: 1.352­4.271; p = .003). Open myomectomy was the preceding aetiological factor in a greater proportion of women with IUA in our study. In cases where pregnancy is desired after open myomectomy, especially where the endometrial cavity is breached, postoperative hysteroscopy to exclude IUAs is recommended.

Comparative clinical study between preoperative oral administration of paracetamol, celecoxib and pregabalin on postoperative pain in gynecological laparoscope

Background: Since the introduction of laparoscopic surgeries, postoperative pain has been generally reduced. However, it can still peak, especially during the early postoperative period and becomes the main cause of overnight hospital stay and prolonged convalescence after this day-case surgical procedure. Thus, optimizing postoperative pain relief, not only to sub-serve reduction of its intensity but to also enhance the recovery and shorten length of stay became the broader target of multimodal pain control regimens nowadays. That is why; searching for a drug that would be effective in reducing pain, safe from major adverse effects and can meanwhile possess an opioid-sparing potentiality would be a merit so as to improve the success rate of ambulatory day-care surgeries. Objective: To study the analgesic effects of preemptive single oral dose of paracetamol, celecoxib and pregabalin in patients undergoing gynecological laparoscope. Method: Preoperative evaluation, preparation and premedication was assessment, and routine laboratory investigations was done. Postoperative pain, Level of Sedation was measured. Results: There was statistical significant difference between the three groups regarding VAS. There was statistical significant difference between the three groups regarding the total pethidine consumption. Regarding postoperative level of sedation, blood glucose there was no statistical significant difference between the three groups. Conclusion: Oral pregabalin in a dose of 150 mg 2 hour before surgery, is significantly attenuating pain intensity and total meperidine consumption during the first 6 hours postoperatively

Prise en charge de la pelvipéritonite en milieu chirurgical à Dakar : à propos de 62 observations

Buts. Évaluer de façon rétrospective les résultats de la prise en charge des pelvipéritonites dans un service de chirurgie générale et définir la place du traitement médical.Patients et méthodes. Durant une période de 5 ans, 62 dossiers de patientes suivies pour pelvipéritonite ont été colligés et analysés. Les collections des organes génitaux internes (abcès tubo-ovariens, endométrite, pyoovaire etc.…) et celles d'origine digestive (appendicite pelvienne, sigmoïdite etc.…) ont été exclus de l'étude. Le diagnostic de pelvipéritonite reposait sur l'existence de douleurs pelviennes, de leucorrhées purulentes, d'un syndrome infectieux et d'une défense strictement pelvienne, et l'absence de suppuration des organes génitaux internes à l'échographie. Résultats. L'âge moyen des patientes était de 27,5 ans [16-55 ans]. 72% d'entre elles avaient moins de 35 ans. Deux patientes étaient porteuses d'un dispositif intra-utérin et chez une, la pelvipéritonite compliquait une hystérosalpingographie. Le délai moyen de consultation était de 11 jours [1-30 jours]. Des leucorrhées purulentes étaient présentes chez 77% des patientes. La défense abdominale localisée sous ombilicale était présente dans 58 cas (93%). Une collection du Douglas était présente à l'échographie chez une patiente. Un traitement médical a été appliqué avec succès chez 58 patientes. Quatre patientes avaient un tableau clinique suffisamment sévère pour justifier une laparotomie exploratrice pour suspicion de péritonite. Des adhérences multiviscérales sous forme de magma adhérentiel cloisonnant le pelvis ont été notées chez trois d'entre elles et un abcès du Douglas chez une patiente. une récidive de pelvipéritonite à 3 et 5 mois a été notée chez et l'évolution sous traitement médical a été favorable pour les deux. Conclusion. Les signes cliniques (fièvre, leucorrhées purulentes et défense strictement pelvienne) sont suffisants pour poser un diagnostic de pelvipéritonite à Dakar. Le traitement médical doit être la règle en l'absence de collection abcédée

Antiemetic prophylaxis with promethazine or ondansetron in major gynaecological surgery

Background: Postoperative nausea and vomiting remain a significant cause of morbidity among patients undergoing general anaesthesia. The optimal strategy for prevention; however; remains controversial. This study evaluated the efficacy of ondansetron 8 mg compared with promethazine 25 mg or placebo for the prevention of nausea and vomiting in patients undergoing elective major gynaecological surgery. Methods: Seventy-five patients received intravenous injection of the study medication (ondansetron-25; promethazine-25 or placebo-25) immediately before the induction of anaesthesia. Nausea and vomiting were assessed over a 24-hour postoperative period. Results: Nausea occurred in 20; 40and 72of the promethazine; ondansetron and placebo groups respectively (p = 0.001). The overall incidence of vomiting was 12; 16; and 60(p = 0.000) for promethazine; ondansetron and the placebo respectively. Postoperative drowsiness was prominent in the promethazine group. There was no significant difference in effectiveness between promethazine and ondansetron. Conclusions: Promethazine 25 mg was significantly more effective than ondansetron 8 mg in the prevention of postoperative nausea and vomiting. Promethazine is inexpensive and the cost of drugs is of importance in developing African countries. Drowsiness was a significant side-effect with promethazine; and this will be a disadvantage in ambulatory surgery

Vault Prolapse Treated by Sacrocolpopexy

Objective. To evaluate the success rate of sacrocolpopexy in 153 patients with stage 3 and 4 vault prolapse. Methods. A retrospective review was done on 153 patient records from a database in a urogynaecological unit. For the sacrocolpopexy procedure; semi-absorbable mesh was placed along the anterior and posterior vaginal walls; and attached to the anterior longitudinal ligament of the sacrum. Results. The median age was 65 years and parity 3.0; 94of the patients were white. Previous surgery for prolapse was reported by 48of the patients and 25were on thyroid hormone treatment. The vault prolapse was stage 3 in 81 patients (52.9) and stage 4 in 72 (47.1). At surgery; the mesh extended from the vaginal vault to the sacrum in 7 patients (4.6). In the remaining 146 patients (95.4) the mesh was attached to the posterior vaginal wall and in 133 (86.9) a second strip of mesh was fixed to the anterior vaginal wall. Follow-up was possiblein 149 patients (97.4); with a median of 29 months. Recurrent prolapse (any type) occurred in 22 patients (14.4)and 12 had repeat surgery for recurrent prolapse (7.8). In total; 25 patients (16.3) had repeat surgery for anyindication. Conclusions. Vault prolapse is difficult to treat owing to absence of support of the upper vagina; but sacrocolpopexy delivered acceptable results