Zoom sur le cancer du col utérin chez les adolescentes à Kananga au Kasaï-Central, en République Démocratique du Congo / NA

Introduction. Le cancer du col de l'utérus (CCU) demeure un problème majeur de santé publique et il est le quatrième cancer le plus répandu chez les femmes à l'échelle mondiale. L'objectif est de contribuer à l'améliorationde niveau de connaissance des adolescentes sur le cancer du col utérin dans la ville de Kananga.Matériel et méthodes.Il s'agit d'une étude transversaledescriptive sur le cancer du col utérin, réalisée dans la ville de Kananga et dont l'étude était basée sur l'interview de 436 Adolescentes selon un échantillonnage à plusieurs degrés, dans les Aires de Santé de la Zone de Santé Urbaine de Kananga.Résultats. La moyenne d'âge des répondantes était de 17,7 ± 1,2 ans. Le niveau de connaissances sur le cancer du col utérin s'est révélé inadéquat chez presque toutes les participantes (90%). Les signes couramment connus étaient le saignement vaginal (80,3%), dyspareunie (4,8%) et règles prolongés (2,3%). Le sexe était pratiqué dans55,5% des adolescents alors que 70,9% savaient l'existence du lien entre le cancer du col utérin et les infections sexuellement transmissible (IST). Les connaissances sur lesfacteurs de risque de survenu du cancer du col étaient: la consummation de tabacdans 31,9% et le rapport sexuel précoce dans 25,5%; la pratique du dépistage était observée dans 0,2% des cas et 37,2% d'adolescentes connaissaient que toutes les femmes étaient prédisposées de développer la pathologie.Conclusion.Le niveau de connaissances de cancer du col utérin s'est révélé inadéquat chez les adolescents et nécessité des campagnes destinées à sensibiliser d'avantage toutes les femmes en particulier et le public de la ville de Kananga en général au sujet de ce cancer du col utérin

Early removal of etonogestrel subcutaneous contraceptive implant at a community health centre in Pretoria

The etonogestrel subcutaneous contraceptive implant offers efficacy for three years, but some women remove it earlier than prescribed. This study discusses factors associated with the early removal of these implants at a Pretoria community health centre between 01January 2020 to 30 June 2020.Methods: A cross-sectional study using a piloted and researcher assistant-administered questionnaire.Results: Of the 124 participants who removed their etonogestrel subcutaneous contraceptive implant earlier than prescribed, most were single, unemployed, in the age group 30­39 years, Christian, with secondary level education and with parity one or more. Etonogestrel subcutaneous contraceptive implant pre-insertion counselling was given to all participants, most of whom had not previously used contraceptives. Those participants with previous contraceptive use had used injectables. Long-term contraception was the main reason for getting the etonogestrel subcutaneous contraceptive implant. Most participants did not attend post-insertion counselling. Heavy bleeding was the most common side effect and reason for early removal. Fifty-one participants kept the etonogestrel subcutaneous contraceptive implant in for a longer period of 12­23 months. From participants' responses, it seems that Etonogestrel implants may be offered from as early as 15­20 years of age. Conclusion: Women having etonogestrel subcutaneous contraceptive implants removed early at a Pretoria community health centre tended to be young, single, unemployed, Christian, with a secondary level education and with parity one or more. All participants attended the etonogestrel subcutaneous contraceptive implant pre-insertion counselling services but not the post-counselling services. Heavy bleeding was the main reason for the early removal of the etonogestrel subcutaneous contraceptive implant.Keywords: early removal; etonogestrel; subcutaneous contraceptive; implant; Pretoria; community health centre; weight gain; vaginal bleeding.

Birth Preparedness and Complication Readiness among Women in Mpwapwa District; Tanzania

Abstract:Avoidable mortality and morbidity remains a formidable challenge in many developing countries like Tanzania. Birth preparedness and complication readiness by mothers are critical in reducing morbidities and mortalities due to these complications. The aim of this study was to assess knowledge and practices with respect to birth preparedness and complication readiness among women in Mpwapwa district in Tanzania. A total of 600 women who became pregnant and or gave birth two years preceding the survey were interviewed. Among them 587 (97.8) attended antenatal clinic (ANC) at least once during their last pregnancy. Two thirds of those who attended ANC made four or more visits. The median gestation age at booking for antenatal care was 16 weeks. However; 73.9 the women booked after 16 weeks of gestation. Two thirds of the women were 20-34years old and had at least primary education level. Three hundred and forty six (57.7) had parity between two and four. Only 14.8 of the women knew three or more obstetric danger signs. The obstetric danger signs most commonly known included vaginal bleeding during pregnancy (19); foul smelling vaginal discharge (15) and baby stops moving (14.3). The majority (86.2) of the women had decisions made on place of delivery; a person to make final decision; a person to assist during delivery; someone to take care of the family and a person to escort her to health facility. Majority (68.1) of the women planned to be delivered by skilled attendant. One third of the women planned to deliver at home in the absence of a skilled birth attendant. In the bivariate analysis; age of the woman; education; marital status; number of ANC visits and knowing ?3 obstetric danger signs were associated with birth preparedness and complication readiness. In multivariate logistic regression analysis; women with primary education and above were twice more likely to be prepared and ready for birth and complications. Women who knew ?3 obstetric danger signs were 3 times more likely to be prepared for birth and complications. In conclusion; women with higher level of education and those who knew obstetric complications were more prepared for birth and complications. Further studies are recommended to find out why women do not prepare for birth or complications especially that need blood transfusion

Life Threatening Vaginal Haemorrhage from Coital Laceration in a Post-Menopausal Woman

Background: Life threatening coital laceration from consensual intercourse in the postmenopausal period is unusual without any predisposing factors(s). The usual site of occurrence is the right side of the posterior fornix. Aim: To report a case of haemorrhagic shock from coital laceration. Design: Case report : A 55-year-old woman who presented as an emergency with haemorrhagic shock following vaginal bleeding from consensual coitus is presented. She was resuscitated with intravenous fluids and blood transfusions. The vaginal laceration of about 5 cm on the right side of the posterior fornix was sutured following examination under anaesthesia. Conclusion: Coital laceration should be considered a differential diagnosis in any postmenopausal vaginal bleeding while prompt recognition and treatment are important to avoid morbidity and even mortality

Risk factors for Placenta Praevia Presenting with severe Vaginal Bleeding in Mulago Hospital; Kampala; Uganda

Objective: To determine the risk factors for placenta praevia presenting with severe vaginal bleeding in Mulago hospital; Kampala; Uganda. Design: A case control study. Set- ting: Mulago hospital labour suite Participants: Between 15th November 2001 and 30th November 2002 we identified and recruited thirty six parturients with placenta previa who developed severe bleeding and 180 women with normal delivery. The risk factors were studied. Variables of interest: Socio demographic characteristics; social and family history; gynaecological operations; blood transfusion; medical conditions; past and present obstetric performance and HIV status. Results: Significant predictors for severe bleeding in parturients with placenta praevia were: previous history of evacuation of the uterus or dilation and curettage (O.R. 3.6; CI: 1.1-12.5); delivery by caesa- rean section in previous pregnancy (O.R. 19.9; CI: 6.4-61.7); residing more than ten kilometres from Mulago hospital (O.R. 2.4; CI: 1.0-5.7) and recurrent vaginal bleeding during the current pregnancy (O.R. 7.3; CI 2.4-63.7). Conclusion: Severe bleeding in placenta praevia is associated with high maternal morbidity and mortality. The determi- nants of severe bleeding in placenta praevia can be used in the antenatal period to identify mothers at risk. These; with prompt interventions to deliver the women can be used to reduce the maternal morbidity associated with this condition

Genital Bleeding in Premenarcheal Girls

Background: Premenarcheal vaginal bleeding is not a common complaint. This study was undertaken to outline the major causes in our environment.Method: A retrospective study of 68 cases managed in the University of Port Harcourt Teaching Hospital(UPTH) over a 20-year period was studied. Simple percentages were used to analyse the results.Results: Sixty-eight cases of premenarcheal vaginal bleeding out of a total of 9;876 gynaecological admissions between January 1985 and December 2005 in UPTH were reviewed. The major causes were urethral prolapse in 34 girls (50); straddle injuries in 11(16.2); foreign bodies 10 in (14.7); rape/sexual abuse 9 (13.2); female genital mutilation 3 (4.4); unknown in 1 (1.5).In some cases; presentation in the clinic occurred days to weeks after onset of symptoms.The ages ranged between 0 and 8 years. Associated presenting complaints were mass protruding from the vagina; pelvic pain; dysuria; foul smelling discharge and fever. Laboratory investigations; examination under anaesthesia; abdominal and pelvic ultrasound scans aided the management. Treatment options were individualized to the causes. They were satisfactory except in one case lost to follow-up.Two of the girls had blood transfusion.There was no mortality in this series.Conclusion: Good care of young girls; early presentation to hospital and competent treatment of presenting cases give satisfactory outcome

Bilateral ligation of internal iliac arteries followed by normal pregnancy and delivery

This text is about a case of normal pregnancy and successful delivery at term; 22 months after bilateral ligation of internal iliac srteries for uncontrollable post abortion haemorrhage in documented. Relevant literature is briefly reviewed