Neonatal outcomes in twin pregnancies with the first twin in breech presentation according to the mode of delivery: A cohort study from Dakar Senegal

The objectives of this study were to compare perinatal outcomes in twin pregnancies where the first twin was in the breech presentation. To do so, we performed a 10-year retrospective cohort study in a single university center. All patients with a twin pregnancy with the first twin in breech presentation, a gestational age greater than or equal to 34 weeks' gestation, and a birth weight >= 1500 g were included. The main outcome measures were 5-minute Apgar score <7 and perinatal mortality. We included 353 pairs of twins which complied with the inclusion criteria. One hundred and fifty (150) patients delivered vaginally while 203 pairs of twins were delivered by caesarean section. Patients who delivered abdominally were similar to those who delivered vaginally with regard to age, parity, and gestational age. Six twins A delivered vaginally and 2 delivered by caesarean section had an Apgar score < 7 (p = 0.76) whereas 12 twins B delivered vaginally and 2 delivered abdominally had an Apgar score <7 (p = 0.001). Perinatal mortality did not differ significantly between twins delivered abdominally and those delivered vaginally. There was no evidence that vaginal delivery was risky with regards to depressed Apgar scores for Twin A and neonatal mortality for breech first twins that weighed at least 1500 g. However, Twin B delivered vaginally were more likely to present with a low 5-minute Apgar score. Along with the literature, the findings of this study do not currently allow to define a consensual obstetric attitude towards management of breech first twin deliveries. Until more prospective multicenter randomized controlled studies shed light on this problem, the skills, experience and judgment of the obstetrician will play a major role in the decision-making process. (Afr J Reprod Health 2022; 26[5]: 50-56).

Maternal and perinatal outcomes in multiple versus singleton pregnancies in Dakar, Senegal: a cross sectional study over 10 years

Background: The birth of twins is a singular event in most societies, and even more when it comes to multiple births. The objective of this study was to investigate maternal and perinatal outcomes in multiple versus singleton pregnancies.Methods: Cross-sectional study carried out at Philippe Maguilen Senghor health center in Dakar, Senegal from January 1, 2011 to June 30, 2019. Data were extracted from this E-perinatal electronic database and then analyzed in statistical package for social science software (SPSS 24, Mac version).Results: A total 42,870 mothers delivered 44,149 newborns including 1250 twins (2.8%) and 29 triplets. The mean maternal age was 27 years. Mothers with multiple pregnancies had 3 times the odds of poor maternal outcome compared to mothers with single pregnancies (OR 2.42, 95% CI; 1.98-2.94, p <0.001, for high blood pressure; OR, 2.66; 95% CI, 2.11-3.32, p= <0.001, for severe pre-eclampsia; and OR, 3.04; 95% CI, 1.64-5.66, p <0.001, for postpartum hemorrhage). Likewise, women with multiple gestations had significantly higher rates of preterm birth (OR 5.62; 95% CI: 4.91-6.41, p <0.001), breech presentations (OR = 11.02; CI = 9.68-12.53, p <0.001) and neonatal deaths (OR = 2.94; CI = 9.6852-12.5328 p= 0.004) as compared to women with singleton gestations. Furthermore, women with multifetal gestations had increased risk for caesarean section (OR 2.14; 95% CI: 1.91-2.41, p <0.001) compared with their singleton counterparts. The risks for episiotomy and perineal injuries were higher for women with singleton gestations as compared to multiple gestation mothers.Conclusions: This study results are in line with previous findings and contradict others. Particular attention should always be paid to multiple pregnancies’ management. However, the pattern of certain complications traditionally correlated with multiple pregnancies is to be confirmed.

Completeness of information in electronic compared with paper-based patients’ records in a maternity setting in Dakar, Senegal

Background: Evaluate the consistency of information in paper-based records when registered in parallel with an electronic medical record.Methods: The study was performed at PMSHC in Dakar Senegal. From the end of year 2016, patients’ files were recorded on both paper-based and electronically. Additionally, previous records were electronically registered. To investigate the completeness of records before and after the electronic recording system has been implemented, information about some maternal and fetal/neonatal characteristics were assessed. When the variable was recorded, the system returned 1, unrecorded variables were coded as 0. We then calculated, for each variable, the unrecorded rate before 2017 and after that date. The study period extended from 2011 to June 2019, a nearly ten-year period. Data were extracted from E-perinatal to MS excel 2019 then SPSS 25 software. Frequencies of unrecorded variables were compared with chi-squared test at a level of significance of 5%.Results: A total of 48,270 unique patients’ records were identified during the eight-year period.  Among the study population, data for patients’ age, address and parity were available most of the time before and after 2017 (0.5% missing data versus 0.3% for age and 2.6% versus 1.3% for home address and from 0.3% to 0.0% for parity). However, phone number, maternal weight, maternal height, last menstrual period and blood group were found to be missing up to 96% before 2017. From 2017, these rates experienced a sudden decrease at a significant level: from 82.4% to 27.8% for phone number, from 96% to 56.3% for maternal weight and from 60.1% to 21.3% for blood group. Regarding newborns’ data, it was found that fetal height, head circumference and chest circumference were missing up to just under 25% before 2017. After that date, their completeness improved and flattened under 5%.Conclusions: Structured and computerized files reduce missing data. There is an urgent need the Ministry of health provides hospitals and health care providers with guidelines that describes the standardized information that should be gathered and shared in health and care records.

Clinical characteristics and outcomes of COVID-19 infection in nine pregnant women: a report from a sub-Saharan African country, Senegal

Introduction: to investigate the clinical characteristics of COVID-19 in pregnancy in Senegal. Methods: this was a cross-sectional and descriptive study of all cases of COVID-19 including nine pregnant women who were admitted in COVID-19 treatment centers in Senegal from March 2 to May 15, 2020. SARS-COV-2 infection was confirmed by PCR. Patients' characteristics, clinical features, treatment and outcome were obtained with a customized data collection form. Results: the frequency of the association COVID-19 and pregnancy was 0.5%. The age range of the patients was 18-42 years with an average 28 years, and the range of gestational weeks at admission was 7 weeks to 32 weeks. None of the patients had underlying diseases. All the patients presented with a headache and only four of them had fever. Other symptoms were also observed: two patients had a cough, two had rhinorrhea, and two patients reported poor appetite. The median time to recovery was 13.6 days, corresponding to the number of days in hospital. None of the nine pregnant women developed severe COVID-19 pneumonia or died. Conclusion: pregnant women appear to have the same contamination predispositions and clinical features of SARS-COV-2 infection as the general population. This study shows no evidence that pregnant women are more susceptible to infection with coronavirus

Laparoscopic management of cervical and endometrial cancer in Africa: experience of the National Hospital Centre of Pikine

Background: Laparotomy represents the standard historical surgical approach to these cancers. Process of treatment of benign adnexal pathologies to the emergence of a new pathway for the management of these cancerous pathologies.Methods: Our prospective study from December 2016 to December 2018 included 10 patients with early-stage uterine cancer and endometrial cancer confirmed by MRI. The characteristics of patients, their cancer, their intervention and morbidity were revealed.Results: Our results show that the average age of the patients was 63 years; There were 2 cases of cervical cancer and 8 cases of endometrial cancer. For cervical cancer, it was essentially squamous cell carcinoma; one patient was at stage Ia2 and the other at stage Ib1. For endometrial cancers, squamous cell carcinoma was 80%; 6 patients were in stage IB and 2 in stage IC. Of the 10 patients undergoing surgery, 9 had laparoscopic colpohysterectomy and lymphadectomy and one complementary laparoscopic lymphadenectomy. The average number of lymph nodes removed was 9 and no lymph node metastasis was found. In the immediate postoperative period, one patient had transient urinary incontinence and another had vaginal slice lymphorhea.Conclusions: The main interest of this practice is to be the least morbid possible for patients at the early stage. With our short experience, we obtained a reduction in operating time, a reduction in hospital stay, a decrease in the consumption of analgesics and antibiotics postoperatively and a reduction in per and postoperative complications.

Apport de l'echographie dans le diagnostic de l'engagement de la tete foetale au cours du travail

Objectifs : Evaluer la sensibilite et la specificite de l'echographie transperineale par rapport au toucher vaginal dans le diagnostic d'engagement de la tete foetale au cours du travail.Patientes et Methodes : Etude pilote prospective et descriptive menee a la maternite du CHN de Pikine; durant la periode allant du 01 Mars au 30 Juin 2012. Toute parturiente admise respectant les criteres d'inclusion avait beneficie a la fois d'un examen vaginal et d'une echographie transperineale afin de definir la notion d'engagement. Une distance seuil inferieure ou egale a 60 mm entre le perinee et la tete foetale avait ete retenue comme signe echographique de l'engagement Resultats : L'evaluation conjointe etait realisee chez 55 parturientes. L'age moyen etait de 26 ans; la parite moyenne de 1;47. L'echographie avait permis de poser le diagnostic d'engagement de la presentation avec une sensibilite de 93;1% et une valeur predictive positive de 81;25%. La specificite de cette exploration etait de 76;92% avec une valeur predictive negative de 90;91%. Le toucher vaginal permettait de predire l'accouchement par voie basse dans 96;4% des cas contre 77;2% pour l'echographie. Conclusion : Le toucher vaginal est un parametre subjectif et peut etre limite dans certaines situations (bosse sero-sanguine; oedeme vulvaire) et l'echographie peut s'averer interessante. L'echographie transperineale parait simple et reproductible. Une valeur seuil de 60 mm revet une bonne sensibilite et une bonne valeur predictive negative pour le diagnostic d'engagement. La diffusion de la technique doit aller de pair avec la vulgarisation de l'echographie en salle de travail dans les maternites de notre pays afin de valider cette technique sur un echantillon beaucoup plus significatif