Incidence, risk factors, clinical presentation and treatment of ectopic pregnancy in the Limbe and Buea Regional Hospitals in Cameroon

Introduction: ectopic pregnancy (EP) is the leading cause of maternal mortality in the first trimester of pregnancy in our environment. This study aimed at evaluating the incidence, risk factors, clinical presentation and treatment of ectopic pregnancy in the Limbe and Buea Regional Hospitals in Cameroon. Methods: this was a retrospective nested case control study carried out from December 2006 to December 2016. A ratio for control vs cases of 3:1 was obtained. Any pregnancy implanted outside the normal uterine cavity was considered as an ectopic pregnancy. Student's t-test was used to compare continuous variables and Pearson's Chi-square test for categorical variables. The association between EP and the demographical and clinical variables was estimated using logistic regression. Statistical significance was set at p-values<0.05.Results: a total of 247 cases of EP were registered out of 17221 deliveries giving an incidence of 1.43% in ten years. History of pelvic inflammatory disease (OR = 3.10, CI (1.76-5.44), p < 0.001), previous EP (OR = 10.22, CI (2.61-14.82), p < 0.001), History of induced abortion (OR = 2.68, CI (3.32-9.73), p< 0.001), history of adnexa surgery (OR = 4.37, CI (2.17-10.32), p < 0.001) and history of appendectomy (OR = 2.16, CI (0.99-6.64) p< 0.001), were also found to be associated with increased risk of EP. More than five percent (5.52%) of the patients were in shock at presentation. Diagnosis was confirmed mainly by use of ultrasound (78.53%) and treatment was principally by laparotomy (97.55%) with salpingectomy (95.60%). Most (90.18%) of ectopic pregnancies were ruptured at presentation. Only 2.45% of cases were manage medically with the use of methotrexate. Conclusion: the incidence of ectopic pregnancy (EP) in our environment is within the global range (hospital-based incidence of 1.43%) and is rising. Late presentation, lack of modern diagnostic and management tools have made laparotomy with salpingectomy the principal method of management of ectopic pregnancy in our environment

Laparoscopic Myomectomy in a Tertiary Care Centre in Douala, Cameroon.

Objective: To assess the feasibility and outcome of laparoscopic myomectomy with single or double-layer closure of myoma bed for management of myomas at a tertiary care centre in Douala, Cameroon. Materials and Methods: Thirty patients with large or moderate-size myomas were managed laparoscopically from September 1996 to September 2008. The indications for surgery included subfertility, heavy menstrual bleeding, abdominal mass and lower abdominal pain. Pre‑operative evaluation included history, clinical examination and sonographic mapping. Myomas were enucleated and retrieved laparoscopically by morcellation. Myoma beds were sutured in a single or double layer by endoscopic intra-corporeal suturing depending on the depth of the fibroids. Results: Among our patients, 14 (46.7%) presented with subfertility, 8 (26.7%) with heavy menstrual flow and 6 (20%) with abdominal mass. Two (6.7%) presented with lower abdominal pain. The average maximum diameter of myoma was about 8.5 cm. The mean duration of surgery was 123.2±90 min and blood loss was minimal. The mean post-operative stay in hospital was averagely 3.03 days. There were no intra-operative complications recorded among our series and hospital stay was uneventful. Conclusion: With proper single layer closure of the myoma bed, laparoscopic myomectomy is feasible for moderate and even large myomas not more than three fibroids, and has excellent outcomes.