Outcome of labor among women admitted at advanced cervical dilatation.

Objective: To identify in our setting the outcome of labor among women admitted at advanced cervical dilatation.Methods: This prospective cohort study was carried out between 1 December 2015 and 31 March 2016. Women carrying live term singletons in vertex presentation admitted with a cervical dilatation >5 cm (late arrival group) or ≤5 cm (early arrival group) were followed up till delivery. The main variables studied included mode of delivery, genital lacerations, and postpartum hemorrhage (PPH). Data from women in both groups were compared. Fisher's exact test and t-test were used for comparison. p < .05 was considered statistically significant.Results: Late arrival in the labor ward was observed in 52.5% of women (126/240). Late arrival in the labor ward was significantly associated with a reduction in the cesarean section (CS) risk (Relative risk (RR) 0.34, 95%CI 0.12-0.94), but with an increased risk of lower genital tract lacerations (RR 2.3, 95%CI 1.3-3.8), PPH (RR 4.5, 95%CI 1.04-20.2), and admission of the newborn in the neonatal intensive care unit for neonatal asphyxia or infection (RR 3.6, 95%CI 1.04-12.5).Conclusion: Late arrival in the labor ward was associated with an increased risk of maternal and neonatal morbidity. Therefore, women should be encouraged to arrive early in the labor ward.

Urethrovaginal fistula following vaginal prolapse of a pedunculated uterine myoma: a case report.

BACKGROUND: Urethrovaginal fistulas are usually secondary to a foreign body in the vagina or to vaginal gynecologic surgeries. We present a case of an urethrovaginal fistula secondary to vaginal prolapse of a huge pedunculated submucosal uterine myoma. CASE PRESENTATION: A 25-year-old black African woman with a past history of huge uterine fibroids and an uncomplicated vaginal delivery 5 weeks prior to presentation consulted for a difficult micturition that occurred 2 days earlier. A vaginally prolapsed huge uterine myoma was diagnosed. The fibroid was easily twisted off per vagina. Around 9 days after prolapse of the fibroid or 5 days after its removal, she complained of a vaginal leaking of urine during micturition. An urethrovaginal fistula was diagnosed using a blue dye test. The fistula was successfully repaired with polyglactin and she was discharged on day 15. CONCLUSIONS: To the best of our knowledge, this is the first case of urethrovaginal fistula secondary to delivered uterine myoma. We recommend close postpartum follow-up of women carrying huge uterine fibroid and urgent management of a vaginally prolapsed uterine fibroid to reduce the risk of urethrovaginal fistula.

Trial of Labor After Cesarean Section Among Women with Unique Lower Segment Scarred Uterus and Fetal Weight >3500 g: Prognostic Factors for a Safe Vaginal Delivery.

OBJECTIVE: To evaluate outcome of trial of labor after cesarean section (TOLAC) with fetal weight >3500 g. MATERIALS AND METHODS: This retrospective descriptive study was carried out between March 1, 2012, and February 28, 2015. Medical and obstetrical records of women with birth weight (BW) >3500 g admitted in the labor ward with advanced labor or admitted in early labor but with underestimated fetal weight >3500 g were analyzed. Main variables analyzed included maternal parity, vaginal delivery prior to TOLAC, the BW and the integrity of the uterine scar. RESULTS: Mean BW was 3789.3 g. Out of 36 women, 75 % had a successful TOLAC. Women who delivered vaginally before TOLAC had a higher success rate than women who never delivered vaginally (94.1 vs. 63.1 %, P < 0.044). CONCLUSION: Successful TOLAC with birth weight >3500 g can be observed among women, especially among those admitted in advanced labor or with successful vaginal delivery prior to the current TOLAC.

Maternal mortality in Cameroon: a university teaching hospital report.

More than 550,000 women die yearly from pregnancy-related causes. Fifty percent (50%) of the world estimate of maternal deaths occur in sub-Saharan Africa alone. There is insufficient information on the risk factors of maternal mortality in Cameroon. This study aimed at establishing causes and risk factors of maternal mortality. This was a case-control study from 1st January, 2006 to 31st December, 2010 after National Ethical Committee Approval. Cases were maternal deaths; controls were women who delivered normally. Maternal deaths were obtained from the delivery room registers and in-patient registers. Controls for each case were two normal deliveries following identified maternal deaths on the same day. Variables considered were socio-demographic and reproductive health characteristics. Epi Info 3.5.1 was used for analysis. The mean MMR was 287.5/100,000 live births. Causes of deaths were: postpartum hemorrhage (229.2%), unsafe abortion (25%), ectopic pregnancy (12.5%), hypertension in pregnancy (8.3%), malaria (8.3%), anemia (8.3%), heart disease (4.2%), and pneumonia (4.2%), and placenta praevia (4.2%). Ages ranged from 18 to 41 years, with a mean of 27.7 ± 5.14 years. Lack of antenatal care was a risk factor for maternal death (OR=78.33; CI: (8.66- 1802.51)). The mean MMR from 2006 to 2010 was 287.5/100,000 live births. Most of the causes of maternal deaths were preventable. Lack of antenatal care was a risk factor for maternal mortality. Key words: Maternal mortality, causes, risk factors, Cameroon.

Knowledge, attitudes and practices of contraception by HIV positive women followed in a Cameroon region with high illiteracy rate: a cross sectional study.

INTRODUCTION: To evaluate the knowledge, attitude and practices of contraception by HIV positive women. METHODS: This cross-sectional descriptive study was carried out in the Maroua Regional Hospital (Cameroon) from September 1(st), 2012 to February 28(th), 2013. All HIV positive women aged between 15 and 49 years who were received in the HIV clinic were recruited. The variables recorded included maternal age, number of living children, marital status, religion, the educational level, and the use of antiretroviral treatment (HAART), the knowledge, attitude and practice of contraception. Analyses were done using SPSS 18.0. Fisher exact test was used for comparison. The level of significance was P < 0.05. RESULTS: A total of 200 HIV positive women were recruited and 98% knew at least one method of contraception The need of a contraceptive method was present in 84% of HIV positive women, as soon as the women were ≥ 30 years (OR 2.6, 95%CI 1.3-4.9), on HAART (OR 2.8, 95%CI 0.8-9.2), divorced (OR 1.7, 95%CI 0.8-3.7), had ≥ 3 living children (OR 1.2, 95%CI 0.6-2.4) and when the women were educated (OR 1.2, 95%CI 0.6-2.4). The rate of condom use was 50.7%. CONCLUSION: The knowledge of contraception as well as the contraception need among HIV positive women was high in this region despite high illiteracy rate. Therefore, all contraceptive methods should be made available to these women. Towards these women and their partner(s), more emphasis should be made on the systematic condom use even when using other contraceptive methods (dual protection).

Hematologic features among anemic Cameroonian pregnant women: a cross sectional study.

INTRODUCTION: Iron deficiency anemia is the leading cause of anemia worldwide. It may also be the leading cause of anemia in pregnancy, although this has not yet been demonstrated in our country. The aim of the study was to describe hematologic features of Cameroonian anemic pregnant women. METHODS: This cross sectional analytical study was carried out in the maternity of the Yaoundé University Teaching Hospital, Cameroon, from March 1(st), 2011 to February 28(th), 2013. Two hundred women with singleton pregnancies and Hb concentration at booking <10 g/dl were recruited. Main variables recorded were maternal age, parity, marital status, gestational age, Hb concentration, blood group, Hb electrophoresis, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), pack cell volume (PCV). Data were analyzed using SPSS 18.0. P<0.05 was considered statistically significant. RESULTS: Figures for 110 women (55%) showed microcytosis, hypochromia was observed in 122 (61%) women and megaloblastic anemia in eight women (4%). Thrombopenia was observed in 16 women (8%) and thrombocytosis in six women (3%). Anemia was microcytic hypochromic in 110 women (55%), megaloblastic in eight women (4%), normocytic hypochromic in 12 women (6%), and normocytic normochromic in 70 women (35%). CONCLUSION: Hematologic features of Cameroonian anemic pregnant women showed that although iron deficiency anemia is the leading cause of anemia, megaloblastic anemia is also present in our environment. A normal hematologic feature in more than the third of women shows that the cause of anemia is not always nutritional.

How risky are second trimester clandestine abortions in Cameroon: a retrospective descriptive study.

BACKGROUND: Complications of clandestine abortions increase with gestational age. The aim of this study was to identify complications of second trimester clandestine abortions (STA) and those of first trimester clandestine abortions (FTA). METHODS: This retrospective descriptive study was conducted between March 1st and August 31st, 2012 in the University Teaching Hospital and the Central Hospital, Yaoundé (Cameroon). The files of women with clandestine abortions carried out outside our units, but received in our settings for some complications were reviewed. Variables studied were maternal age, parity, marital status, gestational age at the time of abortion, the abortion provider and the method used, the duration of antibiotic coverage, the time interval between abortion and consultation, the complications presented and the duration of hospital stay. Data of 20 women with STA (≥13 weeks 1 day) and those of 74 women with FTA (≤13 complete weeks) were analyzed and compared. The t-test was used to compare continuous variables. P value <0.05 was considered statistically significant. RESULTS: Women with STA had high parities (P = 0.0011). STAs were mostly performed by nurses and were usually done by dilatation and curettage or dilatation and evacuation, manual vacuum aspiration, intramuscular injection of an unspecified medication, transcervical foreign body insertion, amniotomy and misoprostol. STA complications were severe anemia, hypovolemic shock, uterine perforation and maternal death. CONCLUSIONS: Clandestine abortions, especially second trimester abortions, are associated with risks of maternal morbidity and mortality especially when done by nurses. Therefore, women should seek for help directly from trained health personnel (Gynecologists & Obstetricians). Moreover, nurses should be trained in uterine evacuation procedures. They should also refer women who want to carry out STA to Gynecologists and Obstetricians. Finally, to reduce the prevalence of abortion in general, the government should make contraception available to all women, as well as use public media to sensitize women on the dangers of abortion and on the need to use family planning services.

Two-dimensional ultrasonography in the assessment of nuchal cord.

OBJECTIVES: The aim of this was to evaluate the accuracy of two-dimensional (2D) ultrasonography in the diagnosis of nuchal cord to enable us determine if it can be recommended for its antenatal diagnosis. MATERIALS AND METHODS: Between 01 January and 30 April 2012, 93 singletons pregnancies in cephalic presentation with 2D ultrasound scan done at term but within 24 h before onset of labor for exploration of the presence or absence of nuchal cord were reviewed. The procedure was carried out using the same equipment (Voluson 730 Expert) and by the same radiologist who had good training in the ultrasonographic diagnosis of nuchal cord. RESULTS: Among the 38 cases of nuchal cord present at delivery, the diagnosis by means of 2D ultrasonography was done in 32 cases (sensitivity: 84.2 %). The diagnosis was also correct among 47 of the 55 absent nuchal cords at delivery (specificity: 85.4 %). In eight cases, nuchal cord diagnosed by 2D ultrasonography was not observed at delivery (positive predictive value: 80 %). Furthermore, six cases of nuchal cord were undiagnosed by 2D ultrasonography (negative predictive value: 88.7 %). CONCLUSION: Two-dimensional ultrasonography for the antenatal diagnosis of nuchal cord by a skilled radiologist can reach sensitivity and specificity of more than 84 %. Therefore, in settings where only 2D ultrasonography is available, efforts should be made by operators for antenatal diagnosis of nuchal cord.

Outcome of breech deliveries in cameroonian nulliparous women.

OBJECTIVE: To evaluate nulliparous breech delivery so as to determine prognostic factors for an unsafe vaginal delivery (VD). METHODS: This retrospective and descriptive study was carried out in the University Teaching Hospital Yaoundé-Cameroon, from January 1, 2005 to December 31, 2009. Files of 126 women with singletons in breech presentation and normal fetal heart beats at a gestational age ≥32 weeks were reviewed with a trial of VD ordered in 104. The parameters recorded were mother's age, gestational age, mode of delivery, birth weight, 5th minute Apgar scores, neonatal outcome, and use of episiotomy. RESULTS: The results showed that 84 (66.7 %) had a successful VD. Failure of VD or poor Apgar score after VD were observed if fetal weight ≥3,500 or <1,800 g, footling breech, maternal age >28 or <19 years, post term, and rigid cervix. CONCLUSIONS: Elective cesarean section should be systematic if the unsafe circumstances above mentioned are present.

Risk factors for obstetric fistula: a clinical review.

Obstetric fistula is the presence of a hole between a woman's genital tract and either the urinary or the intestinal tract. Better knowledge of the risk factors for obstetric fistula could help in preventing its occurrence. The purpose of this study was to assess the characteristics of obstetric fistula patients. We conducted a search of the literature to identify all relevant articles published during the period from 1987-2008. Among the 19 selected studies, 15 were reports from sub-Saharan Africa and 4 from the Middle East. Among the reported fistula cases, 79.4% to 100% were obstetrical while the remaining cases were from other causes. Rectovaginal fistulae accounted for 1% to 8%, vesicovaginal fistulae for 79% to 100% of cases, and combined vesicovaginal and rectovaginal fistulae were reported in 1% to 23% of cases. Teenagers accounted for 8.9% to 86% of the obstetrical fistulae patients at the time of treatment. Thirty-one to 67% of these women were primiparas. Among the obstetric fistula patients, 57.6% to 94.8% of women labor at home and are secondarily transferred to health facilities. Nine to 84% percent of these women delivered at home. Many of the fistula patients were shorter than 150 cm tall (40-79.4%). The mean duration of labor among the fistula patients ranged from 2.5 to 4 days. Twenty to 95.7% of patients labored for more than 24 h. Operative delivery was eventually performed in 11% to 60% of cases. Obstetric fistula was associated with several risk factors, and they appear to be preventable. This knowledge should be used in strengthening the preventive strategy both at the health facility and at the community level.

Risk factors for hypertensive disorders in pregnancy: a report from the maroua regional hospital, cameroon.

INTRODUCTION: A recent study at the Maroua Provincial Hospital revealed that hypertension in pregnancy was the first cause of maternal death, representing 17.5% of the 63 maternal deaths recorded between 2003 and 2005. Knowing little about the causes, this study was to identify the possible risk factors for hypertensive disorders in pregnancy. METHODS: This case-control study was-done at the Maroua Regional Hospital, Cameroon between June 2005 and May 2007. All the 152 deliveries complicated with hypertension were compared and analyzed with 414 pregnancies that were not complicated with the disease. Data analysis was performed using EPI Info 3.5.1. The differences were considered to be significant if the p-values were less than 0.05. RESULTS: Using univariate analysis, several factors linked to hypertensive disorder in pregnancy were identified. They included early adolescence, nulliparity, illiteracy, lack of occupation and family history of hypertension. At multivariate analysis, the risk of having hypertension during pregnancy remained greater for illiterate women (OR: 1.6; 95%CI: 1.0-2.3), housewives (OR: 2.8; 95%CI: 1.1-6.9), nulliparae (OR: 2.8; 95%CI: 1.5-3.6), women with family histories of hypertension (OR: 3.6; 95%CI: 1.6-8.5) and women with histories of hypertension during pregnancy (OR: 7.0; 95%CI: 3.0-16.4). CONCLUSION: Risk factors for hypertensive diseases in pregnancy in Maroua, Cameroon seem to include early teenage status, illiteracy, housewife status, nulliparity and family or personal histories of hypertension. The knowledge about the aforesaid factors seems to lay the tracks for its prevention in Cameroon.

Quality care in vesico-vaginal obstetric fistula: case series report from the regional hospital of Maroua-Cameroon.

The World Health Organization (WHO) proposes a successful closure rate for first repair of vesico-vaginal obstetric fistula to be at 85% in each facility, with the continence achievement among the closed cases at 90 %. We are reporting the vesico-vaginal obstetric fistula outcome at the provincial hospital of Maroua-Cameroon from 2005 to August 2007. Among the overall 32 patients with vesico-vaginal fistula operated, 25 patients were at their first operation. The complete closure of vesico-vaginal fistula (VVF) was 23/25 (92%) and among the 23 patients with complete closure 17(74%) had good continence. When we consider only the 25 patients who were at their first operation, the overall closure of VVF was 23/25 (92%) and among them 17/23 (74%) were continent. Large lesion, bladder neck lesions, vaginal adherence and rigid margin are associated with failure/incontinence. These factors must be taken into consideration when preparing patients for surgery or when assigning them to a surgeon within the surgical team.