Pregnancy Outcomes among Patients with Sickle Cell Disease in Brazzaville.

INTRODUCTION: Sickle cell disease (SCD) is one of the most common genetic diseases in the world. It combines, in its homozygous form, chronic hemolytic anemia, vasoocclusive complications, and susceptibility to infections. It is well known that the combination of pregnancy and sickle cell disease promotes the occurrence of complications that are sometimes fatal for the mother and/or the fetus. OBJECTIVE: The objective of the current study was to compare pregnancy outcomes among women with SCD with those of women without the diagnosis of SCD. Materials and methods. It was a case-control study carried out in four maternity hospitals in Brazzaville in 2 years (July 2017-June 2019). It concerned 65 parturients with SS homozygous SCD. The mode of childbirth and maternal and perinatal morbidity and mortality were compared with those of 130 non-sickle cell pregnant women. RESULTS: The average age was 27 years for SCD women and 31 years for non-SCD women. The average gestational age at delivery was 35 weeks for SCD women and 38 weeks for non-SCD women. From the logistic regression analysis using the comparison group as the reference group, there was excessive risk in SCD compared to non-SCD of infection (29.3% vs. 4.6%, OR = 21.7, 95% CI [7.6-62.7]; p=0.001), cesarean (63% vs. 35.4%, OR = 3.1, 95% CI [1.6-5.7]; p=0.001), prematurity (75.4% vs. 30.8%, OR = 8, 95% CI [3.0-23.2]; p=0.001), low birth weight (52.3% vs. 16.1%, OR = 4.7, 95% CI [2.4-9.4]; p=0.001), neonatal requiring admission to the intensive care unit (40.3% vs. 17.5%, OR = 3.2, 95% CI [1.6-6.3]; p=0.01), and neonatal death (21.5% vs. 4.8%, OR = 4.3, 95% CI [1.5-12.2]; p=0.01). CONCLUSION: The risk of pregnancy in patients with homozygous sickle cell anemia remains high, on both the maternal and fetal sides.

Toxoplasmose au laboratoire de parasitologie-mycologie du Centre Hospitalier Universitaire de Brazzaville : aspects séro-épidémiologiques

Introduction : La toxoplasmose est une protozoose cosmopolite due à une coccidie intracellulaire obligatoire, Toxoplasma gondii. Elle touche les hommes et les femmes mais elle est redoutée chez les femmes enceintes. Les techniques de diagnostic de routine reposent actuellement surtout sur les techniques ELISA (Enzyme-Linked Immuno-Sorbent Assay) pour la détection des immunoglobulines G et M. A Brazzaville, la prévalence de la toxoplasmose est mal connue. Ainsi, cette étude a pour objectif de déterminer les aspects séro-épidémiologiques de la toxoplasmose au laboratoire de Parasitologie- Mycologie du Centre Hospitalier Universitaire de Brazzaville.Résultats : Il s'est agi d'une étude transversale allant de septembre 2015 à mars 2016. Elle a concerné les patients reçus au laboratoire pour une sérologie toxoplasmique. La prévalence de la toxoplasmose a été de 46,8%. L'âge des patients variait de 3,6 mois à 49 ans, avec une moyenne de 27,8 ans. Le sex ratio était de 0,03 en faveur des femmes. La sérologie toxoplasmique était plus demandée dans le cas d'un bilan prénatal (92,3%). Elle était surtout prescrite par les gynécologues obstétriciens (49,4%) et les sages-femmes (46,2%). Les patients présentaient trois profils immunologiques : aucune immunoglobuline (51,9% des cas), uniquement des Ig G (45,5%) et Ig M associées aux Ig G (2,6%). La présence d'Ig M a été retrouvée dans les tranches d'âge de [20-29 ans] et [30-39 ans] sans différence significative (p = 0,104). La prévalence de la toxoplasmose dans notre étude est élevée.Conclusion : Il s'impose de mener des études chez les femmes enceintes dans notre contexte, de rechercher les facteurs de risque et d'évaluer les connaissances, les aptitudes et les pratiques chez les prescripteurs de la sérologie toxoplasmique

Severe antenatal strangulation and sudden fetal death occurs in term: case report.

The authors report a case of a sudden antenatal death, by severe strangulation, unlikely related in a term pregnancy; multiple loops of nuchal umbilical cord (UC) (ten), rarely describe in literature, were observed around the fetal neck. The in utero fetal death (IFD) was suspected by the non-attendance of fetal movements and confirmed by US scan. The tight nuchal cord around the neck (tCAN) diagnostic was made during caesarean delivery, as it was not discovered in pregnancy US scan monitoring nor in the US scan made in emergency. The newborn examination shows severe fetal strangulation by the presence of many spires of a too long UC (1.50 m). Autopsy was not been accepted by the family. Through this reported case the authors wanted to show the difficulties of its diagnosis in less developed Sub-Saharan country were US scan practice is not usual.

Inversion utérine : à propos d'un cas à l'hôpital Général de Loandjili de Pointe-Noire au Congo

L'inversion utérine est un retournement de l'utérus en doigt de gant. Deux éléments essentiels conditionnent la survenue d'une inversion utérine : une atonie utérine et une dilatation cervicale avancée. A ces deux éléments peut s'ajouter une attitude obstétricale inadaptée. Le diagnostic de l'inversion est clinique. Celui-ci est évident lorsqu'il s'agit d'un stade avancé de l'anomalie (stades III et IV). Par contre, l'inversion utérine de stade précoce (stades I et II) peut passer inaperçue, et ne se révéler que par les complications. En effet, les complications les plus redoutables sont l'hémorragie de la délivrance et l'infection puerpérale.La réduction manuelle de l'inversion utérine est possible lorsqu'elle est découverte précocement, et la chirurgie n'est réservée qu'en cas d'échec de tentative manuelle.Le but de cette observation est de préciser les difficultés diagnostiques, ainsi que les particularités de la prise en charge de l'inversion utérine. Nous rapportons l'observation d'une patiente de 36 ans, quatrième geste, troisième pare, avec un antécédent d'interruption volontaire de grossesse ; admise dans le service pour hémorragie génitale persistante au sixième jour du post partum, dans un contexte d'inversion utérine associée à un placenta accreta.La prise en charge a été chirurgicale et faite d'une hystérectomie

Late diagnosis of positive HIV serology in pregnancy incidentally discovered by the widespread appearance of Kaposi's sarcoma.

The authors report a case of Kaposi's sarcoma (KS) found in a pregnant woman. On discovery, the condition had spread throughout her body as is characteristic in some cases of individuals with HIV-positive serology. She was unaware of her HIV positive status. Her HIV infection had been diagnosed at the same time as KS at her last prenatal consultation. The newborn was delivered by an uncomplicated cesarean section. Appropriate treatment and multidisciplinary management after childbirth resulted in complete remission.

[Urological complications of gynecologic surgery]. / Les complications urologiques de la chirurgie gynécologique.

OBJECTIVE: To analyze the epidemiological, anatomoclinical, surgical and evolutionary aspects of the urological complications of gynecological surgery. MATERIAL AND METHODS: It was about a retrospective survey, concerning 81 patients hospitalized in the department of urology of the university hospital, Brazzaville from 2000 to 2008 for urological complications of the gynecological surgery. The epidemiological, diagnostic, surgical and evolutionary parameters have been analyzed. RESULTS: The urological complication of the gynecological surgery has been recovered in 3% of patients hospitalized in urology. The middle age was 37±14.52 years (17 and 74 years). The median was about 36 years. The middle delay of diagnosis was 15 days (0 and 350 days). The revealing clinical signs were: the oligoanuria (n=12), the urinary incontinence (n=57), the lumbar pain (n=9) and the cyclic hematuria (n=2). The surgical interventions in reason were: the Caesarean (n=50), the hysterectomy for fibroma (n=26), the myomectomy (n=3) and the hysterectomy for cancer (n=2). Anatomical lesion were 55 (67.9%) vesicovaginal fistulas, 12 (14.8%) ureteral ligatures, eight (10%) uretero-vaginal fistulas, three (3.7%) vesico-uterine fistulas, two (2.4%) wounds ureteral and one (1.2%) vaginal vesico-fistulas and uretero-vaginal fistulas. The treatment consisted in one termino-terminal ureterorraphia, 20 uretero-vesical reimplantation, 57 cures of vesico-vaginal fistulas and one nephrectomy. The recovery was obtained at 96% of the ureteral lesions and 90% of the vesico-vaginal fistulas. CONCLUSION: The lesions of the ureteral and the bladder were often met during the gynecological surgery. The treatment requires knowledge of the anatomy of pelvis.

[Systematization of proper lymphatic vessels of the diaphragm]. / Systematisation des voies lymphatiques propres du diaphragme.

The aim of this study was to demonstrate lymphatic vessels of the diaphragm, its connexions with mediastinum and abdominal cavity in order to better understand propagation of neoplasic or infectious processes. Diaphragmatic pleura of 30 adult cadavers and 12 fetuses, unscathed of any cardiopulmonary pathology, were injected with modified Gerota's medium to permit lymph vessels and nodes to be visualized and then dissected. Each stage of dissection was described and photographed. Diaphragmatic lymph vessels, their connexions with diaphragmatic lymph nodes, mediastinum and abdominal cavity have been so demonstrated. Diaphragm appear to be a very important lymphatic center, with its own lymphatic vessels, with connexions to the mediastinum and abdominal cavity. The propagation of infectious or neoplasic processes are so better understood.

[Teenage pregnancy and delivery: 276 cases observed at the Brazzaville University Hospital, Congo]. / Grossesse et accouchement chez l'adolescente au Congo. A propos de 276 cas au CHU de Brazzaville.

OBJECTIVE: To study sexuality, pregnancy and delivery in female teenagers. MATERIALS AND METHODS: Cross-sectional prospective study from January 1(st), 1997 to May 31(st), 1998 concerning 276 female teenagers. The studied features were compared with a control group of 300 women aged more than 18 years chosen at random. RESULTS: Among 5204 women who delivered during the study period, 5.30% were teenagers. Their mean age was 14 years five months; 84.06% were single; 2.90% were married and 13.04% were concubines. Analysis of social background showed that 41.66% had attended school, 51.10% had dropped out, and 7.24% were illiterate. Mean age at first sexual intercourse was 13 years 9 months. Only 14.13% practised contraception, none used a condom. Mean term of the first prenatal consultation was 26 weeks gestation. Predominant pathological conditions observed during pregnancy were infections, anemia and complications of high blood pressure. Mean term at delivery (generally vaginal) was 38 weeks gestation. The rates of perinatal mortality and referral to the department of neonatology were higher than in the control population. CONCLUSION: Risk remains high for teenage pregnancy. Reduction of complication requires combined medical, psychological and social management.

Grossesse abdominale au CHU de Yopougon : a propos de 10 cas colliges en trois ans

Notre etude prospective; est realisee dans le service de gynecologie obstetrique du CHU de YOPOUGON sur une periode de trois ans du ler Janvier 2000 au 31 Decembre 2002 L'objectif est de:-Etablir le profil epidemiologique des patientes.-Evaluer la frequence des grossesses abdominales.-Apporter notre experience dans la prise en charge des grossesses abdominales.Dix grossesses abdominales ont ete recensees sur la periode et elles representent 1/723 accouchements. Malgre le petit echantillonnage nous pouvons ressortir un profil des patientes les plus exposees notamment: le bas niveau socio-economique (100pour cent des cas); l'age moyen de 28 ans; la nulliparite (60pour cent des cas); les antecedents d'interruption volontaire de grossesse (70pour cent des cas) qui peut laisser entrevoir un profil infectieux.Le diagnostic est tardif 80pour cent des cas au cours du deuxieme trimestre. Il est domine par l'hemoperitoine 70pour cent des cas et par la douleur abdomino-pelvienne 90pour cent des cas.La prise en charge necessite une intervention chirurgicale. Dans notre contexte; elle a ete realisee en urgence dans 90pour cent des cas. La difficulte chirurgicale reside dans l'extirpation du placenta en fonction de son siege. Dans 100pour cent des cas elle a ete totale; associe a des gestes : hysterectomie 1pour cent; salpingectomie 2pour cent; omentectomie 1pour cent.Le pronostic maternel est bon. Par contre le pronostic foetal est catastrophique avec 100pour cent de deces.La reduction de la frequence de la grossesse abdominale passe par:-la prevention et le traitement precoce et efficace des infections genitales.-La reglementation de la pratique de l'interruption volontaire de grossesse.-le diagnostic precoce de la grossesse abdominale par la systematisation de l'echographie des le premier trimestre.Une sensibilisation du personnel medical dans ce sens parait utile

[Acquired immunodeficiency syndrome in elderly persons in a tropical zone. Apropos of 175 cases in the Congo]. / Le syndrome d'immunodéficience acquise chez les personnes âgées en zone tropicale. A propos de 175 cas congolais.

The objective of this study has been to estimate the frequency of AIDS occurring in older age groups on the basis of hospital statistics and note the prognostic particularities in these groups. One hundred and seventy five (175) cases of AIDS reported to the University Hospital Center of Brazzaville occurring in persons aged 55 years and over were followed up retrospectively from 1 January 1990 to 31 December 1996. The results of this study indicate that AIDS is not rare in older age groups: 4.7% of all infected subjects registered during the period of study. The sex-ratio was 1.3/1 (99 males and 76 females). The overall mean age was 60.45. Contamination seems to be the most often of heterosexual origin. Many symptoms were found. The most frequent ones were weight loss (100% cases), fever (89.7%), diarrhoea (60.5%), neuro-psychiatric disorders (49.7%), and respiratory manifestations (50.2%). Lethal evolution was rapid, with 74% deaths at the end of the 1st year and 100% at the end of 2nd year, as a consequence of delayed diagnosis as well as the natural development of the disease. The results of this study point to the necessity of prevention strategies which include not only young, but older age groups as well.