Risk factors for ectopic pregnancy in a sub-Saharan African country.

Our case-control study aimed at identifying the risk factors (RFs) for ectopic pregnancy (EP), and was carried out between 1st February and 31st May, 2019. Women who had EP were compared to those without EP. Out of 3421 pregnancies, 93 (2.7%) had EP. Independent RFs were previous EP, past history of infertility, first sexual encounter <15 years, past history of chlamydia infection, ≥ 3 sexual partners, use of levonorgestrel based emergency contraceptive pill, and unemployment. Girls should be counselled concerning these RFs and specifically against early sexual intercourse and multiple sexual partnership.

Risk factors for placental abruption.

Our case-control study, aiming at identifying the risk factors for placental abruption (PA), looked at variables including maternal age, daily transportation means, folic acid consumption, smoking, past-history of infertility, number of antenatal visits done, presence of pre-eclampsia and umbilical cord insertion. Significant risk factors for PA were frequent transportation by motorbikes, consumption of haematinic preparation not containing folic acid, passive smoking, past-history of infertility, pre-eclampsia and marginal cord insertion. Pregnant women should be counselled about the above-mentioned risk factors.

Pre-eclampsia in a Sub-Saharan African country and maternal-perinatal outcome.

Our comparative cohort study, carried out between 3rd January and 30th April 2020, looked at the maternal and perinatal outcomes associated with pre-eclampsia. Of 2019 booked pregnant women, 141 (7.0%) had pre-eclampsia, and 59.8% of these were severe at admission. Significant adverse maternal outcomes were eclampsia, HELLP (haemolysis, elevated liver enzymes, and low platelets) syndrome, and placental abruption, and significant adverse perinatal outcomes were intra-uterine fetal death, preterm delivery, low birth weight (LBW), neonatal asphyxia and early neonatal death. Close attention needs to be given to women with pre-eclampsia in poor resource circumstances.

Risk factors for stillbirth after 28 complete weeks of gestation.

PURPOSE: To identify the risk factors for stillbirth (SB). MATERIAL AND METHODS: This case-control study was carried out between 1 December 2019 and 30 April 2020. Women whose fetuses died after the 28th week of gestation, but before delivery and women whose newborns were alive and healthy after delivery were examined. The main variables recorded included maternal age, educational level, medical and obstetrical past histories, number of antenatal visits, whether the woman was referred or not, body mass index (BMI), and sex of newborn. Fisher exact test, t-test and logistic regression were used for comparison. p < .05 was considered statistically significant. RESULTS: Our frequency of SB was 54/1000 births (63 SB out of 1167 deliveries). Significant risk factors for SB were referred parturient (aOR = 7.76, 95%CI = 2.84-21.20), past-history of SB (aOR = 6.54, 95%CI = 1.27-33.63), primary school educational level (aOR = 5.60, 95%CI = 3.63-9.06), pregnancy followed up by a general practitioner (aOR = 5.38, 95%CI = 1.13-25.65 and BMI ≥30kg/m2 (aOR = 3.51, 95%CI = 1.32-9.38). CONCLUSION: When the above-identified risk factors are present, pregnancy and delivery should be well followed up, if we want to reduce the frequency of SB.

Outcome of pregnancies among women with sickle cell disease.

PURPOSE: To evaluate the outcome of pregnancies among women affected by sickle cell disease (SCD). MATERIAL AND METHODS: This retrospective comparative cohort study was carried out between 1 January 2014 and 31 December 2018. The files of pregnant women with and without SCD were analyzed. The main variables recorded included parity, diseases that occurred during pregnancy, maternal and gestational ages at delivery, mode of delivery, birthweight and Apgar score. Data were analyzed using SPSS 21.0. Fisher exact test and the t-test was used for comparison. p < .05 was considered statistically significant. RESULTS: Our frequency of delivery of women with SCD was 0.1% (35/34,895). Significant complications associated with SCD were maternal anemia (RR = 17.00, 95%CI = 5.35-53.99), intra-uterine fetal demise (RR = 12.00, 95%CI = 1.39-103.22), low birthweight (RR = 2.52, 95%CI = 1.50-4.25), neonatal asphyxia (RR = 7.70, 95%CI = 2.57-22.99), transfer of newborn to the neonatal intensive care unit (RR = 3.42, 95%CI = 1.94-6.03), early neonatal death (RR = 4.56, 95%CI = 1.09-19.10), and maternal postpartum severe anemia (RR = 4.50, 95%CI = 1.36-14.87). CONCLUSIONS: Pregnancies amongst women with SCD are still associated with increased risk of maternal anemia as well as perinatal morbidity and mortality despite frequent blood transfusion. Therefore, new strategies should be explored to improve such pregnancies.

Suspected Plasmodium falciparum resistance to artesunate in Cameroon: A case report.

Malaria in pregnancy is associated with adverse maternal and perinatal outcomes. The first-line treatment for severe malaria in the second and third trimesters of pregnancy is parenteral artesunate, according to WHO recommendations. Resistance of Plasmodium falciparum to artesunate has not yet been noted in our country. We report a case highly suspicious of such. A pregnant woman presented with the clinical signs of malaria. After paraclinical confirmation of the diagnosis, she was admitted and injectable artesunate was given for 72 h at the recommended dosage, with antipyretic without any improvement. Artesunate was therefore replaced by parenteral quinine, with favourable evolution. Resistance of Plasmodium falciparum to artesunate might be present in our country. This patient provides a warning about possible artesunate resistance, and this calls for careful monitoring of other cases of malaria been treated with this drug to ascertain the possibility of resistant cases.

Influence of the human immunodeficiency virus on cervical precancerous lesions.

OBJECTIVE: To study the influence of HIV status on the occurrence of cervical precancerous lesions (CPL). METHODS: This analytical cross-sectional study was carried out between December 1, 2019 and May 31, 2020. All women with documented HIV status screened for CPL with biopsies performed were recruited. The main variables recorded included maternal age, educational level, number of sexual partners, age at first sexual intercourse, smoking, alcohol consumption, HIV status, CD4 count, and cervical biopsy result. Fisher exact test and Student's t test were used for comparison. A p value <0.05 was considered statistically significant. RESULTS: Concerning women attending our screening units, CPL was more frequent among those living with HIV/AIDS (20/92; 21.7%) than among those not living with HIV/AIDS (29/290; 10.0%) (p = 0.004). As regards women living with HIV/AIDS, those with a CD4 count below 350/mL were more at risk of having a CPL (odds ratio [OR] 21.39, 95% confidence interval [CI] 5.60-81.56, p Ë‚ 0.001). High-grade lesions (cervical intraepithelial neoplasia Stage 2 or 3) were more often found in women living with HIV/AIDS (OR 3.83, 95% CI 1.09-13.45, p = 0.033). CONCLUSION: More attention should be paid to women living with HIV/AIDS, especially those with CD4 count less than 350/mL, who should be screened more often with biopsy frequently conducted if indicated.

Outcome of pregnancies with marginal umbilical cord insertion.

PURPOSE: To evaluate the outcome of labor in cases of marginal umbilical cord insertions. MATERIAL AND METHODS: This case-control study was carried out between December 1st, 2017 and April 30th, 2018. All singletons with marginal cord insertion (MCI) and three new-borns without MCI were recruited. The main variables studied included gestational age at delivery, occurrence of preeclampsia, intrapartum haemorrhage, mode of delivery, cord insertion, cord length, birth and placenta weights, presence of nuchal cord, Apgar score and admission of the new-born into the neonatal intensive care unit (NICU). Data from both groups were compared. Fisher exact test, t-test and logistic regression were used for comparison. p < .05 was considered statistically significant. RESULTS: Our prevalence of MCI was 7.2% (85/1181). MCI was significantly associated with pre-eclampsia (aOR 2.94, 95%CI 1.14-7.59), placenta abruption (OR 33.68, 95%CI 9.80-115.76), nuchal cord entanglement (aOR 3.07, 95%CI 1.69-5.59), low birth weight (aOR 3.15, 95%CI 1.05-9.45) and transfer of the newborn to the NICU (OR 4.72, 95%CI 2.46-9.04). CONCLUSIONS: MCI is associated with increased maternal, fetal and neonatal adverse morbidities. Therefore, pregnancy with MCI should be well followed up. Moreover, the delivery should be conducted in settings where rapid intensive neonatal care can be offered.

What are the most common sexually transmitted bacteria in women with cervico-vaginitis nowadays?

INTRODUCTION: Cervico-vaginitis is usually the initial infection which, when undiagnosed, can evolve to salpingitis with tubal infertility, ectopic pregnancy, and chronic pelvic pain as consequences. This study aimed at identifying the sociodemographic profile and clinical presentation of women diagnosed with cervico-vaginitis, as well as the microorganisms isolated. MATERIALS AND METHODS: This cross-sectional, descriptive study was carried out between October 1, 2013, and March 31, 2014. Women diagnosed with cervico-vaginitis were recruited. The main variables recorded were maternal age, occupation, marital status, number of sexual partners, clinical presentation, and microorganisms identified. Data were analyzed using SPSS 20.0. RESULTS: The mean maternal age was 25.5 ± 5.6 years. Students were more represented (41.1%), 66% were single, and 69.6% had ≥2 sexual partners. The most frequent symptom was abnormal vaginal discharge (100%). The most frequent microorganisms isolated were genital tract mycoplasmas (67.9%) and Chlamydia trachomatis (55.3%). DISCUSSION: Acute cervico-vaginitis is common among young, single women with multiple sexual partners. Genital tract mycoplasmas were the commonest germs isolated followed by Chlamydia trachomatis. CONCLUSION: Cervico-vaginitis is very common in our setting. Screening for genital tract mycoplasmas should be the first to be requested to women with cervico-vaginitis.

Malaria in the third trimester and maternal-perinatal outcome.

OBJECTIVE: To evaluate maternal and perinatal outcomes in cases of third-trimester malaria (TTM). METHODS: A parity-matched comparative cohort study was carried out between December 1, 2018, and April 30, 2019, in three university teaching hospitals in Yaoundé (Cameroon). Women with and without TTM were followed up till delivery. The variables analyzed included maternal and gestational ages at delivery, the regimen of intermittent preventive treatment, usage of insecticide-treated net, history of malaria recorded during pregnancy, birth and placenta weights, Apgar score, and early neonatal outcomes. Fisher exact test, t-test, and logistic regression were used for comparison. P<0.05 was considered statistically significant. RESULTS: Of 3063 pregnant women, 130 (4.2%) had TTM. Adverse outcomes associated with TTM were maternal anemia (relative risk [RR] 10, 95% confidence interval [CI] 4.91-20.34), intrauterine fetal demise (RR 7.50, 95% CI 1.47-38.06), preterm delivery (RR 4.50, 95% CI 2.37-8.51), low birth weight (adjusted RR 2.88, 95% CI 1.34-6.19), neonatal asphyxia especially if delivery occurred during parenteral treatment (RR 5.18, 95% CI 2.56-10.48), transfer of the newborn to the neonatal intensive care unit (RR 4.38, 95% CI 2.59-7.42), and intrapartum or early neonatal death (RR 4.18, 95% CI 1.48-11.74). CONCLUSION: TTM was associated with adverse perinatal outcome especially if labor started during parenteral treatment.

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.

Factors associated with the resumption of sexual intercourse before the scheduled six-week postpartum visit.

This retrospective cohort study was aimed at evaluating the factors associated with the resumption of sexual intercourse (SI) before the six-week postpartum visit and was carried out between 1 January and 15 February 2014. The main variables studied included maternal age, number of living children, mode of delivery, complications observed at delivery and resumption or not of SI. Data from women who resumed SI were compared to those of women who did not. Fisher's exact test and t-test were used for comparison. We recruited 120 women, among whom 95 (79.1%) resumed SI. Of these, 65/95 (68.4%) did not attend the postpartum visit while 30 (31.6%) did (P = 0.321). The factors associated with early resumption of SI were maternal age of 20-34 years (P < 0.001), women with one child (P < 0.004) and who had had an uncomplicated vaginal delivery (P < 0.001). Our conclusion is that nursing mothers should receive postpartum contraception before leaving the hospital.

Pap smear accuracy for the diagnosis of cervical precancerous lesions.

This cross-sectional descriptive study, aimed at accessing the accuracy of Pap smear in diagnosing cervical precancerous lesions, was carried out between 3 January and 30 April 2017. All women screened for cervical dysplasia by means of Pap smear with biopsy done for confirmation were subsequently recruited. Data were analysed using SPSS 20.0. A total of 231 women were screened for cervical dysplasia using Pap smear with 75 biopsies performed. Cervical dysplasia was noticed in 54 cases. The sensitivity, specificity, positive predictive and negative predictive values of Pap smear were 55.5%, 75%, 88.2% and 33.3%, respectively. The sensitivity of Pap smear remains low. Therefore, biopsy should be done in cases of macroscopic cervical architectural changes irrespective of the result of the Pap smear. Moreover, to reduce the number of women with cervical precancerous lesions, the government should make available financial resources to set up HPV vaccination programmes rather than screening programmes.

Knowledge, attitudes and practices of health personnel of maternities in the prevention of mother-to-child transmission of HIV in a sub-Saharan African region with high transmission rate: some solutions proposed.

BACKGROUND: High mother-to-child (MTC) transmission rate of HIV might contribute to the increased pandemic rate. The aim of this study was to identify the knowledge, attitude and practices of health personnel working in maternities in the prevention of MTC transmission of HIV. METHODS: This cross-sectional descriptive study was carried out from 20th February to 30th April, 2017. All health personnel working in the maternity wards were included in this study. The variables recorded included their age, grade, experience (number of year of practice), gender, educational level, health structure and the training in prevention of MTC transmission of HIV. Analyses were done using SPSS 21.0. The Pearson Chi-square test or Fisher's exact test and logistic regression were used for comparison. The level of significance was P < 0.05. RESULTS: A total of 140 health personnel were recruited. Knowledge was insufficient amongst 73 of them (52.1%). The factors significantly associated with sufficient knowledge were midwifery qualification (aOR 9.01, 95% CI 1.82-48.60) and training in prevention of MTC transmission of HIV (aOR 2.23, 95% CI 1.02-4.81). Regarding attitudes, it was negative in 85 practitioners (60.7%). Only those aged ≥33 years were significantly associated with a positive attitude (aOR 2.34, 95% CI 1.14-4.23). As concerns practices, only 32 practitioners (22.9%) had good practices. Only midwives were associated with good practices (aOR 3.23, 95% CI 1.21-9.95). CONCLUSION: Insufficient knowledge, attitude and practices in the prevention of MTC transmission of HIV were observed among the majority of health personnel in the region. This lack of knowledge in prevention can therefore contribute to the rise of the mother-to-child transmission rate of HIV. To reduce this rate, more health personnel should be trained, especially midwives, in the prevention of MTC transmission of HIV. Moreover, deliveries of all women living with HIV should be conducted or at least supervised by trained midwives, especially those of at least 33 years of age.

An intramural uterine fibroid became submucosal in the puerperium - proposed probable mechanism: a case report.

BACKGROUND: Vaginal prolapse of a large uterine fibroid is a rare phenomenon in a woman who delivered vaginally recently, given that this fibroid might have obstructed labor. The author presents a case report of a vaginally prolapsed large pedunculated submucosal uterine myoma in a woman with a recent uncomplicated vaginal delivery. CASE PRESENTATION: A 25-year-old black African woman had four intramural uterine fibroids of diameters 62 to 94 mm diagnosed in April 2013 with standard ultrasound scan. She got pregnant in July 2014. An ultrasound scan done on 31 August 2014 at 10 weeks' gestation identified four intramural uterine fibroids, with sizes varying from 70 to 150 mm. Her pregnancy was well followed up, without any complications. She had an uneventful vaginal delivery on 10 April 2015. During uterine exploration, indicated for retention of parts of fetal membranes, no pedunculated submucosal fibroid was found. On 15 May 2015, she consulted for difficult micturition and partial urinary retention that occurred 2 days ago. A vaginally prolapsed 10 cm uterine fibroid was diagnosed. Forty-eight hours after administration of intravenously administered broad spectrum antibiotics, the myoma was successfully twisted off by means of vaginal route under general anesthesia, which relieved her symptoms. CONCLUSIONS: To the best of our knowledge, this is the first case of vaginally prolapsed large submucosal uterine fibroid in a woman who delivered vaginally recently. The author recommends that women with known large low situated uterine fibroid should be well observed during the postpartum period to diagnose a vaginally prolapsed uterine fibroid early, so as to prevent fibroid superinfection and obstructive complications.

Risk factors for nuchal cord entanglement at delivery.

OBJECTIVE: To identify nuchal cord risk factors. METHODS: The present case-control study was carried out between December 2016 and April 2017 at two hospitals in Yaoundé, Cameroon. Singletons with a nuchal cord at delivery (case group) as well as the two neonates without a nuchal cord delivered immediately after each case (control group), all in cephalic presentation, were included. Undated pregnancies were excluded. The main variables studied were maternal age, parity, pregnancy duration at delivery, cord insertion site, cord length, delivery weight, and fetal sex. RESULTS: A nuchal cord was present in 121 (6.0%) of 2015 singletons. The final analysis included 114 and 228 neonates in the case and control groups, respectively, with similar maternal age, parity, pregnancy duration, and delivery weight. Significant independent risk factors for nuchal cord formation were a cord length of 70 cm or more (adjusted odds ratio [aOR] 19.10, 95% confidence interval [CI] 8.63-42.04), a pregnancy duration of more than 42 weeks (aOR 7.43, 95% CI 1.46-37.21), marginal cord insertion (aOR 2.90, 95% CI 1.11-9.35), and a male fetus (aOR 2.14, 95% CI 1.16-7.74). CONCLUSION: Marginal cord insertion and post-term pregnancy should be added to the list of known nuchal cord risk factors.

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.

Uterus preserving surgery versus hysterectomy in the treatment of refractory postpartum haemorrhage in two tertiary maternity units in Cameroon: a cohort analysis of perioperative outcomes.

BACKGROUND: Little evidence exists on the efficacy and safety of the different surgical techniques used in the treatment of postpartum haemorrhage (PPH). We aimed to compare uterus preserving surgery (UPS) versus hysterectomy for refractory PPH in terms of perioperative outcomes in a sub-Saharan African country with a known high maternal mortality ratio due to PPH. METHODS: This was a retrospective cohort study comparing the perioperative outcomes of all women managed by UPS (defined as surgical interventions geared at achieving haemostasis while conserving the uterus) versus hysterectomy (defined as surgical resection of the uterus to achieve haemostasis) for PPH refractory to standard medical management in two tertiary hospitals in Cameroon from January 2004 to December 2014. We excluded patients who underwent hysterectomy after failure of UPS. Comparison was done using the Chi-square test or Fisher exact test where appropriate. Bonferroni adjustment of the p-value was performed in order to reduce the chance of obtaining false-positive results. RESULTS: We included 24 cases of UPS against 36 cases of hysterectomy. The indications of surgery were dominated by uterine rupture and uterine atony in both groups. Types of UPS performed were seven bilateral hypogastric artery ligations, seven hysterorraphies, six bilateral uterine artery ligations, three B-Lynch sutures and one Tsirulnikov triple ligation with an overall uterine salvage rate of 83.3%. Types of hysterectomies were 26 subtotal hysterectomies and 10 total hysterectomies. UPS was associated with maternal deaths (RR: 2.3; 95% CI: 1.38-3.93.; p: 0.0015) and postoperative infections (RR: 1.96; 95% CI: 1.1-3.49; p: 0.0215). The association of UPS with maternal death was not attenuated after Bonferroni correction. Hysterectomy had no statistically significant adverse outcome. CONCLUSION: Hysterectomy is safer than UPS in the management of intractable PPH in our setting. The choice of UPS as first-line surgical management of PPH in resource-limited settings should entail diligent anticipation of these adverse maternal outcomes in order to lessen the perioperative burden of PPH.

Placenta abruption surface and perinatal outcome.

OBJECTIVE: To identify the relationship between the placenta abruption (PA) surface and the perinatal outcome. METHODS: This prospective descriptive study was carried out from 1 February to 30 September 2014. We recruited all women whose delivery was complicated by PA with onset preceded by the presence of active fetal movement. PA surface was assessed by placental examination after delivery. Main outcome measures were gestational age, Apgar score, and location and percentage of PA. Data were analyzed using SPSS 17.0 Fisher's exact test was used for comparison. RESULTS: PA occurred in 47 women (1.3%). Mean gestational age was 36.0 weeks. PA percentages varied between 5% and 60%. Detachment ≥45% was always associated with stillbirth and was significantly observed in central PA (p < 0.0002), while separation of 25-44% was associated with various degrees of neonatal asphyxia. Compared to marginal separation of the placenta, central separation was significantly associated with stillbirth (77.8% versus 10.5%, p < 0.0002) and perinatal death (88.9% versus 13.1%, p < 0.0001). CONCLUSION: PA surface ≥45% was associated with stillbirth. This knowledge can be helpful in identifying the cause of stillbirth when PA is found. Central PA was significantly associated with poor perinatal outcome and PA surface ≥45%. Therefore, its diagnosis calls for rapid intervention.

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.