Pregnancy and cirrhosis: four cases at the Lome campus university teaching hospital (Togo).

To evaluate the hepatic and obstetric complications in pregnant women with cirrhosis. We report the cases of four pregnant women with cirrhosis treated in the gastroenterology and obstetrics-gynecology departments of the Lome Campus University Teaching Hospital between 2013 and 2015. The women's mean age was 32 years. Three were in the first trimester of pregnancy. Almost all had signs of advanced cirrhosis, including ascites (50%), lower-limb edema (75%), and jaundice (25%). All (100%) had liver failure and anemia. Cirrhosis was due to hepatitis virus B infection for 3 women. All had singleton pregnancies. Two mothers died; fetal outcome included one fetal loss and one stillbirth. This study shows the high risk associated with the combination of pregnancy and cirrhosis. Prognosis is poor for both mother and fetus.

Profil épidémiologique des patientes suivies dans un protocole de prévention de la transmission mère-enfant du VIH-1 au CHU Sylvanus Olympio

But : Les objectifs de notre étude étaient de décrire les caractéristiques sociodémographiques et obstétricales des patientes d'un protocole de prévention de la transmission mère-enfant du VIH1 au Togo.Patients et méthodes : Nous avons réalisé une étude prospective transversale de type suivi de cohorte dans le site PTME du CHU Sylvanus Olympio. Elle s'était étendue du 27 juin 2011 au 27 juin 2015.Résultats : Au total 255 femmes ont été incluses. L'âge moyen de nos patientes était de 30 ans. Les revendeuses étaient de 38,8% et les femmes au foyer représentaient 17,6%. 48,2% de nos patients avaient un niveau scolaire secondaire. Les célibataires ont représenté 36,1% et 54,5% étaient mariées monogames. 64% des patientes ont été dépistées positives au VIH au cours de leur grossesse et 80,7% étaient au stade clinique I de l'OMS. Quarante-quatre virgule cinq pour cent (44,5%) des patientes ont consulté pour la première fois au 1er trimestre de grossesse.Conclusion : Les résultats de cette étude révèlent que la majorité de nos patientes était jeune, asymptomatique et a majoritairement été dépistée dans notre maternité

[Epidemiological and pathological aspects of the gynecological and mammary cancers in Togo]. / Aspects epidémiologiques et histopathologiques des cancers gynéco-mammaires au Togo.

OBJECTIVE: Gynecologic and mammary cancers occupy a prominent place in female tumor pathology. The purpose of this report is to describe aspects of these cancers in Togo. MATERIAL AND METHODS: This retrospective and descriptive study includes all gynecologic and mammary cancers diagnosed between 1987 and 2006 in the pathology laboratory of Tokoin University Hospital in Lomé, Togo. RESULTS: During the study period, 882 gynecologic and mammary cancers were diagnosed. Breast cancer accounted for 440 cases (49.88%). The most common gynecologic cancer locations were the cervix in 212 cases (24.03%) and uterine corpus in 108 cases (12.25%). Mean patient age was 48.3 years overall, 48,6 years for breast cancer and 49 years for cervical cancer. In almost all cases, cancer was diagnosed at an invasive stage. CONCLUSION: Gynecologic and mammary cancers are common in Togo and most cases are diagnosed at a late stage. An epidemiological monitoring program is needed.

[Epidemiological, aetiological and treatment aspects of obstetrical fistula in Togo]. / Aspects épidémiologiques, étiologiques et thérapeutiques de la fistule obstétricale au Togo.

OBJECTIVE: To appreciate and to analyse the different human and materials capacities available for management in view of its total eradication. PATIENTS AND METHODS: From January 2001 to December 2005, a census of obstetrical urogenital fistulae was carried out from treatment cases notes in all the hospitals of Togo. It was a retrospective and descriptive study which included the age of the patients, the situation of the sanitary institution, the quality of the physician in charge of the obstetrical fistulae, information about the kind of the fistulae, the way in which the delivery was done and the financial incidence for the repair of the fistulae. The subject of the study, the confidentiality on the contents of the case notes and the results expected were clarified to the responders. RESULTS: One hundred and sixty-three (163) cases of obstetrical fistulae were studied. The average age was 21 years (extremes: 15 and 45). Forty-four sanitary institutions comprising 93 treatments service were visited. Hospitals were noted to be far away from patients in the north of the country. All the four hospitals able to take care of obstetrical fistulae effectively were located in the south. Eight hundred and forty health personals were questioned and 467 (55.60%) had said to be able to make the diagnosis of obstetrical fistula. A maximum of four surgeons were trained and competent to manage obstetrical fistula. Operating equipment of obstetrical fistula was inexistent in 40 hospitals, that is 90.90%. CONCLUSION: Obstetrical fistula is present in Togo and represents a public health problem to eradicate. It is more frequent in young women from rural areas and of low educational level. It constitutes also a handicap for the reproduction of humankind.

[Knowledge and acceptance of obstetric peridural analgesia: survey of pregnant women in Togo]. / Niveau de connaissance et acceptabilité e l'analgésie péridurale: enquête auprès des femmes enceintes au Togo.

The purpose of this study was to evaluate knowledge and acceptance of obstetric peridural analgesia among pregnant women in Togo. A prospective, descriptive survey was carried out over a period of one month. A standardized survey form was used to collect data. A total of 303 pregnant women with a mean age of 27 +/- 6 years were interviewed. A proportion of primiparous and multiparous was the same, i.e., 50%. Among multiparous women, 83.5% described labor pain during previous deliveries as severe. Twelve percent of the pregnant women interviewed claimed knowledge of techniques to control labor pain. Three pregnant women reported a detailed understanding of peridural analgesia obtained from the Internet. A total of 253 women (83.5%) replied affirmatively when asked if they would opt for peridural analgesia if it was offered free of charge for delivery at the end of the current pregnancy. Acceptance was motivated by better delivery conditions for the newborn (112 women) and comfort achieved by pain relief (130 women). Refusal was motivated by a religious belief that painful delivery was in the natural order (31 women). Among the six Moslem women that refused painless delivery, two from the Djerma ethnic group stated that pain was the best expression of their femininity. The acceptance rate fell from 83.5% to 70% if peridural analgesia was offered at extra charge. Most pregnant women in Togo expressed interest in trying peridural analgesia. It is compulsory in medical indications.

[Actual experiences of menopause in 342 women]. / Etude du vécu de la ménopause auprès de 342 femmes.

The objective of this study is to assess the actual experiences of menopause in menopaused women without hormone replacement therapy. A cross-sectional study was conducted among 342 women who had natural menopause. The target population was recruited from subjects attending the Departement of Gynécologie-Obstétrique du CHU TOKOIN from November 1996 to October 1997. All women investigated presented clinical signs related to menopause. 51.5% found its symptoms embarrassing. 53.8% of the women enjoyed their menopause. The difference between the two groups of women having accepted their menopausal status or not, where the menstrual period were embarrassing or not (p = 0.0001) and were the climateric symptoms were embarrassing or not (p = 0.0001) were significant. Agreement to undertake a hormone replacement therapy were given by 29.8% of women. In spite of the climateric symptoms, menopaused women hardly accept their status and few were available for a hormone replacement therapy.

[Sexual practices in the school milieu]. / Pratique de la sexualité en milieu scolaire.

OBJECTIVE: To appreciate the real sexual practice among students. POPULATION AND METHODS: From 29th April to 10th May 1997, 1,867 students from lower and upper schools have accepted to take part in the investigation being carried on their practice of sexuality. RESULTS: 1,333 students, that is 72% of the group, have already had sexual intercourse. The average age of the very first sexual intercourse was 17 years and the extreme ages range from 8 to 24 years. 72.7% of the students have already had sexual intercourse less once a month, mostly it is by love in 68.6% or by desire in 21.1%. Among more than half of the girl students, that is 59.5%, their partners was students. 31.3% were at least once pregnant. CONCLUSION: The outcome of this study revealed that sexual activity among students is rare and sporadic. It is motivated by love.

L'eclampsie a la Clinique de Gynecologie-Obstetrique du C.H.U. Tokoin-Lome (Togo)

71 cas d'eclampsie pour 7713 accouchements effectues a la Clinique de Gynecologie Obstetrique du C.H.U. Tokoin-Lome; du 1er janvier au 31 decembre 1993; ont ete repertories. L'incidence de cette pathologie etait de 0;92 pour cent soit 1 eclampsie sur 109 accouchements. Les ages allant de 15 a 25 ans etaient les plus affectes (35 cas). La frequence de l'eclampsie ante-partum etait 49;30 pour cent; celle du per-partum s'elevait a 32;40 pour cent contre 18;30 pour cent de celle du post-partum. Les saisons froides etaient les moments favoris. Les maternites satellites etaient les grandes pourvoyeuses (67 cas). La negligence des consultations prenatales (23 cas d'eclampsie sans consultation prenatale) etait le principal facteur favorisant. Aussi le nombre de cas d'eclampsie du per-partum et du post-partum; reflete la deficience dans la prise en charge des parturientes. Le pronostic foetal facheux (31;03 pour cent de mortinatalite dont 22;41 pour cent de mort per-partum) peut-etre ameliore par la cesarienne d'indication eclectique. Quant au pronostic maternel; il etait domine par 2 deces. La persuasion des gestantes de l'utilite des consultations prenatales; la bonne conduite de ces consultations prenatales; et la prise en charge efficiente des parturientes; reduiraient l'incidence de l'eclampsie

l'hematome retroplacentaire (HRP) a la Clinique de Gynecologie-Obstetrique du CHU Tokoin-Lome (Togo) de 1988 a 1992

Sur une periode de 5 ans (de 1988 a 1992); les auteurs ont collige 211 cas d'HRP pour 44.316 accouchements effectues a la maternite de la Clinique de Gynecologie et d'Obstetrique du CHU-Tokoin-Lome (Togo). La frequence s'elevait a 0;47 pour cent. Les principaux facteurs de risque ont ete : le jeune age; la pauciparite; la toxemie gravidique et le traumatisme direct. Le pronostic maternel etait marque par l'anemie aigue et le deces. Quant au pronostic foetal; il a ete domine par le deces enregistre surtout chez les parturientes transferees. Les elements du pronostic aussi bien maternel que foetal ont ete le retard du diagnostic et la deficience dans la prise en charge de cette pathologie gravidique

[Simultaneous intrauterine and extrauterine pregnancy in the presence of inert intrauterine device: a case report]. / Grossesse intra-utérine et grossesse extra-utérine simultanées sur un dispositif intra-utérin inerte: un cas.

The authors report a case of simultaneous intra-uterine and ectopic pregnancy in the presence of a Lippes loop (inert intra-uterine device) which appeared to have been well tolerated for four years. Predisposing factors appeared to be infection, evidenced by the peri-adnexal adhesions found at surgery for the ectopic pregnancy, together with spontaneous multiple ovulation. The intra-uterine pregnancy culminated in a spontaneous abortion. Although apparently very rare, the association of intra-uterine pregnancy and ectopic pregnancy in the presence of an intra-uterine device should be born in mind whenever intrauterine contraception fails.

[Coexistence of a partial hydatiform mole and a viable twin pregnancy. A case seen at the Sokode regional hospital (Togo)]. / Coexistence d'une môle hydatiforme partielle et d'une grossesse gémellaire viable. Un cas au centre hospitalier régional de Sokodé (Togo).

A case was seen of partial hydatidiform mole coexisting with a viable twin pregnancy. Apart from prematurity which created early problems in caring for these girls twins, born with a good Apgar score and birth weights of 1400 g and 1350 g, the outcome was satisfactory for both the mother and daughters, who thrived marvelously. The incidence of this clinical form of trophoblastic disease which is 1/10,000 deliveries in our series confirms it rarity as reported by many authors.

[Maternal mortality at the Tokoin Lome University Hospital Center from 1990 to 1992]. / La mortalité maternelle au CHU Tokoin Lomé de 1990 à 1992.

190 deaths of mothers per 24,668 deliveries with 21,603 live births were recorded at the Gynaecology-Obstetrics clinic of the CHU Tokoin hospital, Lome, between 1st January 1990 and 31st December 1992. Maternal mortality was estimated to be 379.5 per 100,000 live births and this incidence is increasing. The main risk factors are a low level of education, mothers less than 20 years or more than 35 years in age, first births and high multiparity. Referred patients were most frequently involved (148 deaths out of the 190 reported). The most frequent aetiological factors were haemorrhage (53 deaths), infection (50 deaths), anaemia (39 deaths) and preeclampsia (10 deaths). These factors reflect the shortcomings of the pre-natal monitoring and care provided in our health centres and hospitals. Improvement in the living conditions of women and a change in the health policy of the country could help to reduce maternal mortality rates.

[Stillbirths at the regional center hospital of Sokodé, Togo]. / La mortinatalité au Centre hospitalier régional de Sokodé, Togo.

129 stillbirth cases out of 1,231 deliveries corresponding to a frequency of 104.79 out of 1,000 births have been gathered in ten months of obstetrical activity in the regional hospital of Sokodé. It is a growing frequency. The main risk factors are: The poor process even the carelessness of the prenatal consultations and the per-partum survey. Almost half the pregnancies have been followed up. The foetal per-partum death rate is 65.12%. The delivery at home: 19.38%. The reduction of the still-birth frequency depends on a popular action involving both the decision-makers of the population's health and the collectivity.