Outcome of twin deliveries at the University Teaching Hospital, Yaoundé, Cameroon-a 15-year experience.

From 1982 to 1996, a total of 16 181 deliveries was registered at the obstetric unit of the Yaoundé University, Cameroon, out of which 291 were twins (1.8%). For the latter, the average gestational age was 37 +/- 2.9 weeks. In 45.0% of cases both fetuses presented cephalic, in 42.6% one presented cephalic and the other breech, while both fetuses presented as breech in 9.9% of cases. The frequency of the combination cephalic-transverse was 0.05%. Spontaneous delivery of both babies was observed in 90.2% of the patients, while in 9.7% delivery of both babies was by caesarian section. The caesarian section rate for a retained second twin was 1%. The perinatal mortality rate was 65 per 1000 (38 deaths in the first week of life), out of which the fetal loss was 4.4% for the first twin compared with 7.9% for the second. The perinatal mortality for the second twin was significantly associated with the type of fetal presentation at the time of delivery, as well as the time gap between the delivery of the twins. Sixteen deaths were observed amongst second twins after podalic presentation out of a total of 23 deaths recorded in the group. In addition, the mortality rate among second twins born more than 20 minutes after expulsion of the first was four times higher than in those delivered within 20 minutes time interval (16.0%5 versus 4.3%). The main cause of twin deaths in our study was found to be prematurity which complicated 30 cases of the registered deaths (78.9%).

[Use of tubal sterilization by minilaparotomy after vaginal delivery in a developing country. A retrospective analysis of 347 cases at the Yaoundé University Gynecologic Clinic (Cameroon)]. / Wertigkeit der Tubensterilisation durch Minilaparotomie nach vaginaler Entbindung in einem Entwicklungsland. Eine retrospektive Analyse von 347 Fällen an der Universitätsfrauenklinik Yaoundé (Kamerun).

The authors report the results of a retrospective study of 347 cases of tubal ligation collected between January 1985 and December 1991 in the maternity unit of the Yaoundé teaching hospital group. The tubal ligations were performed through minilaparotomy with local anesthesia using the method of Pomeroy. The frequency of tubal ligation evaluated by 3.8 per cent did not change during the period of this study. The authors note that the majority of patients in this study asked for a tubal ligation only when they had 5 or more surviving children. The authors conclude that because of poorly equiped medical infrastructures in the context of developing countries tubal ligation through minilaparotomy should be promoted by the contraceptive methods in family planning programs.

Regression spontanee de grossesse ectopique et fertilite: A propos d'un cas observe au cours d'une cystectomie

Les auteurs rapportent un cas de grossesse ectopique d'evolution regressive decouverte au cours d'une cystectomie par laparotomie. L'interrogation detaillee de la patiente montre les difficultes de diagnostic de grossesse ectopique dans le contexte d' un pays en developpement ou les infrastructures medicales sont encore peu developpees. En se referant a la litterature; les auteurs indiquent la possibilite de regression de certains cas de grossesse ectopique. Ils insistent sur l'amelioration des infrastructures medicales au Cameroun; ce qui devrait permettre d'integrer l'echographie endovaginale et le dosage de Beta HCG dans le diagnostic precoce de la grossesse ectopique

[Minilaparotomy tubal ligation in the immediate post-partum after vaginal delivery. A retrospective analysis of 253 cases in the maternity service of the Yaounde University Hospital Center (Cameroon)]. / Ligature des trompes par minilaparotomie dans le post-partum immediat apres l'accouchement par voie basse. Une analyse retrospective de 253 cas a la maternite du CHU de Yaounde (Cameroun).

The authors report the results of a retrospective study of 253 cases of tubal ligation collected between January 1985 and December 1989 in the maternity unit of the Yaounde Teaching hospital. The tubal ligations were done through minilaparotomy with local anesthesia using the technique of Pomeroy. The frequency of tubal ligation evaluated at 3,8 per cent did not change during the period of this study. The authors note that the majority of patients in this study wished a tubal ligation only when they have 5 or more surviving children. We had no post-operative death, but our complication rate of 1,6 % can be improved upon by paying more attention to operative details. The authors conclude that because of poorly equipped medical infrastructures in the context of developing countries tubal ligation through minilaparotomy should be promoted as a contraceptive method in family planning programs.

[Treatment of ectopic pregnancies by laparotomy in under-equipped countries. A series of 144 cases at the Yaounde University Hospital Center (Cameroon)]. / Traitement des grossesses extra-utérines par laparotomie en pays sous-équipé. A propos d'une série de 144 cas au CHU de Yaoundé (Cameroun).

We report in the context of a developing country the results of ectopic pregnancies treated by laparotomy in the last ten years (1984-1993) in the maternity unit of the Teaching Hospital Yaounde (Cameroons). There were 144 cases of ectopic pregnancies from a total of 12,507 deliveries; this corresponds to 11 cases of ectopic pregnancies for 1,000 deliveries. In 75 cases (52%) the patients were operated in emergency situations with clinical signs of ruptured ectopic pregnancy which were later confirmed at laparotomy. In 69 cases (47.9%) the patients were retained in hospital for definitive diagnosis and in the follow-up, the diagnosis was confirmed by laparoscopy in 37 cases (53.6%) and by ultrasonography in 22 cases (31.9%). In this study the frequency of ectopic pregnancy was most common among primiparous women (36 cases) and second parity (37 cases). The highest frequency of ectopic pregnancies was found in women in the age range between 25 and 30 years. Radical treatment of ectopic pregnancy was performed in 62 cases (43.0%) and conservative treatment in 82 cases (56.9%). The main complication during the operation was represented by severe hemorrhage in 65 cases (45.1%); blood transfusion was required in 25 cases. Among the patients who were followed up in the prenatal clinic (98 cases) 16 patients (16.3%) presented an intra-uterine pregnancy and 12 patients (12.2%) a recurrence of ectopic pregnancy. Ectopic pregnancy is a frequent pathology in Cameroon. In the absence of methods for early diagnosis of ectopic pregnancy such as endovaginal ultrasonography and the measurement of beta human chorionic gonadotropin (beta hCG), primary use of laparotomy is necessary when clinical signs of ectopic pregnancy exist. This procedure permits the avoidance of severe complications such as hemorrhage and maternal death. It can be said that laparotomy still has its place in the treatment of ectopic pregnancy in developing countries.

Foetal macrosomia in Cameroon: prevalence, risk factors and complications.

102 neonates weighing 4000 g and above were compared to a control group with similar characteristics except for the weight. The sex distribution was 74.19% males and 25.81% females. The prevalence of macrosomia was 6.41%. Maternal risk factors were: age above 30 years (p < 0.05); grand multiparity P > 5(p < 0.05); post term (p = 0.001); height above 1.65 m (p < 0.001); term weight of 90 Kg and above (p < 0.001); pregnancy weight gain of 15 Kg and above (p < 0.001). Macrosomic neonates had the following complications: foetal distress, shoulder dystocia, respiratory distress and hypoglycaemia.

[A comparative study of 2 ways of clinical management in premature rupture of the membranes at term: temporization versus labor induction]. / Etude comparative de deux conduites cliniques en cas de rupture prématurée des membranes à terme. Expectative versus induction du travail.

Two defined management approaches, temporization limited to 48 hours and immediate induction of labor, for premature rupture of the membranes at term were compared in a prospective study between January 1 1991 and November 30 1993 in the Maternity Unit of Yaoundé University Hospital. During this period, 268 cases of premature rupture of the membranes were seen among 3252 deliveries, i.e. an incidence of 8.2%. In the temporization group (153 cases), spontaneous onset of labor was effective in 95 patients (62.1%) within 12 hours and in 137 patients (89.5%) within 24 hours after premature rupture of the membranes. Spontaneous deliveries in this temporization group accounted for 129 cases (92.8%). In the induction of labor group, spontaneous delivery occurred in 119 cases (93.2%). There were ten cesareans in the temporization group and eight cesareans and two vacuum cup extractions in the induction group. Short term (24 hours) prophylactic antibiotics were given to 34 patients, i.e. 16 cases in which the duration of rupture of the membranes was more than 24 hours and 18 cases of cesarean section. Maternal infections concerned 18 cases (6.7%) including 12 cases (4.4%) of malaria. Microbiology of vaginal swabs revealed 6 cases of pseudomonas, 4 cases of staphylococcus aureus and 3 of candida albicans. Neonatal infections confirmed by blood culture and assay of C-reactive-protein involved 24 cases (20.3%). There were three fetal deaths, i.e. perinatal mortality of 1.1%. Risk factors, in these three fetal deaths, included postmaturity (1 case).(ABSTRACT TRUNCATED AT 250 WORDS)

[Fertility after chronic, undiagnosed, ectopic pregnancy. A case observed during a myomectomy]. / Fertilité après grossesse ectopique chronique non diagnostiquée. A propos d'un cas observé au cours d'une myomectomie.

The authors report a case of a spontaneously absorbed ectopic pregnancy, that was fortuitously discovered during myomectomy in a 26 years old patient. She had been married for three years and had no child. She was seen 15 months later with a pregnancy whose outcome was safe through an elective cesarean section at 39 weeks of gestation. The authors emphasize the difficulties of early diagnosis of ectopic pregnancy in the context of a developing country.

[Fetal risk factors in twin pregnancies. Critical analysis of 265 cases]. / Les facteurs de risque foetal dans les accouchements gémellaires. Une analyse critique de 265 cas.

The authors report their critical analysis of perinatal mortality concerning 265 twin pregnancies collected between 1982 and 1993 in the Maternity Unit of the Yaoundé (Cameroon) Teaching Hospital Group. There were a total of 14,277 deliveries during this period. The twin pregnancy rate was 1.8 per cent. Delivery was spontaneous in 89.6 per cent of cases and by cesarean section in 10 per cent of cases. In 3 cases the second twin was delivered by section after spontaneous delivery of the first twin. Perinatal mortality evaluated at 6.9 per cent (37 cases) was analysed according to fetal risk factors such as gestational age, type of delivery, fetal presentation, birth weight, birth rank and the time interval between birth of the first and second twin. Perinatal mortality of premature twins with 25 fetal deaths accounted for approximately 2/3 of the fetal deaths in this series. Twenty-two cases of fetal deaths seen in the group of second twins accounted for more than half of all fetal mortality. The time interval between the two births was an important factor in the fetal prognosis of the second twin. There were 14 cases of death of the second twin for a time interval longer than 20 minutes as compared with 8 fetal deaths for an interval of 20 minutes or less. Breech presentation was associated with abnormally high fetal mortality (16 cases). Our conclusion is that improved perinatal mortality in twin pregnancies must be sought by preventing prematurity. Breech presentation is a factor of poor prognosis, in which it is important to widen indications for prophylactic cesarean section aimed at improving fetal prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Rate of prematurity and perinatal mortality in the Yaoundé (Cameroon) University Gynecologic Clinic 1982-1992> An analysis of 680 cases]. / Frühgeburtenrate und perinatale Mortalität an der Universitätsfrauenklinik Yaoundé (Kamerun) von 1982-1992. Eine Analyse von 680 Fällen.

The authors made an analysis of perinatal mortality on 680 cases of premature births recorded between 1982 and 1992 in the CHU maternity, Yaoundé (Cameroon). During this period, 13,555 births were recorded. The frequency of premature births stood at 5%. The most important etiological factors responsible for these 680 premature cases were depicted as malaria infection and anemia (22.2%), premature rupture of the membranes (13%), multiple pregnancies (11.9%), preeclampsia (10.2%), antepartnal bleeding (5.7%), and urogenital infections (5.0%). The perinatal mortality rate was 16.7% (114 cases). There were 37 cases of antepartual foetal deaths (5.4%), 24 cases of intrapartual foetal deaths (3.2%) and 31 cases of neonatal deaths (4.5%). Perinatal mortality reduced with an increase in the gestation period and the weight of the foetus. The authors noted with astonishment that perinatal mortality was twice as high in cases of non ruptured membranes (19.5%) when compared to premature ruptures of the membrane (10.2%). A plus 30 minutes duration of the expulsion phase was estimated to be a factor that increases perinatal mortality. Breech presentation with a 32.8% perinatal mortality, when compared to cephalic presentation (7.5%), portrays an important risk factor in premature births. Perinatal mortality of premature babies in cases of spontaneous births is two time higher (16.2%) than in cases of caesarean section (7.8%).

[Spontaneous abortion of one twin and later spontaneous delivery of the surviving twin]. / Spontanabort des einen Zwillings und spätere Spontangeburt des überlebenden Zwillings.

The authors report a case of a diamnial-dictorial pregnancy with spontaneous abortion of the first foetus and late spontaneous delivery of the second twin. The intra-uterine death of the first foetus was diagnosed by sonography in the 16th week of pregnancy. The intra-uterine development of the second twin was normal and the spontaneous delivery was in the 32. week of gestation. As conclusion the authors recommend diagnosis of twin pregnancy with distinction between monochorial and dictorial placenta should be made by sonography as early as possible.

[Controversy on the method of sterilization during cesarean section: tubal ligation or hysterectomy? Review of the literature]. / Controverse sur la méthode de stérilisation au cours de la césarienne: ligature des trompes ou hystérectomie? Une revue de littérature.

The results of tubal ligation done during cesarean section are analysed in the context of a developing country during the last eleven years (1982-1992) at the maternity of the University Hospital Centre in Yaounde (Cameroun), ring this time there were 13,759 deliveries, of which 1,062 cases were by cesarean section with 109 cases of tubal ligation and 2 cases of cesarean hysterectomy. The operative and post-operative complications are discussed and compared to that in cesarean hysterectomy. Complications are found to be more in cases of cesarean hysterectomy that in cases of tubal ligation by cesarean section. The author conclude that hysterectomy at the time of cesarean section should be restricted to those cases in which removal of the uterus is necessary to preserve the life of the patient.

[Controversy on the method of sterilization during cesarean section: tubal ligation or hysterectomy? Review of the literature]. / Controverse sur la methode de sterilisation au cours de la cesarienne: ligature des trompes ou hysterectomie? Une revue de litterature.

PIP: During 1982-1992, 111 cesarean sections followed by 109 tubal ligations (Pomeroy method) and two hysterectomies were performed at two hospitals in Yaounde, Cameroon. All the patients were informed of the necessity of limiting births because of risks posed by future pregnancies. All women gave informed consent. The leading indications for cesarean section were limited pelvis associated with previous cesarean section(s)-related scarred uterus (59 cases) and fetal distress (33 cases). The two principal indications for tubal ligation were previous cesarean sections (64 cases) and grand multiparity (i.e., 5 births) (45 cases). 37.1% of tubal ligation cases had more than five children. The number of tubal ligation cases after cesarean section was highest in 1983 (16 cases), 1984 (13 cases), 1990 (16 cases), 1991 (13 cases), and 1992 (12 cases). No woman younger than 24 years old underwent tubal ligation. 77.1% of tubal ligations occurred to women aged 30-40. Immediate hysterectomy was required in two cases to control severe hemorrhaging. Three tubal ligation cases lost more than 1000 cc of blood and had to be transfused. All 111 cesarean section cases received prophylactic antibiotics. The surgeon perforated the bladder of a patient who had had three previous cesarean sections when he/she dissected the lower segment of the peritoneal cavity. This case suffered no postoperative complications. Surgeons had to reintervene two hours after the tubal ligation because the ligature thread loosened at the level of the two fallopian tubes, causing a hemorrhage. No one developed fever. There were no fetal or maternal deaths. The peri- and post-operative complication rate was lower than that of other like studies. The researchers recommend tubal ligation as the preferable sterilization method after cesarean section. Hysterectomy should only be used in cases of severe hemorrhaging which can lead to maternal death.^ieng

[Anencephaly associated with hydramnios. A case diagnosed late by ultrasonographic examination in the third trimester of pregnancy]. / L'anencéphalie associée à l'hydramnios. A propos d'un cas diagnostiqué tardivement par l'examen échographique au troisième trimestre de la grossesse.

The authors report a case of anencephaly seen in the maternity unit of the Yaounde Teaching Hospital Group (Cameroon). This case of fetal malformation complicated by acute hydramnios was diagnosed late by ultrasonography during the 37th week after the LMP. Ultrasonographic findings as well as clinical management are described. Referring to the literature, the authors stress the need to seek fetal malformations in hydramniotic pregnancies. Only routine ultrasonography during pregnancy enables the early discovery of fetal malformations, this forming the basis of management decisions.

[Induced labor: conditions for success and causes of failure. A prospective study of 162 cases]. / Le travail induit: conditions de succès et causes d'échec. Une étude prospective de 162 cas.

The authors report the results of a prospective study of 162 cases of induced labour collected between 30 October 1990 and 31 December 1991 in the maternity unit of the Yaounde teaching hospital group. There were 1,640 deliveries during this period. Premature rupture of the membranes in 72 cases (44.4 per cent) and postmaturity in 42 cases (27.2 per cent) were the chief indications for the induction of labour in this study. There were 138 cases (85.2 per cent) of spontaneous delivery, 20 cases (12.3 per cent) of cesarean section and 4 cases (2.5 per cent) of vacuum extraction. Failure of induction occurred in 16 cases (9.8 per cent). Repeat induction of labour after a rest period led to spontaneous delivery in 6 cases. There were 6 fetal deaths, i.e. a perinatal mortality of 3.7 per cent. Postmaturity (3 cases) and premature rupture of the membranes (2 cases) were the risk factors in these six fetal deaths. Analysis of cases of failed induction and of fetal deaths in this study leads the authors to conclude that ripening of the cervix is an essential parameter for success of the artificial induction of labour. Premature rupture of the membranes, and postmaturity associated with an unripe cervix are unfavourable risk factors for the induction of labour and are potential indications for preventive cesarean section in order to avoid fetal death.

The outcome of labor at the University Teaching Hospital (CHU), Yaounde, Cameroon.

The University Teaching Hospital, Yaounde, Cameroon became operational in 1982. This retrospective study analyses the performance of the maternity unit during the first 5 years. Data was obtained from casenotes, annual reports, delivery and operation registers. The maternal mortality rate (MMR) is one of the lowest in Africa. The perinatal mortality is low but could be improved upon. The reasons for the low MMR is discussed. It is possible to reduce the appalling MMRs of developing countries without sophisticated technologies.

PIP: The University Teaching Hospital, Yaounde, Cameroon, became operational in 1982. This retrospective study analyses the performance of the maternity unit during the first 5 years. Data was obtained from case- notes, annual reports, delivery and operation registers. 5614 deliveries over this 5-year period were analyzed. Patients were 12-49 years old. The maternal mortality rate (MMR) is one of the lowest in Africa (averaging about 33/100,000 births over 5 years). The perinatal mortality rate is also low (about 34.3 in 1000 births), however it can still be improved. The low MMR may be due to the short distance the patients travel to get to the hospital, the fact that 99% of the patients are booked, the existence of an efficient referral system, the use of the partogram in labor, and the existence of family planning clinics. Adequate staffing of maternity units is also important, to relieve overworked staff.