PRATIQUE DE LAVASECTOMIE SANS BISTOURIAU TOGO : L’EXPERIENCE DE LA CLINIQUE PRINCIPALE DE L’ASSOCIATION TOGOLAISE POUR LE BIEN- ETRE FAMILIAL (ATBEF)

Vasectomy is a surgical procedure that involves isolating and cut or coagulate the vas deferens. It represents 1.9% of modern contraceptive methods in the world. Fear of surgery, especially the fear of the pain of the incision and decreased libido, are some reasons to its low acceptance by men. The NSV, unlike conventional vasectomy, requires no incision or sutures and causes less pain. Objective: To describe the epidemiological characteristics and the prognostic of the no scalpel vasectomy in Togo. Methods: It was a prospective and descriptive study conducted at the Principal Clinic of ATBEF from May 1st, 2012 to April 30, 2013. It covered all cases of vasectomy. The variables analyzed using SPSS software were as follows: socio-demographic data, the motivations of patients, duration and complications of no-scalpel vasectomy. Results: The frequency of this vasectomy was 0,27%. The average age of patients was 41,7 years. The average number of children per couple was 4,7. The main motivation was sufficient number of children (72%) in the couple. The average operative time was 30 minutes. Vasectomy failed in 1 case (2%). Nine (9) cases of pain (scrotal and penile) and 2 cases of scrotal hematoma were the postoperative complications (22%). Conclusion: No scapel vasectomy is a simple practice accepted by the population. His prevalence is low but it can be improved by raising awareness

Depistage Des Lesions Du Col Uterin Au Chu Tokoin De Lome : Resultats D’une Serie De 512 Cas.

Purpose: Cervical cancer remains a real public health problem in Togo. This study was undertaken to sensitize women and to determine the prevalence of precancerous and canrous lesions of the cervix in the Togolese woman. Material and methods: This is a retrospective descriptive study of the results of a consecutive series of Pap smears performed in the Laboratory of Pathological Anatomy and Cytology CHU Tokoin Lome 2011-2013. Results: Epidemiological, 512 FCV were interpretable. The average age of women was 37.6 years, extreme 19 and 87 years. By occupation, we noted a predominance of unemployed women (351cas, 68,6%), followed by women traders (103 cases, 20,1%) . The distribution by marital status was possible to observe a predominance of married women (234 cases, 45, 7 %). In terms of reproductive history, we found a mean gravidity and parity respectively 3, 5 and 2. We noted 22 women living with HIV, 77.2% were infected with HIV1. Cytopathological, 512 smears selected, we observed 44 abnormal smears (8,6%). It was indeterminate lesions ASCUS / ASCUS (8 cases), endocervical hyperplasia (3 cases), low-grade lesions (17 cases), high-grade lesions (10 cases) and invasive carcinoma (6 cases). Conclusion: The detection rate of cervical cancer is low among the Togolese woman. The health professionals should take the habit of asking the FCV any woman having a consultation

DEGENERESCENCE KYSTIQUE DE MYOMES UTERINS SIMULANT UN CANCER DE L’OVAIRE : ETUDE D’UN CAS AU CHU DE KARA, AU NORD DU TOGO

Objective : We repport a case of cystic degeneration of two uterine myomas mimicking ovarian cancer. Observation : It concerned a fourty yaers old patient with uterine polymyoma, receeved at jully 15th, 2014 for progressive abdominal tumefaction and recurrent menemetrorrhagia. Huge and renitent mass distended her abdomen. Hemoglogin concentration was 5,78 g/dl and renal assessment was normal. Abdominal ultrasound revealed a huge mixte tumor with ascendancy of the cystic component and uterine polymyoma. Abdominopelvic scanner noted the mixte character of the tumor and suspected his ovarian origin and his malignancy. Tumor was 38 cms of main line. Ther was neither vegetation, nor ascite and nor abdominopelvic lymphatic nods. Xyphopubian laparotomy was practised after correction of the anemia and after prevention of thromboembolic desaese. In the openning, ovaries were normal ; there was left hydrosalpinx ; uterus was polymyomatous with two pediculed cystic degenerescence sub serous myoma measuring 40 cms and 15 cms. Conclusion : Cystic degenerescence of uterus myoma, whatever is rare, can be huge and mimic ovarian cancer instead of médical imaging contribution. It’s necessary to think of behind renitent adnexial masse in clinical context of uterus myoma

Viol Des Mineurs De 10 A 15 Ans Recus Au Chu-So De Lome

Minors of both sexs ages 10 to 15 are most at risk of sexual assault Objective: To determine the prevalence of sexual assault by rape among children aged 10 to 15 years and describe their management at the gynecology and obstetrics clinic of the CHU SO .Patients and methods: 134 files of rape victims were collected from September 1, 2010 to March 31, 2017 at the gynecology and obstetrics clinic of the CHU SO Results: Rape of minors aged 10 to 15 accounted for 26.6% of sexual assaults. There were 91% of girls. Most of our patients (54.5%) were raped between 7pm and 6am. Sixty eight (68) patients (40.3%) were referred for consultation between the 2nd day and the 8th day after the rape. Fifty-five point two percent of the victims had never had sexual intercourse before the rape. The perpetrator was known to the victim in 92.5% of cases. The tear of the hymen was old in 79.5% of the victims. HIV serology was positive in 1.6%. The rate of β HCG was positive in a 15-year-old patient. All our patients had psychological care. Conclusion: The rape of minors of both sexes is a reality in our developing society. The taboo of the sex must be raised for the fast denunciation of the rape and of an adequate care

Premature Rupture of the Membranes at the Sylvanus Olympio University Hospital of Lomé, Togo: Microbiological Findings and Outcomes

Abstract Introduction: To prevent the risk of infections in cases of premature rupture of the membranes (PROM), a pregnancy complication, gynecologists of the Sylvanus Olympio University Teaching Hospital used clavulanic acid and amoxicillin as empiric antibiotic therapy intravenously. This study aims to identify and assess the susceptibility to antibiotics of bacteria involved in PROM. Methods: A cross-sectional study was conducted from February 25 to June 06, 2014 on 60 pregnant women presenting a PROM and their 65 newborns, recruited in the Gynecology and Obstetrics Service of the Sylvanus Olympio University Teaching Hospital of Lomé, Togo. In mothers, cytological and bacteriological examinations of vaginal and endocervix swabs were carried out and among newborns, cytological and bacteriological examinations were performed on gastric fluid and ear swabs at the Microbiology Service of the university hospital. Results: The frequency of PROM was 6.8% of deliveries during the study period. Pathogens were isolated among 48.3% of mothers and 26.2% of newborns. Vaginal and endocervix swabs allowed isolation of pathogens in 45% and 28.3% of cases, respectively. The most isolated pathogens were Candida albicans (28.6%)(14/53) and enterobacteria (41.5%)(22/53), mainly represented by Escherichia coli (59.1%)(13/22). We also isolated Group B Streptococci (GBS) strains (7.5%)(4/53). Pathogen isolation rate among newborns was 26.2%(17/65). Of these pathogens, Escherichia coli represented 60%(15/25). Pathogens found in 10.7% of newborns were phenotypically identical to those isolated from their mothers. Among newborns, E. coli was the most isolated strain in gastric fluid (66.7%)(4/6) as well as from ear swabs (57.9%)(11/19). Conclusion: Half of PROM cases in this study were associated with presence of pathogen amongst pregnant women; E. coli and Group B Streptococcus known to cause neonatal meningitis were found. Unfortunately, a few isolated strains of E. coli were resistant to clavulanic acid-amoxicillin, a combination used as empiric antibiotic therapy by healthcare practitioners in our settings

Feasibility and acceptability of rapid HIV screening in a labour ward in Togo

Background: HIV screening in a labour ward is the last opportunity to initiate an antiretroviral prophylaxis among pregnant women living with HIV to prevent mother-to-child HIV transmission. Little is known about the feasibility and acceptability of HIV screening during labour in West Africa. Findings: A cross-sectional survey was conducted in the labour ward at the Tokoin Teaching Hospital in Lomé (Togo) between May and August 2010. Pregnant women admitted for labour were randomly selected to enter the study and were interviewed on the knowledge of their HIV status. Clinical and biological data were collected from the individual maternal health chart. HIV testing or re-testing was systematically proposed to all pregnant women. Among 1530 pregnant women admitted for labour, 508 (32.2%) were included in the study. Information on HIV screening was available in the charts of 359 women (71%). Overall, 467 women accepted HIV testing in the labour ward (92%). The HIV prevalence was 8.8% (95% confidence interval: 6.4 to 11.7%). Among the 41 women diagnosed as living with HIV during labour, 34% had not been tested for HIV during pregnancy and were missed opportunities. Antiretroviral prophylaxis had been initiated antenatally for 24 women living with HIV and 17 in the labour room. Conclusions: This study is the first to show in West Africa that HIV testing in a labour room is feasible and well accepted by pregnant women. HIV screening in labour rooms needs to be routinely implemented to reduce missed opportunities for intervention aimed at HIV care and prevention, especially PMTCT

Pronostic obstetrical des gestantes Togolaises porteuses de cicatrice de cesarienne. A propos de 282 cas colliges au Chu de Lome(Togo)

Objective: To assess the security granted to women delivering with a scarred uterus in a maternity where labour is monitored only by clinical examination.Methods: Retrospective study held from January 1st 1999 to December 31st 1999. We analysed delivering route, maternal complications, and perinatal prognosis in 282 pregnant women who previously had caesarean operations.Results: Scarred uteri represented 5.9% of all deliveries; caesareans were performed in 116 cases (41.1%); trial of labour was monitored in 166 cases (58.9 %), from which 104 (62.7 %) were deliveredvaginally. Favourable factors raising normal delivery rate were previous vaginal deliveries (p = 0.00001). We registered 1 maternal death (0.35%), 6 ruptures of scarred uterus (2.1%) including 2 frank rupturesand 4 dehiscences of scar. Perinatal mortality rate was 4 % and perinatal morbidity rate 8 % caused by perinatal anoxia (81.8%) especially in cases of failure of trial of labour.Conclusion: An adequate selecting to trial of scar and an adequate monitoring of labours should significantly reduce the likely risky outcomes observable in deliveries on scarred uterus

Causes et mesures de prévention de l’infection uro-génitale basse de la parturiente au CHU-Tokoin (Lomé-Togo)

L’infection uro-génitale basse par l’inflammation et l’irritation du tractus uro-génital inférieur à la suite de l’accouchement à la maternité du CHU-TOKOIN a toujours mis en doute la qualité des soins dans ce service. Plusieurs travaux antérieurs ont confirmé la fréquence à la hausse de cette infection nosocomiale. Une étude prospective a été menée à la maternité du CHU-TOKOIN dans le but de déterminer le taux de prévalence de l’infection uro-génitale basse et des germes responsables pour une prise en charge par l’élaboration d’un plan d’action de traitement efficace. Cent cinquante parturientes ont été concernées par cette étude ; 83 cas d’infection vaginale et 50 cas d’infection urinaire ont été identifiés par le laboratoire; L’association d’infection urinaire et vaginale chez la même parturiente a été notée dans 133 cas. Dix sept parturientes n’ont pas été infectées après l’accouchement à la maternité du CHU-TOKOIN. ESCHREICHIA coli a été le germe le plus dominant. Les sources de contamination ont été diverses. Le plan d’action de prise en charge thérapeutique a consisté en un approvisionnement en matériel médical stérile et suffisant, en un respect des règles hygiéniques de la part des parturientes et du personnel soignant et en un système continu d’information, d’éducation et de communication (IEC) sur l’asepsie et l’antisepsie à la maternité du CHU-TOKOIN. Mots clés : Parturiente, Infection uro-génitale basse ; Etiologies ; prévention, TogoThe uro-genital infection, that means the inflammation and the irritation of the lower uro-genital tractus following the childbirth to the motherhood of the CHU-TOKOIN always put in doubt the quality of the care in this service. Several previous works confirmed the frequency to the rise of this nosocomiale infection. A prospective survey has been led to the motherhood of the CHU-Tokoin in the goal to determine the rate of prévalence of the uro-genital infection and to know the responsible germs for a hold in charge by the development of a plan of action of efficient treatment. Hundred fifty parturientes has been concerned by this survey. 83 cases of vaginal infection and 50 cases of urinary infection have been identified by the laboratory examination. The urinary and vaginal infection association at the same parturiente has been noted in 133 cases. Seventeen parturientes has not been infected after the childbirth to the motherhood of the CHU-Tokoin. Eschreichia Coli was the most dominant germ. The sources of contamination were various. The plan of action of hold in therapeutic charge consisted in a provision in sterile and sufficient medical material, in a respect of the hygienic rules on behalf of the parturientes and the nursing staff and in a continuous system of information, education and communication (IEC) on the asepsis and the antisepsis to the motherhood of the CHU-Tokoin.Key words: Parturientes, genital and lower urinary tractus infection, aetiologies, prevention, Tog

L'influence du niveau socio-economique sur la mortalite perinatale au Chu de Lome-Tokoin

The perinatal mortality rates are the indicators of health service which depend on socio-economic and medical condition of the population. The aim of study is to determine socio-economic profile of the couples touched by perinatal mortality in Lome- Tokoin Teaching Hospital. It is about a forward-looking and descriptive study led over 12 months in the services of Gynaecology and Pediatrics. The new-mothers retained for the study are those who had stillborn or newborn weighing at least 1000g at the birth and dead in the first 7 days of life and who’s pregnancy lasted at least 28 weeks. The frequency of perinatal mortality amounted to 106,8‰. The women old less than 20 years and more than 35 years had the greatest rate of perinatal mortality (116,8 ‰ and 120,18‰ ). The perinatal mortality of the transferred parturients was the double of that of the parturients followed in the service. The mothers had a weak income profession: 212 cases (55,5%) or had a not remunerated profession: 165 cases (43,2%).The proportion of illiterates was the highest : 37,7% (144 cases). More than the half of spouses : 56,5% (261 cases) had a weak income. The socio-economic level has a very strong influence on perinatal mortality in the Lome Tokoin Teaching Hospital. The improvement of the life condition of the population will contribute much to the perinatal mortality reduction.Les taux de mortalité périnatale sont des indicateurs de santé publique qui dépendent des conditions socio-économiques et sanitaires des populations. L’objectif est de déterminer le profil socio-économique des couples touchés par la mortalité périnatale au CHU-Tokoin. Il s’agit d’une étude prospective et descriptive menée sur 12 mois dans les services de Gynécologie de Pédiatrie du CHU-Tokoin. Les critères d’inclusion étaient les femmes dont les grossesses s’étaient arrêtées ou dont les nouveau-nés étaient décédés dans les 7 premiers jours de vie, de même que les grossesses qui ont duré au moins 28 semaines et les nouveau-nés qui ont pesé au moins 1000 g à la naissance.La fréquence de la mortalité périnatale s’élevait à 106,8‰. Les femmes âgées de moins de 20 ans et de plus de 35 ans ont été celles avec qui nous avons enregistré des taux élevés de mortalité périnatale (116 ‰ et 120,1 ‰). La mortalité périnatale chez les parturientes transférées était le double de celle des parturientes suivies dans le service.Au plan de l’emploi, 55,5% des mères (212 cas) exerçaient une profession à faible revenu, 43,2% (165 cas) n’avaient pas de profession rémunératrice. La proportion des analphabètes était la plus élevée (144 cas soit 37,7%). Plus de la moitié des conjoints avaient un revenu faible (216 cas soit 56,5 %). Le niveau socio-économique a une très forte influence sur la mortalité périnatale au CHU-Tokoin. L’amélioration des conditions de vie de la population réduira sans doute les taux de mortalité périnatale dans nos milieux.

Aspects epidemiologiques et chirurgicaux de fibromes uterins operes a l’hopital du district n° III de Lome

Objectifs: Décrire les caractéristiques épidémiologiques, les différents aspects de la prise en charge chirurgicale et le pronostic immédiat des cas de fibromes utérins.Patientes et méthodes : Etude prospective descriptive ayant porté sur 100 cas de fibromes utérins opérés de septembre 2009 à avril 2010 à l’Hôpital du District sanitaire N°III de Lomé. Les données ont été recueillies par observation et interview directes et traitées par le logiciel Sphinx Plus 4.5.Résultats : Le traitement chirurgical des fibromes utérins a occupé 60% de la pratique chirurgicale gynécologique dans le service. L’âge moyen des patientes opérées était de 40,54 ans. La myomectomie (dans 53%) et l’hystérectomie (dans 47%), tous deux par voie abdominale, ont été au centre de la prise en charge chirurgicale. Les suites opératoires immédiates ont été simples et la durée moyenne du séjour hospitalier a été de 6 jours.Conclusion : Il y a besoin d’amélioration du plateau technique du centre et de renforcement des compétences en chirurgie du fibrome utérin par voie vaginale et par voie endoscopique.Mots clés : Fibrome utérin, traitement chirurgical.Objectives: To describe the epidemiological characteristics, different aspects of surgical management and immediate prognosis of cases of uterine fibroids.Patients and methods: A prospective study that examined 100 cases of uterine fibroids operated from September 2009 to April 2010 at the Hospital of District No III of Lomé. Data were collected by direct observation and interview and processed using Sphinx Plus 4.5Results: The surgical treatment of uterine fibroids has occupied 60% of gynecological practice in the service. The average age of operated patients was 40.54 years. Myomectomy (53%) and hysterectomy (47%), both abdominally, were the focus of surgical management. The immediate postoperative outcome was uneventful and the average length of hospital stay was 6 days.Conclusion: There is need for improvement of the center’s technics and performing skills in surgery of uterine fibroids by vaginal and endoscopical ways.Key words: Uterine fibroid, epidemiological and surgical aspects