Epidemiological, clinical, prognostic and therapeutic aspects of twin delivery in two referral maternity units in Dakar (Senegal)

Background: Twin pregnancy is the simultaneous development of two embryos and then two fetuses in the uterine cavity. Objective of present study was to assess the epidemiological, clinical, prognostic and therapeutic aspects of twin delivery in two referral maternity units in Dakar.Methods: A descriptive and analytical retrospective bi-centric study of all cases of twin deliveries recorded in two referral center in Dakar was conducted during the period January 1st, 2005-December 31st, 2015, i.e. an 11-year period. It concerned 619 pregnant women who gave birth to twins in these two referral medical structures. The epidemiological parameters, clinical, prognostic and therapeutic aspects of twin childbirth were studied. The data were entered and analysed using Epi info version 3.5.3.Results: The twinning prevalence was 1.11%. The majority of our parturient women (506 or 81.7% of the cases) came from the Dakar suburbs. The average age of the parturient women was 28 years and the gestity age 3.1. Pregnancy was well monitored for 98.5% of the parturient women with an average number of prenatal consultations of 3.6. The first prenatal consultation was performed in 52% of cases in the first quarter. In more than one third of cases (234 or 37.8%), the diagnosis was made in the third quarter of pregnancy. 113 cases (18.2%) of premature rupture of membranes, 10 cases (1.61%) of threat of premature delivery and 7 cases (11.13%) of placenta previa were registered. During labour, the diagnosis was made by clinical examination in 32.2% of cases. Bichorial biamniotic twin pregnancy was the most frequent anatomical type (62.6%). On admission, the first twin (T1) was in cephalic presentation in 56.7%, in breech presentation in 15.2%; The second twin (T2) was in breech presentation in 21.1% of the cases. Caesarean section was related to the first twin in 50.6% and the second twin in 53.8% of the cases. Caesarean section was performed in 50.6% for the first twin and in 53.8% for the second twin. The mean time interval between the delivery of T1 and that of T2 was 17.4 min. Low birth weight was more frequent for the second twin (54.3%). The stillbirth rate was 48.26 per thousand. Maternal complications were dominated by renal-vascular syndromes (4.2%), haemorrhagic causes (1.86%), perineal lesions (1.6%) and uterine rupture (0.97%). Postpartum haemorrhage was observed in 8 cases (1.29%). Maternal mortality was nilConclusions: Twin delivery poses varying difficulties due to the complexity of obstetrical mechanics and the frequency of dystocic presentations. Despite improved maternal prognosis, in recent years, perinatal mortality and morbidity, still high, remain a constant concern

A hospital based case control study of female breast cancer risk factors in a Sub-Saharan African country

Background: Breast cancer is the most common cancer diagnosed in women worldwide with over 1.3 million new cases per year. There is a wide variation in the geographical burden of the disease with the highest incidences seen in the developed regions of the world and the lowest incidences observed in the least developed regions. The objective of this study was to understand further the risks for breast cancer in Senegalese population which can then inform public health strategies to try and reduce the burden of breast cancer.Methods: This matched case control study was conducted in 2015 in Aristide Le Dantec Teaching Hospital in Dakar. All women with pathologically confirmed primary breast cancer were considered as cases. For each case, 2 age-matched women were recruited. We collected and compared demographic factors, family history of breast cancer, socioeconomic variables, reproductive variables (age at menarche, age at first pregnancy and first live birth, parity, menopausal status, duration of breastfeeding), and exogenous hormone use up to 6 months. Odds ratios from univariate logistic regression were used to estimate the relative risk of breast cancer associated with the various factors, and their predictive effects.Results: In all, 212 women with breast cancer who were diagnosed as having breast cancer and 424 control women were involved in the study. The mean±SD age of cases and controls was 43.37±11.94 years (range 18-83 years) and 42.04±11.08 years (range 18-84 years), respectively. There were no significant differences between cases and controls with regards to marital status, parity, age at menarche, past oral contraceptive use, age at first last full-term pregnancy and history of breastfeeding. Breast cancer risk was significantly greater in women with a family history of the disease (OR 2.12, 95% confidence interval [CI] 1.35-3.31). A significant increase in breast cancer was observed among illiterate women compared to educated women (OR 1.27, CI 1.02-1.58), in premenopausal women and those without occupation.Conclusions: In this study, reproductive factors as early menarche or menopausal status were not associative to the risk of breast cancer and the early age at diagnosis and the positive history of breast cancer suggest a genetic pattern of this disease in Senegalese woman. But this fact is difficult to confirm for financial reasons

Laparoscopic management of cervical and endometrial cancer in Africa: experience of the National Hospital Centre of Pikine

Background: Laparotomy represents the standard historical surgical approach to these cancers. Process of treatment of benign adnexal pathologies to the emergence of a new pathway for the management of these cancerous pathologies.Methods: Our prospective study from December 2016 to December 2018 included 10 patients with early-stage uterine cancer and endometrial cancer confirmed by MRI. The characteristics of patients, their cancer, their intervention and morbidity were revealed.Results: Our results show that the average age of the patients was 63 years; There were 2 cases of cervical cancer and 8 cases of endometrial cancer. For cervical cancer, it was essentially squamous cell carcinoma; one patient was at stage Ia2 and the other at stage Ib1. For endometrial cancers, squamous cell carcinoma was 80%; 6 patients were in stage IB and 2 in stage IC. Of the 10 patients undergoing surgery, 9 had laparoscopic colpohysterectomy and lymphadectomy and one complementary laparoscopic lymphadenectomy. The average number of lymph nodes removed was 9 and no lymph node metastasis was found. In the immediate postoperative period, one patient had transient urinary incontinence and another had vaginal slice lymphorhea.Conclusions: The main interest of this practice is to be the least morbid possible for patients at the early stage. With our short experience, we obtained a reduction in operating time, a reduction in hospital stay, a decrease in the consumption of analgesics and antibiotics postoperatively and a reduction in per and postoperative complications

Epidemiological, clinical, prognostic and therapeutic aspects of twin delivery in two referral maternity units in Dakar (Senegal)

Background: Twin pregnancy is the simultaneous development of two embryos and then two fetuses in the uterine cavity. Objective of present study was to assess the epidemiological, clinical, prognostic and therapeutic aspects of twin delivery in two referral maternity units in Dakar.Methods: A descriptive and analytical retrospective bi-centric study of all cases of twin deliveries recorded in two referral center in Dakar was conducted during the period January 1st, 2005-December 31st, 2015, i.e. an 11-year period. It concerned 619 pregnant women who gave birth to twins in these two referral medical structures. The epidemiological parameters, clinical, prognostic and therapeutic aspects of twin childbirth were studied. The data were entered and analysed using Epi info version 3.5.3.Results: The twinning prevalence was 1.11%. The majority of our parturient women (506 or 81.7% of the cases) came from the Dakar suburbs. The average age of the parturient women was 28 years and the gestity age 3.1. Pregnancy was well monitored for 98.5% of the parturient women with an average number of prenatal consultations of 3.6. The first prenatal consultation was performed in 52% of cases in the first quarter. In more than one third of cases (234 or 37.8%), the diagnosis was made in the third quarter of pregnancy. 113 cases (18.2%) of premature rupture of membranes, 10 cases (1.61%) of threat of premature delivery and 7 cases (11.13%) of placenta previa were registered. During labour, the diagnosis was made by clinical examination in 32.2% of cases. Bichorial biamniotic twin pregnancy was the most frequent anatomical type (62.6%). On admission, the first twin (T1) was in cephalic presentation in 56.7%, in breech presentation in 15.2%; The second twin (T2) was in breech presentation in 21.1% of the cases. Caesarean section was related to the first twin in 50.6% and the second twin in 53.8% of the cases. Caesarean section was performed in 50.6% for the first twin and in 53.8% for the second twin. The mean time interval between the delivery of T1 and that of T2 was 17.4 min. Low birth weight was more frequent for the second twin (54.3%). The stillbirth rate was 48.26 per thousand. Maternal complications were dominated by renal-vascular syndromes (4.2%), haemorrhagic causes (1.86%), perineal lesions (1.6%) and uterine rupture (0.97%). Postpartum haemorrhage was observed in 8 cases (1.29%). Maternal mortality was nilConclusions: Twin delivery poses varying difficulties due to the complexity of obstetrical mechanics and the frequency of dystocic presentations. Despite improved maternal prognosis, in recent years, perinatal mortality and morbidity, still high, remain a constant concern

Hepatitis E Virus Seroprevalence and Associated Risk Factors in Pregnant Women Attending Antenatal Consultations in Senegal

In West Africa, research on the hepatitis E virus (HEV) is barely covered, despite the recorded outbreaks. The low level of access to safe water and adequate sanitation is still one of the main factors of HEV spread in developing countries. HEV infection induces acute or sub-clinical liver diseases with a mortality rate ranging from 0.5 to 4%. The mortality rate is more alarming (15 to 25%) among pregnant women, especially in the last trimester of pregnancy. Herein, we conducted a multicentric socio-demographic and seroepidemiological survey of HEV in Senegal among pregnant women. A consecutive and non-redundant recruitment of participants was carried out over the period of 5 months, from March to July 2021. A total of 1227 consenting participants attending antenatal clinics responded to a standard questionnaire. Plasma samples were collected and tested for anti-HEV IgM and IgG by using the WANTAI HEV-IgM and IgG ELISA assay. The overall HEV seroprevalence was 7.8% (n = 96), with 0.5% (n = 6) and 7.4% (n = 91) for HEV IgM and HEV IgG, respectively. One of the participant samples was IgM/IgG-positive, while four were declared indeterminate to anti-HEV IgM as per the manufacturer’s instructions. From one locality to another, the seroprevalence of HEV antibodies varied from 0 to 1% for HEV IgM and from 1.5 to 10.5% for HEV IgG. The data also showed that seroprevalence varied significantly by marital status (p < 0.0001), by the regularity of income (p = 0.0043), and by access to sanitation services (p = 0.0006). These data could serve as a basis to setup national prevention strategies focused on socio-cultural, environmental, and behavioral aspects for a better management of HEV infection in Senegal