Assessment of the side effects of progestogen only contraception in the immediate postpartum period: the case of implants with levonorgestrel Jadelle®

Background: The aim of this study was to evaluate the side effects of Jadelle® implants in the immediate postpartum.Methods: To do this, we inserted the implants at two different postpartum period: first, between the first and the seventh day for the immediate postpartum period (IPP) group; second, between the 45th and the 3rd postpartum months for the late postpartum (LPP) group. The variables studied were age, gesture, parity, abortions, number of live children, childbirth, caesarean section, quality of milky climb, age last child, pregnancy-attendant, pregnancy term at time of delivery, complaints, weight.Results: From May 2012 to December 2013, we collected two hundred patients, one hundred from each group (immediate postpartum and late postpartum). The average age of mothers in the IPP group was 28 years and 29 years for LPP group. After insertion, in both group, spotting were the most frequent complaints. The weight variations were between +800 g and -600 g for the group IPP and +260 g and -170 g for the other group; which makes a statistically significant difference. In both groups, at the end of the six months, no patient had menstruation.Conclusions: Our results are encouraging to further promote contraception in the immediate postpartum period in developing countries and thus reach a wide range of users. We can therefore say that the side effects are not different during this period and largely are also tolerated

Medical management of ectopic pregnancy in a low resource setting: the role of methotrexate

Background: Medical treatment using methotrexate. However, its indications and the protocol of administration are still under discussion. Even if follow-up problems are often raised in developing countries, medical treatment of ectopic pregnancy remains a reasonable option that we practice and share our experience here.Methods: We performed a retrospective cohort study of patients managed for an unruptured ectopic pregnancy in two university hospital facilities in Dakar: the Centre Hospitalier National de Pikine and the Centre de Santé de Philipe Maguilen Senghor. The data of this study are spread over a period of 10 years, from 2010 and 2019. We planned to evaluate maternal age, parity, gestational age, diagnosis circumstances, medical management, monitoring, and outcome. A single dose protocol was used. Data extracted from the registries were transferred to Microsoft Excel 2019, Mac version and then moved to SPSS (Statistical Package for Social Sciences, 26.Results: Over ten years, we had registered 18 patients who had received medical treatment out of a total of 263 ectopic pregnancies treated in the two facilities, i.e., a frequency of 6.8%. The average age was 28.8 years. The average initial HCG level was 10,460 mIU/ml. Treatment succeeded in more than 6 out of 10 patients (61.1%). However, we noted 5 cases of failure that had secondarily benefited from salpingectomy by laparotomy.Conclusions: Methotrexate is now part of the therapeutic arsenal in the management of unruptured tubal ectopic pregnancies. However, in developing countries, particularly in Senegal, there is a reluctance to use this therapeutic method, which, however, when a personalized follow-up is carried out, is achievable with a success rate comparable to other therapeutic methods

Tumeur à cellules de Sertoli-Leydig de l’ovaire: à propos d’un cas chez une jeune fille de 22 ans

Les tumeurs à cellules de Sertoli et Leydig sont des tumeurs sécrétantes rares du mésenchyme et des cordons sexuels. Cependant elles constituentl’une des tumeurs le souvent responsables de syndrome de virilisation. La certitude diagnostique est histologique après la chirurgie et il n’ y'a pasde signe échographie spécifique malgré la forte présomption clinique. Le pronostic comme la plupart des néoplasies est lié au degré dedifférenciation cellulaire et la présence d’éléments hétérologue en leur sein. L’objectif de notre travail était de rapporter un authentique syndromede virilisation chez une jeune fille de 22 ans secondaire à une tumeur non épithéliale de l’ovaire à cellule de Sertoli et à cellule de Leydig. Lesformes peu différenciées des tumeurs de Sertoli-Leydig ont un potentiel de malignité non négligeable. Le traitement est chirurgical, lachimiothérapie par association de sels de platine et de taxanes constitue un adjuvant intéressant. Le pronostic après la chirurgie est dominé pardes récidives. Sertoli-Leydig cell tumors are rare secreting mesenchymal and sex cord-stromal tumors. However, they constitute one type of tumor most often responsible for virilization syndrome. A definite diagnosis is provided by histological examination following surgical excision of the tumor. It has no characterizing features on ultrasonography, in spite of the strong clinical presumption. Like many neoplasias, prognosis is related to the degree of cellular differentiation and to the presence of heterologous elements. The aim of our study was to report the case of a 22-year old woman suffering from a real virilization syndrome secondary to non-epithelial Sertoli-Leydig cell tumor of the ovary. Poorly differentiated Sertoli-Leydig tumors have high malignant potential. Treatment is surgical; taxane-platinum combination chemotherapy is an interesting adjuvant. Prognosis after surgical resection is related to the risk of relapses. 

Sexualité des femmes ménopausées en Afrique sub-saharienne: exemple du Sénégal

Introduction: en Afrique, la vie sexuelle après la ménopause reste un domaine mal exploré du fait de son caractère tabou. L'objectif de cette étude était d'apprécier la qualité de la sexualité du couple au cours de la ménopause. Methodes: il s'agissait d'une une enquête transversale concernant un échantillon représentatif de 320 femmes ménopausées. Les critères d'inclusion étaient la ménopause naturelle. N'étaient pas incluses de l'étude les patientes ayant fait l'objet d'une ménopause précoce ou iatrogène. La fiche d'enquête était divisée en 4 chapitres : les caractéristiques socio-culturelles de la femme, les données cliniques, les données psycho-sexuelles et les données thérapeutiques. Nous avons utilisé la comparaison des proportions et le test du Chi 2 avec un seuil de signification inférieur à 0,05. Resultats: l'âge moyen des femmes était de 60 ans. L'âge moyen de survenue de la ménopause était de 48 ans et l'ancienneté de la ménopause était de 11,3 ans. Aucune femme de notre étude n'était épargnée par les manifestations du syndrome climatérique. Les bouffées de chaleur étaient présentes dans 85,9%, la sècheresse vaginale dans 62,8% et les troubles urinaires dans 52,5%. Seules les femmes mariées déclaraient avoir des rapports sexuels avec leurs conjoints (62,1%). Ces rapports sexuels étaient occasionnels dans 68,9% des cas alors que 18,1% des femmes n'avaient plus d'activité sexuelle. La diminution de l'activité sexuelle était due aux troubles de l'érection du conjoint (62% des couples) et au manque de désir sexuel (83,5% des femmes). Une absence d'excitation sexuelle et d'orgasme étaient également retrouvée respectivement dans 92% et 100%. Cependant, 93,5 % des femmes mariées jugeaient supportable leur vécu. Conclusion: le statut marital, la dyspareunie, la sècheresse vaginale et les troubles érectiles du conjoint ont un impact réel sur la sexualité de la femme ménopausée au Sénégal

Funiculars anomalies during childbirth: about 562 cases collected in Pikine National Hospital

Background: Establish an epidemiological description of the different types of umbilical cord anomalies in our reference structure and to assess their impact on the prognosis of childbirth.Methods: We conducted a descriptive study, cross over a period of one year in Obstetrics and Gynecology Service Level III of Pikine Hospital. We included all women in labor have reached the term less than 28 weeks gestation and delivering a newborn with umbilical cord abnormality diagnosed during labor or during the expulsion.Results: During this period, we compiled 562 anomalies of the umbilical cord, which gave a frequency of 23.8%. Length discrepancies were far the most frequent (67.4%). Only the prolapsed cord was an independent risk factor for cesarean section (p = 0.036). The rate of episiotomy and tear was significantly higher in case of brevity (primitive or induced) cord (p = 0.042). Apgar score ≤7 was significantly related to the presence of brevity (p = 0.000), excessive length (p = 0.048) or cord prolapse (p = 0.037).Conclusions: This study has allowed us to see that the funicular abnormalities impede the smooth running of childbirth. Their occurrence is facilitated by the excess amniotic fluid, prematurity and low birth weight. Their research during prenatal ultrasounds should be systematic

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

Pseudo tumor tuberculosis of the uterine cervix: about a case at the colposcopy and cervico vaginal pathologies unit of the University hospital Le Dantec, Dakar, Senegal

Tuberculosis is still common in developing countries and particularly in sub-Saharan Africa since the advent of the HIV/AIDS. Genital tuberculosis usually affects young women in genital activity period. The most frequent locations are tubal, endometrial and ovarian. The cervical location is rare. We report on the case of a 36 years old patient with eight pregnancies and eight deliveries who lives in a rural area and has got in her history 8 vaginal deliveries with four living children and 4 dead children and who was referred by a colleague for a "tumor of the uterine cervix". In her medical history, there was a BCG vaccination during childhood and she had never received Pap smear. The colposcopy revealed an ulcerating budding tumor of the cervix with necrotic areas. The colposcopy biopsy revealed fibrocaseous tuberculosis of the uterine cervix. Tuberculosis is still a common disease in developing countries. The cervical localization is rare but should be considered in case of an ulcerating tumor budding of the cervix

Migration of intrauterine device into the pelvic cavity: exploration strategy and management in African environment

IUD migration is a rare complication. We report our experience in the treatment of five cases of uterine perforation and migration of IUDs. The average age of patients was 34.6 years, an average parity was 4. All patients felt an unusual pain during insertion of the IUD Tcu 380A. The location of the IUD was done through ultrasound and hysterography. Removal by laparoscopy was performed in all cases. The immediate impacts of the surgery were simple. Hysterography has its place in the location of the migrated IUD. Prevention is a good IUD insertion technique

Assessment of the quality of the management of childbirth by vaginal delivery in 5 reference maternity clinics in Dakar, Senegal

Background: The current strategy to fight maternal and perinatal mortalities is mainly based on three pillars: family planning, skilled delivery and emergency obstetric and neonatal cares. The objective of the study was to assess the quality of the management of low-risk deliveries in 5 reference maternity clinics in the region of Dakar.             Methods: This is an observation-based multicentric, prospective and descriptive study, carried out over a four-month period, from September 1st to December 31st, 2012, in 5 reference maternity hospitals in the region of Dakar. For each delivery, the focus was put on parturient socio-demographic features, the surveillance techniques of the labour, the handling of the exit and delivery phases, materno-fetal complications but also on the new-born care. To assess the quality of childbirth management, a comparison between the practices was made and observed on the field and the World Health Organization's recommendations which fall into 4 categories (A, B, C and D) depending on the appropriateness or not of their use. For data input and analysis, we used the 13.0 version of the SPSS software. Results: During the study period, 200 childbirths were observed. The epidemiologic profile used for this study was that of a literate woman with a low record of childbirth who was 27 on average with a mean parity of 3. Forty seven percent of childbirth deliveries were observed in Roi Baudouin hospital centre. The A-category recommendations of the World Health Organization, such as the consumption of drinks, mobility during labour, the use of a partograph, the active management of the third stage of labour (AMTSL) and the examination of the placenta were applied in 22.5%, 86.2%, 23.4%, 100% and 23.4% of cases respectively. As for the B-category recommendations, which recommend the removal of those practices deemed harmful such as the back position during labour, the placement of an intravenous line and the oxytocin infusion, they were carried out in 91.84%, 98.08% and 7.28% of cases respectively. C and D categories which deal with non-recommended practices such as the use of abdominal expressions during labour and episiotomy were used in 47.6% and 39.7% of cases respectively.Conclusions: In our study, the most followed A-category recommendations from the WHO are: encouraged mobility, the use of single-use equipment, AMTSL and skin-on-skin contact. However, some B, C and D-category practices are still widely used in our maternity hospitals. The health authorities should make sure that the WHO recommendations are followed