Psycho-sexual impact of the hysterectomy of African woman: experience of Cocody University Hospital (UH-C)

Background: Specify the psychological and sexual impact of hysterectomy on the life of the women after the surgical operation.Methods: It is a cross-sectional study which was undertaken in the obstetrical gynaecology department of the CHU of Cocody and in the National Institute of Mental Health of Abidjan over an 18-month period from December 1st, 2015 to May 31st, 2016. During that period, for gynaecological indications, hysterectomized patients who resumed sexual activities and accepted to take part in the study have been included.Results: The frequency of hysterectomy has been 3.82% of the whole of more important surgical operations of the obstetrical gynaecology department. The epidemiologic profile of our patients has been that of a 43 years old woman, pauciparous and a single person. The indications were dominated by the uterine fibrome (56%), followed by the peritonitis post abortum, the by the cancer of uterine cervix, and finally by the cancer of the ovarian tumors, with 10% each one. In less than 90 days, 88% of the women had resumed sexual intercourses. Six months after the hysterectomy, 66% of the women had a feeling of being better and 44% felt a change in their sexual life.Conclusions: The hysterectomy undoubtedly brings about changes in the daily life, and sexual intercourses of the patients. Therefore, it must be taken into account whenever that intervention is essential

Prognosis of umbilical cord prolapse: experiency of an African maternity

Background: Assess the fetal prognosis of umbilical cord prolapse (UCP) at Cocody University Hospital.Methods: It was a cross-sectional, descriptive and case-control study about 92 cases of umbilical cord prolapse beating. It took place over a period of 3 years from 1 January 2013 to 31 December 2015.Results: The frequency of the umbilical cord prolapse beating was 0.73%. The patients came from other maternity in 84.8%. Upon arrival in our maternity, therapeutic attitude was dominated by the positioning of Trendelenburg (73.9%). The c-section was performed in 63% of cases. The fetal prognosis was bad; neonatal mortality was 41.3% at 5 minutes of life against 9.8% in the control group. The factors aggravating the fetal prognosis were the long delay between the occurrence of the umbilical cord prolapse and childbirth, the delivery mode and the small birth weight.Conclusions: The late management and the evacuations negatively affect the fetal prognosis. Improving fetal prognosis requires quick care and the provision of an efficient technical platform surrounding maternity.

Mayer-Rokitansky-Kuster-Hauser syndrome and ovarian benign teratoma: a case report

Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) is an unknown congenital etiology disorder characterized by agenesia or hypoplasia of the Müller ductal system, including the upper vagina, uterus and fallopian tubes. The occurrence of an associated ovarian tumor is rare, with fewer than 20 cases reported to date according to the literature. We report the case of a 14-year-old girl, virgin, who had not yet seen her menarche, complaining of an abdomino-pelvic mass associated with pain. The ultrasound performed revealed a large left ovarian tumor and an absence of uterus. The indication of a laparotomy confirmed the ovarian mass and a complete absence of uterus associated with vaginal hypoplasia. The contralateral ovary was present, and of normal appearance. The pathological examination was in favor of a mature benign multi-tissular teratoma. This is the first case described in our service. The mode of transmission of this entity appears to be autosomal dominant with low penetrance and variable expressivity, suggesting that the incidence of this syndrome is likely underestimated. With the development of techniques of medical assistance to procreation, maternity remains possible, particularly through gestational surrogacy

Epidemio-clinical study of the first iterative cesarean in the gynecology-obstetric service at the teaching hospital of Cocody

Background: The iterative caesarean section, is a caesarean section that is performed on a uterus already healed, therefore for fear of maternal and perinatal risks, is recognized as one of the main causes of the inflation of caesarean section in the world. One in three caesarean sections is performed because of a scar uterus. Objective of this study was to analyse the epidemiological and clinical factors of iterative caesarean sections in the gynecology-obstetrics department at the Teaching Hospital of Cocody (Abidjan).Methods: This was a retrospective and descriptive study conducted from June 1st, 2018 to May 31st, 2019, including 349 iterative caesarean section cases.Results: The first iterative C-section accounted for 16.1% of the C-section indications during the study period. The average age of the patients was 30 years. Nearly half of the patients practiced in the informal sector 47.9%, were uneducated in 38.1% of cases and lived with a partner in 73.1% of cases. The majority of patients in this series 75.1% performed at least 4 ANCs. Patients were followed by prenatal visits in 61% of cases by midwives and in 8.6% of cases had an inter-reproductive space of less than 18 months. This study patients were evacuated in 46.4% of cases. Acute fetal distress was the first indication of first iterative caesarean section with 20.3% of cases. Emergency caesarean sections accounted for 84.4% of the cases in this series. Authors found maternal death 0.3% and 6.7% perinatal mortality.Conclusions: The iterative caesarean section is a caesarean section likely to cause difficulties and complications per- operative. Although in constant improvement the prognosis of the mother-child couple still remains a problem in this context, prenatal monitoring should be the prerogative of obstetrician gynecologists

Management and prognosis of uterine rupture during labor in an under-medicalized country: about 513 cases collected at the Cocody University Hospital Center (Abidjan-Cote d'Ivoire)

Background: Even today, uterine rupture is necessary as an indicator of health status in developing countries, like Cote d’Ivoire. The objective of this study was to describe the factors influencing the management and the prognosis of this pathology in a level III maternity of a third world country.Methods: The study was made in Cocody University Hospital Center (Abidjan-Cote d’Ivoire). A retrospective descriptive study of all women with ruptured uterus during labor managed between January 2002 and December 2014 was conducted. It covered 513 cases of uterine ruptures collected in 13 years.Results: The overall incidence of uterine ruptures was 0.95% or 1 in 105 deliveries. Most cases occurred in women with unscarred uterus (76.8%) and 23.2% of women had a scarred uterus. Surgical treatment was radical by hysterectomy in 35.3% of all women. Treatment was more conservative by uterine suture in women from the communes of Abidjan and its suburbs (71%) versus 25% of women who came from inland towns (p=0.000). Maternal mortality rate was 5.8% and was significantly influenced by the type of surgery (p=0.000), by the time of uterine rupture (p=0.000) and by the transportation distance (p=0.000). Fetal mortality was 94.1% for all women.Conclusions: Uterine rupture still poses a major public health problem in under-developed countries. The multiplication of obstetric surgical units but also the availability of blood products and the effectiveness of free care will be a vital contribution to effectively and sustainably improve the prognosis of this serious pathology when just constituted

Surgical Management of Uterine Fibroids at the Teaching Hospital of Angre Abidjan Cote d’Ivoire: 193 Cases Report

Objective: To evaluate the surgical management of myomas at the Teaching Hospital of Angré according to the FIGO (International Federation of Gynecology and Obstetrics) classification.Patients and methods: This was a cross-sectional study at the Teaching Hospital of Angre from January 1, 2020, to December 31, 2022. Patients whose operative indication was clearly identified were included in the study. Incomplete files were not included. The variables studied were anthropometric parameters, clinical characteristics of myomas, and surgery. Due to the large size and multifocal location of uterine myomas, the therapeutic option remained surgery by laparotomy.Results: Most patients were over 35 years old (71.5%) and nulliparous (52.8%). The first indication for surgery was menometrorrhagia (88.6%), followed by the desire for motherhood (37.8%) and dysmenorrhoea (20.2%) for myomas most often FIGO type 4 (p = 0.0031). Myomectomy under cervical-isthmic tourniquet was the most common procedure for FIGO type 4 myomas (66.1%; p = 0.0543). Hysterectomy was most frequently performed for FIGO type 7 myomas (43.9%; p = 0.0543). For myomectomy, the first complication was anaemia (3.5%) followed by uterine suture haemorrhage (1.7%) (p = 0.5139).Conclusion: Our surgical practice at the Teaching Hospital of Angre is in accordance with FIGO recommendations. However, an effort should be made to promote the minimally invasive surgical approach (laparoscopic, hysteroscopic, transvaginal ablation) for small fibroids (≤ 5 cm) or FIGO type 0 to 3, which is not very frequent in our current practice