Acute Pelvic Inflammatory Disease in Cameroon: A Cross Sectional Descriptive Study

This cross-sectional descriptive study, aimed at identifying the sociodemographic characteristics of women diagnosed with acute pelvic inflammatory disease (PID), as well as the microorganisms isolated, was carried out between October 1st, 2013 and March 31st, 2014 in two major hospitals in Yaoundé, Cameroon. Seventy women diagnosed with acute PID were recruited. The main variables recorded were maternal age, occupation, marital status, number of current sexual partners, the clinical presentation at admission and the microorganisms identified. Data were analyzed using SPSS 20.0. Mean maternal age was 29.0 ± 7.7 years. Students were more represented (37.1%), 58.6 % were single, 64.3% had ≥2 sexual partners. The most frequent signs and symptoms were abnormal vaginal discharge (100%), adnexal tenderness (97.1%), cervical motion tenderness (94.3%) and fever ≥38.3°C (82.9%). No microorganism was isolated in 20% of cases, especially among women who underwent intra-uterine procedures. The most frequent microorganisms were genital tract mycoplasmas (54.3%). Acute PID is common among young, single women with multiple sexual partners. The micro-organisms frequently responsible for acute PID were genital tract mycoplasmas, whose identification should be included among routine tests for women with suspected acute PID in the hospitals.Keywords: Acute pelvic inflammatory disease- Patients' sociodemographic profile- Clinical presentation- Microorganisms isolate

Dilatation and curettage versus manual vacuum aspiration for first trimester clandestine abortions

Background: Unintended pregnancy rate is rising worldwide and most of these pregnancies end by clandestine abortion. This study aimed at comparing complications of clandestine abortions done with Manual Vacuum Aspiration (MVA) to those of clandestine abortions done with Dilatation and Curettage (D&C).Methods: This retrospective descriptive study was carried out in the Yaoundé University Teaching Hospital (Cameroon) from March 1st to August 31st, 2012. Abortions carried out with MVA or D&C were recruited. Main variables studied were abortionist, method used, complications presented and hospital stay. Data were analyzed using SPSS 18.0. Analyses included the t test and the Fisher exact test. The level of significance was P <0.05.Results: Main abortionists were nurses and general practitioners. Compared to MVA, women in the D&C group had more uterine perforations (P=0.004), severe anemia (OR 1.5, 95%CI 0.5-4.3), prolonged hospital stay (P=0.018) and maternal death (one case). D&C done by nurses carried more risk of severe complications (OR 3.6, 95%CI 0.2-53.8).Conclusions: MVA constitutes a safer method than D&C. However, abortionists should receive adequate training before using MVA.

Acute pelvic inflammatory disease in a sub-Saharan country: a cross sectional descriptive study

Background: Acute Pelvic Inflammatory Disease (PID) can lead to tubal damage resulting in tubal infertility, ectopic pregnancy and chronic pelvic pain. This study aimed at identifying the sociodemographic profile and clinical presentation of women diagnosed with acute PID, as well as the microorganisms isolated.Methods: This cross-sectional descriptive study was carried out between October 1st, 2013 and March 31st, 2014 in the University Teaching Hospital and the Central Hospital, both of Yaoundé (Cameroon). Seventy women diagnosed with acute PID were recruited. The main variables recorded were: maternal age, occupation, marital status, number of current sexual partners, the clinical presentation at admission and the microorganisms identified. Data were analyzed using SPSS 20.0.Results: Mean maternal age was 29.0 ± 7.7 years. Students were more represented (37.1%), 58.6% were single, 64.3% had ≥2 sexual partners. The most frequent signs and symptoms were abnormal vaginal discharge (100%), adnexal tenderness (97.1%), cervical motion tenderness (94.3%) and fever ≥38.3°C (82.9%). No microorganism was isolated in 20% of cases, especially among women who underwent intra-uterine procedures. Among the cases where microorganisms were isolated, the most frequent germs were genital tract mycoplasmas (54.3%) and Chlamydia trachomatis (37.1%). Conclusions: Acute PID is common among young, single women with multiple sexual partners, who should be regularly screened for the various sexually transmissible infections. The micro-organisms frequently responsible for acute PID were genital tract mycoplasmas, whose identification should be included among the routine tests done to women with acute PID. Cases of acute PID due to intra-uterine procedures reminds us that adequate asepsis should be observed during these procedures

Outcome of labor in vertex malposition in Cameroon

Background: Vertex malposition is associated with increased maternal and neonatal adverse effects, but its magnitude has not been well established in sub-Saharan women. This study aimed at evaluating labor outcome in cases of Vertex Malposition (VM) in Cameroon.Methods: This prospective cohort study was conducted in the University Teaching Hospital of Yaoundé (Cameroon) from March 1st, 2013 to February 28th, 2014. Women carrying singletons with or without VM in labor were monitored during labor. The main variables recorded included the duration of the second stage of labor, mode of delivery, birth weight and neonatal wellbeing. Data of women with VM were compared to those of women without it. Fisher’s exact test and t-test were used for comparison where appropriate. P<0.05 was considered statistically significant.Results: A total of 100 women were recruited in each group. There was no difference in the mean birth weights (P=0.56). VM was significantly associated with prolonged second stage of labor (RR 12.1, 95%CI 4.4-33.1), cesarean section (RR 12.6, 95%CI 5.3-30), instrumental delivery (RR 7.7, 95%CI 2.6-22.3), episiotomy (RR 6.2, 95%CI 2.8-13.7) and neonatal death (RR 8, 95%CI 1.01-62.7).Conclusions: VM is associated with increased maternal and neonatal adverse effects. Hence, delivery should be carried out in settings where cesarean section, instrumental delivery and neonatal resuscitation can rapidly be performed.

An intramural uterine fibroid became submucosal in the puerperium – proposed probable mechanism: a case report

Abstract Background Vaginal prolapse of a large uterine fibroid is a rare phenomenon in a woman who delivered vaginally recently, given that this fibroid might have obstructed labor. The author presents a case report of a vaginally prolapsed large pedunculated submucosal uterine myoma in a woman with a recent uncomplicated vaginal delivery. Case presentation A 25-year-old black African woman had four intramural uterine fibroids of diameters 62 to 94 mm diagnosed in April 2013 with standard ultrasound scan. She got pregnant in July 2014. An ultrasound scan done on 31 August 2014 at 10 weeks’ gestation identified four intramural uterine fibroids, with sizes varying from 70 to 150 mm. Her pregnancy was well followed up, without any complications. She had an uneventful vaginal delivery on 10 April 2015. During uterine exploration, indicated for retention of parts of fetal membranes, no pedunculated submucosal fibroid was found. On 15 May 2015, she consulted for difficult micturition and partial urinary retention that occurred 2 days ago. A vaginally prolapsed 10 cm uterine fibroid was diagnosed. Forty-eight hours after administration of intravenously administered broad spectrum antibiotics, the myoma was successfully twisted off by means of vaginal route under general anesthesia, which relieved her symptoms. Conclusions To the best of our knowledge, this is the first case of vaginally prolapsed large submucosal uterine fibroid in a woman who delivered vaginally recently. The author recommends that women with known large low situated uterine fibroid should be well observed during the postpartum period to diagnose a vaginally prolapsed uterine fibroid early, so as to prevent fibroid superinfection and obstructive complications

Urethrovaginal fistula following vaginal prolapse of a pedunculated uterine myoma: a case report

Abstract Background Urethrovaginal fistulas are usually secondary to a foreign body in the vagina or to vaginal gynecologic surgeries. We present a case of an urethrovaginal fistula secondary to vaginal prolapse of a huge pedunculated submucosal uterine myoma. Case presentation A 25-year-old black African woman with a past history of huge uterine fibroids and an uncomplicated vaginal delivery 5 weeks prior to presentation consulted for a difficult micturition that occurred 2 days earlier. A vaginally prolapsed huge uterine myoma was diagnosed. The fibroid was easily twisted off per vagina. Around 9 days after prolapse of the fibroid or 5 days after its removal, she complained of a vaginal leaking of urine during micturition. An urethrovaginal fistula was diagnosed using a blue dye test. The fistula was successfully repaired with polyglactin and she was discharged on day 15. Conclusions To the best of our knowledge, this is the first case of urethrovaginal fistula secondary to delivered uterine myoma. We recommend close postpartum follow-up of women carrying huge uterine fibroid and urgent management of a vaginally prolapsed uterine fibroid to reduce the risk of urethrovaginal fistula

Curettage is a risk factor for marginal umbilical cord insertion

Objective: To identify the risk factors for marginal cord insertion (MCI). Material and Methods: This case-control study was carried out between 1st February and 30th June 2019. Singletons with and without MCI at delivery were recruited. Main variables analyzed included maternal age, parity, number of previous dilatation and curettage (D&amp;C) or manual vacuum aspiration (MVA), time interval between each procedure and conception, cord insertion. Fisher&rsquo;s exact test, t-test and logistic regression were used to compare data from both groups. Results: We found 60 cases of MCI (4.1%). The significant (p &lt; 0.05) risk factors for MCI were past-history of D&amp;C (aOR 5.97, 95% CI 1.95-18.25) particularly when conception occurred ˂ 5 months after D&amp;C (OR 10.5, 95% CI 1.36-81.05), fetal female sex (aOR 3.82, 95% CI 1.41-10.32), parity &ge; 4 (aOR 2.63, 95% CI 1.05-12.71) and past-history of MVA (aOR 2.06, 95% CI 1.23-8.76). Conclusion: Women should be advised to conceive at least five months after D&amp;C

Knowledge, attitudes and practices of health personnel of maternities in the prevention of mother-to-child transmission of HIV in a sub-Saharan African region with high transmission rate: some solutions proposed

Abstract Background High mother-to-child (MTC) transmission rate of HIV might contribute to the increased pandemic rate. The aim of this study was to identify the knowledge, attitude and practices of health personnel working in maternities in the prevention of MTC transmission of HIV. Methods This cross-sectional descriptive study was carried out from 20th February to 30th April, 2017. All health personnel working in the maternity wards were included in this study. The variables recorded included their age, grade, experience (number of year of practice), gender, educational level, health structure and the training in prevention of MTC transmission of HIV. Analyses were done using SPSS 21.0. The Pearson Chi-square test or Fisher’s exact test and logistic regression were used for comparison. The level of significance was P < 0.05. Results A total of 140 health personnel were recruited. Knowledge was insufficient amongst 73 of them (52.1%). The factors significantly associated with sufficient knowledge were midwifery qualification (aOR 9.01, 95% CI 1.82–48.60) and training in prevention of MTC transmission of HIV (aOR 2.23, 95% CI 1.02–4.81). Regarding attitudes, it was negative in 85 practitioners (60.7%). Only those aged ≥33 years were significantly associated with a positive attitude (aOR 2.34, 95% CI 1.14–4.23). As concerns practices, only 32 practitioners (22.9%) had good practices. Only midwives were associated with good practices (aOR 3.23, 95% CI 1.21–9.95). Conclusion Insufficient knowledge, attitude and practices in the prevention of MTC transmission of HIV were observed among the majority of health personnel in the region. This lack of knowledge in prevention can therefore contribute to the rise of the mother-to-child transmission rate of HIV. To reduce this rate, more health personnel should be trained, especially midwives, in the prevention of MTC transmission of HIV. Moreover, deliveries of all women living with HIV should be conducted or at least supervised by trained midwives, especially those of at least 33 years of age

Additional file 3: of Knowledge, attitudes and practices of health personnel of maternities in the prevention of mother-to-child transmission of HIV in a sub-Saharan African region with high transmission rate: some solutions proposed

Table S3. Practice distribution according to grade of participants. Contains details of answers assessing practice according to grade of participants as well as the statistical analysis. (DOC 56 kb