Risk factors of poor outcome of pregnancy and delivery in adolescents: a case-control study at the Yaounde Gynaeco-Obstetric and Pediatric Hospital

Background: Adolescence is a period of life between 10 and 19 years, marked by a state of psychological imbalance and immaturity of organs. The occurrence of pregnancy at this age group can cause social, psychological or obstetric problems (prematurity, unsafe abortion, obstructed labor).  The objective of this study was to identify the risk factors of poor outcome of pregnancy and delivery in adolescents.Methods: It was a case-control study with a retrolective data collection from January 1st, 2004 to December 31st, 2013 in the Yaounde Gynaeco-Obstetric and Pediatric Hospital. We included adolescent girls of 11 to 19 years old who delivered in the study site. We compared 128 adolescents of the case group who encountered poor outcome with 128 ones of the control groups with favorable outcome.Results: At univariate analysis, the number of antenatal care consultations less than four OR: Odds Ratio (OR= 2.44 [1.41-4.22]; P=0.000), the antenatal care consultations done out of our study site (OR= 1.65(95%CI: 1.00-2.70); p=0.003) and the uterine fundal height less than 33 cm at the time of childbirth (OR=1.80(95%CI:1.08-2.98); p=0.015) were identified as risk factors of poor outcome. After linear logistic regression analysis, the number of antenatal care less than four (OR=1.92(1.0-3.56); p=0.037) remained as independent risk factor of poor outcome.Conclusions: The number of antenatal visits less than four is an important risk factor of poor outcome of pregnancy and childbirth in adolescents at the Yaoundé gynaeco-obstetric and pediatric hospital

Practice of ovarian stimulation among poor responders in a country with limited resources: case of the Paul and Chantal Biya human reproduction center, Yaoundé, Cameroon

Background: Approximatively 2 to 30% of women who undergo ovarian stimulation have a poor response. The management is not clearly defined, constituting a challenge for clinicians and biologist. Methods: This was a longitudinal descriptive study with prospective data collection that took place at Paul and Chantal Biya Gynecological Endoscopic surgery and Human Reproductive Teaching Center, during a period of 1 year and 6 months, from June 2020 to November 2021. Our objective was to describe the practice of ovarian stimulation of patients judged to be poor responders in CHRACERH. We highlighted the numbers, percentages, averages and their standard deviations. Statistical analyzes were carried out using SPSS v15.0 software. Results: Out of 159 cycles included, we identified 55 patients considered possible poor responders, i.e. a prevalence of 34.6%; the average age was 36.36±6.2 years with extremes ranging from 33 to 44 years, mainly overweight in 81.8% of cases. The average AMH level was 0.9±0.4 ng/ml, the average CFA 6.15±3.7. 87.3% of patients were on their first stimulation attempt, the long-delay agonist protocol and the short agonist protocol were used in 58.2% and 41.8% respectively. The maximum daily dose in patients was 300 IU with an average total dose of gonadotropin used of 3371.8±874 IU. At the end of the ovarian stimulation, the average number of follicles collected and mature oocytes were respectively 5.6±3.6 and 4±2.9 with an average maturity rate of 70.7±31% as well as an average fertilization rate in ICSI of 45.2±32%. The pregnancy rate was 12% among poor responders. Conclusions: Poor responders constitute a large proportion of patients stimulated at CHRACERH; their still low pregnancy rates prompt an improvement in care

Diagnostic, therapeutic and prognostic aspects of uterine synechiae managed by hysteroscopy in the gyanecological endoscopic surgery and human reproductive teaching hospital

Background: Uterine synechiae refers to a total or partial union of the inner walls of the uterus resulting from endometrial trauma. It is a cause of reproductive failure. Until now, synechia was not optimally treated and has remained understudied in Cameroon. Objective of present study was to Evaluate the diagnostic, therapeutic and prognostic aspects of uterine synechiae treated by hysteroscopy.Methods: We conducted a descriptive cross-sectional study with an analytical component from January 1st 2015 to July 31st 2017 at Yaounde. All patients diagnosed with uterine synechiae and treated with hysteroscopy were our sample. Sampling was consecutive. The chi-square test was used for the comparison of qualitative variables and Fisher's test for ANOVA variance analysis. The comparison of the averages was made by the Student's test. P-value less than 0.05 was considered as statistically significant.Results: Hysteroscopies were indicated for uterine synechiae in 14.50%. Nulliparous were 56.67%. A history of curettage/aspiration was present in 66.66%. All of the patients had a form of infertility and 83.33% had menstrual disorders. Hysterosalpingography showed a better sensitivity (88%). After hysteroscopic treatment, 63.30% had a complete anatomical restitution. There is a significant correlation between the stage of severity of synechia and anatomical restitution (p=0.008; Spearman correlation coefficient=-0.477).Conclusions: Uterine synechiae represent one-sixth of all indications for hysteroscopy and present clinically as menstrual disorder associated with infertility. A past history of uterine curettage is common. Hysterosalpingography has a better preoperative diagnostic sensitivity. Hysteroscopy allows optimal treatment

Accuracy of saline infusion sonography versus hysteroscopy in the evaluation of uterine cavity abnormalities in infertile women at CHRACERH, Yaounde, Cameroon

Background: Uterine cavity abnormalities are seen as a cause of infertility in around 10%-15% and can go up to 50% in women with recurrent implantation failure. Saline infusion sonohysterography (SIS) is a minimally invasive diagnostic modality in the evaluation but hysteroscopy remains the gold standard in the assessment of intra uterine cavity. The aim of this study was to compare the diagnostic accuracy of saline infusion sonography (SIS) considering hysteroscopy (HS) as the gold standard to evaluate uterine cavity pathologies in infertile women at CHRACERH.Methods: Authors carried out a cross-sectional, retrospective study, over 2 years, from the 1st January 2016 to the 31st December 2017, with retrospective data collection in 110 records of infertile patients subjected to an ultrasound assessment of uterine cavity using saline as the contrast medium with a 6.5-MHz transvaginal transducer. When SIS found intra uterine abnormality, HS was done on a later date, using a 5 mm Bettocchi hysteroscope. Sensitivity, specificity, accuracy, positive and negative predictive values of SIS and HS were compared using the SPSS 20 software.Results: The mean age and body mass index were respectively 39.3±7.8 years and 28.7±4.1 kg/m². The main findings both in SIS and Hysteroscopy were respectively polyps (n=61; 55.5% vs 52.7%; n=58), myomas (n=43; 39.1% vs 31.8%; n=35), intrauterine adhesions (n=18; 16.4% vs 21.8%; n=24). The overall sensitivity, specificity and accuracy of SIS were 81.2%, 86.9% and 86.5% respectively.Conclusions: SIS as a diagnostic tool in the evaluation of intrauterine lesions has a good accuracy and can therefore replace HS when this later is not available, especially in our African setting

Diagnostic, therapeutic and prognostic aspects of uterine synechiae managed by hysteroscopy in the gyanecological endoscopic surgery and human reproductive teaching hospital

Background: Uterine synechiae refers to a total or partial union of the inner walls of the uterus resulting from endometrial trauma. It is a cause of reproductive failure. Until now, synechia was not optimally treated and has remained understudied in Cameroon. Objective of present study was to Evaluate the diagnostic, therapeutic and prognostic aspects of uterine synechiae treated by hysteroscopy.Methods: We conducted a descriptive cross-sectional study with an analytical component from January 1st 2015 to July 31st 2017 at Yaounde. All patients diagnosed with uterine synechiae and treated with hysteroscopy were our sample. Sampling was consecutive. The chi-square test was used for the comparison of qualitative variables and Fisher's test for ANOVA variance analysis. The comparison of the averages was made by the Student's test. P-value less than 0.05 was considered as statistically significant.Results: Hysteroscopies were indicated for uterine synechiae in 14.50%. Nulliparous were 56.67%. A history of curettage/aspiration was present in 66.66%. All of the patients had a form of infertility and 83.33% had menstrual disorders. Hysterosalpingography showed a better sensitivity (88%). After hysteroscopic treatment, 63.30% had a complete anatomical restitution. There is a significant correlation between the stage of severity of synechia and anatomical restitution (p=0.008; Spearman correlation coefficient=-0.477).Conclusions: Uterine synechiae represent one-sixth of all indications for hysteroscopy and present clinically as menstrual disorder associated with infertility. A past history of uterine curettage is common. Hysterosalpingography has a better preoperative diagnostic sensitivity. Hysteroscopy allows optimal treatment

Pronostic des références obstétricales à l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé (HGOPY)

Introduction: L’impact des références sur la survenue des complications obstétricales n’est pas encore connu. Notre but était d’identifier les complications associées aux références obstétricales à Yaoundé. Méthodes: Il s’agissait d’une étude transversale descriptive et analytique du 1er Février au 31 Juillet 2015 à l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé, ayant comparé les femmes référées aux non référées et leurs nouveau-nés respectifs. L’échantillonnage était consécutif et exhaustif pour l’analyse des caractéristiques sociodémographiques, obstétricales et néonatales précoces. Les tests de Chi carré et exact de Fisher ont aidé à comparer les variables qualitatives. L’analyse par régression logistique a permis d’éliminer les facteurs confondants. P était significatif si p < 0,05. Résultats: Après analyse multi variée, les complications obstétricales statistiquement significatives chez les patientes référées étaient: la rupture prématurée des membranes (OR ajusté = 9,37, IC95%: 2,52-66,98, p = 0,002); la prématurité (OR ajusté = 4,14 (1,88-9,16; P < 0,001) et le décès après asphyxie néonatale sévère (OR ajusté = 6,48 (1,17-35,80); P = 0,032). Conclusion: La rupture prématurée des membranes, la prématurité et le décès après asphyxie néonatale sévère sont les complications associées aux références obstétricales à Yaoundé

Local building cultures for sustainable & resilient habitats - Examples of local good practices and technical solutions

International audienceThis booklet has been prepared by CRAterre, IFRC and SC-CF and several of their partners. It is part of a set of tools now developed within the framework of a working group (leaded by CARE and CRAterre) within the Global Shelter Cluster to enhance the appreciation of local practices developed by communities to adapt their housing / settlements to their specific environment, including risk preparedness. It presents a series of worldwide examples of local techniques, know-how and knowledge that can be used in reducing housing vulnerability. Though, rather than being a catalogue, it has been conceived as an eyeopener for field operators. The idea is that, with these examples in mind, they will have a sharpened capacity to identify such local solutions during preliminary field inspections. With basic information on why and how these practices are relevant, it is expected that at least those with higher potential are fully reused in habitat projects, both in post disaster and preparedness situations. These solutions being local, they can be implemented with local resources and so, offer large potential for wide application. Overall, that process gives more chance to provide durable benefits and enhanced resilience capacity for local communities while making sure that the qualities of local architecture are preserved. Moreover, it is also hoped that the scientific community will be encouraged to work on their understanding and retro-engineering for adaptation to today’s socio-economic, cultural and environmental context so as to go further in building back safer processes towards more efficiency in recovery and further, sustainable development

Local building cultures for sustainable & resilient habitats - Examples of local good practices and technical solutions

International audienceThis booklet has been prepared by CRAterre, IFRC and SC-CF and several of their partners. It is part of a set of tools now developed within the framework of a working group (leaded by CARE and CRAterre) within the Global Shelter Cluster to enhance the appreciation of local practices developed by communities to adapt their housing / settlements to their specific environment, including risk preparedness. It presents a series of worldwide examples of local techniques, know-how and knowledge that can be used in reducing housing vulnerability. Though, rather than being a catalogue, it has been conceived as an eyeopener for field operators. The idea is that, with these examples in mind, they will have a sharpened capacity to identify such local solutions during preliminary field inspections. With basic information on why and how these practices are relevant, it is expected that at least those with higher potential are fully reused in habitat projects, both in post disaster and preparedness situations. These solutions being local, they can be implemented with local resources and so, offer large potential for wide application. Overall, that process gives more chance to provide durable benefits and enhanced resilience capacity for local communities while making sure that the qualities of local architecture are preserved. Moreover, it is also hoped that the scientific community will be encouraged to work on their understanding and retro-engineering for adaptation to today’s socio-economic, cultural and environmental context so as to go further in building back safer processes towards more efficiency in recovery and further, sustainable development