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.

Knowledge, attitudes and practices of contraception by HIV positive women followed in a Cameroon region with high illiteracy rate: A cross sectional study

Introduction: To evaluate the knowledge, attitude and practices of contraception by HIV positive women. Methods: This cross-sectional descriptive study was carried out in the Maroua Regional Hospital (Cameroon) from September 1st, 2012 to  February 28th, 2013. All HIV positive women aged between 15 and 49 years who were received in the HIV clinic were recruited. The variables recorded included maternal age, number of living children, marital status, religion, the educational level, and the use of antiretroviral treatment (HAART), the knowledge, attitude and practice of contraception. Analyses were done using SPSS 18.0. Fisher exact test was used for comparison. The level of significance was P&lt;0.05.Results: A total of 200 HIV positive women were recruited and 98% knew at least one method of contraception The need of a contraceptive method was present in 84% of HIV positive women, as soon as the women were .30 years (OR 2.6, 95%CI 1.3-4.9), on HAART (OR 2.8, 95%CI 0.8-9.2), divorced (OR 1.7, 95%CI 0.8-3.7), had .3 living children (OR 1.2, 95%CI 0.6-2.4) and when the women were educated (OR 1.2, 95%CI 0.6-2.4). The rate of condom use was 50.7%. Conclusion: The knowledge of contraception as well as the contraception need among HIV positive women was high in this region despite high  illiteracy rate. Therefore, all contraceptive methods should be made  available to these women. Towards these women and their partner(s),  more emphasis should be made on the systematic condom use even when using other contraceptive methods (dual protection)

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.

Aspects Psycho-Sociaux chez Patients Infertiles à laMaternite Principale de l’Hopital Central de Yaoundé, Cameroun

L&rsquo;infertilit&eacute; demeure un sujet d&rsquo;actualit&eacute; au Cameroun, de part la multitude d&rsquo;&eacute;tudes r&eacute;alis&eacute;es sur ce th&egrave;me. Pourtant l&rsquo;aspect psycho-social de l&rsquo;infertilit&eacute; jusqu&rsquo;ici n&rsquo;a r&eacute;ellement pas &eacute;t&eacute; explor&eacute;. Les objectives &eacute;taient de d&eacute;terminer les caract&egrave;res sociod&eacute;mographiques, d&eacute;terminer la pr&eacute;valence du stress, de la d&eacute;pression, le rapport interpersonnel et la pr&eacute;valence des consid&eacute;rations sociales. Nous avons men&eacute; une &eacute;tude prospective et descriptive &eacute;tal&eacute;e sur 10 mois. Tous les couples venus consulter pour infertilit&eacute; etaient &eacute;ligibles pour notre &eacute;tude. Nous avons recens&eacute; un total de 104 patients. Notre &eacute;chantillon &eacute;tait constitu&eacute; majoritairement de femmes 92 (88,46%) que d&rsquo;hommes 12 (11,54%). L&rsquo;&acirc;ge moyen &eacute;tait de 30,76 ans &plusmn; 6,68. La dur&eacute;e moyenne de l&rsquo;infertilit&eacute; &eacute;tait de 4,70 &plusmn; 3,58 ans. Les troubles psycho-sociaux ont &eacute;t&eacute; retrouv&eacute;s chez nos patients aux proportions suivantes : le stress (84,61%), la d&eacute;pression (53,85%), de la mal&eacute;diction (24,0%). L&rsquo;assimilation de l&rsquo;infertilit&eacute; &agrave; la sorcellerie &eacute;tait report&eacute;e par 36,5% et une moiti&eacute; consultait des marabouts. Infertilit&eacute; se trop complique suivant des troubles psychosocial. Il est donc important d&rsquo;impliquer les travailleurs sociaux dans la prise en charge de ses couples.Mots Cl&eacute;s infertilit&eacute; ; stress ; d&eacute;pression ; sexualit&eacute; ; marabou

Cord prolapse, associated factors and fetal outcome: a report of 47 cases from the Yaounde Central Hospital, Cameroon.

Cord prolapse is a condition in which the umbilical cord comes ahead of the presenting part. Fetal demise occurs as a consequence of the compression of the cord by the presenting part. We conducted this study to determine profile of pregnancy and its outcome at the Central Hospital Yaounde, Cameroon. This was an observational, descriptive and retrospective study of deliveries complicated by cord prolapse between January 2003 and December 2006 at the Central Maternity of the Central Hospital Yaounde. Data was retrieved from patient’s files, operation room registers and admission registers. During this period, there were a total of 6924 deliveries amongst which 47 were complicated by umbilical cord prolapse (2.8 per 1000 deliveries). Among the women with cord prolapse, 62.2% were delivered by emergency caesarean section. Fetal demise was reported in 32 % of the women upon admission. An abnormal pelvis was seen in 25.5% of the women. Artificial rupture of membranes was carried out in 40.4%. This study shows that cord prolapse is associated with severe fetal consequences in our unit. A good knowledge of the risk factors, prompt diagnosis and rapid intervention by medical staff are required.KEY WORDS: Cord prolapsed - Perinatal morbidity and mortality - Caesarean section - Vaginal delivery

Previous Second Trimester Abortion: A risk factor for third trimester uterine rupture in three subsequent pregnancies. Report of three cases

The authors report on three cases of uterine rupture. The first two cases occurred spontaneously and the third occurred in labour. All the patients refused voluntary termination of pregnancy before surgery. The true story was only re-constituted after surgery. Literature on spontaneous rupture of the uterus is scanty but cases occurring after hysteroscopic metroplasty,resectroscopy for Asherman´s syndrome, hysteroscopic fundal perforation, and voluntary termination of pregnancy and in a primiparous woman are reported. Spontaneous uterine rupture though rare should always be considered in the differential diagnosis of a woman who presents with severe pain in the later half of pregnancy, with foetal loss, anaemia, with a stable orunstable hemodynamic status and a past history of unsafe termination of a second trimester pregnancy. Though rare, this possibility should be considered in the differential diagnosis of a prolonged third stage of labour. Thorough clinical history and physical examination of patients remains the cornerstone for accurate diagnosis of uterine rupture

Périhépatite de découverte percoelioscopique pour infertilité a l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé : Prévalence et corrélation avec les lésions tubo-pelviennes

Dans le but de d&#233;terminer la pr&#233;valence de la p&#233;rih&#233;patite en coelioscopie pour infertilit&#233; et de rechercher la corr&#233;lation avec les l&#233;sions&#160; tubo-pelviennes retrouv&#233;es, nous avons analys&#233; de fa&#231;on transversale lestrouvailles percoelioscopiques des patientes op&#233;r&#233;es pour infertilit&#233; &#224; l&#8217;H&#244;pital Gyn&#233;co-Obst&#233;trique et P&#233;diatrique de Yaound&#233; de novembre 2008 &#224; octobre 2009. Nous avons enregistr&#233; 52 cas de p&#233;rih&#233;patite sur 130 coelioscopies effectu&#233;es pour infertilit&#233; ; soit une fr&#233;quence de 40%. La moyenne d&#8217;&#226;ge &#233;tait de 32,28 ans. Les ant&#233;c&#233;dents les plusretrouv&#233;s &#233;taient la pelvialgie chronique (50,8%), la notion d&#8217;infection sexuellement transmissible &#224; chlamydia et/ou mycoplasmes (46,9%), la chirurgie pelvienne (27,7%). L&#8217;infertilit&#233; secondaire &#233;tait retrouv&#233;e chez 73,8% de nos patientes. Une corr&#233;lation &#233;tait not&#233;e entre la pr&#233;sence de la p&#233;rih&#233;patite et la s&#233;v&#233;rit&#233; des l&#233;sions tubaires et pelviennesadh&#233;rentielles. En conclusion, nous notons une fr&#233;quence &#233;lev&#233;e de la p&#233;rih&#233;patite chez nos patientes infertiles lors des coelioscopies et une forte corr&#233;lation avec la s&#233;v&#233;rit&#233; des l&#233;sions tubaires et adh&#233;rentielles pelviennes

Efficacy of highly active triple antiretroviral therapy in preventing mother-to-child HIV transmission in the university teaching hospitals in Yaounde, Cameroom

Paediatric HIV-infection rates remain high in Cameroon in spite of the various existing preventive strategies. This study will provide scientific evidence that HIV-infected pregnant women receiving highly active triple antiretroviral therapy would be expected to have significantly lower viral loads and a lower risk of HIV mother-to-child transmission (MTCT) without scheduled Caesarean section. We enrolled 90 newly diagnosed HIV-infected pregnant women who accepted to participate in the study from the 4 Teaching Hospitals in Yaoundé between January 1, 2006 and December 31, 2008. In addition to routine antenatal care, they received two types of potent triple antiretroviral regimens depending on their initial CD4 counts. Drug efficacy and safety were assessed by CD4 count, viral load, liver enzymes level, fasting blood sugar level, blood urea and haemoglobin concentration level before and after treatment and the paediatric seroprevalence rate. Highly active triple antiretroviral therapy was associated with maternal immunological improvement, statistically significant reduction of maternal viral load (P< 0.05) with resultant low paediatric HIV infection rate (1.1%) and minimal maternal biological impairment. Short courses of highly active triple antiretroviral therapy to prevent HIV MTCT is therefore not only efficacious compared to other treatment options like monotherapy, bitherapy, and bitherapy associated with scheduled caesarean section, but also safe and should constitute the mainstay intervention strategy.KEY WORDS: HIV MTCT- Triple antiretroviral therapy- Adverse effects - Paediatric HIV infection rate

The Risk of Adverse Maternal and Neonatal Outcomes in Cameroonian Primiparous Women Aged More Than 26 Years

Primiparas with advanced age are predisposed to adverse maternal and neonatal risks. The aim of this retrospective cohort study, conducted between January 1st and December 31st, 2004 in the maternity of the Yaounde University Teaching Hospital, Cameroon, was to identify from what age these adverse risks become significant in Cameroonian women. The medical files of 233 primiparae aged 26 and above (case) and that of 404 primiparae aged between 20 and 25 years (control) were reviewed and some data compared. Cesarean sections, instrumental deliveries, low Apgar scores at 5th minute and early neonatal death rates were significantly higher in primiparae aged 27 years and above. Hence, Cameroonian women should be enlightened about the risks of delaying first delivery. Furthermore, first pregnancies to be carried at term and first deliveries in women aged 27 and above shall be considered at high risk and consequently well followed.Keywords primiparas aged more than 26 years; soft tissue dystocia; increased cesarean section risk; poor neonatal outcom

Quality care in vesico-vaginal obstetric fistula: case series report from the regional hospital of Maroua-Cameroon

The World Health Organization (WHO) proposes a successful closure rate for first repair of vesico-vaginal obstetric fistula to be at 85% in each facility, with the continence achievement among the closed cases at 90 %. We are reporting the vesico-vaginal obstetric fistula outcome at the provincial hospital of Maroua- Cameroon from 2005 to August 2007. Among the overall 32 patients with vesico-vaginal fistula operated, 25 patients were at their first operation. The complete closure of vesico-vaginal fistula (VVF) was 23/25 (92%) and among the 23 patients with complete closure 17(74%) had good continence. When we consider only the 25 patients who were at their first operation, the overall closure of VVF was 23/25 (92%) and among them 17/23 (74%) were continent. Large lesion, bladder neck lesions, vaginal adherence and rigid margin are associated with failure/incontinence. These factors must be taken into consideration when preparing patients for surgery or when assigning them to a surgeon within the surgical team