African experiences of laparoscopic hysterectomy about a continuous series of 52 cases by the same practitioner: indications, surgical procedures and complications

Background: Laparoscopy is a modern surgical technique that began in 1940 with Raoul Palmer. The present study aimed to analyse the results of a fifty-two-laparoscopic hysterectomy performed.Methods: A prospective study over a period of seven years from 1st January 2010 to 31st December 2015. A total of 52 patients who underwent a laparoscopic hysterectomy were recruited at the teaching hospital of Yopougon-Abidjan.Results: The mean age was 50.2 years (±3.9 years) (36-62 years). The average parity was 3. Few patients had undergone anterior pelvic surgery for either myomectomy or caesarean section. Uterine fibroid was the major surgical indication with a rate of 61.54%. The average size of the uterus was 12 cm (8-18 cm). Total hysterectomies type II and III with or without adnexectomy were essentially performed with rates of 28.85% and 32.69%, respectively. Sometimes it was associated with a lymphadenectomy or a colpo-suspension. The average length of a hysterectomy is 170 minutes (87-385 minutes). Four cases of laparo-conversions have been noted. Blood loss was approximately 95 ml (±12 ml) with a maximum of 300 ml. The complications were mainly two digestive wounds and a bladder fistula. The average length of hospital stay is three days apart from any complication.Conclusions: The laparoscopic approach is less painful, is associated with less blood loss, shorter hospital stay, faster recovery, fewer complications, and better care. A training period of surgeons associated with the equipment of the health structures is necessary to popularize this procedure surgical

Epidemiological, bacteriological profile and bacterial resistance of urinary tract infections at pregnant woman in prenatal consultation in African setting

Background: Urinary tract infection is a common pathology during pregnancy due to hormonal and morphological changes. Objective of this study was to improve management of urinary tract infection during prenatal care.Methods: A total of 987 pregnant women who have been in prenatal care have freely accepted to participate in cross-sectional study carried out from 1st May 2016 to 30th April 2017 at Yopougon University Hospital (Abidjan Côte d’Ivoire) were included. Patients were submitted to questionnaire by one of investigators for epidemiological component and then physical examination was carried out by her attending physician for clinical component. Then at laboratory urine was taken for culture after dipstick test.Results: Of the 987 patients included 9.4% had a urinary tract infection of which 81.7% were asymptomatic. Significant risk factors retained were existence of a history of urinary tract infection (OR=0.46; p=0,038) and gestational age of pregnancy (OR=0.44; p=0.05). Urine culture isolated germs were mainly Escherichia Coli (51.6%) and Klebsiella pneumoniaie (23.6%). These germs were all susceptible to cephalosporins. They had resistances of more than 50% to penicillins.Conclusions: Escherichia coli and Klebsiella pneumoniae are most common germs of urinary tract infections in pregnant women. Escherichia coli is not susceptible to penicillins with a resistance of 70% for penicillins except for clavulanic acid amoxicillin. It appears as first choice antibiotic for our prescriptions in case of probabilistic antibiotic therapy

Uterine fibroid delivered through the cervix: diagnostic and therapeutic management about 23 cases collected at Yopougon teaching hospital, Abidjan, Côte d’Ivoire

Uterine leiomyomas or fibromyomas, more commonly known as fibroid are the most common tumours of the female reproductive tract. Sometimes a submucosal leiomyoma may become pedunculated and progressively externalize from the uterine cavity, causing increased uterine irritability, metrorrhagia and anaemia, pelvic pain and heaviness, and perception of a vaginal mass. Prevalence of this clinical form is rare. We report our experience of taking a series of twenty-three patients, which objectives was contributed to improvement of management of uterine fibroids. We reported our observation in the epidemiological, clinical and therapeutic aspects of cervical delivered forms. It took place from November 2017 to November 2021. These were housewives with an average age of 41.30 years (27-56 years). 63.61% of whom were over 40 years old, the majority of whom were pauciparous (45.46%) with an average parity of 2.91. Nulliparous women accounted for 18.18% of the total. The average duration of the disease was 7.56 months and could reach 48 months. The reason for consultation was dominated by anaemia with 77.27%. The fibroids varied in size (mean 7 cm) and sometimes exceeded 15 cm. Transfusion of concentrated red blood cells was almost constant (88.24%). Surgical treatment was myomectomy by twisting with 53.33% followed by hysterectomy in 26.67%. Management of fibroma delivered through the cervix were anemia frequently requiring a prior blood transfusion. Treatment remains surgery. Informing and educating patients about early consultation would improve the morbidity associated with this condition

Depistage Des Lesions Du Col Uterin Au Chu Tokoin De Lome : Resultats D’une Serie De 512 Cas.

Purpose: Cervical cancer remains a real public health problem in Togo. This study was undertaken to sensitize women and to determine the prevalence of precancerous and canrous lesions of the cervix in the Togolese woman. Material and methods: This is a retrospective descriptive study of the results of a consecutive series of Pap smears performed in the Laboratory of Pathological Anatomy and Cytology CHU Tokoin Lome 2011-2013. Results: Epidemiological, 512 FCV were interpretable. The average age of women was 37.6 years, extreme 19 and 87 years. By occupation, we noted a predominance of unemployed women (351cas, 68,6%), followed by women traders (103 cases, 20,1%) . The distribution by marital status was possible to observe a predominance of married women (234 cases, 45, 7 %). In terms of reproductive history, we found a mean gravidity and parity respectively 3, 5 and 2. We noted 22 women living with HIV, 77.2% were infected with HIV1. Cytopathological, 512 smears selected, we observed 44 abnormal smears (8,6%). It was indeterminate lesions ASCUS / ASCUS (8 cases), endocervical hyperplasia (3 cases), low-grade lesions (17 cases), high-grade lesions (10 cases) and invasive carcinoma (6 cases). Conclusion: The detection rate of cervical cancer is low among the Togolese woman. The health professionals should take the habit of asking the FCV any woman having a consultation

Analysis of caesarean rate and indications of university hospitals in sub-Saharan African developing countries using Robson classification system: the case of Cocody’s hospital center, Abidjan-Cote d’Ivoire

Background: According to the World Health Organization (WHO), it has become imperative to monitor caesarean rates in hospitals since these rates continue to increase; WHO recommends this monitoring by the Robson’s system. The study objective was  to describe caesarean rates in a level 3 maternity of developing country using this system, to identify the groups likely increase overall rate of caesarean.Methods: A retrospective and comparative study made in Cocody University Hospital Center (Abidjan-Cote d’Ivoire) over a period of twelve years.  A total of 21,067 women who delivered during this period by caesarean were included.Results: The overall rate of caesarean during the study period was 38.7% with a significant increase from Period I to Period II (34.8 vs. 41.7%; p ˂0.000). The subgroup 2 (nulliparas, single cephalic term pregnancy, caesarean before labor) made the greatest contribution to the overall CS rate with an increase of +5% (10.1 vs. 15.1%; p˂0,000). Women with previous CS (groups 5, 7, 8, 9, 10) increased the caesarean rate of +3.4% (7 vs. 10.4%; p˂0.000). The group 6 increased it of +2.9% (4.7 vs 7.6%; p˂0.000). Caesarean indications were dominated by fetal acute distress (24.5 vs. 22.6%; p˂0,000), then followed by fetal-pelvic disproportion (21.8 vs. 10.7%), severe preeclampsia/eclampsia (13.5 vs. 17.5%; p˂0.000), scarred uterus and breech presentation.Conclusions: Robson classification has identified the groups led to a significant increase in caesarean rates in our service and therefore has good focus our preventive actions.

Polyflagellated macrocephalic spermatozoa: failure factor in IVF/ICSI

The authors report two cases of male infertility characterized by spermatic abnormalities of polyflagellated macrocephalic spermatozoa type affecting the entire gametes population. They demonstrate, on the one hand, the technical limitations of microinjection with such spermatozoa due to the large volume of their head and, on the other hand, the unfavourable outcome of the IVF-ICSI with this type of spermatozoa carrying abnormalities constituent. Molecular analysis of the somatic DNA of these subjects revealed a homozygous c.144delC mutation of the Aurora Kinase C gene. Consanguinity at the level of these subjects’ parents appears to be the main risk factor.  This situation constitutes a factor of failure of the IVF and leads to direct the couple towards the donation of gametes or the adoption as solution to the parental project

Breast cancer in adolescent and young adult Ivory coast women: epidemiological and clinical features and molecular subdivision

Background: To describe the anatomy and clinical features and then determine the histological and molecular profile of Ivorian women under 40 years.Methods: This is a retrospective multi-centre study descriptive and analytic performed over a period of 20 months. It involved 76 women on 355 selected in the Ivoirian cancer registry. An additional immunohistochemical analysis to assess hormone receptors and HER overexpression in a single unit.Results: Adolescents and young adults represented 20.3% of women with breast cancer. The average age of women was 35 years. (∂=3.4 years, 95% CI=[2.6415 to 4.1785]). 15.8% of patients had a good socioeconomic level with a stable job, well paid and 28.9% had a university degree. The discovery circumstances were a breast nodule (53%) followed by locoregional complications (21%) and breast self-examination (20%). The consultation delay was less than three months in 34.2% of cases. 78% of cancers were diagnosed in stage II and III. The most common histological subtypes were respectively RP (+) / Her (-) (41%) followed by triple negative (30%).Conclusions: This study showed that 20,3% of women under 40 years. The most tumors were classified as stage II and III of tumors at diagnosis. the most common histologic subtypes are the Luminal A (41%) and triple-negative (30%). This disease is more aggressive with a poor prognosis in this age group

African experience of hysterosalpingography abnormalities tubes management by laparoscopy in infertile women

Background: Infertility affects about 80 million people worldwide and one in ten couples. The objective of this study was to report our experience of the contribution of laparoscopy in the diagnostic and prognostic approach of fallopian tubes pathology in infertile women in sub-Saharan Africa.Methods: We conducted a retrospective study in the Gynecology and Obstetrics unit of Yopougon Teaching Hospital over a 2-year period (January 1, 2017 to December 31, 2018) which included 49 cases of tubo-peritoneal infertility diagnosed by hysterosalpingography (HSG) then laparoscopy procedure.Results: The average age was 33 years old.  30.6 % were single. 75% had secondary infertility. 59.2% had a medical history of abortion. Pelvic Inflammatory Disease and pelvic surgery accounted 84.2% and 49 respectively. Laparoscopy showed a predominance of distal tubal damage (66.6%) whose 47% hydrosalpinx. Bilateral tubal patency was demonstrated in 77.5% of our patients during laparoscopy procedure. We observed a sensitivity, a specificity, and a concordance laparoscopy / HSG of 63.6%, 80% 63.1% respectively. Laparoscopy also allowed therapeutic procedures such as adhesiolysis or tubal plasty in 22 patients (44.89% of our cases). At the end of laparoscopy procedure, 35 patients (71.42%) were turned towards IVF.Conclusions: Laparoscopy allows an assessment of tubal abnormalities revealed by hysterosalpingography and the fertility prognostic as well as better therapeutic approach in management of tubal infertility

DEGENERESCENCE KYSTIQUE DE MYOMES UTERINS SIMULANT UN CANCER DE L’OVAIRE : ETUDE D’UN CAS AU CHU DE KARA, AU NORD DU TOGO

Objective : We repport a case of cystic degeneration of two uterine myomas mimicking ovarian cancer. Observation : It concerned a fourty yaers old patient with uterine polymyoma, receeved at jully 15th, 2014 for progressive abdominal tumefaction and recurrent menemetrorrhagia. Huge and renitent mass distended her abdomen. Hemoglogin concentration was 5,78 g/dl and renal assessment was normal. Abdominal ultrasound revealed a huge mixte tumor with ascendancy of the cystic component and uterine polymyoma. Abdominopelvic scanner noted the mixte character of the tumor and suspected his ovarian origin and his malignancy. Tumor was 38 cms of main line. Ther was neither vegetation, nor ascite and nor abdominopelvic lymphatic nods. Xyphopubian laparotomy was practised after correction of the anemia and after prevention of thromboembolic desaese. In the openning, ovaries were normal ; there was left hydrosalpinx ; uterus was polymyomatous with two pediculed cystic degenerescence sub serous myoma measuring 40 cms and 15 cms. Conclusion : Cystic degenerescence of uterus myoma, whatever is rare, can be huge and mimic ovarian cancer instead of médical imaging contribution. It’s necessary to think of behind renitent adnexial masse in clinical context of uterus myoma

Viol Des Mineurs De 10 A 15 Ans Recus Au Chu-So De Lome

Minors of both sexs ages 10 to 15 are most at risk of sexual assault Objective: To determine the prevalence of sexual assault by rape among children aged 10 to 15 years and describe their management at the gynecology and obstetrics clinic of the CHU SO .Patients and methods: 134 files of rape victims were collected from September 1, 2010 to March 31, 2017 at the gynecology and obstetrics clinic of the CHU SO Results: Rape of minors aged 10 to 15 accounted for 26.6% of sexual assaults. There were 91% of girls. Most of our patients (54.5%) were raped between 7pm and 6am. Sixty eight (68) patients (40.3%) were referred for consultation between the 2nd day and the 8th day after the rape. Fifty-five point two percent of the victims had never had sexual intercourse before the rape. The perpetrator was known to the victim in 92.5% of cases. The tear of the hymen was old in 79.5% of the victims. HIV serology was positive in 1.6%. The rate of β HCG was positive in a 15-year-old patient. All our patients had psychological care. Conclusion: The rape of minors of both sexes is a reality in our developing society. The taboo of the sex must be raised for the fast denunciation of the rape and of an adequate care