Meckel-Gruber syndrome: about a case identified during deliver

Meckel-Gruber syndrome is an autosomal recessive disorder, usually lethal, most commonly characterised by the classic triad of polycystic kidneys, occipital encephalocele and polydactyly. Antenatal diagnosis can be made by ultrasound between 10 and 14 weeks of amenorrhoea. Recognition of this syndrome is important in order to establish the diagnosis and provide genetic counselling. Finally, well supervised termination of pregnancy should be the rule for lethal fetal malformations in order to relieve the psychological suffering of patients. However, in certain situations or working conditions, the diagnosis can be made late or even discovered during childbirth. We report a case of Meckel Gruber syndrome discovered at birth

Analysis of cesarean section rate according to Robson’s classification in an urban health centre in Senegal

Background: Robson, proposed a new classification system, the Robson’s Ten-Group Classification System to allow critical analysis according to characteristics of pregnancy. The objective was to describe caesarean rates in an urban health centre in Dakar using Robson’s Ten groups classificationMethods: This study was performed in Philippe Senghor health centre in Dakar (Senegal), a secondary health centre that performs CS since 2011. Before this date, only midwifes performed deliveries in this centre. The study took place between 1 January and 31 December 2013. All patients who delivered during this period by CS were included.Women were classified in 10 groups according to Robson’s classification, using maternal characteristics and obstetrical history. For each group, we calculated its relative size and its contribution to the overall caesarean rate.Results: The overall rate of caesarean was 18.2%. The main contributors to the overall caesarean rate were primiparous women in spontaneous labour (group 1) and women with previous caesarean section (group 5). Further analysis of group 1 showed that more than half of CS indications in this group were fetal-pelvic disproportion in 55.2% and fetal hypoxia in 27%.Conclusion: The Robson’s classification is easy to use. Each maternity unit can compare its rates with those of units with similar level, to find whether some groups of women have very high rates of caesarean sections. Attention should be made because CS rates is rising up and will be problematic in our low resource countries. It is time to implement obstetric audits to lower the CS rates

Invasive mole: a rare cause of postmenopausal bleeding

Gestational trophoblastic disease (GTD) describes a number of gynaecological tumours that originate in the trophoblast layer, including hydatidiform mole (complete or partial), placental site trophoblastic tumour, choriocarcinoma and invasive mole. Invasive moles are responsible of most cases of localized gestational trophoblastic neoplasia (GTN). Invasive mole is a condition where a molar pregnancy, such as a partial hydatidiform mole or complete hydatidiform mole, invades the wall of the uterus. It is an extremely rare condition. As GTN is not considered in the differential diagnosis of postmenopausal uterine malignancies, its preoperative diagnosis is challenging. We report a case of invasive hydatidiform mole in a postmenopausal woman discovered in a context of postmenopausal bleeding. She underwent hysterectomy and followed up till her beta hCG levels were within normal limits. The patient is in complete remission in the first postoperative year.

Unruptured tubal pregnancy in the second trimester

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Aspects épidémiologiques, pronostiques et thérapeutiques de l’hématome retro placentaire (HRP) dans une maternité de référence en zone rurale

Introduction: IL s'agira ici d' identifier les particularités diagnostiques et la prise en charge de l'HRP au Centre Hospitalier de Ndioum au Sénégal.Méthodes: Etude rétrospective descriptive menée à l'hôpital régional de Ndioum, durant la période allant du 1er Janvier 2009 au 31 Décembre 2011. Toutes les patientes qui avaient présenté un HRP étaient  incluses. Pour chaque patiente, nous avions étudié les paramètres sociodémographiques et cliniques, les données thérapeutiques et le pronostic materno-foetal. Résultats: La fréquence était de 6,05%. L'âge moyen de nos patientes était compris entre 29 et 84 ans  et la parité moyenne de 4,92. Aucune consultation prénatale n'était effectuée chez 16 % des patientes. Les évacuations représentaient 66% de cas. L'âge gestationnel moyen était de 36 semaines  d'aménorrhées et la majorité des patientes (86%) était en travail. La gravite du tableau clinique était appréciée selon la classification de Sher avec 63% (114 cas) au grade 3. Une coagulopathie était observée chez 27,2% des patientes. Nous avions retrouvé une relation statistiquement significative entre la  gravite du tableau clinique et le pronostic maternel (p=0,026) et foetal (p=0,0000). Une direction du travail était effectuée chez 109 patientes (60% des cas). L'expulsion foetale était obtenue par voie basse dans 49% des cas et une césarienne était effectuée dans 51 % des cas. La morbidité maternelle était dominée par l'anémie secondaire à une hémorragie aigue dans 17,8% des cas et à l'insuffisance rénale aigue dans 6,1% des cas. Les éléments de mauvais pronostic étaient représentés par la gravité du tableau clinique (p=0,03) et le mode d'admission dominé par les évacuations (p=0,01), la relation était statistiquement significative. La voie d'accouchement n'était pas retrouvée comme élément de mauvais pronostic (p=0,09). Nous avions noté douze cas de décès maternels soit 6,6% des patientes.Conclusion: La prévention de la mortalité maternelle et foetale liée à cette affection passe par une  amélioration du suivi prénatal, une meilleure organisation du plan d'accouchement et une améliorationdes conditions d'évacuation. La mise en place d'une banque de sang fonctionnel, d'une unité réanimation médicale ainsi qu'un service de prise en charge néonatale devient une nécessité pour améliorer le pronostic maternel et néonatal.Key words: Hématome rétro placentaire, mortalité maternelle, mortalité périnatal

Epidemiological, clinical, prognostic and therapeutic aspects of twin delivery in two referral maternity units in Dakar (Senegal)

Background: Twin pregnancy is the simultaneous development of two embryos and then two fetuses in the uterine cavity. Objective of present study was to assess the epidemiological, clinical, prognostic and therapeutic aspects of twin delivery in two referral maternity units in Dakar.Methods: A descriptive and analytical retrospective bi-centric study of all cases of twin deliveries recorded in two referral center in Dakar was conducted during the period January 1st, 2005-December 31st, 2015, i.e. an 11-year period. It concerned 619 pregnant women who gave birth to twins in these two referral medical structures. The epidemiological parameters, clinical, prognostic and therapeutic aspects of twin childbirth were studied. The data were entered and analysed using Epi info version 3.5.3.Results: The twinning prevalence was 1.11%. The majority of our parturient women (506 or 81.7% of the cases) came from the Dakar suburbs. The average age of the parturient women was 28 years and the gestity age 3.1. Pregnancy was well monitored for 98.5% of the parturient women with an average number of prenatal consultations of 3.6. The first prenatal consultation was performed in 52% of cases in the first quarter. In more than one third of cases (234 or 37.8%), the diagnosis was made in the third quarter of pregnancy. 113 cases (18.2%) of premature rupture of membranes, 10 cases (1.61%) of threat of premature delivery and 7 cases (11.13%) of placenta previa were registered. During labour, the diagnosis was made by clinical examination in 32.2% of cases. Bichorial biamniotic twin pregnancy was the most frequent anatomical type (62.6%). On admission, the first twin (T1) was in cephalic presentation in 56.7%, in breech presentation in 15.2%; The second twin (T2) was in breech presentation in 21.1% of the cases. Caesarean section was related to the first twin in 50.6% and the second twin in 53.8% of the cases. Caesarean section was performed in 50.6% for the first twin and in 53.8% for the second twin. The mean time interval between the delivery of T1 and that of T2 was 17.4 min. Low birth weight was more frequent for the second twin (54.3%). The stillbirth rate was 48.26 per thousand. Maternal complications were dominated by renal-vascular syndromes (4.2%), haemorrhagic causes (1.86%), perineal lesions (1.6%) and uterine rupture (0.97%). Postpartum haemorrhage was observed in 8 cases (1.29%). Maternal mortality was nilConclusions: Twin delivery poses varying difficulties due to the complexity of obstetrical mechanics and the frequency of dystocic presentations. Despite improved maternal prognosis, in recent years, perinatal mortality and morbidity, still high, remain a constant concern

Puerperal uterine inversion: a new case report

Puerperal uterine inversion is a rare and severe affection which the uterine fundus collapses into the endometrial cavity. The diagnosis is essentially made on clinical examination, which also allows to determinate the gravity. The management must be done early, which can be surgical or non-surgical. Through a case study we will review the literature

About a case of a specific complication of monoamniotic twin pregnancy: umbilical cord entanglement

Monoamniotic twin pregnancies are uncommon and often complicated by umbilical cord entanglement. It is important to investigate a umbilical cord entanglement during antenatal ultrasound examinations. The diagnosis is based on ultrasound with color and pulsed Doppler. Despite the high percentage of cord entanglement, the perinatal mortality rate remains very low. Rigorous ultrasound monitoring and recording of fetal heart rhythms can improve the prognosis. We report a case of umbilical cord entanglement in a monoamniotic twin pregnancy discovered during a caesarean section with a favorable outcome

Amniotic band syndrome: a new case report

Amniotic band syndrome is a pathology affecting the extremities of the fetus. It is uncommon with rates around 1 per 10,000 births. The pathophysiology is poorly understood until now with several theories reported in the literature. The diagnosis is most often made at birth. We reported a case of a 40 year old patient with no particular history who had consulted for spontaneous premature rupture of membranes in a 20 weeks pregnancy. The diagnostic of amniotic band syndrome was made after the delivery with amputation of a limb, amniotic syndactilia and deformation of the right foot in equinovarus

Choriocarcinoma with uterine rupture presenting as acute haemoperitoneum and shock

Choriocarcinoma is a rare neoplasm and a malignant form of gestational trophoblastic disease. Invasive mole may perforate uterus through the myometrium resulting in uterine perforation and intraperitoneal bleeding. But uterine perforation due to choriocarcinoma is rare. We present a case of a young woman who presented 1 year after uterine evacuation of a molar pregnancy with invasive choriocarcinoma complicated by a uterine rupture and haemoperitoneum