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

Predictive factors for perinatal death in nuchal cord cases: a case control study

Background: Nuchal cord is a common occurrence at delivery and it is known to be associated with birth asphyxia and perinatal death. The objective of this study was to identify the predictive factors of perinatal death in the presence of nuchal cord.Methods: This was a case-control study carried out during the period from October 1st 2014 to April 30th 2015 in three hospitals of Yaoundé, Cameroon, involving 204 parturients whose babies presented with a nuchal cord at delivery.Results: After multivariate analysis, independent predictive factors for perinatal death in nuchal cord cases were: post-term (OR=209.70; CI= 3.09-14212.66), antepartum hemorrhage (OR=18.21; CI=1.47-224.78), fetal heart rate abnormalities during labor (OR=11.74; CI=1.33-103.37), augmentation of labor (OR=24.04; CI=1.85-311.52), second stage of labor lasting more than 30 minutes (OR=172.50; CI=20.60-1444.20) and tight nuchal cord at birth (OR=16.29; CI=2.07-127.87).Conclusions: We recommend the identification of predictive factors for perinatal death in cases of known or suspected nuchal cord in order to consider cesarean section to prevent adverse fetal outcomes

Profil des cancers gynécologiques et mammaires à Yaoundé - Cameroun

Introduction: En Afrique subsaharienne, les cancers constituent un fléau dont les caractéristiques restent à préciser. Méthodologie: Afin de déterminer les aspects histologiques et cliniques des cancers  gynécologiques et mammaires au Cameroun, nous avons mené une étude descriptive et rétrospective sur une période de 54 mois à l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé. Méthodes: Afin de déterminer les aspects histologiques et cliniques des cancers gynécologiques et  mammaires au Cameroun, nous avons mené une étude descriptive et rétrospective sur une période de 54 mois à l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé. Résultats: Les 424 cas enregistrés se répartissaient ainsi: cancers du col de l'utérus: 210 cas (49.5%); du sein: 144 cas (34%); de l'ovaire: 31 cas (7.4%); de l'endomètre: 21 cas (4.9%); de la vulve: 14 cas (3.3%); du vagin: 1 cas (0.2%) et les sarcomes utérins: 3 cas (0.7%). Pour le cancer du sein, l'âge moyen au diagnostic était de 46.08±4.0 ans, 92.4% de patientes présentaient une masse (dont 60.9% localisées au quadrant supéro-externe), 76.4% étaient découverts aux stades T3 et T4, et 71.5% étaient les carcinomes canalaires. Pour les cancers du col, l'âge moyen au diagnostic était de 52.43±3.82 ans,  62.9% étaient découverts aux stades FIGO 1 et 2, et 87.6% étaient des carcinomes épidermoïdes. Pour le cancer de l'ovaire, l'âge moyen au diagnostic était de 49.0±9.31 ans, 90.3% étaient des tumeurs  épithéliales et 74.2% étaient aux stades 2 et 3 (FIGO). Quant aux cancers de l'endomètre, l'âge moyen au diagnostic était de 59±14.55 ans, 90.5% étaient des adénocarcinomes. Conclusion: Les principaux cancers étaient ceux du col de l'utérus et du sein. Le diagnostic étant souvent fait aux stades tardifs et par conséquent de mauvais pronostic, la prévention des cancers gynécologiques et mammaires devrait être renforcée au Cameroun.Key words: Cancer, sein, col, utérus, endomètre, ovaire, gynécologique, vagin, vulve, Camerou

Assessment of labor and delivery in pregnant women on sulfadoxine-pyrimethamine regimen in Yaoundé gynaeco-obstetric and paediatric hospital: a comparative study of 313 cases

Background: Malaria is still a major public health problem in sub-Saharan Africa. The aim was to determine the prevalence of malaria infection at the onset of labor and the resulting complications.Methods: We carried out a five-month cross-sectional study at the Yaoundé Gyneco-Obstetric and Pediatric Hospital.  We used results from the rapid diagnostic test (RDT) to compare two groups of pregnant women admitted into the labor room. Women who tested positive were assigned to the exposed group versus negative to the non-exposed group. Independent factors associated with malaria infection were investigated by the logistic regression method.Results: Up to 79.6% (249/313) of women had received the sulfadoxin-pyrimethamine regimen with 32.9% (82/249) receiving at least 3 doses.  Malaria infection was detected in 32.2% (101/313) of women. Only 14.9% (15/101) of the exposed group had received 3 doses of SP versus 31.6% (67/212) of the non-exposed group. After univariate analysis, malaria infection at the onset of labor was associated to premature rupture of membranes (OR=1.39; CI=1.01-1.94), fever during labor (OR=73.37; CI=64.80-681.95), non-reassuring fetal status (OR=2.08; CI=1.36-3.20), low birth weight (OR=1.65; CI=1.23-4.13), prematurity (OR=2.79; CI=2.12-367), a poor Apgar score at the 1st minute and postpartum fever (OR=3.19; CI=2.56-4.00). Linear logistic regression indicated that the occurrence of fever during labor (aOR=63.09), and low Apgar score at the first minute (aOR=6.27) remained significant and malaria infection was significantly associated to the single marital status (aOR=2.56) and a history of malaria during the current pregnancy (aOR=2.56).Conclusions: Systematic RDTs is thus recommended at the last antenatal consultation to avoid identified complications

Facteurs prédictifs de l’échec du Traitement Préventif Intermittent du paludisme à la sulfadoxine – pyriméthamine (TPIp-SP) dans une population de femmes enceintes à Yaoundé

Introduction: Le traitement préventif intermittent à la sulfadoxine-pyriméthamine (TPIp-SP) est recommandé pour prévenir le paludisme pendant la grossesse. Nous avons recherché les facteurs associés à l'échec de cette stratégie. Méthodes: Nous avons mené une étude cas - témoins dans deux formations sanitaires de Yaoundé, du 1er Mai 2014 au 30 Avril 2015. Les femmes enceintes sous TPIp-SP hospitalisées pour paludisme ayant un Test de Diagnostic Rapide (TDR) positif (cas) étaient comparées aux femmes enceintes sous TPIp-SP ayant un TDR négatif (témoins). Les logiciels Epi info 7 et SPSS 18.0 ont été utilisés avec P<0,05 comme seuil de significativité. Résultats: Nous avons recruté 234 sujets, 109 cas (46,6%) et 125 témoins (53,4%). Les facteurs associés retrouvés étaient : la primiparité (P=0,03 ; OR=1,15; IC= 0,32 - 4,10), la non utilisation de la MILDA (P=0,006 ; OR= 2,31 ; IC= 1,26 - 4,25), un antécédent d'hospitalisation pour paludisme (P=0,007 ; OR= 2,19 ; IC= 1,23 - 3,89), le début de la TPIp-SP après la 28ème semaine de grossesse (P=0,001, OR= 3,55; IC= 1,7 - 7,61). Après régression logistique, la primiparité (P=0,024 ; OR=2,01 ; IC=1,1-3,7) et un antécédent d'hospitalisation pour paludisme (P=0,001 ; OR=2,83 ; IC=1,50-5,4) restaient associés à l'échec du TPIp-SP. Conclusion: Un antécédent d'hospitalisation pour accès palustre et la primiparité sont des facteurs prédictifs indépendants de l'échec de la TPIp-SP.Pan African Medical Journal 2016; 2

Descriptive analysis of 192 cases of breast cancer occurring before age 40 in Yaounde, Cameroon

Background: Breast cancer is today a global health problem. With 1,671,149 new cases diagnosed in 2012, it is the most common female cancer in the world and accounts for 11.9% of all cancers and it affects more people than prostate cancer. In 2008, The United States statistics showed that, for all cancer that affect women before 40 years, more than 40% of them concerned the breast. The aim of this study was to describe the clinical, histopathological and therapeutic aspects of breast cancer in women under 40 years of age in Yaoundé.Methods: This was a retrospective study with data collected from 192 medical case files of women treated over a period of 12 years, from January 2004 to December 2015 at the Yaounde General Hospital and the Yaounde Gyneco-Obstetric and Pediatric Hospital. Microsoft Epi Info version 3.4.5 and SPSS version 20.0 softwares were used for data analysis.Results: From 2004 to 2015, 1489 cases of breast cancer were treated in both hospitals. Of these, 462 women were less than 40 years old, representing a proportion of 31.0%. The mean age at diagnosis was 33.5±5.0 years and 17.7% of women had a family history of breast cancer. The average time before an initial consultation was 6.7±6.6 months.  Most cases were classified as T4 (46.1%). The most common histological type was ductal carcinoma (87.4%). Grades SBR II and SBR III were predominant (76.4%). Axillary dissection (64.4%) and neoadjuvant chemotherapy (43.9%) were the main therapeutic modalities. The overall survival rate at 5 years was 51.2%. Five-year survival rates with no local recurrence and no metastatic occurrence were 35.8% and 43.2% respectively.Conclusions: Breast cancer largely affects women under the age of 40 and is often discovered late, at an advanced stage. The prognosis appears poor. Only screening could facilitate diagnosis at an early stage of the disease for better outcomes

Cytopathological Aspects of Breast Discharge in Women without Palpable Breast Mass in Yaounde, Cameroon

Objective: Describe cytopathological characteristics of nipple discharge.Methods: Four years retrospective cross- sectional study in Yaounde, Cameroon. We included all complete files of adult women with cytopathological analyses of breast discharge without palpable mass. Exclusion Criteria: Pregnant or breastfeeding women, puerperium and first 4 weeks post- abortum. Cytological modifications were classified as benign or malignant. Results: We retained 153 cases. Mean age was 41.2+/-14.4 years. Cytological modifications were malignant in 27 (17.65%) and benign in 126 (82.35%) cases. Of the 27 malignant cases, 18 (11.77%) were carcinomas and 9 (5.88%) were lymphomas. Upon histological analyses, all suspected lymphomas were confirmed while only 1 case of suspected carcinoma turned to be an atypical ductal hyperplasia. Of the 126 cases with benign modifications, 54 (35.29%) had inflammatory lesions, 48 (31.38%) had non inflammatory lesions and 24 (15.69%) had papillomas. Conclusion: Cytology of breast discharge can enhance early detection of breast cancers

Management of a post-coital recto vaginal fistula at the Douala Gyneco-Obstetric and Pediatric Hospital: a case report

Recto vaginal fistula can be secondary to various and multiple causes. However, intercourse is an exceptional cause. The objective of this work is to expose its clinical, therapeutic and prognostic particularities. We report the case of rectovaginal fistula in a 29-year-old patient, following consensual sex. She underwent posterior colpoperineorraphy under spinal anesthesia, with a favorable outcome. Post-coital recto vaginal fistula is a stigmatizing pathology responsible for polymorphic complications. Prompt care can improve quality of life and the obstetrical prognosis of the patient

Risk factors for ectopic pregnancy in a population of Cameroonian women: A case-control study.

ObjectiveTo identify the risk factors for ectopic pregnancy (EP) in a population of Cameroonian women.Sample and methodsWe performed a matched case-control study; 88 women with diagnosed EP (cases), and 176 women with first trimester intrauterine pregnancy (IUP) (controls), who underwent questionnaires. Odds Ratio (OR) and 95% confidence intervals (CIs) were calculated and adjusted for potential confounding factors via multivariate logistic regression analysis.ResultsOf the fifteen identified risk factors, 4 were independently associated with increased odds of EP: prior pelvic inflammatory disease (PID) (adjusted odds ratio [AOR] 13.18; 95% CI 6.19-27.42), followed by current use of levonorgestrel-only pills for emergency contraception (LNG-EC) (AOR 10.15; 95% CI 2.21-46.56), previous use of depot medroxyprogesterone acetate (DMPA) (AOR 3.01; 95% CI 1.04-8.69) and smoking at the time of conception (AOR 2.68; 95% CI 1.12-6.40).ConclusionThe present study confirms the wide variety of EP's risk factors. Moreover, some new findings including current use of LNG-EC, previous use of DMPA, smoking at the time of conception are noteworthy. Thus, in our limited resources country where prevention remains the cornerstone for reducing EP chances of occurrence, clinicians should do enough counselling, especially to women with known risk factors. The necessity to facilitate access to more equipment to enable early diagnosis of EP is very crucial and should be seriously considered, in order to reduce the burden of EP in Cameroonian women

Predictive factors for perinatal death in nuchal cord cases: a case control study

Background: Nuchal cord is a common occurrence at delivery and it is known to be associated with birth asphyxia and perinatal death. The objective of this study was to identify the predictive factors of perinatal death in the presence of nuchal cord.Methods: This was a case-control study carried out during the period from October 1st 2014 to April 30th 2015 in three hospitals of Yaoundé, Cameroon, involving 204 parturients whose babies presented with a nuchal cord at delivery.Results: After multivariate analysis, independent predictive factors for perinatal death in nuchal cord cases were: post-term (OR=209.70; CI= 3.09-14212.66), antepartum hemorrhage (OR=18.21; CI=1.47-224.78), fetal heart rate abnormalities during labor (OR=11.74; CI=1.33-103.37), augmentation of labor (OR=24.04; CI=1.85-311.52), second stage of labor lasting more than 30 minutes (OR=172.50; CI=20.60-1444.20) and tight nuchal cord at birth (OR=16.29; CI=2.07-127.87).Conclusions: We recommend the identification of predictive factors for perinatal death in cases of known or suspected nuchal cord in order to consider cesarean section to prevent adverse fetal outcomes