What can a mother die of at the Parakou University Hospital Center in Africa?

Background: Maternal mortality is a scourge that severely undermines Benin and affects its development. The fact is that despite the efforts that have been made for decades, the causes remain unchanged. What is the evolution of maternal deaths in the maternity CHUD of the Borgou-Alibori which serves the departments of the Borgou and the Alibori populated by 1,245,264 inhabitants? The objectives of the present study aim to assess the ratio of maternal deaths, profile of deceased women, causes of death.Methods: This study took place at the maternity CHUD-B and covered a five-year period from January 1, 2010 to December 31, 2014. This is a retrospective, cross-sectional, analytical and descriptive study covering 113 cases of maternal death.  Results: During this period, we noted from 2010 to 2014 an evolution from 953 to 1388 deaths for 100,000 live births. The deceased women were for the most part illiterate, without any profession and married. The main direct causes of maternal deaths in order of frequency are hemorrhage 47.7%, eclampsia 19.5%, infection 9.8%, dystocia 3.5%. Indirect causes account for 19.5% of maternal deaths. The administration of emergency obstetric care has occurred under conditions where the third delay is found in 22.1% of cases with as the dominant factor the non-availability of blood products.  Conclusions: In the face of these circumstances, it is necessary to revise the system of the management of the Gravido-puerperium in the peripheral formations and in the maternity of the CHUD-B and then the conditions of transfer in order to positively influence the reduction of the mortality Maternal.

Maternal outcomes of the childbirth among primiparous teenagers in South Kivu, RD Congo

Background: Adolescent births remain at high risk. The aim of this study was to determine the maternal prognosis of births among primiparous teenagers in South Kivu.Methods: A case-control study of 250 primiparous teenagers (cases) and another group of 500 primiparous adults aged 20-34 years (control) was performed in 4 General Reference Hospitals of South Kivu in Republic Democratic Congo. The study period was from January to December 2017. A survey sheet was used to collect the data. The analysis were performed using SPSS 22.0 and EPIINFO version 7.2.2.6.Results: Out of a total of 8490 deliveries recorded at the 4 General Reference Hospitals in South Kivu in 2017, authors recorded 250 deliveries of primiparous teenagers, or 2.9%. The maternal prognosis of adolescent deliveries was more marked by a high rate of caesarean section (OR=13.5), the presence of complications (OR=7.37), prolonged labor (OR=4.51), lesions soft tissues (OR=3.92), intraoperative bleeding (OR=3.26) and fever by puerperal infection (OR=2.13).Conclusions: The frequency of childbirth among primiparous teenagers and maternal-neonatal prognosis has been determined and is of concern. The prevention of adolescent obstetric complications includes the respect for the legal age of marriage, adequate antenatal care and childbirth in a specialized hospital setting

Partially four-vessel umbilical cord: about a diagnosed case at Panzi hospital

Umbilical cord malformations are described in the literature; and it's about the umbilical artery and the umbilical vein. There are sometimes cases of a single umbilical artery. In contrast, the number of vessels in the umbilical cord can increase by three to four. A supernumerary umbilical vein is particularly rare and is usually found in association with congenital anomalies; sometimes the supernumerary umbilical vein is associated with no malformation. We report a case of umbilical cord having a four-vessel part diagnosed at the maternity ward of Panzi Hospital, in the town of Bukavu, South Kivu, DR Congo

Factors associated with caesarean section at Bukavu Provincial Hospital in Democratic Republic of Congo

Background: Caesarean section is the most common major surgery performed on women Worldwide. Even if caesarean can be useful for mother and foetus, it can provoke some medical and social complications like infection, expensive cost and maternal death. This study aimed at determining the factors associated with caesarean section in Bukavu, at the Provincial Hospital.Methods: Data were collected retrospectively by exploring the files of childbirth established systematically for each pregnant woman. 466 files were exploited including 233 caesarean s (case) and 233 vaginal delivery (control). The normal childbirth which followed a caesarean was served as control. This study was a case-control. Logistic regression was used to model factor associated with caesarean section.Results: During the study period, there were 2170 deliveries in which 491 of them by caesarean section (22.6%). The factors associated with the caesarean section at the Provincial Hospital in Bukavu town were foetal distress, bleeding in the third trimester of the pregnancy, previous caesarean section, referral status and the moment of delivery (day shift).Conclusion: This study recommends an adequate monitoring of the pregnancy and training of professionals in best practices; implementation and technical audit of caesarean with feedback can significantly reduce the rate of Caesarean section in this hospital. Also, allocation in equipment suitable for the treatment of pregnant women is necessary

Factors associated with episiotomy practice in Bukavu, Democratic Republic of the Congo

Background: The primary objective of the present study is to determine the episiotomy rate and factors associated with practice of episiotomy at the maternities in Bukavu town, South-Kivu, DRC.Methods: A case-control study was carried out the women who underwent the episiotomy (case) and those which did not undergo episiotomy (control) over one 12 months period between January to December 2015. A total of 1878 women had a vaginal delivery at a rate of one case for one control (939 cases and 939 controls) were included. Their medical files were exploited. The factors associated with episiotomy were performed by logistic regression.Results: The rate of episiotomy was 20.4%. It was found that after the logistic regression, the Primiparity (OR = 4,5;95% CI:2,31-4,49), the existence of a foetal distress (OR = 4,2;IC to 95% CI :2,36-5,29), the antecedent of episiotomy (OR = 3,9;95% CI:2,83-7,07), private character of maternity (OR= 3,3; 95% CI :2,12-6,30) and the fact that the childbirth was directed by a doctor (OR = 2,3; 95% CI :1,85-5,08) were strongly associated with the practice of the episiotomy in our medium of study.Conclusions: This study showed UA-S/D ratio and UA-RI>2SD are significant predictors of perinatal deaths and immediate neonatal resuscitation in preeclampsia. Acute fetal distress in labour or neonatal nursery admission could not be predicted

Macroscopic examination of fetal appendices in delivery room: good practice at Panzi hospital

The review of fetal appendices is described in the literature, and its importance is well established. Indeed, pathological findings in the placenta can provide information on the pathogenesis of the fetus, including intrauterine growth retardation, mental retardation or neurodevelopmental disorders. This helps to understand a child's disability, but also maternal complications such as preeclampsia. Despite the relevant information provided by the various studies, fetal appendices are not systematically examined in several maternity hospitals in our country, DR Congo. We report good practice from the examination of fetal appendices to the maternity ward of Panzi Hospital, in the town of Bukavu, South Kivu, DR Congo

What can a mother die of at the Parakou University Hospital Center in Africa?

Background: Maternal mortality is a scourge that severely undermines Benin and affects its development. The fact is that despite the efforts that have been made for decades, the causes remain unchanged. What is the evolution of maternal deaths in the maternity CHUD of the Borgou-Alibori which serves the departments of the Borgou and the Alibori populated by 1,245,264 inhabitants? The objectives of the present study aim to assess the ratio of maternal deaths, profile of deceased women, causes of death.Methods: This study took place at the maternity CHUD-B and covered a five-year period from January 1, 2010 to December 31, 2014. This is a retrospective, cross-sectional, analytical and descriptive study covering 113 cases of maternal death.  Results: During this period, we noted from 2010 to 2014 an evolution from 953 to 1388 deaths for 100,000 live births. The deceased women were for the most part illiterate, without any profession and married. The main direct causes of maternal deaths in order of frequency are hemorrhage 47.7%, eclampsia 19.5%, infection 9.8%, dystocia 3.5%. Indirect causes account for 19.5% of maternal deaths. The administration of emergency obstetric care has occurred under conditions where the third delay is found in 22.1% of cases with as the dominant factor the non-availability of blood products.  Conclusions: In the face of these circumstances, it is necessary to revise the system of the management of the Gravido-puerperium in the peripheral formations and in the maternity of the CHUD-B and then the conditions of transfer in order to positively influence the reduction of the mortality Maternal.

Minimally invasive treatment of traumatic high rectovaginal fistulas

Background: We propose a new minimally invasive technique by laparoscopic approach which minimizes parietal damage and allows precise location of the fistula, hence reduces blind dissection. Methods: Ten consecutive patients suffering from a HRVF benefited from the described technique. Location and time frame were east of the Democratic Republic of Congo and September 2012 through January 2014. By laparoscopy, dissection of the mesorectum in the “holy plane” is taken posteriorly as distally on the sacrum as possible. Dissection subsequently continues laterally beyond the fistula in an effort to maximally circumvene the fistulous area where no plane of cleavage can be found. If the cleavage plane beyond the fistula addresses a healthy rectum, a suture of vaginal and rectal defect is performed. If the cleavage plane beyond the fistula involves significant laceration of the rectum, while leaving at least 2 cm of healthy rectum above the sphincter, rectal resection and colorectal anastomosis are performed. If the rectal laceration involves the distal 2 cm but halts short of the sphincter (large fistula), the pull-through technique is performed. Results: Of ten participants, four had large HRVF and two presented significant fibrosis. Three underwent simple suture of rectal and vaginal defect, one rectal resection and six a “pull-through” technique. The median procedure time was 1h50 (1h00–3h30). There was no morbidity. None of the patients required protective ileostomy or colostomy. Nine patients were declared clinically cured with a median follow-up of 14.3 months (11–36). The Cleveland Clinic Incontinence Score was 20 in all patients before the treatment and was significantly (p = 0.004) reduced to 2.6 [0–20] after the treatment. Conclusions: This minimally invasive technique allowed us to treat HRVF, including complex ones in ten patients without significant morbidity. Clinical success with a median follow-up of 14.3 months was 90 %.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Prevalence of colonization by Streptococcus agalactiae among pregnant women in Bukavu, Democratic Republic of the Congo

Maternal vaginal colonization by Streptococcus agalactiae (GBS) has an important impact on neonatal health but has not been studied in the Democratic Republic of Congo. The aim of this study was to determine its frequency and influencing factors.status: publishe

Prioritizing Pregnant Women for Coronavirus Disease 2019 Vaccination in African Countries

Coronavirus disease 2019 (COVID-19) in pregnancy is associated with excess maternal and infant morbidity and mortality in both African and higher-resource settings. Furthermore, mounting evidence demonstrates the safety and efficacy of COVID-19 vaccination for pregnant women and infants. However, national guidelines in many African countries are equivocal or lack recommendations on COVID-19 vaccine in pregnancy. We summarize key data on COVID-19 epidemiology and vaccination among pregnant African women to highlight major barriers to vaccination and recommend 4 interventions. First, policymakers should prioritize pregnant women for COVID-19 vaccination, with a target of 100% coverage. Second, empirically supported public health campaigns should be sustainably implemented to inform and support pregnant women and their healthcare providers in overcoming vaccine hesitancy. Third, COVID-19 vaccination for pregnant women should be expanded to include antenatal care, obstetrics/gynecology, and targeted mass vaccination campaigns. Fourth, national monitoring and evaluation of COVID-19 vaccine uptake, safety, surveillance, and prospective outcomes assessment should be conducted