Endometriosis with massive recurrent hemorrhagic ascites: A case report

Ascites is a rare manifestation of endometriosis. The case reported is that of a 26‑year‑old woman with recurrent massive hemorrhagic ascites. The analysis of biopsy specimens made at laparoscopy confirmed the diagnosis. The report noted pelvic endometriosis associated but there was no umbilical or pleural involvement. The evolution was favorable under a long term hormone treatment (by GnRH analogues) with relay through continuous estrogen‑progestogen. The diagnostic and therapeutic difficulties of this rare form of endometriosis are presented through a review of the literature.Keywords: Endometriosis; hemorrhagic ascites; managemen

A rare case of dicephalic parapagus conjoined twins

Dicephalic parapagus are one of the rare forms of conjoined twins. Their prognosis is usually very poor. Early prenatal diagnosis of these serious congenital abnormalities remains a real challenge for health systems in the low-income countries. The late antenatal diagnosis of a case of this abnormality was presented. The diagnosis was made at the 33rd week on the only ultrasound performed during the pregnancy. The pregnancy was interrupted with the agreement of the couple and delivery was performed by caesarean section.

Immediate postpartum insertion of intrauterine devices: experience of maternity ward of the university and teaching hospital of Treichville, Abidjan

Background: In Côte d’Ivoire, where the rate of undesired pregnancies is high, we were the first Maternity centre, to benefit from training on immediate postpartum insertion of intrauterine devices (IUD).  The objective of this study is to share our experience and present the results of this practice in our hospital.Methods: It was a prospective and descriptive cohort study from the 11th of November 2013 to the 30th of April 2016 including the patients who delivered at the maternity of CHU Treichville (University Hospital Centre, Abidjan, Côte d’Ivoire), and had immediate postpartum IUD insertion, with a control 6 weeks later and then 3 months later.Results: 790 IUD have been, inserted to women with average age and gravidity of respectively 31.3 years old (13-52 years) and 4.4 (1-12 pregnancies). Most of our patients had a low socioeconomic status (poor education: 51.1%; not married: 59.9%). The counseling occurred during the latent phase of the labour for 57.2% of the women and the major parts of the IUD (59, 1%) were insert during a caesarean section. We noticed a poor rate of default patients (14 lost after 3 months), no complications but 9% of side effects (spontaneous expulsion, missing string). During the follow up period, four patients decided to remove the device. One of them for pelvic pain and three for a non-motivated request of the patients.Conclusions: Our experience shows that on immediate postpartum insertion of IUD is possible in our environment

Problem of obstetrical evacuations of patients coming from maternities outside the coverage zone of the university and hospital center of Treichville (Abidjan-Côte d’Ivoire)

Background: In developing countries, the organization of obstetrical evacuations is experiencing real problems causing certain preventable maternal and fetal morbidity and mortality. Objective of present study was to describe the sociodemographic characteristics and conditions of transfer of patients from peripheral maternities not dependent on the health coverage zone of the University and Hospital Center of Treichville (called maternity out of zone).Methods: This is a prospective and descriptive study, conducted at the maternity of the University and Hospital Center of Treichville, from 1st August 2012 to 31st July 2014 about 266 patients evacuated from maternity out of zone.Results: Only 30% of the patients had properly documented evacuation records. Patients had an average age of 26.9 years, poor follow-up of their pregnancy (92.1%), and were generally low socio-economic level: without monthly income (61.7%), not attending school (35.3%). The majority of evacuations were decided by midwives (60.9%) and were done by taxi (69.5%). In 71.4% of the cases, the patients were re-evacuated to our department with the main reason for the unavailability of the operating rooms (84.3%). 46.6% of the patients took more than 3 hours to arrive in our department and 35% arrived in an aggravated condition and sometimes without venous routes. In our department, complications occurred in 27.1% of the patients, and maternal and fetal death rates were respectively 1.5% and 21.3%.Conclusions: This study revealed malfunctions encountered during evacuations: unsafe transportation, transfer card misinformed, long transfer time

Illegals abortions and utero-digestives lesions: retrospective study of 12 cases in the Department of Gynecology and Obstetrics at the Treichville teaching hospital (Abidjan, Cote D’ivoire)

Background: Traumatic intestinal digestive damage after abortion by endo-uterine manoeuvres are not uncommon. The purpose of this study is to describe the diagnostic, therapeutic and prognostic aspects of these lesions.Methods: This is a retrospective study of 3 years on patients with a uterine lesion associated with a digestive traumatic injury during illegal abortions endo-uterine manoeuvres.Results: 12 patients with a median age of 23, 9 are included. The clinical manifestations are not specific: impairment of the general condition 33.3%; hyperthermia 83.3% (or 10 cases); digestive disorders such as diarrhoea 25%, vomiting 33.3%; abdominal pain 100%; occlusive syndrome 16.7%; acute abdominal syndrome 75%. The seat of traumatic injuries is variable. The lesions were for hail alone in 4 cases (33.3%), colon alone for 2 cases (16.7%), rectum 1 case and epiploon 2 cases. In these 3 cases, the lesions were associated, sitting on both the hail and the colon at a time. All these lesions were associated with uterine perforation of variable siege. The therapeutic management consisted of a small bowel resection with ileostomy in 5 cases or 41.7%; colon resection with colostomy 3 cases or 25%; suture lesions after beveling beiges 5 cases either 41, 7 in 2 cases, we performed haemostasis on the bleeding epiploon. Treatment of the uterine lesion was conservative 75% of the time. The evolution on the 10 patients was favorable, 83.3%. Two patients died early in the operative course after septic shock.Conclusions: The digestive lesions are a factor aggravating the prognosis of post-abortion uterine manoeuvres. Their management must be rapid and requires close collaboration between the digestive surgeon and the Gynecologist

Review of mastectomy in the department of gynecology at the Treichville teaching hospital, Abidjan-Cote d’Ivoire

Background: Mastectomy plays a key role in the management of breast cancer in our regions of sub-Saharan Africa. Because the advanced forms represent the essential stages of the diagnosis and some therapeutic means remain unavailable. Objective of this study was to report the experience of the practice of mastectomy in the treatment of breast cancer in our service.Methods: This is a retrospective and prospective, descriptive study conducted from January 1, 2013 to May 31, 2017 (age 05) at the University Hospital of Treichville involving 56 breast cancer patients who had undergone a mastectomy.Results: The frequency of the mastectomy was 28.5% and the average age of our patients was 48 years old. The majority of patients had an average socio-economic level (66%). 85.6% of our cancers discovered at advanced stages (T3 and T4). Adenocarcinoma accounted for 96% and infiltrating ductal carcinoma 82% of adenocarcinoma.Patey mastectomy associated with axillary dissection was performed in 96.4% and simple mastectomy in 3.5%. The results of axillary dissection reported lymph node invasion in 38 patients; With an average number of lymph nodes taken from 6.1 and an average number of ganglia affected is 3. Neoadjuvant chemotherapy was administered in 96.4% and adjuvant chemotherapy in 91%. Radiotherapy was performed in 34%. Complications were dominated by lymphoceles in 34% of cases. The 5-year survival of patients operating in the service is 37.8%.Conclusions: Mastectomy is at the forefront of breast cancer surgery in our service. She is supervised by chemotherapy. Radiotherapy remains inaccessible for most patients. Early detection would lead to conservative treatment and a reduction in the postoperative complication rate

Problem of obstetrical evacuations of patients coming from maternities outside the coverage zone of the university and hospital center of Treichville (Abidjan-Côte d’Ivoire)

Background: In developing countries, the organization of obstetrical evacuations is experiencing real problems causing certain preventable maternal and fetal morbidity and mortality. Objective of present study was to describe the sociodemographic characteristics and conditions of transfer of patients from peripheral maternities not dependent on the health coverage zone of the University and Hospital Center of Treichville (called maternity out of zone).Methods: This is a prospective and descriptive study, conducted at the maternity of the University and Hospital Center of Treichville, from 1st August 2012 to 31st July 2014 about 266 patients evacuated from maternity out of zone.Results: Only 30% of the patients had properly documented evacuation records. Patients had an average age of 26.9 years, poor follow-up of their pregnancy (92.1%), and were generally low socio-economic level: without monthly income (61.7%), not attending school (35.3%). The majority of evacuations were decided by midwives (60.9%) and were done by taxi (69.5%). In 71.4% of the cases, the patients were re-evacuated to our department with the main reason for the unavailability of the operating rooms (84.3%). 46.6% of the patients took more than 3 hours to arrive in our department and 35% arrived in an aggravated condition and sometimes without venous routes. In our department, complications occurred in 27.1% of the patients, and maternal and fetal death rates were respectively 1.5% and 21.3%.Conclusions: This study revealed malfunctions encountered during evacuations: unsafe transportation, transfer card misinformed, long transfer time

Cervical cancer prevention in reproductive health services: knowledge, attitudes and practices of midwives in Cote d'Ivoire, West Africa.

International audienceBACKGROUND: Cervical cancer is the most common cancer among women and the leading cause of cancer deaths in women in Cote d'Ivoire. Low resource countries can now prevent this cancer by using HPV vaccine and effective and affordable screening tests. However the implementation of these prevention strategies needs well-trained human resources. Part of the solution could come from midwives by integrating cervical cancer prevention into reproductive health services. The aim of this survey was to assess knowledge, attitudes and practices of midwives towards cervical cancer prevention in Abidjan, Cote d'Ivoire, and to find out factors associated with appropriate knowledge. METHODS: A cross-sectional survey was conducted among midwives in the urban district of Abidjan, using a self-administered questionnaire. Knowledge was assessed by two scores. Factors associated with appropriate knowledge were determined using a logistic regression analysis. Attitudes and practices were described and compare using the Chi2 test. RESULTS: A total of 592 midwives were enrolled, including 24.5% of final-year students. 55.7% of midwives had appropriate knowledge on cervical cancer, and 42.4% of them had appropriate knowledge on cervical cancer prevention strategies. Conferences, courses taken at school of midwifery and special training sessions on cervical cancer (OR = 4.9, 95% CI [1.9 to 12.6], p <0.01) were associated with good knowledge on the management of this disease. Among these midwives, 18.4% had already benefited from a screening test for themselves, 37.7% had already advised screening to patients and 8.4% were able to perform a visual inspection. 50.3% of midwives knew HPV vaccine as a preventive method; among them 70.8% usually recommended it to young girls. CONCLUSION: Despite sufficient knowledge about cervical cancer prevention, attitudes and practices of midwives should be improved by organizing capacity building activities. This would ensure the success of integration of cervical cancer prevention into reproductive health services in countries like Cote d'Ivoire

Illegals abortions and utero-digestives lesions: retrospective study of 12 cases in the Department of Gynecology and Obstetrics at the Treichville teaching hospital (Abidjan, Cote D’ivoire)

Background: Traumatic intestinal digestive damage after abortion by endo-uterine manoeuvres are not uncommon. The purpose of this study is to describe the diagnostic, therapeutic and prognostic aspects of these lesions.Methods: This is a retrospective study of 3 years on patients with a uterine lesion associated with a digestive traumatic injury during illegal abortions endo-uterine manoeuvres.Results: 12 patients with a median age of 23, 9 are included. The clinical manifestations are not specific: impairment of the general condition 33.3%; hyperthermia 83.3% (or 10 cases); digestive disorders such as diarrhoea 25%, vomiting 33.3%; abdominal pain 100%; occlusive syndrome 16.7%; acute abdominal syndrome 75%. The seat of traumatic injuries is variable. The lesions were for hail alone in 4 cases (33.3%), colon alone for 2 cases (16.7%), rectum 1 case and epiploon 2 cases. In these 3 cases, the lesions were associated, sitting on both the hail and the colon at a time. All these lesions were associated with uterine perforation of variable siege. The therapeutic management consisted of a small bowel resection with ileostomy in 5 cases or 41.7%; colon resection with colostomy 3 cases or 25%; suture lesions after beveling beiges 5 cases either 41, 7 in 2 cases, we performed haemostasis on the bleeding epiploon. Treatment of the uterine lesion was conservative 75% of the time. The evolution on the 10 patients was favorable, 83.3%. Two patients died early in the operative course after septic shock.Conclusions: The digestive lesions are a factor aggravating the prognosis of post-abortion uterine manoeuvres. Their management must be rapid and requires close collaboration between the digestive surgeon and the Gynecologist