Study of Perineal Tears During Delivery of Singletons in Cephalic Presentation

Background: Perineal lacerations are associated with short and long term maternal complications likeperineal pain and superficial dyspareunia and must be prevented.Aims: To look for risk factors in order to prevent themMethods: This retrospective study was conducted from the 1<sup>st</sup> of January to the 31<sup>st</sup> of December 2007in the maternity of the University Teaching Hospital Yaoundé (Cameroon). All cases of perineal tear that occurred during delivery of singletons in cephalic presentation were recruited. Our data were analysed using SPSS 12.0. The Student's t-test and the Fisher's exact test were used for comparison. The level of significance was 0.05.Results: The incidence of perineal tear was 13.5% (230/1695). Second degree perineal tears represented rd th 22.1% and 3 degree 01.3% of cases. No 4 degree perineal tear was observed. Risk factors for seconddegree perineal tears were nulliparity especially if maternal age was 27 and above, foetal weight = 3500 rd g, instrumental deliveries and deliveries of adolescents while that of 3 degree were forceps delivery (1case) and macrosomic babies (2) in patients of 27 and 29 years.Conclusion: In the above mentioned conditions, the perineum must be well protected and a mediolateral episiotomy must be done to prevent severe perineal tears if many risk factors are present.Keywords: Singletons in cephalic presentation- Perineal tears-Risk factors

Indication des cesariennes a la maternite du CHU de Yaounde de 2000 A 2004

Il s.agit d.une étude rétrospective réalisée à la maternité du Centre Hospitalier et Universitaire (CHU) de Yaoundé (Cameroun) du 1er janvier 2000 au 31 décembre 2004. Les dossiers médicaux des patientes ont été examinés et certaines données analysées. Nous avons eu un total de 1167 césariennes sur 9164 accouchements soit un taux de césarienne de 12,7 %.La moyenne d.âge de nos patientes est de 27,8 ans. La césarienne a été réalisée dans 43,6 % chez les primipares. Les césariennes en urgence ont été les plus pratiquées (81,9 %). Les principales indications étaient la disproportion cephalo-pelvienne (DCP) (24 %), l.utérus cicatriciel associé à un ou plusieurs autres facteurs de risque (15,4%), la souffrance f.tale aiguë (12,1%), le placenta praevia (9,5 %) et les anomalies de présentation (7%). Nous avons eu 74 décès f.taux (6,3% de décès f.tal) au cours ou au décours de la césarienne, et 3 décès maternels, soit 0,25%). Le taux de césarienne a augmenté, principalement à cause de l.évacuation des parturientes à partir des autres formations sanitaires, la principale indication était la DFP retrouvée surtout chez les primipares. La mortalité néo-natale est en baisse probablement grâce à l.amélioration des soins obstétriques et pédiatriques. Clinics in Mother and Child Health Vol. 3(1) 2006: 453-45

Rupture of a previously scarred uterus during second trimester misoprostol-induced labour for a missed abortion: A case report

Misoprostol is useful in ripening the cervix prior to mid-trimester termination of pregnancy. It is particularly indicated in cases of missed abortions whether the uterus is scarred or not. The procedure is safe in the majority of cases. We present a case of uterine rupture during induction of labour with vaginal misoprostol for a missed abortion at 23 weeks gestation in a woman with one previous lower segment caesarean scar. We decided to present this case in order to alert practitioners that although the practice is safe in the majority of cases, there are risks of uterine rupture. Clinics in Mother and Child Health Vol. 3(1) 2006: 501-50

Gynecological cancer profile in the Yaounde population, Cameroon

This population-based retrospective study was carried out in the Yaounde Population Cancer Registry (YPCR) at the General Hospital Yaounde, Cameroon. The aim was to find out the socio-economic, epidemiologic, anatomic and pathologic profile of patients with gynecological cancers in the Yaounde population. The database of the registry was reviewed between January 1, 2004 and June 30 2005 (18 months). All cases of microscopically confirmed gynecological cancers registered within this period were recruited. Defined as gynecological cancers are cancers of the breast (in women), ovary, uterine corpus, vulva, vagina, and cervix. The results showed that gynecological cancers have a monthly incidence of 30 cases. Whereas cancers of the placenta, vagina, breast, and ovary affect younger adults, endometrial, vulval and cervical cancers predominate in the elderly. 58% of the women were aged between 34-54 years. Most patients are from the West (30.55%), Centre (28.90%) and Littoral (10.00%) provinces respectively. The commonest cancers are the breast (48.12%), cervix (40.18%), and ovary (5.82%) at respective average ages of 42.80 years (19-76 years range), 53.08 years (24-78 years range) and 44.22 years (9-75 years range). Cancers of the uterine corpus are rare. Most patients were illiterate, of low to average socio-economic status, presenting at advanced stage of disease. Cancer of the breast is common in the upper social class; while malignancies of the cervix, endometrium, and vagina predominate in the low and middle classes. Only 17.5% of our patients had been previously screened for any form of cancer prior to present disease. We had no data on family history of cancer. We recommend intensive public health education and sensitization of women on primary and secondary prevention especially for cervical and breast cancers. Gynaecological services should be vulgarized and existing ones improved with defined referral and counter referral systems. Further in-depth studies to document trends on cancer survival are recommended. Clinics in Mother and Child Health Vol. 3(1) 2006: 437-44

Improvements in access to malaria treatment in Tanzania after switch to artemisinin combination therapy and the introduction of accredited drug dispensing outlets - a provider perspective

BACKGROUND\ud \ud To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO) was created in Tanzania. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (ALu) in 2007. Subsidized ALu was made available in both health facilities and ADDOs. The effect of these interventions on access to malaria treatment was studied in rural Tanzania.\ud \ud METHODS\ud \ud The study was carried out in the villages of Kilombero and Ulanga Demographic Surveillance System (DSS) and in Ifakara town. Data collection consisted of: 1) yearly censuses of shops selling drugs; 2) collection of monthly data on availability of anti-malarials in public health facilities; and 3) retail audits to measure anti-malarial sales volumes in all public, mission and private outlets. The data were complemented with DSS population data.\ud \ud RESULTS\ud \ud Between 2004 and 2008 access to malaria treatment greatly improved and the number of anti-malarial treatment doses dispensed increased by 78%. Particular improvements were observed in the availability (from 0.24 shops per 1,000 people in 2004 to 0.39 in 2008) and accessibility (from 71% of households within 5 km of a shop in 2004 to 87% in 2008) of drug shops. Despite no improvements in affordability this resulted in an increase of the market share from 49% of anti-malarial sales 2005 to 59% in 2008. The change of treatment policy from SP to ALu led to severe stock-outs of SP in health facilities in the months leading up to the introduction of ALu (only 40% months in stock), but these were compensated by the wide availability of SP in shops. After the introduction of ALu stock levels of the drug were relatively high in public health facilities (over 80% months in stock), but the drug could only be found in 30% of drug shops and in no general shops. This resulted in a low overall utilization of the drug (19% of all anti-malarial sales)\ud \ud CONCLUSIONS\ud \ud The public health and private retail sector are important complementary sources of treatment in rural Tanzania. Ensuring the availability of ALu in the private retail sector is important for its successful uptake

Spontaneous Uterine Rupture during Pregnancy: Case Report and Review of Literature

Rupture of a gravid uterus is a surgical emergency. Predisposing factors include a scarred uterus. Spontaneous rupture of an unscarred uterus during pregnancy is a rare occurrence. We hereby present the case of a spontaneous complete uterine rupture at a gestational age of 34 weeks in a 35 year old patient. The case was managed at the University Teaching Hospital of Yaounde (Cameroon). She had past history of two uterine curettages. She presented with abdominal pain of sudden onset. After ultrasound scan, uterine rupture was diagnosed and an emergency laparotomy done. The entire amniotic sac was found in the peritoneal cavity with a rupture of the uterine fundus. Spontaneous uterine rupture occurs when there is an upper segment uterine scar. This case report shows that past history of curettage is a risk factor for the presence of uterine scar.Rupture spontanée de l'utérin pendant la grossesse: rapport du cas et bilan de la documentation La rupture d'un uterus gravid est une urgence chirurgicale. Les facteurs de prédisposition comprennent un utérin cicatriciel. La rupture spontannée d'un utérin non-cicatriciel pendant la grossesse est rare. Nous présentons ici un cas d'une rupture complète et spontanée de l'utérin à un âge gestationnel de 34 semaines chez une patiente de 35 ans. Le cas a été pris en charge au Centre Hospitalier Universitaire de Yaounde (Cameroun). Elle avait un antécédent de deux curettages de l'utérin. Lorsqu'elle s'était présentée pour la première fois, elle souffrait d'une douleur abdominale qui avait commencé soudain. Après avoir une échographie, nous avons diagnostiqué une rupture de l'utérin et une laparotomie d'urgence a été faite. La cavité amniotique entière se trouvait dans la cavité péritonéale avec une rupture du fond de l'utérus. La rupture spontanée de l'utérin se produit quand il y a une cicatrice du segment supérieur de l'utérin. Ce rapport de cas montre que les curettages comme antécédents constituent un facteur de risque quant à la présence de la cicatrice de l'utérin

Rupture uterine au centre hospitalier et universitaire de Yaounde au Cours des 10 derniere annees (1997-2006)

No abstractClinics in Mother and Child Health Vol. 4 (1) 2007: pp. 651-65

Devenir materno - foetal precoce des parturientes evacuees au chu de Yaounde

Cette étude avait pour but d'Evaluer la morbidité et la mortalité maternelles et périnatales des parturientes évacuées d'une autre formation sanitaire. Ce travail prospectif a été réalisé à la maternité du CHU de Yaoundé - Cameroun, du 1er Novembre 2003 au 31 Août 2004. Les parturientes évacuées d'autres formations sanitaires où elles étaient en travail ont été recrutées et certaines données ont été analysées. Nous avons eu un total de 122 patientes évacuées sur un total de 1943 accouchements, soit 6,3%. Les nullipares représentaient 45,9 % contre 8,2% de grandes multipares .La décision d'évacuation de la plupart des parturientes (86,9%) a été prise par des infirmiers. La plupart des patientes (85%) venaient des centres de santé, des hôpitaux de district ou de l'hôpital militaire de Yaoundé. L'accouchement a été réalisé par césarienne dans 46,7% des cas contre 51,6% des cas par voie basse. Les complications maternelles ont été dominées par l'hémorragie ante-partum: 4cas (3,2%), l'endométrite du post-partum: 2 cas (1,6%), et le décès maternel : 2 cas (1,6%). Quant aux complications foetales, elles ont été marquées par le décès foetal : 26 cas (21,3%) et l'infection néonatale précoce : 16 cas (13,1%). Nous pouvons conclure de cette étude que les complications maternelles et foetales chez les parturientes évacuées sont dues à un certain nombre de facteurs tels que l'incapacité de poser un diagnostic intrapartal correct par manque ou par indisponibilité du personnel qualifié, l'hésitation dans la décision d'évacuation, l'absence des moyens rapides de communication. Mots cles: parturientes evacuees, mortalité et morbidité maternofoetales Clinics in Mother and Child Health Vol. 2(1) 2005: 261-26

Caeserean section for preeclampsia-eclampsia at the University Teaching Hospital (CHU) Yaounde

The aim of this study was to determine the frequency of caeserean section indicated for preeclampsia-eclampsia, describe the clinical features and evaluate the maternofoetal outcome. A retrospective review of all cases of caeserean section between January 2002 and December 2003 to identify all cases of caeserean deliveries indicated for deterioration of maternal condition despite medical treatment of preeclampsia-eclampsia. Cases indicated for acute foetal distress were excluded. Forty-six out of the 565 caeserean deliveries were indicated for preeclampsia-eclampsia giving a frequency of 8.1%. Up to 54.5% of all the 33 retrieved files were evacuated cases. The majority were young women less than 25years (63.6%) and usually nulliparous (60.6%). Only 45.5% of paturients had a first trimester baseline blood pressure. Evidence of the deterioration of maternal conditions was suggested by the persistence of severe hypertension, seizures (45.5%), visual disturbances (24.2%), headache (15.2%) or epigastralgia (12.1%). Maternal morbidity was dominated by anaemia (51.5%). No case of maternal death following caesarean delivery was recorded during this period. Neonatal morbidity was due to prematurity (36.4%) or intrauterine growth restriction (9.1%). Perinatal mortality up to the first 24 hours postpartum was 12.1%. Mother and Child Health Clinics Vol. 1(3) 2004: 166-17