Retained sponge after abdominal surgery: experience from a third world country

Background: Retained abdominal sponge after surgery is a quite rare condition which can have heavy medico-legal consequences; its frequency is generally underestimated. Few reports of these conditions are available in African environment with specific technical and medico-legal background. We present our local experience of retained sponges after abdominal surgery and review current literature. Methods: A retrospective analysis of the medical files of 14 consecutive patients with a retained surgical sponge after abdominal and urological surgery. Results: The incidence was 1every 677 abdominal operations; no metallic foreign body described, only sponges; the female sex predominated with 10/14 patients. 85.71% of retained sponge occurred after an emergency procedure and 64.28% were gynecological or obstetrical procedures. Most cases presented as intestinal obstruction, localized persistent pain or abdominal mass and pre-operative diagnosis could be done only in 28.57% of cases. A falsely correct sponge count was reported in 71.42% of cases. 92.85% of patients were re-operated and the morbidity was low; no death was reported. None of our cases ended in a medico-legal claim despite proper counseling. Conclusion: The incidence of retained sponge might be significantly higher in an environment with reduced medico-legal threat; most cases of retained sponges are still related to human errors; the incidence will probably be reduced by a greater awareness about the condition

Prevalence and Risk Factors of Perineal Tears at the Limbe Regional Hospital, Cameroon Prospective

Background: Most of the studies on the prevalence and predisposing factors of perineal tears have been in developed countries. A few studies have been carried out in developing countries including Cameroon. The aim of this study is two fold: to 1) determine the prevalence and risk factors of perineal tear during vaginal delivery at the Limbe Regional Hospital, and 2) provide baseline data needed in auditing obstetric practice. Patients and Methods: This is a retrospective and prospective cross-sectional study. The retrospective data were obtained from the birth registers. Data was obtained for two consecutive years: 2011 and 2012, and included a total of 1336 birth records that were analysed to determine the prevalence and types of perineal tear and prevalence of episiotomies. The prospective study comprised a total of 200 women who gave birth at the LRH during the period January 21st through May 24th 2013. They were administered a structured questionnaire. The data for the prospective study was used to determine the predisposing factors of perineal tear. Data analysis was with Epi Info 7.0, and Microsoft Excel 2010 version. Statistical significance was set at P<0.05. Results: The average age of the participants was 25.8 (SD 5.0). The prevalence of perineal tear at the LRH was 19.2% and that of episiotomies was 2.3%. 13.1% of perineal tears were second-degree tears. Factors identified to be independently associated with perianal tears were: maternal age (25-40) (OR 2.6, 95% CI: 1.1-4.3;P=0.02), history of previous perineal tear (OR 3.4, 95% CI: 1.6-7.3;P<0.001), Antenatal care (ANC) visits (< 4) (OR 2.4, 95% CI: 1.26-4.53; P < 0.007), position of presenting part (occiputo-posterior) (OR 3.2, 95% CI: 1.6-6.12; P<0.001) and duration of second phase of labour (>30 minutes) (OR 3.2, 95% CI: 1.7-6.04; P<0.001). Conclusion: The prevalence of perineal tear was much higher than those of episiotomies in the LRH. Second-degree tears were more prevalent among the participants. Perineal outcomes at the LRH were excellent and should be maintained or improved