Absence of Wharton's jelly around an umbilical artery

Wharton's jelly is a mucoid, avascular and connective tissue which plays the role of umbilical vessels protection. Its absence exposes to poor neonatal outcomes or fetal death. We report a rare case of Absence of Wharton’s Jelly, diagnosed by examination of the placenta the examination with a live fetus

Meckel-Gruber syndrome: about a case identified during deliver

Meckel-Gruber syndrome is an autosomal recessive disorder, usually lethal, most commonly characterised by the classic triad of polycystic kidneys, occipital encephalocele and polydactyly. Antenatal diagnosis can be made by ultrasound between 10 and 14 weeks of amenorrhoea. Recognition of this syndrome is important in order to establish the diagnosis and provide genetic counselling. Finally, well supervised termination of pregnancy should be the rule for lethal fetal malformations in order to relieve the psychological suffering of patients. However, in certain situations or working conditions, the diagnosis can be made late or even discovered during childbirth. We report a case of Meckel Gruber syndrome discovered at birth

About a case of a specific complication of monoamniotic twin pregnancy: umbilical cord entanglement

Monoamniotic twin pregnancies are uncommon and often complicated by umbilical cord entanglement. It is important to investigate a umbilical cord entanglement during antenatal ultrasound examinations. The diagnosis is based on ultrasound with color and pulsed Doppler. Despite the high percentage of cord entanglement, the perinatal mortality rate remains very low. Rigorous ultrasound monitoring and recording of fetal heart rhythms can improve the prognosis. We report a case of umbilical cord entanglement in a monoamniotic twin pregnancy discovered during a caesarean section with a favorable outcome

Puerperal uterine inversion: a new case report

Puerperal uterine inversion is a rare and severe affection which the uterine fundus collapses into the endometrial cavity. The diagnosis is essentially made on clinical examination, which also allows to determinate the gravity. The management must be done early, which can be surgical or non-surgical. Through a case study we will review the literature

Amniotic band syndrome: a new case report

Amniotic band syndrome is a pathology affecting the extremities of the fetus. It is uncommon with rates around 1 per 10,000 births. The pathophysiology is poorly understood until now with several theories reported in the literature. The diagnosis is most often made at birth. We reported a case of a 40 year old patient with no particular history who had consulted for spontaneous premature rupture of membranes in a 20 weeks pregnancy. The diagnostic of amniotic band syndrome was made after the delivery with amputation of a limb, amniotic syndactilia and deformation of the right foot in equinovarus

Uterine ruptures during labor: a study of 26 cases at Nabil Choucair Medical Center, in the suburbs of Dakar

Background: This study aims to clarify the epidemiological profile of patients and describe the diagnostic, therapeutic and prognostic aspects of uterine ruptures at Nabil Choucair Health Center, in the suburbs of Dakar.Methods: This was a retrospective and prospective, descriptive and analytical study conducted over a period of 112 months, from July 31, 2005 and March 31, 2015; it concerned all diagnosed cases with uterine rupture, managed at Nabil Health Center Choucair Dakar. Data were collected from antenatal notebooks, delivery records, surgical reports and anesthetic records. The following parameters were studied: socio-demographic characteristics (frequency, chracteristics of patient), the course of pregnancy, diagnostic, prognostic, and therapeutic aspects. Data analysis was performed using SPSS software (version 11.0).Results: During the study period, we recorded 26 uterine ruptures from a total of 34,097 deliveries, that is a frequency of 8 out of 10,000 births. The epidemiological profile of the patients was that of a 30-year old woman, on average, few previous deliveries with an average parity of 3, who received on average 3 antenatal and evacuated in 50% of cases. Uterine rupture occurred in 17 patients on a new uterus (65, 4%) and in 9 patients on a scarred uterus (34.6%). Two patients (7%) were in hemorrhagic shock. A laparotomy aimed at specifying the place of rupture and making the treatment was performed in all patients. It was 18 uterine segmento-corporeal ruptures (69.2%), 5 segmental ruptures (19.2%) and 2 corporeal ruptures (7.6%). We recorded 9 uterine ruptures with living fetus (38.5%). Twenty-three patients (88.5%) underwent conservative suture against only 3 hemostasis hysterectomy (11.5%). The postoperative courses were uneventful in 57.7% of cases. Eleven patients (42.3%) had anemia and we recorded maternal deaths, which is a maternal mortality of 3.84%.Conclusions: Uterine rupture is a serious complication that is still responsible for significant maternal and fetal mortality. Prevention is based on careful monitoring of pregnancy and delivery

Impact of day of delivery on obstetric and perinatal outcome: a 10 years retrospective descriptive and analytical study at the Phillipe Maguilen Senghor Health Centre, Dakar, Senegal

Background: For a lot of women, childbirth is still a feared moment. Despite considerable progress in the management of childbirth and its complications, maternal and neonatal morbidity and mortality are still a major problem even in developed countries. To evaluate the influence of day of delivery on obstetrical and perinatal outcome.Methods: Retrospective cohort study conducted at the Philippe Maguilen SENGHOR health center maternity ward from January 1, 2011 to June 30, 2019, on patients with a pregnancy of more than 22 weeks of amenorrhea who were received for delivery management. The deliveries periods were divided according to whether they occurred on a working day (deliveries from Monday to Friday, excluding public holidays) or on weekends and public holidays (deliveries on Saturdays, Sundays and days declared as public holidays according to the Gregorian and Senegalese event calendars). The data were extracted from our E-perinatal database and analysed in the Statistical Package for Social Science (SPSS 24, Mac version).Results: Over 102 months, we recorded 42 870 deliveries. The average age of the patients was 27 years with extremes of 13 and 50 years. Nearly one in three deliveries took place on a holiday or weekend (n=13566-31.6%). The rate of caesarean delivery on weekends/holidays (18.8%) was lower than that on weekdays (21%). The odds ratio of having/benefiting from a weekend/holiday caesarean section was 0.87 (CI 0.83-0.92, p<0.0001). Our results suggest that patients who deliver on weekdays are more likely to receive a caesarean section than those who deliver on weekends or holidays. Perineal injury, World Health Organization obstetric complications, and neonatal outcome showed no significant difference by day of delivery.Conclusions: Our results contradict the idea that deliveries on weekends and holidays are more risky for patients and their children

A hospital based case control study of female breast cancer risk factors in a Sub-Saharan African country

Background: Breast cancer is the most common cancer diagnosed in women worldwide with over 1.3 million new cases per year. There is a wide variation in the geographical burden of the disease with the highest incidences seen in the developed regions of the world and the lowest incidences observed in the least developed regions. The objective of this study was to understand further the risks for breast cancer in Senegalese population which can then inform public health strategies to try and reduce the burden of breast cancer.Methods: This matched case control study was conducted in 2015 in Aristide Le Dantec Teaching Hospital in Dakar. All women with pathologically confirmed primary breast cancer were considered as cases. For each case, 2 age-matched women were recruited. We collected and compared demographic factors, family history of breast cancer, socioeconomic variables, reproductive variables (age at menarche, age at first pregnancy and first live birth, parity, menopausal status, duration of breastfeeding), and exogenous hormone use up to 6 months. Odds ratios from univariate logistic regression were used to estimate the relative risk of breast cancer associated with the various factors, and their predictive effects.Results: In all, 212 women with breast cancer who were diagnosed as having breast cancer and 424 control women were involved in the study. The mean±SD age of cases and controls was 43.37±11.94 years (range 18-83 years) and 42.04±11.08 years (range 18-84 years), respectively. There were no significant differences between cases and controls with regards to marital status, parity, age at menarche, past oral contraceptive use, age at first last full-term pregnancy and history of breastfeeding. Breast cancer risk was significantly greater in women with a family history of the disease (OR 2.12, 95% confidence interval [CI] 1.35-3.31). A significant increase in breast cancer was observed among illiterate women compared to educated women (OR 1.27, CI 1.02-1.58), in premenopausal women and those without occupation.Conclusions: In this study, reproductive factors as early menarche or menopausal status were not associative to the risk of breast cancer and the early age at diagnosis and the positive history of breast cancer suggest a genetic pattern of this disease in Senegalese woman. But this fact is difficult to confirm for financial reasons