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

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

Laparoscopic surgery for ectopic pregnancies in peripheric hospital: about 7 cases at Amath Dansokho regional hospital in Kedougou, Senegal

We report 7 cases of laparoscopic management of ectopic pregnancy but also the benefits and limitations of laparoscopic surgery in rural areas. This was a series of cases of ectopic pregnancy managed with laparoscopic surgery at the maternity ward of Amath Dansokho regional hospital of Kedougou from January 01 2023 to October 31 2023. We recorded 7 cases of ectopic pregnancy managed by laparoscopy. In 5 patients, it was an ectopic pregnancy complicated with hemoperitonea. The pregnancy was ampullary in most cases and cornual in one patient. The procedure consisted of a total salpingectomy in all 6 patients and a salpingotomy in one patient who had a history of total salpingectomy on the contralateral tube. The average duration of the operation was 45 minutes. Laparoscopic surgery is the gold standard for surgical treatment of ectopic pregnancy. It results in lower morbidity, less impact on reproductive health and a quicker return to normal activity. Through these advantages, it is well adapted in our environment, where the average distance to a health facility is 37 to 42 km.

Hepatocellular carcinoma associated with pregnancy about 2 cases at the gynecological and obstetrical clinic of the Aristide Le Dantec hospital, Dakar, Senegal

The objective of our study was to report 2 cases of hepatocellular carcinomas associated with pregnancy followed in our structure and to review the literature. Our patients were 30 and 37-year-old multi-gesture females with chronic unattended viral hepatitis B in whom the diagnosis of hepatocellular carcinoma was made in the third trimester of pregnancy at 31 weeks of amenorrhea and 4 days and at 32 weeks of amenorrhea after the incidental finding of tumor hepatomegaly on abdominal-pelvic ultrasound. The main clinical signs were jaundice and hepatomegaly and paraclinical signs were dominated by hepatic cytolysis and anemia in addition to ultrasound images. Follow-up of pregnancies revealed no particularities. A caesarean section was scheduled at 32 weeks of amenorrhea and 32 weeks of amenorrhea and 3 days allowing the birth of two preterm newborns weighing 1210 and 1500 gm with Apgar scores of 8-10/10 and 7-9/10 respectively at the fifth minute. The immediate post-operative follow-up was simple. However, the maternal-fetal prognosis was poor with the death of both patients in a multi-visceral failure table occurring respectively at 6 weeks and 3 weeks after caesarean section. The newborns had died 8 days after birth. Although rare, these two cases challenge any obstetrician to think about liver cancer in pregnant women, especially those with chronic hepatitis B. Ultrasound examination of the liver, or even better, the MRI, which is more efficient, in order to suspect early on a possible liver cancer. Indeed, early diagnosis and a thorough medical approach are essential for the treatment of HCC in pregnant patients

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

Choriocarcinoma with uterine rupture presenting as acute haemoperitoneum and shock

Choriocarcinoma is a rare neoplasm and a malignant form of gestational trophoblastic disease. Invasive mole may perforate uterus through the myometrium resulting in uterine perforation and intraperitoneal bleeding. But uterine perforation due to choriocarcinoma is rare. We present a case of a young woman who presented 1 year after uterine evacuation of a molar pregnancy with invasive choriocarcinoma complicated by a uterine rupture and haemoperitoneum

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

Obstetrical vacuum extraction practice in Senegal: knowledge, attitude and practices

Background:Assess knowledge, attitudes and practices of healthcare providers in the three biggest regions in Senegal, appreciate their level of training and determine the frequency of the practice of vacuum extraction in health facilities.Methods: This was a prospective study conducted over 1 year from January 1 to December 31, 2015 with a survey through interviews using a semi-structured questionnaire with open or closed questions, single or multiple-choice. Were included in the study providers practicing vacuum extractor, officiating in Dakar, Thies and Saint-Louis in the private and/or public sector who agreed to participate in the study. Data were captured and analyzed using File Maker Pro version 12 Inc*, then SPSS (Statistical Package for Social Science) version 21.0.Results: Out of 250 healthcare providers, 223 accepted to answer the questionnaire leading to an acceptance rate of 89.2%. 142 healthcare providers (63.7%) were trained in vacuum extraction. A proportion of 62.3% of providers knew the indications of vacuum extraction. For contraindications, only 34.5% of providers were able to cite one of them. Complications of vacuum extraction were known to 58.7% of our providers. There was a statistically significant difference between doctors and the others (midwifes, nurses) in the knowledge of indications, contraindications and complications of vacuum extraction. The only discriminatory parameter leading to this difference was initial and continuous training in vacuum extraction.Conclusions: It is important to introduce obstetric vacuum training in the gynaecology and obstetrics program for medical students and midwifery training schools, reinforce this training using simulators, include the practice of vacuum extraction in the internship objectives of medical students and midwives and evaluate them regularly