E. T. Mboudou

Conservative treatment of ectopic pregnancy in a sub-Saharan African setting

In the sub-Saharan African setting, laparotomy for salpingectomy is the common method of treatment for ectopic pregnancy (EP). The objective of this retrospective study was to find out how common EP is treated conservatively in the Yaounde Gynaeco-Obstetric and Paediatric Hospital, Cameroon. Of the 281 patient files analysed, 126 patients (44.8%) were treated conservatively and successfully for EP. Of these, 86 (68.2%) had received conservative surgical treatment while 40 (31.8%) had non-surgical treatment. Salpingostomy was the conservative surgery for 79.1% of the cases. According to the publications available for the sub-Saharan setting, the rate of conservative management of EP at the Yaounde Gynaeco-Obstetric and Paediatric Hospital, Cameroon is high. We recommend that this rate should be improved so that, eventually, the conservative treatment methods of EP become routine.

Gynaecological laparoscopic surgery: eight years experience in the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Cameroon.

This is a retrospective analysis of eight years of gynaecological laparoscopic surgery in a resource-limited setting. All gynaecological patients managed by laparoscopy at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital from 1 January 2004 to 30 November 2011 were included. Amongst the 9194 gynaecological surgeries performed during the study period, 6.9% (633) were done by laparoscopy. Most of the women underwent an operative laparoscopy (568/592; 95.9%). The most common indication was infertility (415/592; 70.1%). Diagnostic laparoscopies were mostly indicated for chronic pelvic pain (18/24; 75%). The most common surgical finding was tubo-peritoneal adhesions (412/592; 69.6%). A total of 35 patients (35/592; 5.9%) had at least one complication. The mean duration of hospitalization was 3.4 ±1.8 days. The general uptake of gynaecological laparoscopic surgery is low in our setting. The laparoscopic complication rate of 5.9% is encouraging.

Facteurs de risque et pronostic des césariennes d’urgence à l’hôpital gynéco-obstétrique et pédiatrique de Yaoundé (Cameroun)

OBJECTIVE To identify the risk factors for emergency cesarean deliveries and assess the effects of the emergency situation on maternal and fetal prognosis. METHODS This retrospective cohort study compared emergency and elective cesarean deliveries performed at the Yaoundé Womens and Childrens Hospital in Cameroon, analyzing socioeconomic variables, the indications for surgery, and complications for mother and child. RESULTS Risk factors predisposing to emergency cesareans were: age <20 years, not having a salaried job, unmarried status, no university-level education, referral from other health facilities, primiparity, prenatal care in a health center or in a district hospital, prenatal care by a nurse, and preadmission rupture of membranes. Emergency cesareans increased the mothers risk of general anesthesia, unavailability of standard preoperative work-up during surgery, infection, and a longer hospital stay. Babies born by emergency cesarean delivery had a higher risk of admission to the neonatology unit, neonatal asphyxia, neonatal infection, preterm birth, and perinatal death. CONCLUSION In our setting, lack of reproductive experience (primiparity), low socioeconomic level, poor prenatal care, and preadmission rupture of membranes were risk factors for emergency cesarean deliveries. The emergency situation exposes mother and child to a significant risk of morbidity and mortality.

Le vécu du premier examen gynécologique en milieu africain : cas du CamerounQuels ajustements apporter à son déroulement pour un meilleur vécu ?

UNLABELLED The gynecological examination is a key element in the diagnosis of the most genitourinary disorders. Improving how women experience the first gynecological examination (FGE) should have a significant impact on their perception of this examination and on their general feeling about it afterwards. OBJECTIVE The aim of our study was to describe the general feeling of Cameroonian women towards the FGE and to identify the factors associated with negative feelings. METHODOLOGY In this one-month survey study, we asked patients to complete a questionnaire about how they had experienced the FGE. The answers have been analyzed and the factors influencing the way they experience this examination determined. RESULTS At the end of the FGE, 41.5% of the women had negative feelings, and 38.6% reported that the examination had been painful. The average age of women who experienced pain was younger than that of those who did not [19.4 vs 20.39 years, P = 0.029], as was that of women with negative feelings lower [19.41 vs 20.43 years, P = 0.024]. A negative experience was significantly associated with a painful examination [P≤0.001], an examiner not specialized in gynecology [P = 0.04], lack of information [P = 0.001], and lack of a separate room to undress [P = 0.038]. The rate of subsequent refusals of a gynecological examination was higher among women with a negative first experience [56.2% vs. 35.9%, P = 0.008]. CONCLUSION The FGE is experienced by Cameroonian women as very difficult. Their feelings at the end of this examination significantly influences their behavior towards gynecological examinations in general.

The diagnosis of uterine cervical polyps in a low resource setting: the positive predictive value of clinical judgment--a series of 192 cases at the Yaounde Gynaeco-Obstetric and Paediatric Hospital, Cameroon.

As far as we know, the accuracy of clinical judgment in diagnosing uterine cervical polyps has not been assessed in sub-Saharan Africa. Our objective was to discover the positive predictive value (PPV) of clinical judgment in the diagnosis of cervical polyps. This is a retrospective descriptive study of 192 patients, carried out by the Departments of Pathology and Gynaecology of the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Cameroon. The diagnosis of cervical polyp was confirmed by histopathology examination in 169 patients, giving a PPV rate of 88.0%. The PPV of clinical judgment in the diagnosis of cervical polyps is acceptable in our setting but the frequency of premalignant and malignant lesions encountered is too high (10.4%), even in the presence of a confirmed cervical polyp (8.9%). Even in areas where there are limited resources, we recommend a systematic histopathology examination of any clinically suspected cervical polyp.

Male versus female condoms for contraception

CITATION: Motaze, N. V., Okwundu, C. I., Temfack, E. & Mboudou, E. 2013. Male versus female condoms for contraception. Cochrane Database of Systematic Reviews, 6. Art. No.: CD010579, doi:10.1002/14651858.CD010579.