Elie Nkwabong

Neonatal outcome in cases of nuchal cord in Cameroon

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Indications and maternofetal outcome of instrumental deliveries at the University Teaching Hospital of Yaoundé, Cameroon:

Instrumental deliveries are believed to be associated with increased maternal and, especially, fetal morbidity and mortality. Hence, it is less practiced in many developing countries. The aim of this retrospective study, conducted between 1 January 2007 and 31 December 2008, was to assess the prevalence, indications, neonatal wellbeing and maternal complications of instrumental deliveries. Of 3623 vaginal deliveries, 84 (2.3%) instrumental deliveries were conducted. The most common indication was a prolonged second stage of labour. Fetal wellbeing, measured by the Apgar score, was good and was similar in the group who had forceps delivery and that of the vacuum extraction delivery group. Maternal complications, usually minor, were vaginal and perineal tears. Instrumental delivery should be encouraged and taught in order to reverse the rising caesarean section rate.

Factors associated with poor attendance at the postpartum clinic six weeks after delivery in Cameroon

To identify reasons why women do not attend the 6‐week postpartum clinic in Cameroon.

Stillbirths at University Teaching Hospital, Yaoundé, Cameroon

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Urethrovaginal fistula following vaginal prolapse of a pedunculated uterine myoma: a case report

BackgroundUrethrovaginal fistulas are usually secondary to a foreign body in the vagina or to vaginal gynecologic surgeries. We present a case of an urethrovaginal fistula secondary to vaginal prolapse of a huge pedunculated submucosal uterine myoma.Case presentationA 25-year-old black African woman with a past history of huge uterine fibroids and an uncomplicated vaginal delivery 5 weeks prior to presentation consulted for a difficult micturition that occurred 2 days earlier. A vaginally prolapsed huge uterine myoma was diagnosed. The fibroid was easily twisted off per vagina. Around 9 days after prolapse of the fibroid or 5 days after its removal, she complained of a vaginal leaking of urine during micturition. An urethrovaginal fistula was diagnosed using a blue dye test. The fistula was successfully repaired with polyglactin and she was discharged on day 15.ConclusionsTo the best of our knowledge, this is the first case of urethrovaginal fistula secondary to delivered uterine myoma. We recommend close postpartum follow-up of women carrying huge uterine fibroid and urgent management of a vaginally prolapsed uterine fibroid to reduce the risk of urethrovaginal fistula.

Urethrovaginal Fistula Following Vaginal Prolapse of a Pedunculated Uterine Myoma: A Case Report

Urethrovaginal fistulas are usually secondary to vaginal foreign body or to gynaecological surgery. The authors hereby present a case of an urethrovaginal fistula that occurred in a woman with vaginal prolapse of a pedunculated myoma. The fistula was successfully repaired. The authors recommend the urgent management of a vaginally prolapsed uterine fibroid to reduce the risk of urethrovaginal fistula formation.

An intramural uterine fibroid became submucosal in the puerperium – proposed probable mechanism: a case report

BackgroundVaginal prolapse of a large uterine fibroid is a rare phenomenon in a woman who delivered vaginally recently, given that this fibroid might have obstructed labor. The author presents a case report of a vaginally prolapsed large pedunculated submucosal uterine myoma in a woman with a recent uncomplicated vaginal delivery.Case presentationA 25-year-old black African woman had four intramural uterine fibroids of diameters 62 to 94 mm diagnosed in April 2013 with standard ultrasound scan. She got pregnant in July 2014. An ultrasound scan done on 31 August 2014 at 10 weeks’ gestation identified four intramural uterine fibroids, with sizes varying from 70 to 150 mm. Her pregnancy was well followed up, without any complications. She had an uneventful vaginal delivery on 10 April 2015. During uterine exploration, indicated for retention of parts of fetal membranes, no pedunculated submucosal fibroid was found. On 15 May 2015, she consulted for difficult micturition and partial urinary retention that occurred 2 days ago. A vaginally prolapsed 10 cm uterine fibroid was diagnosed. Forty-eight hours after administration of intravenously administered broad spectrum antibiotics, the myoma was successfully twisted off by means of vaginal route under general anesthesia, which relieved her symptoms.ConclusionsTo the best of our knowledge, this is the first case of vaginally prolapsed large submucosal uterine fibroid in a woman who delivered vaginally recently. The author recommends that women with known large low situated uterine fibroid should be well observed during the postpartum period to diagnose a vaginally prolapsed uterine fibroid early, so as to prevent fibroid superinfection and obstructive complications.

Outcome of labor among women admitted at advanced cervical dilatation

Abstract Objective: To identify in our setting the outcome of labor among women admitted at advanced cervical dilatation. Methods: This prospective cohort study was carried out between 1 December 2015 and 31 March 2016. Women carrying live term singletons in vertex presentation admitted with a cervical dilatation >5 cm (late arrival group) or ≤5 cm (early arrival group) were followed up till delivery. The main variables studied included mode of delivery, genital lacerations, and postpartum hemorrhage (PPH). Data from women in both groups were compared. Fisher’s exact test and t-test were used for comparison. p < .05 was considered statistically significant. Results: Late arrival in the labor ward was observed in 52.5% of women (126/240). Late arrival in the labor ward was significantly associated with a reduction in the cesarean section (CS) risk (Relative risk (RR) 0.34, 95%CI 0.12–0.94), but with an increased risk of lower genital tract lacerations (RR 2.3, 95%CI 1.3–3.8), PPH (RR 4.5, 95%CI 1.04–20.2), and admission of the newborn in the neonatal intensive care unit for neonatal asphyxia or infection (RR 3.6, 95%CI 1.04–12.5). Conclusion: Late arrival in the labor ward was associated with an increased risk of maternal and neonatal morbidity. Therefore, women should be encouraged to arrive early in the labor ward.

Risk factors for nuchal cord entanglement at delivery

To identify nuchal cord risk factors.

Uterus preserving surgery versus hysterectomy in the treatment of refractory postpartum haemorrhage in two tertiary maternity units in Cameroon: a cohort analysis of perioperative outcomes

BackgroundLittle evidence exists on the efficacy and safety of the different surgical techniques used in the treatment of postpartum haemorrhage (PPH). We aimed to compare uterus preserving surgery (UPS) versus hysterectomy for refractory PPH in terms of perioperative outcomes in a sub-Saharan African country with a known high maternal mortality ratio due to PPH.MethodsThis was a retrospective cohort study comparing the perioperative outcomes of all women managed by UPS (defined as surgical interventions geared at achieving haemostasis while conserving the uterus) versus hysterectomy (defined as surgical resection of the uterus to achieve haemostasis) for PPH refractory to standard medical management in two tertiary hospitals in Cameroon from January 2004 to December 2014. We excluded patients who underwent hysterectomy after failure of UPS. Comparison was done using the Chi-square test or Fisher exact test where appropriate. Bonferroni adjustment of the p-value was performed in order to reduce the chance of obtaining false-positive results.ResultsWe included 24 cases of UPS against 36 cases of hysterectomy. The indications of surgery were dominated by uterine rupture and uterine atony in both groups. Types of UPS performed were seven bilateral hypogastric artery ligations, seven hysterorraphies, six bilateral uterine artery ligations, three B-Lynch sutures and one Tsirulnikov triple ligation with an overall uterine salvage rate of 83.3%. Types of hysterectomies were 26 subtotal hysterectomies and 10 total hysterectomies. UPS was associated with maternal deaths (RR: 2.3; 95% CI: 1.38–3.93.; p: 0.0015) and postoperative infections (RR: 1.96; 95% CI: 1.1–3.49; p: 0.0215). The association of UPS with maternal death was not attenuated after Bonferroni correction. Hysterectomy had no statistically significant adverse outcome.ConclusionHysterectomy is safer than UPS in the management of intractable PPH in our setting. The choice of UPS as first-line surgical management of PPH in resource-limited settings should entail diligent anticipation of these adverse maternal outcomes in order to lessen the perioperative burden of PPH.