Emile Mboudou

Profil des cancers gynécologiques et mammaires à Yaoundé - Cameroun

Introduction En Afrique subsaharienne, les cancers constituent un fléau dont les caractéristiques restent à préciser. Méthodes Afin de déterminer les aspects histologiques et cliniques des cancers gynécologiques et mammaires au Cameroun, nous avons mené une étude descriptive et rétrospective sur une période de 54 mois à lHôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé. Résultats Les 424 cas enregistrés se répartissaient ainsi: cancers du col de lutérus: 210 cas (49.5%); du sein: 144 cas (34%); de lovaire: 31 cas (7.4%); de lendomètre: 21 cas (4.9%); de la vulve: 14 cas (3.3%); du vagin: 1 cas (0.2%) et les sarcomes utérins: 3 cas (0.7%). Pour le cancer du sein, l’âge moyen au diagnostic était de 46.08±4.0 ans, 92.4% de patientes présentaient une masse (dont 60.9% localisées au quadrant supéro-externe), 76.4% étaient découverts aux stades T3 et T4, et 71.5% étaient les carcinomes canalaires. Pour les cancers du col, l’âge moyen au diagnostic était de 52.43±3.82 ans, 62.9% étaient découverts aux stades FIGO 1 et 2, et 87.6% étaient des carcinomes épidermoïdes. Pour le cancer de lovaire, l’âge moyen au diagnostic était de 49.0±9.31 ans, 90.3% étaient des tumeurs épithéliales et 74.2% étaient aux stades 2 et 3 (FIGO). Quant aux cancers de lendomètre, l’âge moyen au diagnostic était de 59±14.55 ans, 90.5% étaient des adénocarcinomes. Conclusion Les principaux cancers étaient ceux du col de lutérus et du sein. Le diagnostic étant souvent fait aux stades tardifs et par conséquent de mauvais pronostic, la prévention des cancers gynécologiques et mammaires devrait être renforcée au Cameroun.

Successful medical treatment of a hepatic pregnancy: a case report

BackgroundHepatic pregnancy is a rare form of abdominal pregnancy, often documented only as case reports.Case presentationWe report here the case of a 24-year-old African woman, gravida 4 para 3, presenting with right upper quadrant pains and metrorrhagia after amenorrhea of 8xa0weeks 5xa0days. Elements in favor of the diagnosis of hepatic pregnancy were her clinical presentation, the kinetics of β-human chorionic gonadotropin titers, and the presence of a sub-hepatic mass on ultrasound. We successfully treated this patient with intramuscular methotrexate only.ConclusionsThe interest of this case resides in the rarity of this condition and the therapeutic approach used. Clinicians should raise their index of suspicion for hepatic pregnancy when faced with females of reproductive age with such a clinical presentation.

Neonatal survival following cesarean delivery in northern Cameroon

a Department of Obstetrics and Gynecology, Provincial Hospital, Maroua, Cameroon b Department of Obstetrics and Gynecology, University Teaching Hospitals, Yaoundé, Cameroon c Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK d Department of Anesthesiology and Reanimation, University Teaching Hospitals, Yaoundé, Cameroon e Department of Pediatrics, University Teaching Hospitals, Yaoundé, Cameroon

Fertility after ectopic pregnancy in a district hospital in Cameroon.

To assess spontaneous conception after an ectopic pregnancy (EP) in a rural area of a low‐resource country.

Factors preventing the use of modern contraceptive methods in sexually active adolescents in Yaounde

Introduction: The use of contraceptives is timid in adolescents. We aimed to identify the determinants against modern contraception in adolescents in Yaoundé. Methodology: We conducted a case-control study, carried out in schools during a 5-month period from January to May 2016. All sexually active adolescents who were contraception-shy were compared to their peers who used modern contraceptive methods. We analysed the data obtained using Epi info 3.5.4 and SPSS 2.0. Results: We recruited 270 adolescents aged 15 to 19 years (135 cases and 135 control subjects). After univariate analysis, the factors preventing the use of modern contraception included: living with both parents (OR=1.71; CI=1.03-2.88), living with a single father (OR=3.25; CI=1.07-11.74), not living with one’s mother (OR=6.83; CI=3.33-14.83), being unable to talk about sexuality with one’s peers (OR=5.84; CI= 2.79-12.23), having only one partner (OR=2.28; CI=1.32-3.94), anal sex (OR=4.24; CI=2.15-8.35), pornography (OR=1.66; CI=1.03-2.696), abstention from family planning services (OR=2.32; CI=1.294.16), ignorance on the after pill (OR=2.28; CI=1.12-4.82) and not knowing injectable contraceptives. Following logistic regression, the independent factors we identified included: living with both parents (aOR= 3.24), not living with one’s mother (aOR=6.02), being unable to talk about sexuality with one’s peers (aOR=8.64), the practice of anal coitus (aOR= 4.32) as well as ignorance regarding injectable contraceptive methods (aOR=3.23). Conclusion: The family environment, sexual habits and knowledge on contraception limit the request for modern contraception on the part of adolescents. Adolescents need better support to face the challenges of their sexuality. Correspondence to: Felix Essiben, Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé 1, Yaounde-Cameroon, Tel: 00236 675024885, E-mail: essibenx@yahoo.com

Comparison of materno-fetal predictors and short-term outcomes between early and late onset pre-eclampsia in the low-income setting of Douala, Cameroon.

To describe and compare materno‐fetal predictors and short‐term outcomes of early onset pre‐eclampsia (EOPE) and late onset pre‐eclampsia (LOPE) in Douala, Cameroon.

Pronostic des références obstétricales à l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé (HGOPY)

Introduction L’impact des références sur la survenue des complications obstétricales n’est pas encore connu. Notre but était d’identifier les complications associées aux références obstétricales à Yaoundé. Méthodes Il s’agissait d’une étude transversale descriptive et analytique du 1er Février au 31 Juillet 2015 à l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé, ayant comparé les femmes référées aux non référées et leurs nouveau-nés respectifs. L’échantillonnage était consécutif et exhaustif pour l’analyse des caractéristiques sociodémographiques, obstétricales et néonatales précoces. Les tests de Chi carré et exact de Fisher ont aidé à comparer les variables qualitatives. L’analyse par régression logistique a permis d’éliminer les facteurs confondants. P était significatif si p < 0,05. Résultats Après analyse multi variée, les complications obstétricales statistiquement significatives chez les patientes référées étaient: la rupture prématurée des membranes (OR ajusté = 9,37, IC95%: 2,52-66,98, p = 0,002); la prématurité (OR ajusté = 4,14 (1,88-9,16; P < 0,001) et le décès après asphyxie néonatale sévère (OR ajusté = 6,48 (1,17-35,80); P = 0,032). Conclusion La rupture prématurée des membranes, la prématurité et le décès après asphyxie néonatale sévère sont les complications associées aux références obstétricales à Yaoundé.IntroductionnThe impact of referred patients with an obstetric emergency due to complications is not yet known. This study aimed to identify the complications associated with obstetric emergency in referred patients in Yaoundé.nnnMethodsnWe conducted a cross-sectional descriptive and analytical study at the Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital from 1 February to 31 July 2015. We compared the women referred to the Emergency Department with the non-referred women and their newborns respectively. Consecutive and comprehensive sampling technique was used for early analysis of the sociodemographic, obstetric and neonatal features. Chi-squared tests and Fisher exact probability test helped to compare the qualitative variables. Logistic regression analysis helped to eliminate the confounding factors. The significant level was set at p < 0.05.nnnResultsnAfter multivariate analysis, statistically significant obstetric complications in referred patients were: premature rupture of membranes (adjusted OR = 9.37, CI 95%: 2,52-66,98, p = 0.002); preterm birth (adjusted OR = 4.14 (1,88-9,16; p < 0.001) and death after severe neonatal asphyxia (adjusted OR = 6.48 (1,17-35,80); p = 0.032).nnnConclusionnPremature rupture of the membranes, preterm birth and death after severe neonatal asphyxia are the complications associated with obstetric emergency in referred patients in Yaoundé.

Evaluation of patientssatisfaction after laparoscopic surgery in a tertiary hospital in Cameroon (Africa)

Introduction Access to laparoscopy is low in Cameroon where customers satisfaction has not been reported so far. We assessed patients satisfaction with the process of care during laparoscopic surgery in a new tertiary hospital. Methods A questionnaire was addressed to consenting patients (guardians for patients under 18) with complete medical records who underwent laparoscopy at the Douala Gynaeco-Obstetric and Paediatric Hospital (Cameroon) from November 1, 2015 to July 31, 2016. The following modified Likerts scale was used to assess satisfaction: very weak: 0-2.5; weak 2.6-5; good: 5.1-7.5; very good: 7.6-10. Only descriptive statistics were used. Results Response rate was 90% (45/50). Of the 45 respondents, 39 (86.7%) were female, 14(31.1%) were referred and 39 (86.7%) paid by direct cash deposit. Mean age was 36.8±11.9 years. Laparoscopies were carried out in emergency for 3 (6.7%) patients. Digestive abnormalities indicated 13 (28.9%) laparoscopies while gynaecologic diseases accounted for 32 (71.1%) cases. Perception of the overall care process was good with a mean satisfaction score of 6.8 ± 1.4. Scores in categories were: 0% (Very weak); 13.3% (weak); 57.8% (good) and 28.9% (very good). Specifically mean satisfaction scores were: 7.8 ± 1.0 with doctors care; 7.1 ± 1.3 with hospital administration; 7.0 ± 1.2 with nursing and 4.7 ± 1.4 with the costs. Main complaints were: long waiting time (73.3%), constraining geographical access (66.7%) and expensiveness (48.9%). Conclusion Patients were globally satisfied with the process of care but financial and geographical barriers should be addressed.

Maternal and neonatal outcomes of vaginal breech delivery for singleton term pregnancies in a carefully selected Cameroonian population: a cohort study

Background and objectives Vaginal breech delivery (VBD) is known to be associated with more perinatal and maternal complications. Very few studies on the subject have been carried out in poor-resource settings. The aim of this study was to determine maternal and neonatal outcomes in carefully selected cases of VBD for singleton term pregnancies in a tertiary centre in Cameroon. Design A retrospective cohort study. Setting A tertiary hospital in Yaounde, Cameroon. Participants Cases of VBD of newborns weighing 2500–3500u2009g were matched in a ratio of 1:4 to consecutive vaginal cephalic deliveries (VCDs) of newborns weighing 2500–3500u2009g over a 5-year period. Both groups were matched for maternal age and parity. We excluded cases of multiple gestations, footling breech, clinically inadequate maternal pelvis, preterm delivery, post-term pregnancies, fetal demise prior to the onset of labour, placenta praevia and fetal anomaly incompatible with vaginal delivery. Outcome measures Neonatal and maternal adverse outcomes of VBD observed till 6u2009weeks after delivery analysed using Bonferroni correction. Results Fifty-three (53) VBDs were matched against 212 VCD. Unlike women who had VCD, those who underwent VBD were more likely to have prolonged labour (OR 8.05; 95%u2009CI 3.00 to 11.47; P<0.001), and their newborns were more likely to suffer from birth asphyxia (OR 10.24; 95%u2009CI 4.92 to 21.31; P<0.001). Conclusion The study infers a strong association between VBD of singleton term pregnancies and maternofetal morbidity when specific protocols are applied. This, however, failed to translate into higher differences in perinatal mortality. This finding does not discount the role of VBD in low-income countries, but we emphasise the need for specific precautions like close monitoring of labour and adequate anticipation for neonatal resuscitation in order to reduce these complications.

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.