Félix Essiben

Maternal and Fetal Outcomes Following Labour at Term in Singleton Pregnancies with Meconium-Stained Amniotic Fluid: A Prospective Cohort Study

Background: Meconium stained amniotic fluid (MSAF) is frequently encountered in obstetric practice. Literature on the subject is still poorly documented in the African setting. Objective: The aim of this study was to determine the maternal and fetal outcomes in case of meconium stained amniotic fluid observed during term labour. Materials and Methods: We conducted a prospective cohort study enrolling all consenting pregnant women with term singleton fetus in cephalic presentation admitted for labour with ruptured fetal membranes in the maternity units of the Yaounde Central Hospital (YCH) and the Yaounde Gynaeco-Obstetric and Pediatric Hospital (YGOPH) of Cameroon between December 2014 and April 2015. The exposed grouped was considered as participants having MSAF, while the non-exposed group comprised those with clear amniotic fluid (CAF). The two groups were monitored during labor using the WHO partograph, and then followed up till 72 hours after delivery. Variables studied included the colour and texture of amniotic fluid as well as maternal and fetal complications. Data was analyzed using Epi-info version 3.5.4. The chi-square and Fischer’s exact tests were appropriately used to compare the two groups. A p-value less than 5% was considered statistically significant. Results: 2376 vaginal deliveries were recorded during the study period among which MSAF was observed in 265 cases, hence a prevalence rate of MSAF of 11.15%. Among these cases of MSAF, 52.1% was thick meconium and 47.9% was light meconium. Maternal morbidity was high in the group with MSAF; these included: Higher proportions of caesarean delivery (RR = 2.35 p < 10-4) and prolonged labor (RR = 3 p < 10-4). In this same group, the incidences of chorioamnionitis and puerperal sepsis were low (0.94% and 0.70% respectively), although there was a three-fold higher risk that was not statistically significant (RR = 3, P = 0.31). Fetal and neonatal outcomes were poorer in the MSAF group compared to the CAF group. The complications included fetal heart rate abnormalities, low Apgar score at the 5th minute, need for neonatal resuscitation, neonatal asphyxia and neonatal infection which were significantly higher in the MSAF group (all p < 0.05). Meconium aspiration syndrome (MAS) was found in 2.34% of MSAF cases. Perinatal mortality was 2.34% and all cases of death occurred in the thick MSAF group. Conclusion: MSAF observed during labour is associated with increased perinatal morbidity and mortality. Its detection during labor should strongly indicate very rigorous intra partum and postpartum monitoring. This will ensure optimal management and reduction in the risks of complications.

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

GAD-7 and PHQ-9 measurement of perinatal anxiety and depression in women with hypertensive disorders of pregnancy in Yaounde, Cameroon

Worldwide, millions of pregnant women are identified as being at high risk for obstetrical complications yearly. Mental health is fundamental to health and pregnancy and the puerperium is at times sufficiently stressful to provoke exacerbation, recurrence or new onset of mental illness thereby leading to complications. Hence maternal perinatal health has enormous consequences for the wellbeing of the mother, her baby and the family.4 Because perinatal anxiety and depression could lead to serious consequences including poor obstetric and neonatal outcome, the American College of Obstetricians and Gynecologists (ACOG) recommends that women be screened during pregnancy. The Royal College of Obstetricians and Gynecologists equally recommends ABSTRACT

Facteurs prédictifs de l’échec du Traitement Préventif Intermittent du paludisme à la sulfadoxine – pyriméthamine (TPIp-SP) dans une population de femmes enceintes à Yaoundé

INTRODUCTION Intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) is recommended for malaria prevention during pregnancy. We investigated factors associated with the failure of this strategy. METHODS We conducted a case-control study in two health care facilities in Yaounde, from 1 May 2014 to 30 April 2015. Pregnant women treated with IPTp-SP, hospitalized for malaria and having a positive Rapid Diagnostic Test (RDT) result (case-subjects) were compared to pregnant women treated with IPTp-SP having a negative RDT result (control-subjects). Epi Info 7 software and SPSS 18.0 software were used with P< 0.05 as significance threshold. RESULTS We recruited 234 subjects, 109 (46.6%) case-subjects and 125 control-subjects (53.4%). The associated factors found were: prematurity (P=0.03; OR=1.15; IC= 0.32 - 4.10), the non-use of LLIN (P=0.006; OR= 2.31; IC= 1.26 - 4.25), a history of hospitalization for malaria (P=0.007; OR= 2.19; IC= 1.23 - 3.89), IPTp-SP administration after 28 gestational weeks (P=0.001, OR= 3.55; IC= 1.7 - 7.61). After logistic regression, prematurity (P=0.024; OR=2.01; IC=1.1-3.7) and a history of hospitalization for malaria (P=0.001; OR=2.83; IC=1.50-5.4) remained associated with IPTp-SP failure. CONCLUSION A history of hospitalization for malaria and prematurity are independent predictor of IPTp-SP failure.