Jeanne Hortence Fouedjio

Viable abdominal pregnancy: a case report in Yaoundé (Cameroon)

We herein report a case of abdominal pregnancy managed in Yaounde (Cameroon). The 33 year old G5P2022 woman was referred to our setting for management of an abdominal pregnancy of 34 weeks diagnosed during the first routine obstetrical ultrasonography done two days earlier. This ultrasonography revealed a live foetus within intestinal loops with a severe oligoamnios. After two days of lung maturation, laparotomy was carried out and the live male baby weighed 2 600 grammes. The placenta was left on its implantation sites: omentun, uterine fundus and intestinal loops. The mother did well post-operatively and the resorption of the placenta took 11 months. The newborn presented compression deformities and died three days later of respiratory distress. This case illustrates that intra-abdominal fetuses can reach viability. Though rare, abdominal pregnancy remains a threat to mothers. Practitioners should therefore know the traps in its management.

A case of abdominal textiloma following gynecologic surgery at the Yaounde Central Hospital, Cameroon.

Textiloma is the inadvertent retention of a textile foreign body on the surgical site. It is a rare complication of surgery but which carries severe consequences for both patients and surgeons in terms of morbi-mortality and medico-legal procedures respectively. We herein report the case of an abdominal textiloma in a 42 year old woman who underwent a total abdominal hysterectomy for symptomatic leiomyomas. We also depict the errors that led to this mishap in a tertiary hospital in Yaounde (Cameroon). The textiloma was recognized six weeks after the causative surgery and removed by laparotomy without further complications.

Ovarian pregnancy: a case report in a resource-poor setting

Ovarian pregnancy is very rare and to our knowledge, no case has been reported in Cameroon. We herein report a case at the Yaounde Central Hospital. It is the case of a 29 years old woman who consulted in emergency for left pelvic pain at 9 weeks of pregnancy. The level of beta human chorionic gonadotropin was 96702 milli-international Units/ milliliter and ultrasound revealed an intra-ovarian gestational sac, an empty uterus and no peritoneal effusion. In the absence of facilities for laparoscopy, an emergency laparotomy was done. We found the non ruptured mass inside the left ovary. The left fallopian tube, the uterus and the right adnexae were normal. We did a successful ovarian dissection and resection of gestational sac. Trophoblastic tissue was found at pathology. Similar symptoms should draw attention of practitioners on the plausibility of ovarian pregnancy.

Fetal outcome of deliveries among teenagers in Centre Region of Cameroon.

1 Department of Obstetrics and Gynecology, Higher Institute of Medical Technologies of YaoundeCameroon, Obstetrics and Gynecology Unit of Yaounde Central Hospital, Research, Education and Health Development Group “GARES falaise” Dschang, P.O.Box: 31186 Yaounde, Cameroon. 2 Obstetrics and Gynecology Unit of Yaounde Central Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine and BioMedical Sciences of University of Yaounde I, Cameroon. 3 Department of Obstetrics and Gynecology, Faculty of Medicine and BioMedical Sciences of University of Yaounde I, Cameroon. 4 Faculty of Medicine, University of Lome, Togo, School of Armies Health Services of Lome, P.O.Box:14148 Lome, Togo. Department of Pediatrics, Faculty of Medicine and BioMedical Sciences of University of Yaounde I, Cameroon, P.O.Box:1364 Yaounde, Cameroon. Head of Obstetrics and Gynecology Unit of Yaounde Central Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine and BioMedical Sciences of University of Yaounde I, Cameroon.

Spontaneous second-trimester ruptured pregnancy of rudimentary horn: a case report in Yaounde, Cameroon

Rudimentary uterine horn pregnancy is rare and, to our knowledge, has not been previously reported in Cameroon. We herein report the case of a 22 year old second gravida referred for acute abdominal pain at 17 weeks of gestation. Physical examination revealed hemoperitoneum with hypovolemic shock. After resuscitation, an emergency exploratory laparotomy was done and we found hemoperitoneum of 3,500 milliliters, a bicornuate uterus with a ruptured right rudimentary communicating horn containing a non viable foetus. There were no other abnormalities. We performed an excision of the rudimentary horn with ipsilateral salpingectomy. Post-operative course was uneventful and the woman was discharged seven days later. This case emphasizes the importance of good antenatal care to avoid complications.

Ruptured heterotopic pregnancy in a natural conception cycle: a case report at the Yaounde central Hospital (Cameroon).

Heterotopic pregnancy is very rare under natural circumstances. We report the case of a 28 year old Gravida2 Para1001 woman at 9 weeks of pregnancy who consulted in emergency for acute pelvic pain following metrorrhagia. Physical exam revealed hemoperitoneum without shock. An emergency ultrasonography revealed two gestational sacs, one intra-uterine and the other extra-uterine. Laparotomy was done and the findings were: a ruptured right tubal pregnancy with 1,300 milliliters of hemoperitoneum, type B left utero-adnexal adhesions and an increased uterus consistent with a 9 weeks pregnancy. Right total salpingectomy was done and the patient did well postoperatively. That intrauterine pregnancy evolved normally under progesterone supply and the woman delivered a termed live female baby weighing 3.1 kilogrammes. In our context where ultrasound is not always available, practitioners carrying out salpingectomy for ruptured ectopic pregnancies should bear in mind the plausibleness of heterotopic pregnancy in order to properly handle the uterus.

Seroprevalences and Correlates of Hepatitis B and C Among Cameroonian Pregnant Women

Background and rationale: Viral hepatitis B (VHB) and viral hepatitis C (VHC) are major public health issues in resource-poor countries where vertical transmission remains high. Aim: To assess prevalences and correlates of VHB and VHC among women attending antenatal clinic. Methods: A cross-sectional study at the Yaounde Central Hospital from January 1 to June 30, 2016. We included 360 pregnant women who were screened for hepatitis B virus surface antigen (HbsAg) and VHCAb by rapid diagnostic test (DiaSpot Diagnostics, USA) followed by confirmation of positive results by a reference laboratory. Odds ratios (95% confidence interval [CI]) were used to measure associations between variables. Statistical significance was set for P-value <.05. Results: Mean age was 27.9 ± 5.6 years. The prevalences of HbsAg and VHCAb were 9.4% (n = 34) and 1.7% (n = 6), respectively. Multiplicity of sex partners was significantly associated with HbsAg positivity (adjusted odds ratio [aOR]: 11.6; 95% CI: 5.1-26.7; P < .001) while none of the studied factors was associated with VHCAb. Conclusion: The high prevalence of hepatitis B among pregnant women supports systematic screening and free vaccination of pregnant women and women of childbearing age.

Prise en charge des plaies du périnée en post partum: faut-il prescrire systématiquement un antibiotique?

Introduction Genital tract integrity is not always mantained during childbirth. No treatment protocol for post-partum perineal wounds (tears and episiotomies) existed in our Department, thus their management depends upon clinician. This study aimed to establish the role of antibiotic in the treatment of post-partum perineal wounds as well as the impact of antibioprophylaxis on wound healing and on prevention of infectious complications after repair. Methods We conducted a prospective cohort study in the Department of Gynecology and Obstetrics at the Central Hospital of Yaoundé over a period of 6 months, from 1 January to 31 May 2016. Post-partum women with perineal tear and/or episiotomy were divided into two groups (A and B) and followed up. The group A was composed by 85 post-partum women under treatment protocol based on compresses soaked in Betadine® (placebo). The Group B (or test group) was composed of post-partum women who had received placebo plus antibiotic (oral amoxicillin/clavulanic acid 875 mg/125 mg twice a day for 05 days). Both groups were followed up on day 0, day 2 and day 9. Our criteria for the evaluation of treatment were: pain, infection, swelling, cleanliness of the wounds and average healing time. Data were collected and analyzed using the software Epidata analysis version 3.2 and STATA version 12.0 (Texas USA 2001). The correlations between the variables were identified by chi-square, odds ratio and p value (using any p-value ≤ 0.05 as statistical significance cut-off) according to the case. Results The average age was 26.32 ± 6.5 years, ranging between 15 and 43 years. Primiparous women accouted for 55.9% of the study population. At day 0 post-partum the main symptom was pain, without significant predominance of a group (OR = 0.9; CI = 0.14-7.19; p = 1). Swollen wounds were the second complaint, without significant variation between the two groups (OR = 1.69; CI = 0.88-3.24; p = 0.13). At day 0, day 2 and day 9 no significant variation was observed between the two treatment protocols with regard to the indicators analyzed: pain evolution, infection, swelling and average healing time. At day 9 the healing was complete in both groups and the two treatment protocols were shown to be equivalent in their effectiveness and prevention of infections. Conclusion At the end of this study the two treatment protocols were shown to be equivalent. Antibiotics should not be prescribed for perineal wounds in order to contain the healthcare costs.

Seroprevalences and Associated Factors of Viral Infections (HIV, Hepatitis B and C) among Pregnant Women Attending Antenatal Care at the Yaoundé Central Hospital

Aims: A viral infection is a proliferation of a harmful virus inside the body. HIV infection, viral hepatitis B (HBV) and C (HCV) constitute a public health problem. They affect millions of people worldwide and particularly in Sub-Saharan Africa, and sometimes share common modes of transmission, among which vertical transmission. The objective of this study was to assess Original Research Article Fouelifack et al.; BJMMR, 20(1): 1-14, 2017; Article no.BJMMR.31003 2 seroprevalences and associated factors of these infections among pregnant women. Study Design: We carried out a cross-sectional and analytical study. Place and Duration of Study: Antenatal care clinic (ANC) of the Obstetrics and Gynecology Unit, at the Yaoundé Central Hospital (Cameroon) from 1st January to 30 June 2016. Methodology: We consecutively enrolled 360 women attending ANC. Blood samples were collected to screen for HIVAb, HBsAg and HCVAb through rapid diagnostic tests, and confirmed at the “Centre Pasteur” laboratory of Cameroon. Data were processed using Excel 2007, EpiData Analysis Version 3.2 and STATA version 12.0 (Texas USA 2001) softwares. Odds ratios were used to assess strength of the association between variables. Statistical significance was accepted for P value less than 0.05. Results: The mean age was 27.99 +/5.63 years, ranging from 15 and 47 years. The prevalence of HIVAb, HBsAg and HCVAb were 13.1% (n = 47), 9.4% (n = 34) and 1.7% (n = 6) respectively. We had 1.4% and 0.6% of HIV/HBV and HIV/HCV co-infections respectively. Independent risk factors associated with HIV were: the level of primary study (OR: 7.97; 95% CI = 2.23 28.49; P = 0.001) and multiple sexual partners (OR: 4 79; 95% CI = 1.79 12.79, P = 0.002). Multiple sexual partners was the Independent risk factor associated with HBsAg (OR: 11.62; 95% CI = 5.057 26.731; P = <0.001). No factor was associated with HCVAb. Conclusion: Increased awareness, promotion of screening and / or treatment of infections and immunization against HBV in the general population, and in women of childbearing age in particular, would reduce their impact and therefore prevent their horizontal and vertical transmission.

Aspects épidémiologiques, cliniques et thérapeutiques des tumeurs ovariennes présumées bénignes à l’Hôpital Central de Yaoundé

INTRODUCTION Supposed benign ovarian tumors (SBOT) are considered one of the most frequent reasons for gynecological consultation and one of the most common indications for gynecological surgery. METHODS We conducted a retrospective descriptive study in the Department of Obstetrics and Gynecology at the Central Hospital of Yaoundé. We carried out a 6-month study, over a five-year period, from 1 January 2010 to 31 December 2014. The study population consisted of all patients undergoing surgery for the treatment of supposed benign ovarian tumor during the study period. RESULTS The mean age was 29.33 ± 6.83 with a minimum age of 20 years and a maximum age of 48 years. The most represented age range was 21-25 years. The reason for consultation was pelvic pain in 93.90% of the cases. Eleven patients were pregnant women (33.3% of our study population) and 72.70% were in their first trimester. SBOTs in our series were: cyst rupture (36.40%), ovarian torsion (adnexal torsion) (27.30%), voluminous ovarian cyst (21.20%) intracystic haemorrhage (15.20% ). 26 (78.78%) patients were treated conservatively. However, adnexectomy was performed in 5 out of 9 patients with ovarian torsion. CONCLUSION Complex SBOTs can occur in our mids, especially in patients of reproductive age. Late diagnosis, especially in the case of ovarian torsion, obliges to perform radical procedure with deleterious effects upon the patient. Laparoscopy is the most recommended surgical procedure if the technical equipment is available because it reduces the risk of complications.