Joseph Nelson Fomulu

Neonatal outcome in cases of nuchal cord in Cameroon

[1] KhanM, Pillay T, Connolly CA, Moodley JM. Durban Perinatal TB HIV-1 Study Group. Maternal mortality associated with tuberculosis-HIV-1 co-infection in Durban, South Africa. AIDS 2001;15(14):1857–63. [2] Jana N, Vasishta K, Jindal SK, Khunnu B, Ghosh K. Perinatal outcome in pregnancies complicated by pulmonary tuberculosis. Int J Gynecol Obstet 1994;44(2):119–24. [3] Ali AA, Adam I. Lack of antenatal care, education, and high maternal mortality in Kassala hospital, eastern Sudan during 2005–2009. J Matern Fetal Neonatal Med 2011;24(8):1077–8. [4] Maddineni M, Panda M. Pulmonary tuberculosis in a young pregnant female: challenges in diagnosis and management. Infect Dis Obstet Gynecol 2008;2008: 628985.

Surgical outcome following treatment of obstetric vesicovaginal fistula among HIV-positive and HIV-negative patients in Cameroon.

a Department of Obstetrics and Gynecology, University Centre Hospital, Yaoundé, Cameroon b Ligue d’Initiative et de Recherche Active pour la Santé et l’Education de la Femme (LIRASEF), Yaoundé, Cameroon c Department of Obstetrics and Gynecology, Maroua Regional Hospital, Maroua, Cameroon d Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon e Geneva Foundation for Medical Education and Research, Geneva, Switzerland

Risk factors for obstetric vesicovaginal fistula at University Teaching Hospital, Yaoundé, Cameroon

eclampsia. However, some authors have documented an increased risk of developing pregnancy-induced hypertension in employed women because of the stress these patients are under; however, these authors did not evaluate the effect of employment on the risk of convulsion [6]. Prenatal care and bed rest have been recommended as possible preventive measures or a way of delaying the onset of convulsions in pre-eclamptic women who come under this category [5]. Prenatal care awareness is invariably linked to the level of education of pregnant women. In a less educated region like the Far North of Cameroon—where the level of illiteracy is 67% among women aged 15–49 years, as reported in the 2004 Demographic and Health Survey—it is not surprising that 48.7% of the patients in the present study with these high-risk pregnancies had no formal education. In conclusion, teenage pregnancy, nulliparity, and low educational status were identified as risk factors for convulsion in women with pre-eclampsia. Further research is needed to explore the risk factors that are likely to have high predictive values for eclampsia. Identification of these factors, good prenatal surveillance, and institution of proper management will decrease feto-maternal morbidity and mortality associated with hypertensive disorders in pregnancy. Conflict of interest

Risk factors for eclampsia among patients with pregnancy-related hypertension at Maroua Regional Hospital, Cameroon

[1] Doumouchtsis SK, Papageorghiou AT, Arulkumaran S. Systematic review of conservative management of postpartum hemorrhage: what to do when medical treatment fails. Obstet Gynecol Surv 2007;62(8):540–7. [2] National Department of Health. A Monograph of the Management of Postpartum Haemorrhage. South Africa: National Department of Health; 2010. Available at: http://www.doh.gov.za/docs/policy/2011/haemorrhage.pdf. [3] Ikeda T, Sameshima H, Kawaguchi H, Yamauchi N, Ikenoue T. Tourniquet technique prevents profuse blood loss in placenta accreta cesarean section. J Obstet Gynecol Res 2005;31(1):27–31. [4] Verkuyl DA. Fast and easy provisional treatment of severe postpartum haemorrhage. BJOG 2007;114(7):908–9. Table 1 Details of 13 patients who had a tourniquet applied to control postpartum hemorrhage.

Emergency obstetric hysterectomy at University Hospital, Yaoundé, Cameroon

day of the week (weekdays or weekends) [4] that maternal deaths occurred. Although it is difficult to draw definite conclusions on the linkages between the hospital shifts and the maternal deaths, the low numbers of doctors and midwives available on any given day of the week might be an area to be reviewed by hospital managers. There is however the need for further qualitative research to draw these linkages and implement recommendations to avert maternal deaths.

Prognostic value of repeated surgery on obstetric vesico-vaginal fistula outcome: A Cameroonian experience

Abstract Objective To analyze the outcome of repeat repair of vesico-vaginal fistula following a failure. Methods This was a cross-sectional analytic study in two different obstetric fistula surgery units at the Regional Hospital of Maroua-Cameroon and the University Teaching Hospital of Yaounde-Cameroon. The study period covered from January 2005 to December 2007 for the regional Hospital and from January 2008 to December 2011 for the University Teaching Hospital. During these periods, the first author was medical consultant in these institutions. Among the overall 81 operations analyzed, we had 31 repeat operations and 50 operations at first attempt. The chi -square test was used to compare the distribution of the various variables in the two study populations. Results Among the overall 81 operations analyzed, we had 31 repeat operations (37%) and 50 operations (63%) at first attempt. The success rates of closure of the fistula deteriorate with the number of attempts and vary from 88.2% at the first attempt, 76.9% at the second attempt, to 64.7% as from the third attempt. The result in terms of closing with continence also varies with the order of attempt with respective rates of 72.5%, 69.2% and 41.1% at the first, second and third attempts. Conclusion The result in terms of closing with continence of obstetric fistula surgery decreases with the number of surgical attempts.

Stillbirths at University Teaching Hospital, Yaoundé, Cameroon

[1] Rüdiger RA, Haase W, Passarge E. Association of ectrodactyly, ectodermal dysplasia, and cleft lip-palate. Am J Dis Child 1970;120(2):160–3. [2] Roelfsema NM, Cobben JM. The EEC syndrome: a literature study. Clin Dysmorphol 1996;5(2):115–27. [3] BronshteinM, Gershoni-Baruch R. Prenatal transvaginal diagnosis of the ectrodactyly, ectodermal dysplasia, cleft palate (EEC) syndrome. Prenat Diagn 1993;13(6):519–22. [4] Clements SE, Techanukul T, Coman D, Mellerio JE, McGrath JA. Molecular basis of EEC (ectrodactyly, ectodermal dysplasia, clefting) syndrome: five new mutations in the DNA-binding domain of the TP63 gene and genotype-phenotype correlation. Br J Dermatol 2010;162(1):201–7.

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.

Postpartum hemorrhage at Yaoundé University Hospital, Cameroon

Postpartum hemorrhage (PPH) is one of the leading causes of pregnancy-related mortality, accounting for up to 38% of maternal deaths [1,2]. The case fatality rate ranges from 1%–5% in many studies [1–3]. A retrospective cross-sectional study was conducted at the University Hospital Center, Yaoundé, Cameroon after receiving Ethical Committee approval. The files of patients seen between January 1, 2005 and December 31, 2009 were included in the study and reviewed. Informed consent from the patients was not required. A total of 10 302 deliveries were registered, including 419 cases of PPH. Of the PPH cases, 76 (18.1%) were excluded: 73 files were not found, 2 files were wet and therefore illegible, and 1 file was empty. A total of 343 files from women who had experienced early PPH— defined as PPH occurring within the first 24 hours following delivery— were identified. For every case of PHH, 2 consecutive patients without PPH who delivered after the PPH patient were selected as controls (686 women). Data were collected on sociodemographic characteristics, clinical and obstetric history, management, and maternal outcome in both groups of patients. Epi Info version 3.5.1 (CDC, Atlanta, GA, USA) was used for data analysis. Odds ratios and 95% confidence intervals were used to assess the effect of potential risk factors on the occurrence of PPH. Pb0.05 was considered statistically significant. Of 10 302 births recorded, there were 419 (4.1%) cases of PPH. This prevalence is similar to that reported by others [3]. The etiology of PPH included atony (49.9%), retained placenta (39.2%), vaginal and perineal tear (6.9%), cervical tear (5.5%), uterine rupture (1.5%), placenta accreta (1.2%), stillbirth (1.2%), and endometritis (0.9%). The mean age of the patients was 27.3±5.8 years (Table 1). Of those with PPH, 124 (36.2%) had prolonged labor (over 12 hours), 18 (5.2%) had had a previous cesarean delivery, 8 (2.3%) had uterine fibroids, 10 (2.9%) had placental abruption, and 3 (0.9%) had experienced previous PPH. Risk of PPH was higher in patients who had a stillbirth delivery (Pb0.01), fever during labor (Pb0.01), multiple pregnancy (Pb0.01), labor induction (Pb0.01), instrumental vaginal delivery (P=0.04), prolonged labor (over 12 hours) (Pb0.01), history of uterine fibroids (P=0.01), history of placental abruption (Pb0.01), history of cesarean delivery (Pb0.01), and history of polyhydramnios (P=0.01) (Table 2). After adjusting for confounding factors, several independent risk factors for PPH were identified: history of uterine fibroids (adjusted odds ratio [aOR] 6.29; 95% CI, 1.6–25.3; Pb0.01); history of cesarean delivery (aOR 2.31; 95% CI, 1.2–4.3; Pb0.01); parity of 4 and above (aOR 2.03; 95% CI, 1.3–3.2, Pb0.01); prolonged labor (aOR 1.74; 95% CI,1.1– 2.8; P=0.01); twin delivery (aOR 3.18; 95% CI,1.7–5.8; Pb0.01); and fever during labor (aOR 4.89; 95% CI, 1.3–18.5); Pb0.01) (Table 2). Similar risk factors were reported by other authors [3,4]. Endouterine evacuation was performed immediately after diagnosis in 289 (84.3%) PPH cases by either a midwife or gynecologist. Surgical management included 4 (1.2%) cases of hysterectomy, 4 (1.2%) cases of manual removal of complete retained placenta, and 1 (0.3%) case of hypogastric artery ligation. Among the 343 patients with PPH, there were 5 maternal deaths, giving a case fatality rate of 1.5%. This is higher than the level recommended by the UN for low-resource countries of below 1% [4]. The 5 maternal deaths comprised 4 cases of disseminated intravascular coagulation and 1 case of hypovolemic shock after abdominal hysterectomy. Unsatisfactory medical management of PPH must justify a surgical procedure. Uterine compression, uterine suture, bilateral ligation of hypogastric arteries, and hysterectomy as treatment options have been used successfully and reported by others [5]. The present findings highlight the pressing need for research on clinical audit and the availability of quality emergency obstetric care in this setting.