Magatte Mbaye

Spontaneous Uterine Rupture of an Unscarred Uterus before Labour

Uterine rupture is a public health problem in developing countries. When it is spontaneous, it occurs most often during labor in a context of scarred uterus. Uterine rupture during pregnancy is a rare situation. The diagnosis is not always obvious and morbidity and maternal and fetal mortality is still high. We report a case of spontaneous uterine rupture during pregnancy at 35 weeks of an unscarred uterus before labour. This is an exceptional case that we observe for the first time in our unit.

Gestational trophoblastic neoplasia after achieving a nondetectable serum human chorionic gonadotrophin level.

To determine the risk of recurrent trophoblastic disease after normalisation of human chorionic gonadotrophin (hCG) levels in women with hydatidiform mole.

Premiers résultats de la cœlioscopie gynécologique au Centre hospitalier universitaire (CHU) de Dakar : série prospective de 128 cas

OBJECTIVES To analyze the results of, and to evaluate, gynaecologic laparoscopy in Dakar Teaching Hospital. METHODS This exploratory and descriptive study deals with a continuous series of 128 gynaecologic laparoscopies carried out between January 1, 2006, and December 31, 2009. In each operative case, sociodemographic and clinical parameters,operative data, and outcomes were studied. RESULTS Laparoscopies represented 14.37% of the programmed operative activities. The average age of the patients was 32 years,and the average parity was 1.2. The interventions were most frequently undertaken because of infertility (78.9%). A history of pelvic infections was found in 39.8% of the cases. The most frequent pathologies were tubal anomalies (70% of infertility cases) followed by ovarian cysts (10.1%) and endometriosis. The operative interventions included adhesiolysis in 35.1% of cases,and tubal surgery in 30.4%. A conversion, necessary in 7% of cases, was necessitated by the extent of adhesions (3 cases),the treatment of an associated pathology (4 cases), or a technical difficulty (2 cases).The main complications were vascular wounds and uterine perforations. The average operating times for diagnostic and operative laparoscopies were 56 minutes and 107 minutes,respectively. Outcomes were simple in 91.8% of cases. During the immediate postoperative period, a death occurred due to an acute pneumopathy. The average length of hospital stay was 3 days. We observed a pregnancy rate of 4.6%. Assisted reproduction was indicated in 28.7% of infertility cases. CONCLUSION Given its many advantages, diagnostic and operative laparoscopy must be integrated and developed by gynaecology departments in developing countries. This necessity is emphasized by the prevalence of tubal infertility of infectious origins, which, if diagnosed and treated early by laparoscopy,could have a better prognosis.

Assessment of Five Years of Endoscopic Activity in a Maternity Hospital in the Suburbs of Dakar

Introduction: The practice of minimally invasive surgery in Senegal occupies more and more of a preponderant place in fields that previously did not allow it. Thus in our practice in gynecology we are witnessing an explosion of these operative indications especially for benign adnexal pathology. Patients and Method: The objective of this study was to evaluate the evolution of laparoscopic practice in terms of frequency, indication of duration and operative complications. For this reason, we have collected all the laparoscopic procedures carried out at the Gynecology and Obstetrics Department of the Pikine National Hospital since January 1st, 2012 over a period of 60 months. Endoscopic surgery accounted for 20.1% of all gynecological and breast procedures. There were 195 cases (14.9%) of laparoscopic surgery and 69 cases (5.2%) of operative hysteroscopy. The average age of our patients was 34 years with extremes of 15 and 67 years. The intervention was motivated by the exploration or management of infertility in 101 cases, or 57.1% of patients. Laparoscopy remained exploratory in 15.3% of cases (279 patients) with 55 cases of ovarian tumors presumed to be benign. The mean duration of diagnostic laparoscopy was 39 min with extremes of 20 to 150 min; while that of operative laparoscopy was 59 min with extremes of 20 to 250 min. It was noted that 4 cases of laparoconversion are 2.8% of all patients in our series. The postoperative course was 99.4% simple. Conclusion: In our practice and as in the developed countries, we are witnessing a considerable decline in the indications of laparotomy to the profile of laparoscopy, especially for benign adnexal pathology and infertility. An extension to the gynecological malignant pathology is the ultimate challenge.

Epidemiological, clinical, prognostic and therapeutic aspects of twin delivery in two referral maternity units in Dakar (Senegal)

Background: Twin pregnancy is the simultaneous development of two embryos and then two fetuses in the uterine cavity. Objective of present study was to assess the epidemiological, clinical, prognostic and therapeutic aspects of twin delivery in two referral maternity units in Dakar. Methods: A descriptive and analytical retrospective bi-centric study of all cases of twin deliveries recorded in two referral center in Dakar was conducted during the period January 1, 2005-December 31, 2015, i.e. an 11-year period. It concerned 619 pregnant women who gave birth to twins in these two referral medical structures. The epidemiological parameters, clinical, prognostic and therapeutic aspects of twin childbirth were studied. The data were entered and analysed using Epi info version 3.5.3. Results: The twinning prevalence was 1.11%. The majority of our parturient women (506 or 81.7% of the cases) came from the Dakar suburbs. The average age of the parturient women was 28 years and the gestity age 3.1. Pregnancy was well monitored for 98.5% of the parturient women with an average number of prenatal consultations of 3.6. The first prenatal consultation was performed in 52% of cases in the first quarter. In more than one third of cases (234 or 37.8%), the diagnosis was made in the third quarter of pregnancy. 113 cases (18.2%) of premature rupture of membranes, 10 cases (1.61%) of threat of premature delivery and 7 cases (11.13%) of placenta previa were registered. During labour, the diagnosis was made by clinical examination in 32.2% of cases. Bichorial biamniotic twin pregnancy was the most frequent anatomical type (62.6%). On admission, the first twin (T1) was in cephalic presentation in 56.7%, in breech presentation in 15.2%; The second twin (T2) was in breech presentation in 21.1% of the cases. Caesarean section was related to the first twin in 50.6% and the second twin in 53.8% of the cases. Caesarean section was performed in 50.6% for the first twin and in 53.8% for the second twin. The mean time interval between the delivery of T1 and that of T2 was 17.4 min. Low birth weight was more frequent for the second twin (54.3%). The stillbirth rate was 48.26 per thousand. Maternal complications were dominated by renal-vascular syndromes (4.2%), haemorrhagic causes (1.86%), perineal lesions (1.6%) and uterine rupture (0.97%). Postpartum haemorrhage was observed in 8 cases (1.29%). Maternal mortality was nil Conclusions: Twin delivery poses varying difficulties due to the complexity of obstetrical mechanics and the frequency of dystocic presentations. Despite improved maternal prognosis, in recent years, perinatal mortality and morbidity, still high, remain a constant concern.

A Rare Case of Extra-Uterine Pelvic Leiomyoma

Extra-uterine leiomyomas are rare, benign, and may arise in any anatomic sites. Extra-uterine leiomyomas are diagnostic challenge due to their rare unusual locations. We present a case of pelvic leiomyoma mimicking ovarian mass in a 34-year-old woman who was suffering for right pelvic pain. Clinical and imaging findings revealed an ovarian leimyoma. A laparotomy using Pfannenstiel incision was performed. Pelvic organs and both ovaries appeared normal. There was a firm mass about 5 cm in size distinct from the left ovary and attached to uterus with some fine adhesions that were cut allowing removal of the mass. Pathologic examination concluded to a benign leiomyoma. The recovery was uneventful and pelvic pain disappeared. Leiomyomas occur infrequently outside the uterus. Although they are histologically benign, extra-uterine leiomyomas may mimic malignant tumours at imaging and may present a diagnostic challenge. Surgical excision is the most common treatment.

Analysis of cesarean section rate according to Robson’s classification in an urban health centre in Senegal -

Background: Robson, proposed a new classification system, the Robson’s Ten-Group Classification System to allow critical analysis according to characteristics of pregnancy. The objective was to describe caesarean rates in an urban health centre in Dakar using Robson’s Ten groups classification Methods: This study was performed in Philippe Senghor health centre in Dakar (Senegal), a secondary health centre that performs CS since 2011. Before this date, only midwifes performed deliveries in this centre. The study took place between 1 January and 31 December 2013. All patients who delivered during this period by CS were included. Women were classified in 10 groups according to Robson’s classification, using maternal characteristics and obstetrical history. For each group, we calculated its relative size and its contribution to the overall caesarean rate. Results: The overall rate of caesarean was 18.2%. The main contributors to the overall caesarean rate were primiparous women in spontaneous labour (group 1) and women with previous caesarean section (group 5). Further analysis of group 1 showed that more than half of CS indications in this group were fetal-pelvic disproportion in 55.2% and fetal hypoxia in 27%. Conclusion: The Robson’s classification is easy to use. Each maternity unit can compare its rates with those of units with similar level, to find whether some groups of women have very high rates of caesarean sections. Attention should be made because CS rates is rising up and will be problematic in our low resource countries. It is time to implement obstetric audits to lower the CS rates.

Obstetrical Ultrasound in Senegal: Knowledge, Attitude and Practice

Objectives: Identify the profile of providers, determine their level of knowledge of protocols and standards in obstetric ultrasound, assess the attitude and quality of the relationship provider-patient, assess the quality of ultrasound examinations and identify the need for continuing medical education in obstetric ultrasound. Materials and methods: This is a prospective study over a period of four months from January 1, 2009 to May 31, 2009, targeting providers practicing obstetrical ultrasound and officiating in the regions of Dakar and Thies. The parameters studied were socio professional characteristics, training received, knowledge of norms and standards in obstetric ultrasound, the attitude during the ultrasound examination, the level of practice of obstetric ultrasound, the standards and obstetrical ultrasound protocols and training in obstetrical ultrasound. Data were analyzed using the software Sphinx. Results: The rate of acceptance was 76.2%. Gynecologists (59.4%) and radiologists (25%) were most represented in our sample. The ultrasound machine used was up to 10 years old or more in 70.1% of cases. The recommended frequency array of abdominal probe was known by 71.9% and 40.4% for the transvaginal probe. The recommended number of fetal ultrasound during normal pregnancy were known by 84.5% of operators and their frequency by 72.9%, 83.3% knew the criteria for fetal biometry and 44.4% of fetal morphology. Conclusion: The legal framework for the practice of ultrasound is urgent to prevent further abuses and increase the quality of exams. There is urgent need for standardized basic training, certification and periodic recertification based on continuing medical education for providers in our country.

Uterine cervical prolapse following delivery

Uterine cervical prolapse concurrent with pregnancy is rare. This article reports three cases of third-degree cervical prolapse following delivery. No history of preexisting prolapse was reported. The first case was treated by hysterectomy, the second case by partial cervical excision and the third case, conservatively. Uneventful recoveries and any further complications were noted. We believe that an extensive uterine cervical prolapse needs surveillance and can be managed conservatively.