Marie Edouard Faye Dieme

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.

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.

Cervical cancer screening in pregnancy at the maternity clinics of Nabil Choucair health center and the Institute of Social Hygiene of Dakar, Senegal: a study on 67 cases

Background: This study aims were to develop the epidemiological profile of patients who received Pap smears during pregnancy, to describe aspects of cytological smears performed in pregnant women and to describe the therapeutic management in case of anomalies in the cervical smear during pregnancy. Methods: This was a prospective, descriptive and analytical study conducted from January 15, 2015 to June 31, 2015 at maternity of Nabil Choucair Health Centre and the Institute of Social Hygiene in Dakar. The Pap smear was performed in all patients who had given their consent to the experience. The parameters studied concerned sociodemographic aspects, gynecological and obstetric background, gestational age at the time of collection, cervicovaginal smear results, diagnostic and therapeutic management of cytological and histological abnormalities. The data collected on a survey sheet prepared for this purpose were entered and analyzed through the version 3.5.3 of Epi info software. Results: During the study period, 67 pregnant women had received a Pap smear. The epidemiological profile of our patient was a paucipare gestity with an average of 3 with extremes ranging from 1 to 7, an average parity of 2.4 with extremes ranging from 1 to 7. The mean age of pregnancy was 15.4 weeks of amenorrhea (range of 6 and 32 weeks). Only 5 patients (7.4%) had already received a cervical-vaginal swab before the study. The smear was normal in 88.7% of the cases but got abnormalities in 11.3% of the cases. The abnormalities were mainly found in squamous cells and were divided into low-grade lesions (57.1%) and skew-cell abnormalities whose meaning was undetermined (42.1%). Colposcopy was performed in 8 patients. Colposcopy was normal and satisfactory in 4 patients (50%) and identified as atypical grade 1 transformation in 2 patients (25%) and an atypical grade 2 transformation in 2 patients (25%). From a therapeutic point of view, diathermic loop conduction associated with strapping was performed in one patient (12.5%) for severe dysplasia. In postpartum, all dysplastic cervical lesions diagnosed during pregnancy had declined. Conclusions: In the context of our study, where there is no organized screening policy for cervical cancer, antenatal clinics are an excellent screening opportunity to seize.

Hemoperitoneum due to spontaneous uterine rupture of varicose veins in a twin pregnancy at term: A clinical case study presentation

Introduction: spontaneous rupture of uterine vessels during pregnancy is an exceptional situation. case report: We report a case of massive hemoperitoneum due to spontaneous rupture of uterine varicose veins, occurring in a patient with twin pregnancy at 38 weeks gestation. the patient presented abdominal pain associated with a sudden drop in blood pressure and severe decompensated anemia. Ultrasound scan revealed in-utero fetal demise of the twins with a peritoneal effusion. An emergency laparotomy followed by a cesarean section confirmed the diagnosis, etiology and management with a favorable maternal outcome. Mariétou Thiam1, Mouhamadou Mansour Niang2, Papa Abdoulaye BA3, Lamine Gueye4, Marie Edouard Faye Diémé5, Mamadou Lamine Cissé6 Affiliations: 1MD, Assistant Professor, Department of Obstetrics and Gynecology of the Thiès Regional Hospital, Faculty of Medicine, Thiès University, Thiès, Senegal; 2MD, Assistant Professor, Department of Obstetrics and Gynecology, Cheikh Anta Diop University, Dakar, Senegal; 3MD, Assistant Professor Department of General Surgery, Faculty of Medicine, Thiès University, Thiès, Senegal; 4MD, Department of Obstetrics and Gynecology, regional hospital Thiès, Senegal; 5MD, Professor, Department of Obstetrics and Gynecology, Cheikh Anta Diop University, Dakar, Senegal; 6MD, Professor, Department of Obstetrics and Gynecology of the Thiès Regional Hospital, Senegal, Thiès University, Thiès, Senegal. Corresponding Author: Mariétou Thiam, MD, Assistant professor, Department of Obstetrics and Gynecology of the Thiès Regional Hospital, Faculty of Medicine, Thiès University, Thiès, Senegal. BP 34 A Thiès; E-mail: maricoulibaly10@gmail.com Received: 19 December 2015 Accepted: 25 April 2016 Published: 24 May 2016 conclusion: spontaneous rupture of uterine varicose veins during pregnancy is a rare condition. clinicians should be aware with this rare condition as delayed diagnosis can be fatal for mother and fetus. the definitive diagnosis of this condition is often made intraoperatively. However, the clinical presentation with ultrasound scanning is very important in planning the management of this condition.

Puerperal uterine inversion managed by the uterine balloon tamponade.

The uterine inversion is a rare and severe puerperal complication. Uncontrolled cord traction and uterine expression are the common causes described. We report a case of uterine inversion stage III caused by poor management of the third stage of labor. It was about a 20 years old primigravida referred in our unit for postpartum hemorrhage due to uterine atony. After manual reduction of the uterus, the use of intra uterine balloon tamponade helped to stop the hemorrhage. The uterine inversion is a rare complication that may cause maternel death. The diagnosis is clinical and its management must be immediate to avoid maternal complications.

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.