Thomas Obinchemti Egbe

Management of uterine rupture: a case report and review of the literature

AbstractBackgroundnMaternal morbidity and mortality has been a major World Health Organization concern over the years, especially in sub-Saharan Africa. This paper reports uterine rupture with severe hypovolemic shock managed at the Douala General Hospital, Cameroon. Early clinical diagnosis is paramount to maternal survival.nCase presentationnMrs. MM aged 25xa0years, G3P2012, of the Bamileke tribe in Cameroon was admitted to our Department in hypovolemic shock BPxa0=xa070/40xa0mmHg, pulse 120 beats per minute, with altered consciousness (Glasgow Coma Scalexa0=xa013). She has a history of missed abortion at 19xa0weeks gestation and an attempt to evacuate the uterus with misoprostol that led to uterine rupture. She underwent a total abdominal hysterectomy and blood transfusion. Her post-operative stay in hospital was uneventful.ConclusionUterine rupture is a complication that can be eliminated under conditions of best obstetric practice. To attain this objective, use of misoprostol in primary health facilities should be stopped or proper management of the medication instituted. The survival of patients after uterine rupture depends on the time interval between rupture and intervention, and the availability of blood products for transfusion.

Ten years analysis of stillbirth in a tertiary hospital in sub-Sahara Africa: a case control study

ObjectiveStillbirth measures provide means to assess adequacy of maternal and perinatal care in a given population. The aim of this study was to describe the determinants of stillbirth in Douala general hospital, Cameroon.ResultsDeterminants of stillbirth in this hospital are: maternal agexa0≥35xa0years (OR 1.79, 95% CI 1.26–2.54, pxa0=xa00.001), pre-eclampsia/eclampsia (OR 2.97, 95% CI 0.87–8.89, p value of 0.03), diabetes in pregnancy (OR 9.97, 95% CI 1.15–86.86, pxa0=xa00.03), stillbirth in previous pregnancies (OR 3.94, CI 2.02–7.7, pxa0<xa00.0001), inter-pregnancy intervalxa0>2xa0years (OR 2, 06 CI 1.22–3.49; pxa0=xa00,006), referral from another hospital (OR 14.16, 95% CI 7.08–28.3, pxa0<xa00.0001), gestational agexa0<37 (OR 19.9, 95% CI 12.3–32.2, pxa0<xa00.0001) andxa0>42 (OR 6.27, 95% CIxa0=xa00.86–45.2, pxa0=xa00.096), congenital malformation (OR 11.09, 95% CI 3.2–38,5, pxa0<xa00.0001) and birth weightxa0<2500xa0g (pxa0<xa00.0001).

Outcome of Late Second Trimester Emergency Cerclage in Patients with Advanced Cervical Dilatation with Bulging Amniotic Membranes: A Report of Six Cases Managed at the Douala General Hospital, Cameroon

Purpose. To show the feasibility of emergency late second trimester cerclage with advanced cervical dilatation and bulging of amniotic membranes. Setting. Department of Obstetrics and Gynecology of the Douala General Hospital. Method. This is a retrospective study of case files of patients who underwent emergency late second trimester cerclage with advanced cervical dilatation, some with bulging of fetal membranes between June 2003 and June 2010. The modified Shirodkar technique was employed in all the cases. Results. Altogether, six patients (100%) underwent late second trimester cervical cerclage between 24 and 26 weeks of gestational age. Four cases (66.7%) carried on their pregnancies to term that resulted in healthy live-born babies all delivered vaginally. The other two cases (33.3%) presented with preterm premature rupture of fetal membranes (PPROM) which led us to undo the stitch with eventual delivery of live-born premature fetuses which died in the neonatal intensive care unit because of complications of prematurity and neonatal infection. Conclusion. In experienced hands and in the absence of other risk factors like infection, the success rates of this procedure are encouraging with improved prognosis. Finally, the modified Shirodkar technique yielded excellent results in our series.

Estimating HIV Incidence during Pregnancy and Knowledge of Prevention of Mother-to-Child Transmission with an Ad Hoc Analysis of Potential Cofactors

Background. We determined the incidence of HIV seroconversion during the second and third trimesters of pregnancy and ad hoc potential cofactors associated with HIV seroconversion after having an HIV-negative result antenatally. We also studied knowledge of PMTCT among pregnant women in seven health facilities in Fako Division, South West Region, Cameroon. Method. During the period between September 12 and December 4, 2011, we recruited a cohort of 477 HIV-negative pregnant women by cluster sampling. Data collection was with a pretested interviewer-administered questionnaire. Sociodemographic information, knowledge of PMTCT, and methods of HIV prevention were obtained from the study population and we did Voluntary Counselling and Testing (VCT) for HIV. Results. The incidence rate of HIV seroconversion during pregnancy was 6.8/100 woman-years. Ninety percent of the participants did not use condoms throughout pregnancy but had a good knowledge of PMTCT of HIV. Only 31.9% of participants knew their HIV status before the booking visit and 33% did not know the HIV status of their partners. Conclusion. The incidence rate of HIV seroconversion in the Fako Division, Cameroon, was 6.8/100 woman-years. No risk factors associated with HIV seroconversion were identified among the study participants because of lack of power to do so.

Use of the Partogram in the Bamenda Health District, North-West Region, Cameroon: A Cross-Sectional Study

Background: The partogram is an effective instrument in the follow-up of labor. It enables timely diagnoses of abnormalities and helps in decision-making. Objectives: This study was carried out to 1) establish and compare the proportion of labor cases followed up with the partogram in primary and secondary healthcare facilities in the Bamenda Health District and 2) appraise the attitudes of the health workers towards the partogram and how those attitudes impact outcomes. Methods: A cross-sectional study was carried out in which 383 files were reviewed and 42 questionnaires were administered to health workers. The information extracted from the files focused mainly on the number of partograms used and the standard criteria under study were: cervical dilatation, station, the state of the amniotic fluid and maternal temperature monitored every four hours. Maternal blood pressure, pulse rate and Fetal Heart Rate (FHR) were monitored every hour. Each of the parameters was judged as correctly filled if they met the above criteria; as not correctly filled if the criteria were not met; and as not filled if no information was recorded. Statistical analysis was with Epi-InfoTM. Results: The results showed that 223(58.2%) deliveries were followed up with the partogram, only 4(1.0%) of which had all the parameters filled to standard. Two hundred and six (86.2%) deliveries in the Bamenda Regional Hospital and 17(11.8%) in the primary healthcare facilities were followed up with the partogram. Forty (95.2%) health workers agreed that the partogram was useful in following up labor. Conclusions: The health workers had a positive attitude towards the partogram, but on the whole it was incorrectly used. The instrument was for the most part unavailable, and even where it was, poor supervision and absence of guidelines on its use led to poor diagnoses. We recommend that supportive supervision and regular in-service training be encouraged; and that partograms and guidelines be made available.

Risk Factors and Barriers to Male Involvement in the Choice of Family Planning Methods in the Buea Health District, South West Region, Cameroon: A Cross-Sectional Study in a Semi-Urban Area

Background: Family Planning (FP) promotion and services are often focused on women, but nonetheless men have an important role to play also. Engaging men in family planning pro- grams and services has the potential to improve the use of FP methods, increase healthy preg- nancy timing and child spacing, and improve on the overall health of the community. It may also facilitate decision-making by men and their partners in reproductive health matters that include FP. Objectives: The aim of this study is twofold; to 1) determine the risk factors associated with male involvement in the choice of FP methods; and 2) describe the perceived barriers to male involvement in family planning. Methods: We conducted a cross-sectional, community-based study among men in the Buea Health District (BHD). The multistage sampling technique was used to select four health areas and twenty communities. Eligible participants were selected by consecutive and convenient sampling and were administered a structured questionnaire to measure their involvement in the choice of FP methods. Socio-demographic and reproductive characteristics of participants were obtained; and so were communication factors and barriers in FP. The logistic regression model was used to determine the factors associated with male involvement. Statistical significance was set at p<0.05. Results: A total of 292 men participated in this study, more than half (57.2%) of whom were involved in the choice of FP methods. Factors affecting the choice of FP methods were mens age ((adjusted Odds Ratio (aOR)=0.35; 95% Confidence Interval (CI): 0.12-0.86; p=0.042)), knowledge level (aOR=2.62; 95% CI: 1.50-4.58; p=0.001), educational level (aOR=2.45; 95% CI: 1.10-5.48; p=0.029), partners level of education (aOR=2.37; 95% CI: 1.12-5.02; p=0.024) and birth spacing between partners last two deliveries (aOR=3.14; 95% CI: 1.48-6.68; p=0.003). The identified barriers to male involvement were financial constraints (lack of money), concep - tion difficulties, inadequate information on FP methods, tradition, unskilled healthcare provid- ers, weight gain by partners, and desire for large family size. Conclusion: This study revealed that men in the BHD were highly involved in FP. Their age, level of education, FP knowledge level, partners level of education, and birth spacing between partners last two deliveries were among the factors that influenced male involvement in FP. Identified barriers to male involvement in FP methods were lack of money to pay for FP meth -

Determinants of Maternal Mortality in Mezam Division in the North West Region of Cameroon: A Community-based Case Control Study

Background: Since 2008, an average of 358,000 women die annually worldwide of pregnancyrelated causes. About 99% of these deaths occur in developing countries, 43% of which occur in Sub-Saharan Africa alone. In Cameroon, the rate has increased from 669 maternal deaths/100,000 live births in 2005 to 1000/100,000 live births in 2010. Socio-economic, cultural, and obstetric factors have been found to account for this jump. Objectives: The aims of this study were 1) to identify the causes, both direct and indirect, of maternal mortality, 2) to investigate the factors associated with maternal deaths, and 3) to describe Original Research Article Egbe et al.; IJTDH, 15(2): 1-15, 2016; Article no.IJTDH.24927 2 the age distribution of maternal mortality in Mezam Division in the North West Region of Cameroon. Materials and Methods: We carried out a retrospective, community-based case-control study from January 1, 2011 to November 30, 2014 on 89 maternal deaths (cases), and 178 women who survived delivery (controls). Cases were identified with the aid of key community leaders. A questionnaire for maternal death review or verbal autopsy was administered and controls effected among the sisters or neighbours of the cases. Microsoft Excel, Epi Info and InterVA-4 were used for data analysis. Results: A total of 89 maternal deaths (cases) were identified during the study period, sixty-nine (77.53%) of which were from direct causes, mainly post-partum haemorrhage (30.43%), unsafe abortion (26.09%), and hypertensive disorders of pregnancy (14.49%); 21.35% from indirect causes, while 1.12% were incidental deaths, mainly severe malaria (5.6%), HIV/AIDS (5.6%). Among the risk factors of maternal death were inadequate antenatal care (RR=1.87: 95% CI; 1.332.63, P=0.0003), pre-existing co-morbidities (RR=1.45: 95% CI; 1.03-2.03, P =0.03), place of delivery(RR= 2.44: 95% CI; 1.79-3.32,P<0.0001), healthcare provider qualification(RR= 2.87: 95% CI 2.17-3.79; P<0.0001), and delays in arrival at health facilities(RR=1.420: 95% CI 1.01-2.0; P=0.04). The peak age of maternal death ranged from 20-24 years (24.72%). Conclusion: Post-partum haemorrhage, unsafe abortion and hypertensive disorders of pregnancy were the leading causes of maternal death. Effectively combating the factors associated with maternal deaths will reduce if not eliminate maternal morbidity.

Successful pregnancy with donor eggs in-vitro fertilization after premature ovarian insufficiency in a tertiary hospital in a low-income setting: a case report

BackgroundPremature Ovarian Insufficiency (POI) is classically defined as 4–6 months of cessation of menses (amenorrhea) in women under 40, associated with menopausal level of serum gonadotropins FSHu2009>u200940xa0IU/L and hypo-estrogenism and is also referred to as hypergonadotropic hypogonadism. This disorder can manifest as primary amenorrhea without the onset of menses (menarche), or as secondary amenorrhea after menarche and pubertal development. The diagnosis of this condition in Cameroon is sometimes difficult because of the high cost of hormonal assays and the few laboratories offering these services.Case presentationThe patient was a 38-year-old G2P0020, blood group O Rh positive, genotype AA and BMI 19xa0kg/m2 who came to our service because of secondary amenorrhea and infertility of 2xa0years’ duration. She has a history of pulmonary tuberculosis that was treated in Cameroon. After laparoscopy and hormonal profile, the diagnosis of premature ovarian insufficiency was reached. The woman underwent a successful donor egg in-vitro fertilization cycle and delivered a female fetus. Two years later YE requested IVF with autologous eggs, which was not possible, and since then she has remained with one child.ConclusionThe diagnosis of premature ovarian insufficiency is difficult in Cameroon because of the high cost of laboratory investigations and difficult access to the tests. In-vitro fertilization with donor egg is a better treatment option. Unfortunately, it is not accessible to most Cameroonians because of lack of technical ability and the existence of cultural and financial barriers.

In-vitro fertilization and spontaneous pregnancies: matching outcomes in Douala, Cameroon

BackgroundCouples are considered infertile if they do not conceive over a 12-month period of unprotected intercourse. Studies have shown that female causes accounted for between 25 to 37 percent of infertility worldwide (with larger proportions in sub-Saharan Africa and Southeast Asia) and male causes accounted for between 8 to 22 percent. Both male and female causes accounted for between 21 to 38 percent. Although the majority of ART children are normal, there are concerns about the increased risk for adverse pregnancy outcomes. More than 30 % of ART pregnancies are twins or higher-order multiple gestations (triplets or greater) and more than one half of all ART neonates are the products of multifetal gestations, with an attendant increase in prematurity complications. The aim of this study was to evaiuate the outcome of pregnancies conceived by In-vitro fertilisation compared to those conceived naturally in two hospitals in Douala, Cameroon.MethodsThis was a prospective study carried out from October 1, 2011 to September 30, 2012. Participants were recruited from two hospitals: the Douala General Hospital (DGH) and the Clinique de l’ Aéroport (CDA), also in Douala. A total of 102 women were recruited for study: 51 who conceived by IVF (cases) and 51 who conceived naturally (controls). Of the 102 women, 52.9xa0% were between 31 – 39xa0years of age, while 21.6xa0% were above 40.ResultsParticipants who conceived through IVF-ET were 4.1 times more likely to undergo cesarean delivery than those who conceived naturally [OR 4.10, 95xa0% CI 1.78–9.42]. Similarly, a higher percentage of patients in the IVF group than those in the control group have never given birth (33.3xa0% vs 2.0xa0%) (Pu2009<u20090.0001). The percentage of multiple pregnancies was 7.5 times higher in the IVF group than in the control group (14.7xa0% vs.1.96xa0%) (Pu2009=u20090.000).The leading indication for cesarean delivery was advanced maternal age (27.3xa0%) followed by IVF or precious pregnancy (18.2xa0%).ConclusionsCesarean delivery was more frequent amongst the IVF group than in the control group. The leading indications for cesarean delivery were advanced maternal age and IVF or precious pregnancy.The long-term neonatal outcomes of IVF babies beyond 5-min Apgar scores should be studied in Cameroon and follow-up beyond 1xa0year encouraged.

Pyosalpinges after hysterosalpingography in a patient with lower genital tract infection and managed by laparoscopic surgery in a resource low tertiary hospital case report and literature review

BackgroundPyosalpinges (a complication of pelvic inflammatory disease) is infection of the fallopian tubes and the morbidity associated with it has major health implications. We are reporting a case of pyosalpinges diagnosed after hysterosalpingography and managed by laparoscopic surgery at the Douala General Hospital, Cameroon.Case presentationA 29-year-old single woman, an assistant nurse of the Douala tribe in Cameroon. She is G1P0010 and came to our attention because of secondary infertility of three years duration. She has a history consistent with four lifetime sexual partners, self-medication for chlamydia trachomatis infection and induced abortion by dilatation and aspiration. Furthermore, she is HIV positive and had an ultrasound scan suggestive of bilateral hydrosalpinges. After a hysterosalpingography examination she developed painless muco-purulent vaginal discharge and bilateral adnexal tenderness on bimanual examination suggestive of pyosalpinges. Vaginal and cervical cultures isolated Ureaplasma urealyticum and Gardnerella vaginalis sensitive to ofloxacin and metronidazole, respectively.At laparoscopy, bilateral pyosalpinges, pelvic adhesions and peri-hepatic adhesions were found. Bilateral salpingectomy with adhesiolysis including lysis of perihepatic adhesions and peritoneal toileting was done. She was discharged from hospital 72xa0h later and her hospital stay was uneventful. She was counseled for in-vitro fertilization and to register in the national HIV treatment programme. Her husband was prescribed ofloxacin empirically.ConclusionAntimicrobial prophylaxis should be given to patients prior to HSG, especially those with a history of chlamydia or evidence of hydrosalpinges. There should also be universal STI testing in high risk and HIV positive patients or the danger for suboptimal antibiotic usage in areas where self-medication is common.In resource-low tertiary hospitals where computed tomography or magnetic resonance imaging is not readily available and/or affordable, clinical examination and pelvic ultrasound remains the key diagnostic tool. Surgical treatment is the best option for pyosalpinges and when plausible, laparoscopic surgery is the treatment of choice. Laparotomy is the mainstay in most hospitals in Cameroon. The parent of the patient did not consent to histo-pathologic examination.