The diagnostic accuracy of external pelvimetry and maternal height to predict dystocia in nulliparous women: a study in Cameroon.

OBJECTIVE: In many developing countries, most women deliver at home or in facilities without operative capability. Identification before labour of women at risk of dystocia and timely referral to a district hospital for delivery is one strategy to reduce maternal and perinatal mortality and morbidity. Our objective was to assess the prediction of dystocia by the combination of maternal height with external pelvimetry, and with foot length and symphysis-fundus height. DESIGN: A prospective cohort study. SETTING: Three maternity units in Yaoundé, Cameroon. POPULATION: A total of 807 consecutive nulliparous women at term who completed a trial of labour and delivered a single fetus in vertex presentation. METHODS: Anthropometric measurements were recorded at the antenatal visit by a researcher and concealed from the staff managing labour. After delivery, the accuracy of individual and combined measurements in the prediction of dystocia was analysed. MAIN OUTCOME MEASURES: Dystocia, defined as caesarean section for dystocia; vacuum or forceps delivery after a prolonged labour (>12 hours); or spontaneous delivery after a prolonged labour associated with intrapartum death. RESULTS: Ninety-eight women (12.1%) had dystocia. The combination of a maternal height less than or equal to the 5th percentile or a transverse diagonal of the Michaelis sacral rhomboid area less than or equal to the 10th percentile resulted in a sensitivity of 53.1% (95% CI 42.7-63.2), a specificity of 92.0% (95% CI 89.7-93.9), a positive predictive value of 47.7% (95% CI 38.0-57.5) and a positive likelihood ratio of 6.6 (95% CI 4.8-9.0), with 13.5% of all women presumed to be at risk. Other combinations resulted in inferior prediction. CONCLUSION: The combination of the maternal height with the transverse diagonal of the Michaelis sacral rhomboid area could identify, before labour, more than half of the cases of dystocia in nulliparous women.

[Delivery outcome of adolescents in Far North Cameroon]. / Accouchement des adolescentes à l'Extrême Nord du Cameroun: des proportions inadmissibles!

UNLABELLED: Delivery in teenager is associated with increased risk. The aim of this study was to evaluate the contribution of teenagers (10-19 years or less) to the total number of deliveries over a 10 year period in the Maroua provincial hospital (Cameroon) This was a retrospective study. The deliveries of 3.328 teenagers were analysed as far as their contribution to the deliveries is concerned and how this contribution changed with time from 01/01/1995 to 31/12/2004 at the Provincial Hospital Maroua (Cameroon). Analyses were performed using Excel and Epi Info 6. The chietaiota2 tests of the tendency, taking in account all ten age groups, was used to appreciate the phenomenon over time. This trend was considered significant if p<0.05. RESULTS: During the study period 13.026 women delivered, 489 cases were excluded because the age was not specified. Finally, 3.328 teenagers were analysed out of a total of 12537 cases, as far as their contribution to the number of deliveries from 1995 to 2004 in the Maroua provincial hospital. Teenagers contributed for 26,54% of total deliveries in Maroua Provincial Hospital, (Cameroon). Teenagers of 16 and less contributed for 7,58%, and those aged 17 to 19 years contributed for 18,25%. We found out that the trend over the study period, has not changed (p>0.05). This study emphasizes the need of redynamisation of adolescents health services in Extreme North Cameroon. Studies should be done to determine the impact of young age on the delivery outcome.

Interactions between human immunodeficiency virus and herpes viruses within the oral mucosa.

There is evidence from clinical case reports and epidemiological studies that human immunodeficiency virus (HIV) can be transmitted through oral sex. Herpes viruses that appear in the oral mucosa might influence the oral replication of HIV. A review of data suggesting that interactions occur between HIV and herpes viruses indicates that such interactions might operate in the oral mucosa. Defining the mechanisms by which herpes viruses interact with HIV in the oral mucosa should permit intervention measures to be targeted more precisely.

Regional and geographical variations in infertility: effects of environmental, cultural, and socioeconomic factors.

Fertility is affected by many different cultural, environmental, and socioeconomic factors, especially in developing countries where poverty and infections are commonplace. Environmental factors play a major role in infertility in Africa. One of the most important health problems in sub-Saharan Africa is the high rate of infertility and childlessness. The African society has a strong traditional heritage, and the study of the patterns of infertility in this part of the world would be incomplete without consideration of the sociocultural and environmental factors. The most cost-effective approach to solving the infertility problems in Africa is prevention and education. In Mexico, problems of reproductive health are associated with pregnancy in adolescents, sexually transmitted diseases and genitourinary neoplasms. Infertility affects 10% of couples, usually as a result of asymptomatic infection. Education, poverty, nutrition, and pollution are problems that must be tackled. The government has taken positive action in the State of São Paulo in Brazil, where gender discrimination is a major factor affecting women's health and reproductive outcomes. The implementation of new policies with adequate funding has resulted in marked improvements.

PIP: The impact of cultural, environmental, and socioeconomic factors on reproductive health and infertility are discussed in general terms. Conditions in sub-Saharan Africa, Kenya, Mexico, and Brazil are described. In Mexico, high levels of arsenic in drinking water pose a major environmental hazard affecting reproductive health. Chronic arsenic poisoning in Comarca Lagunera, Mexico, contributes to male infertility and birth defects. Additional problems are adolescent pregnancy, sexually transmitted diseases (STDs), congenital malformations, genitourinary neoplasms, malnourishment, and poverty. The example of Sao Paolo's investment in the well-being of women shows how effective government policy can accomplish rapid improvement in women's health. Infertility in Africa is around 30-40%. Infertility in the US is only 8%. The African cultural emphasis on women's status and childbearing makes infertility a major concern. African infertility is related to disease. In the Cameroon, over 50% of infertility is accounted for by pelvic inflammatory disease. Prevention programs should include improvement in diagnosis and treatment of sexually transmitted diseases (STDs), sex education for men and women, expanded family planning (FP) services, and better obstetric care. Infertility in Zaire, Cameroon, Gabon, and Uganda is high compared to other non-African countries. Infertility is geographically and ethnically variable within each country. Politics and government FP policy, traditional attitudes, polygamous relationships, and induced abortion all impact on infertility. Traditional practices, such as female genital mutilation, result in infections during the healing process; infections also occur during childbirth. Vesico-vaginal fistula and incontinence are problematic and can be corrected through surgical methods. Illegal abortions contribute to morbidity and mortality. STDs are a main cause of infertility in Kenya. Cultural beliefs place the blame on females. In both Africa and Mexico, men account for 30% of couple infertility.

Cephalopelvic disproportion at term involving a lithopedion: a case report.

A case of obstructed labor in a term pregnancy caused by cephalopelvic disproportion as a result of a lithopedion retained in a sacculus of the lower uterine segment is reported. Detection and management of this condition are discussed, and a review of relevant literature is also presented.

The risk approach for reducing maternal mortality: the Yaounde experience.

A review of the strategy of the risk approach to maternal care in the obstetrics and gynecology services of CUSS over a 12-year period has been reported. By combining antepartum, intrapartum, and postpartum family planning components and by a rational deployment of personnel and restricted resources, the maternal mortality ratio was decreased by up to 60% in one unit and maintained at 0-0.84 per 1000 in the other unit. The package is proposed as a prototype for Africa and the developing world.

[Premature rupture of membranes: maternal and fetal outcome in the absence of antibiotic prophylaxis]. / Rupture prématurée des membranes: devenir maternel et foetal en l'absence de la prophylaxie antibiotique.

Antibiotic prophylaxis in the management of Premature Rupture of foetal Membranes (PROM) before term still remains controversial. 110 pregnant women with PROM were assigned to either group A (no treatment) or group B (treatment group). The rates of premature deliveries were similar in the two groups, 71% versus 77% (p = 0.56). Additionally, low birth weight, Apgar score, foetal distress, neonatal icterus and foetal sepsis were all observed in similar proportions in both groups. 6.5% of the subjects in group A developed endometritis as against 5.7% in group B (p = 0.69). Perinatal mortality rates were high (33.3% and 50%, in group A and B, respectively), but not statistically different in the two groups (p = 0.13). Prophylactic antibiotics do not seem to influence maternal and foetal outcome in patients who present with PROM in this environment.

[Study of 500 cases of sterilization by tubal ligation]. / Etude de 500 cas de stérilisation par ligature des trompes.

PIP: The authors examined 500 consecutive tubal ligations performed at Maisonneuve-Rosemont Hospital during the years 1970-2, with a follow-up of 5 years or more. The majority of these patients were contacted either at the Clinic or by phone in 1977. The posttubal ligation failure frequency rate was 0.8% uncorrected and 0.6% corrected. 8.6% of the cases required at least 1 consultation due to menorrhagia or metrorrhagia; however, this elevated figure was found mainly in the group of women ages 36-45 years. The postpartum sterilization group formed 16.4% of the patients, and the remaining 43.2%. In this latter group, 3 patients became pregnant. The great majority of the women were Catholic (99.8%) but it is not known if they were still practicing their religion. (author's)^ieng

Introduction of high risk pregnancy care in rural Cameroon: health service research approach.

PIP: A 3-year study (1982-1985) in Cameroon showed that high-risk pregnancy identification and care could successfully be introduced in rural communities through inexpensive training and supervision of local nurses, particularly when motivation for use of antenatal clinics (ANCs) was provided by the local Community Women's Organization (CWO). 11 communities, all rural except Tsinga, were randomly allocated to Groups I (control) or II. A retrospective baseline survey of ANCs showed that high-risk pregnancy detection had been nonexistent. For both groups, nurses were given 2-week training courses on high-risk identification and family planning. The registers for recording prenatal consultations and deliveries were modified to include recording of risk factors. Special forms were created for reporting on each high-risk case thus identified. These forms proved more difficult for the nurses to complete than the registers. For Group II communities, CWO leaders were recruited to urge women to attend ANCs. 2548 cases of high-risk pregnancy (21.9% of pregnancies) were identified on the special forms, although the number of cases identified in clinic registers was consistently higher. Posttest attendance at ANCs was higher than pretest and significantly higher in areas where CWO motivation had been used. Major risk factors in the identified cases were grand multiparity, teenage pregnancy and previous complicated obstetrics history, although semiurban Tsinga had less grand multiparity and teenage pregnancy and more obesity, diabetes, hypertension and preclampsia. Only 23.4% of the identified cases delivered in the clinics, showing the need for more comprehensive maternal service programs. Since only 5% of the high-risk pregnancy population accepted modern contraceptives after delivery, research is needed on the determinants.^ieng

Detection of the Plasmodium falciparum antigen histidine-rich protein 2 in blood of pregnant women: implications for diagnosing placental malaria.

Pregnant women have an increased susceptibility to infection by Plasmodium falciparum. Parasites may be present in the placenta yet not detectable in peripheral blood smears by routine light microscopy. In order to determine how frequently misdiagnosis occurs, peripheral blood and placental samples were collected from 1,077 Cameroonian women at the time of giving birth and examined for the presence of malarial parasites by using light microscopy. Results showed that 20.1% of the women who had placental malaria were peripheral blood smear negative. Thus, malarial infection was not detected by microscopic examination of peripheral blood smears from approximately one out of five malaria-infected women. Since P. falciparum parasites secrete histidine-rich protein 2 (HRP-2), we sought to determine if detecting HRP-2 in either peripheral plasma or whole blood might be used to diagnose the presence of parasites "hidden" in the placenta. Samples of peripheral plasma from 127 women with different levels of placental malarial infection were assayed by HRP-2-specific enzyme-linked immunosorbent assay. HRP-2 was detected in 88% of the women with placental malaria who tested negative by blood smear. Additionally, whole blood was obtained from 181 women and tested for HRP-2 with a rapid, chromatographic strip test (ICT). The ICT test accurately detected malarial infection in 89.1% of P. falciparum-infected women. Furthermore, 94% of women with malaria were accurately diagnosed by using a combination of microscopy and the ICT test. Thus, detection of HRP-2 in conjunction with microscopy should improve diagnosis of malaria in pregnant women.