Maternal mortality in Maroua Provincial Hospital, Cameroon (2003-2005).

BACKGROUND: In September 2000, the Heads of States of the 191 countries of the United Nations approved the Millennium Declaration in which reduction of pregnancy-related deaths to a quarter by 2015 was one of its goals. However, before the middle of the first decade of this millennium, there were no reports on the status of maternal mortality in Maroua, Cameroon. OBJECTIVE: The aim of this study was to establish baseline data on maternal mortality for future evaluation of pregnancy-related mortality trends in this city. SUBJECTS AND METHODS: Maternal deaths that occurred from 2003 to 2005 in Maroua City, Cameroon, were analyzed. Mortality ratios were determined by comparing the number of the deaths related to pregnancy with that of women with safe deliveries. Mortality risks were determined by comparing the characteristics of women with pregnancy-related deaths to those of women with safe deliveries. RESULTS: The overall maternal mortality ratio was 1266 maternal deaths per 100,000 live births. The leading causes of death were hypertension (17.5%), obstetric infections (14.3%), uterine rupture (14.3%), anaemia (12.7%) and HIV complications (9.5%). Among the women who died, 28.6% were teenagers and 14.3% were at their sixth delivery (or above). Compared with women aged 20 to 24 years, those aged 25 to 29 years were more than twice as likely to die from pregnancy-related causes (HR: 2.34; CI: 1.07,5.08; p = 0.029). A similar trend was also found in those aged 30 to 34 years (HR: 2.26; CI: 1.02,5.00; p = 0.042). CONCLUSION: The findings suggest that Maternal Mortality Ratio in Maroua, City Cameroon, is very high. Since most of the causes of death were preventable, we propose that the current maternal and Family Planning strategies be reviewed with the view to reducing the current trend. Such a strategy would enable the Maroua city to meet the Millennium goals by 2015.

[Historical cohort study of delivery in women of forty years of age and older]. / Etude cohorte historique de l'accouchement a 40 ans et plus a Yaoundé-Cameroun.

In a recent study at the Yaounde-Cameroon University Teaching Hospital, we found that delivery at extreme ages of reproductive health was associated with increased foetal and maternal risks. However we were not able to evaluate the impact of advanced age on exposure do different risks observed. The purpose of this study was to test the hypothesis that deliveries of women aged 40 years and above were associated with increased risk. Data collection was retrospective from delivery room registers at the Yaoundé University Teaching Hospital Between 01/01/1991 - 31/12/2000. The deliveries of 180 women in their forties were compared with those of 532 women in their twenties. The software EPI Info 6 and SPSS were used in analysis. At unvaried analysis, the risk of delivery by caesarean section for women in their forties (16.1%) was significantly high compared to women in their twenties (10.0%), (HR: 1.7; 95% CI: 1.1-2.8; p = 0.027). After adjustment for different factors associated with the occurrence of delivery by caesarean section, its risk for women aged 40 and above remained significantly increased (HR: 1.7; 95% CI: 1.0-2.9; p = 0.039). Similar observation was found for stillbirth with 11.7% by women aged 40 and above compared to 5.8% by women in their twenties (HR: 2.1; 95% CI: 1.1-3.9; p = 0.011). After adjustment for different factors associated with mortinatality, its occurrence remained significantly increased at age 40 and above (HR: 1.9; 95% CI: 1.1-3.6; p = 0.032). Women aged 40 years and above had an increased risk of stillbirth and delivery by caesarean section than those in their twenties. Studies are needed to establish the exact causes of these risks and evaluate management options in these women.

Maternal genital Chlamydia trachomatis infection and the risk of preterm labor.

OBJECTIVE: To determine the association between maternal genital Chlamydia trachomatis infection in pregnancy and the risk of preterm labor. The hypothesis tested was that a greater proportion of women experiencing preterm labor would have Chlamydia trachomatis than controls who were not experiencing preterm labor. METHODS: A case-control study in Yaoundé (Cameroon), involving 126 women of gestational age between 28 and 34 weeks, using serology and cervical swab cultures. Data analysis involved simple comparative descriptive statistics as well as univariate and multivariate analysis. RESULTS: The odds of experiencing preterm labor and having genital chlamydial infection were 72.59 (exact 95% C.I. 0.99-7.14); O.R.MH (Mantel-Haenszel) 2.80 (approximate 95% C.I. 1.13-6.97) using serological tests. The proportion of women with positive cervical swab cultures was statistically significantly different between cases and controls (Fisher's exact test, P = 0.02). CONCLUSION: Routine screening and treatment of pregnant women with Chlamydia trachomatis (along with their partners) may be beneficial in reducing the incidence of preterm labor and delivery and hence the perinatal mortality rate.

[Treatment of ectopic pregnancies by laparotomy in under-equipped countries. A series of 144 cases at the Yaounde University Hospital Center (Cameroon)]. / Traitement des grossesses extra-utérines par laparotomie en pays sous-équipé. A propos d'une série de 144 cas au CHU de Yaoundé (Cameroun).

We report in the context of a developing country the results of ectopic pregnancies treated by laparotomy in the last ten years (1984-1993) in the maternity unit of the Teaching Hospital Yaounde (Cameroons). There were 144 cases of ectopic pregnancies from a total of 12,507 deliveries; this corresponds to 11 cases of ectopic pregnancies for 1,000 deliveries. In 75 cases (52%) the patients were operated in emergency situations with clinical signs of ruptured ectopic pregnancy which were later confirmed at laparotomy. In 69 cases (47.9%) the patients were retained in hospital for definitive diagnosis and in the follow-up, the diagnosis was confirmed by laparoscopy in 37 cases (53.6%) and by ultrasonography in 22 cases (31.9%). In this study the frequency of ectopic pregnancy was most common among primiparous women (36 cases) and second parity (37 cases). The highest frequency of ectopic pregnancies was found in women in the age range between 25 and 30 years. Radical treatment of ectopic pregnancy was performed in 62 cases (43.0%) and conservative treatment in 82 cases (56.9%). The main complication during the operation was represented by severe hemorrhage in 65 cases (45.1%); blood transfusion was required in 25 cases. Among the patients who were followed up in the prenatal clinic (98 cases) 16 patients (16.3%) presented an intra-uterine pregnancy and 12 patients (12.2%) a recurrence of ectopic pregnancy. Ectopic pregnancy is a frequent pathology in Cameroon. In the absence of methods for early diagnosis of ectopic pregnancy such as endovaginal ultrasonography and the measurement of beta human chorionic gonadotropin (beta hCG), primary use of laparotomy is necessary when clinical signs of ectopic pregnancy exist. This procedure permits the avoidance of severe complications such as hemorrhage and maternal death. It can be said that laparotomy still has its place in the treatment of ectopic pregnancy in developing countries.

Prevention of mother-to-child transmission of HIV in Cameroon: experiences from the University Teaching Hospital in Yaounde (Cameroon).

OBJECTIVE: The aim of this study was to assess the effectiveness of nevirapine (NVP) in the prevention of mother-to-child transmission (MTVT) of HIV-1 in children in the Yaounde University Teaching Hospital, Cameroon. METHODS: This was a prospective and descriptive hospital-based study in which pre-counselled HIV-infected pregnant women who gave their consent were included. At the onset of labour a single dose of 200 mg oral NVP was administered to each woman. Their newborns were also given 2 mg/kg of oral NVP syrup within 72 hours of their birth. These NVP-treated babies were assessed at 6 weeks, 6 months and between 15 and 18 months for viral load levels, using a branched DNA technology. Viral load levels were classified as undetectable (< 50 copies/ml); intermediate (50-3 500 cp/ml) or high (> 3 500 cp/ml). RESULTS: Of the 350 women screened for HIV 22 (6.3 %) were positive for HIV-1, but only 18 children were duly tested until 18 months. Viral load levels were undetectable at 6 weeks in 61.1 % of the children; intermediate in 38.9 % and no child had a high VL (> 3 500 cp/ml). At 6 months 5 of 7 children with intermediate levels had dropped to undetectable levels. By 15-18 months, a total of 16 children (88.9 %) had undetectable levels while 2 children (11.1 %) with detectable levels were confirmed to be HIV positive using ELISA test and immunoblot analysis. CONCLUSIONS: We conclude that the rate of HIV-1 MTCT with NVP is about 11 % in CHU Yaounde.

[Induced labor: conditions for success and causes of failure. A prospective study of 162 cases]. / Le travail induit: conditions de succès et causes d'échec. Une étude prospective de 162 cas.

The authors report the results of a prospective study of 162 cases of induced labour collected between 30 October 1990 and 31 December 1991 in the maternity unit of the Yaounde teaching hospital group. There were 1,640 deliveries during this period. Premature rupture of the membranes in 72 cases (44.4 per cent) and postmaturity in 42 cases (27.2 per cent) were the chief indications for the induction of labour in this study. There were 138 cases (85.2 per cent) of spontaneous delivery, 20 cases (12.3 per cent) of cesarean section and 4 cases (2.5 per cent) of vacuum extraction. Failure of induction occurred in 16 cases (9.8 per cent). Repeat induction of labour after a rest period led to spontaneous delivery in 6 cases. There were 6 fetal deaths, i.e. a perinatal mortality of 3.7 per cent. Postmaturity (3 cases) and premature rupture of the membranes (2 cases) were the risk factors in these six fetal deaths. Analysis of cases of failed induction and of fetal deaths in this study leads the authors to conclude that ripening of the cervix is an essential parameter for success of the artificial induction of labour. Premature rupture of the membranes, and postmaturity associated with an unripe cervix are unfavourable risk factors for the induction of labour and are potential indications for preventive cesarean section in order to avoid fetal death.

[Use of tubal sterilization by minilaparotomy after vaginal delivery in a developing country. A retrospective analysis of 347 cases at the Yaoundé University Gynecologic Clinic (Cameroon)]. / Wertigkeit der Tubensterilisation durch Minilaparotomie nach vaginaler Entbindung in einem Entwicklungsland. Eine retrospektive Analyse von 347 Fällen an der Universitätsfrauenklinik Yaoundé (Kamerun).

The authors report the results of a retrospective study of 347 cases of tubal ligation collected between January 1985 and December 1991 in the maternity unit of the Yaoundé teaching hospital group. The tubal ligations were performed through minilaparotomy with local anesthesia using the method of Pomeroy. The frequency of tubal ligation evaluated by 3.8 per cent did not change during the period of this study. The authors note that the majority of patients in this study asked for a tubal ligation only when they had 5 or more surviving children. The authors conclude that because of poorly equiped medical infrastructures in the context of developing countries tubal ligation through minilaparotomy should be promoted by the contraceptive methods in family planning programs.

[Controversy on the method of sterilization during cesarean section: tubal ligation or hysterectomy? Review of the literature]. / Controverse sur la méthode de stérilisation au cours de la césarienne: ligature des trompes ou hystérectomie? Une revue de littérature.

The results of tubal ligation done during cesarean section are analysed in the context of a developing country during the last eleven years (1982-1992) at the maternity of the University Hospital Centre in Yaounde (Cameroun), ring this time there were 13,759 deliveries, of which 1,062 cases were by cesarean section with 109 cases of tubal ligation and 2 cases of cesarean hysterectomy. The operative and post-operative complications are discussed and compared to that in cesarean hysterectomy. Complications are found to be more in cases of cesarean hysterectomy that in cases of tubal ligation by cesarean section. The author conclude that hysterectomy at the time of cesarean section should be restricted to those cases in which removal of the uterus is necessary to preserve the life of the patient.

[A comparative study of 2 ways of clinical management in premature rupture of the membranes at term: temporization versus labor induction]. / Etude comparative de deux conduites cliniques en cas de rupture prématurée des membranes à terme. Expectative versus induction du travail.

Two defined management approaches, temporization limited to 48 hours and immediate induction of labor, for premature rupture of the membranes at term were compared in a prospective study between January 1 1991 and November 30 1993 in the Maternity Unit of Yaoundé University Hospital. During this period, 268 cases of premature rupture of the membranes were seen among 3252 deliveries, i.e. an incidence of 8.2%. In the temporization group (153 cases), spontaneous onset of labor was effective in 95 patients (62.1%) within 12 hours and in 137 patients (89.5%) within 24 hours after premature rupture of the membranes. Spontaneous deliveries in this temporization group accounted for 129 cases (92.8%). In the induction of labor group, spontaneous delivery occurred in 119 cases (93.2%). There were ten cesareans in the temporization group and eight cesareans and two vacuum cup extractions in the induction group. Short term (24 hours) prophylactic antibiotics were given to 34 patients, i.e. 16 cases in which the duration of rupture of the membranes was more than 24 hours and 18 cases of cesarean section. Maternal infections concerned 18 cases (6.7%) including 12 cases (4.4%) of malaria. Microbiology of vaginal swabs revealed 6 cases of pseudomonas, 4 cases of staphylococcus aureus and 3 of candida albicans. Neonatal infections confirmed by blood culture and assay of C-reactive-protein involved 24 cases (20.3%). There were three fetal deaths, i.e. perinatal mortality of 1.1%. Risk factors, in these three fetal deaths, included postmaturity (1 case).(ABSTRACT TRUNCATED AT 250 WORDS)

[Controversy on the method of sterilization during cesarean section: tubal ligation or hysterectomy? Review of the literature]. / Controverse sur la methode de sterilisation au cours de la cesarienne: ligature des trompes ou hysterectomie? Une revue de litterature.

PIP: During 1982-1992, 111 cesarean sections followed by 109 tubal ligations (Pomeroy method) and two hysterectomies were performed at two hospitals in Yaounde, Cameroon. All the patients were informed of the necessity of limiting births because of risks posed by future pregnancies. All women gave informed consent. The leading indications for cesarean section were limited pelvis associated with previous cesarean section(s)-related scarred uterus (59 cases) and fetal distress (33 cases). The two principal indications for tubal ligation were previous cesarean sections (64 cases) and grand multiparity (i.e., 5 births) (45 cases). 37.1% of tubal ligation cases had more than five children. The number of tubal ligation cases after cesarean section was highest in 1983 (16 cases), 1984 (13 cases), 1990 (16 cases), 1991 (13 cases), and 1992 (12 cases). No woman younger than 24 years old underwent tubal ligation. 77.1% of tubal ligations occurred to women aged 30-40. Immediate hysterectomy was required in two cases to control severe hemorrhaging. Three tubal ligation cases lost more than 1000 cc of blood and had to be transfused. All 111 cesarean section cases received prophylactic antibiotics. The surgeon perforated the bladder of a patient who had had three previous cesarean sections when he/she dissected the lower segment of the peritoneal cavity. This case suffered no postoperative complications. Surgeons had to reintervene two hours after the tubal ligation because the ligature thread loosened at the level of the two fallopian tubes, causing a hemorrhage. No one developed fever. There were no fetal or maternal deaths. The peri- and post-operative complication rate was lower than that of other like studies. The researchers recommend tubal ligation as the preferable sterilization method after cesarean section. Hysterectomy should only be used in cases of severe hemorrhaging which can lead to maternal death.^ieng

Outcome of twin deliveries at the University Teaching Hospital, Yaoundé, Cameroon-a 15-year experience.

From 1982 to 1996, a total of 16 181 deliveries was registered at the obstetric unit of the Yaoundé University, Cameroon, out of which 291 were twins (1.8%). For the latter, the average gestational age was 37 +/- 2.9 weeks. In 45.0% of cases both fetuses presented cephalic, in 42.6% one presented cephalic and the other breech, while both fetuses presented as breech in 9.9% of cases. The frequency of the combination cephalic-transverse was 0.05%. Spontaneous delivery of both babies was observed in 90.2% of the patients, while in 9.7% delivery of both babies was by caesarian section. The caesarian section rate for a retained second twin was 1%. The perinatal mortality rate was 65 per 1000 (38 deaths in the first week of life), out of which the fetal loss was 4.4% for the first twin compared with 7.9% for the second. The perinatal mortality for the second twin was significantly associated with the type of fetal presentation at the time of delivery, as well as the time gap between the delivery of the twins. Sixteen deaths were observed amongst second twins after podalic presentation out of a total of 23 deaths recorded in the group. In addition, the mortality rate among second twins born more than 20 minutes after expulsion of the first was four times higher than in those delivered within 20 minutes time interval (16.0%5 versus 4.3%). The main cause of twin deaths in our study was found to be prematurity which complicated 30 cases of the registered deaths (78.9%).

Maternal mortality in Maroua Provincial Hospital, Cameroon (2003-2005)

Background: In September 2000, the Heads of States of the 191 countries of the United Nations approved the Millennium Declaration in which reduction of pregnancy-related deaths to a quarter by 2015 was one of its goals. However, before the middle of the first decade of this millennium, there were no reports on the status of maternal mortality in Maroua, Cameroon.Objective: The aim of this study was to establish baseline data on maternal mortality for future evaluation of pregnancy-related mortality trends in this city. Subjects and Methods: Maternal deaths that occurred from 2003 to 2005 in Maroua City, Cameroon,were analyzed. Mortality ratios were determined by comparing the number of the deaths related to pregnancy with that of women with safe deliveries. Mortality risks were determined by comparing the characteristics of women with pregnancy-related deaths to those of women with safe deliveries. Results: The overall maternal mortality ratio was 1266 maternal deaths per 100 000 live births. The leading causes of death were hypertension (17.5%), obstetric infections (14.3%), uterine rupture(14.3%), anaemia (12.7%) and HIV complications (9.5%). Among the women who died, 28.6% were teenagers and 14.3% were at their sixth delivery (or above). Compared with women aged 20 to 24 years, those aged 25 to 29 years were more than twice as likely to die from pregnancy-related causes (HR: 2.34; CI: 1.07,5.08; p = 0.029). A similar trend was also found in those aged 30 to 34 years (HR: 2.26; CI: 1.02,5.00; p = 0.042). Conclusion: The findings suggest that Maternal Mortality Ratio in Maroua, City, Cameroon, is veryhigh. Since most of the causes of death were preventable, we propose that the current maternal and Family Planning strategies be reviewed with the view to reducing the current trend. Such a strategy would enable the Maroua city to meet the Millennium goals by 2015.

Antecedentes: En septiembre del 2000, los Jefes de Estado de 191 países de la Naciones Unidas, aprobaron la Declaración del Milenio, una de cuyas metas es la reducción hasta una cuarta parte, de las muertes relacionadas con el embarazo, para el año 2015. Sin embargo, antes de mediados de la primera década de este milenio, no habia reportes sobre el estado de la mortalidad materna en Maroua, Camerún. Objetivo: El objetivo de este estudio fue establecer los datos preliminares comparativos de referenciasobre la mortalidad materna para la evaluación futura de las tendencias de la mortalidad en relación con el embarazo en esta ciudad. Sujetos y Métodos: Se analizaron las muertes maternas ocurridas del 2003 al 2005 en la ciudad de Maroua, Camerún. Las tasas de mortalidad fueron determinadas comparando el número de muertesrelacionadas con el embarazo, con el número de mujeres que tuvieron partos seguros. Los riesgos de mortalidad fueron determinados comparando las características de mujeres que murieron por causas asociadas al embarazo, con mujeres que tuvieron partos seguros. Resultados: La tasa general de mortalidad materna fue de 1266 muertes maternas por cada 100 000nacidos vivos. Las causas principales de muerte fueron: hipertensión (17.5%), infecciones obstétricas (14.3%), ruptura uterina (14.3%), anemia (12.7%) y complicaciones por VIH (9.5%). De las mujeres que murieron, 28.6% eran adolescentes y 14.3% estaban en su sexto parto (o por encima). En comparación con las mujeres de 20 a 24 años de edad, las de 25 a 29 años presentaban una probabilidad dos veces mayor de morir por causas relacionadas con el embarazo (HR: 2.34; CI: 1.07, 5.08; p =0.029). Una tendencia similar se halló también en las mujeres de 30 a 34 años de edad (HR: 2.26; CI: 1.02, 5.00; p = 0.042). Conclusión: Los hallazgos sugieren que la tasa de mortalidad maternal en la ciudad de Maroua,Camerún, es muy alta...