Effectiveness of vaginal hysterectomy for benign conditions in semi-urban hospital: report from Maroua-Cameroon.

We assessed the effectiveness of vaginal hysterectomy for benign uterine conditions in Northern Cameroon. This is a case series study of 29 elective vaginal hysterectomies carried out between February 2005 and June 2007 in Maroua, Cameroon. Hysterocele was found as the only or associated indication in 17 (58.6%) patients, symptomatic uterine fibroids in 4 (13.8%) and other indications in 8 (27.6%) patients. The mean duration of the operation was 132 minutes and the mean blood loss at surgery was 150 ml. Twenty-five of the 28 (89.3%) women had less than seven days of hospitalisation. There was a negative correlation (r = -0.45, P = 0.015) between duration of the surgery and the order of operation. One urinary tract and one wound infection were observed. Two patients had conversion to laparotomy. This study has shown that vaginal hysterectomy is a safe and feasible method of hysterectomy in a semi-urban hospital.

[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.

Visual inspection with acetic acid and cytology as screening methods for cervical lesions in Cameroon.

OBJECTIVES: To assess the accuracy of visual inspection with acetic acid (VIA) as a screening method for cervical lesions. METHODS: VIA and cytological smears were carried out on the cervices of non-pregnant women aged 30-60 years with no previous history of cervical cancer. Cervices with aceto white lesions or positive Pap smears, and one in ten negative cervices (control), were biopsied. RESULTS: 5010 women were enrolled, 4813 (96.1%) were screened. 4767 (99.%) had adequate cytology smears. 574 (11.9%) had colposcopy. 1743 biopsies were obtained of which 528 were controls. The sensitivity of VIA was 70.4% versus 47.7% for Pap smear. VIA specificity was 77.6% versus 94.2% for Pap smear; PPV for VIA was 44.0% versus 67.2% for Pap smear; and NPV for VIA was 91.3% versus 87.8% for Pap smear. CONCLUSIONS: VIA has acceptable test qualities and may in low resource settings be implemented as a large scale screening method.

Laparoscopic fimbrioplasty and neosalpingostomy. Experience of the Yaoundé General Hospital, Cameroon (report of 194 cases).

OBJECTIVE(S): To study the fertility results after laparoscopic distal tuboplasty and compare them with the data in the literature. STUDY DESIGN: 194 laparoscopic distal tuboplasties were carried out from May 1992 to May 1994 in the Yaounde General Hospital (Cameroon). The results were analysed according to the age of the patients, the type and duration of infertility, past history of abortion, laparotomy and Chlamydia trachomatis infection, the tube and adhesion scores, surgical procedures and achievement of pregnancy. The fertility rates were calculated according to Cramer's method [11]. The cumulative pregnancy rate curves were drawn up from the life table [12] and compared using the Log-Rank test. RESULTS: 53 patients obtained pregnancy (27.3%) of which 45 were inter-uterine (23.2%) and 8 ectopic (4.1%). Of the 45 intra-uterine pregnancies (IUP), 36 were obtained after fimbrioplasty (33.3%) and 9 after neosalpingostomy (10.5%). The monthly fertility rate at one year was 1.4%. The rate of IUP for tube stages I and II is significantly higher than that for stages III and IV (p<0.001). However the rate of ectopic pregnancies (EP) is proportional to damage to the tubes. Infection with Chlamydia trachomatis, and residual inflammation could have an effect on the achievement of pregnancy. CONCLUSION(S): Our results are similar to those found in the literature. The tube stage thus remains the decisive factor in terms of fertility (Cox: p<0.001). Operative laparoscopy is the best alternative in our countries compared with laparotomy for distal tubal pathology.

The outcome of labor at the University Teaching Hospital (CHU), Yaounde, Cameroon.

The University Teaching Hospital, Yaounde, Cameroon became operational in 1982. This retrospective study analyses the performance of the maternity unit during the first 5 years. Data was obtained from casenotes, annual reports, delivery and operation registers. The maternal mortality rate (MMR) is one of the lowest in Africa. The perinatal mortality is low but could be improved upon. The reasons for the low MMR is discussed. It is possible to reduce the appalling MMRs of developing countries without sophisticated technologies.

PIP: The University Teaching Hospital, Yaounde, Cameroon, became operational in 1982. This retrospective study analyses the performance of the maternity unit during the first 5 years. Data was obtained from case- notes, annual reports, delivery and operation registers. 5614 deliveries over this 5-year period were analyzed. Patients were 12-49 years old. The maternal mortality rate (MMR) is one of the lowest in Africa (averaging about 33/100,000 births over 5 years). The perinatal mortality rate is also low (about 34.3 in 1000 births), however it can still be improved. The low MMR may be due to the short distance the patients travel to get to the hospital, the fact that 99% of the patients are booked, the existence of an efficient referral system, the use of the partogram in labor, and the existence of family planning clinics. Adequate staffing of maternity units is also important, to relieve overworked staff.

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.

An advanced case of double primary malignancy involving the breasts and uterine cervix: satisfactory response to non-surgical management.

Double primary cancers are fairly rare. We report here a case of metachronous lesions; advanced cancer of the breasts and squamous cell carcinoma of the cervix. What is peculiar in this case is the rather unusual positive response to conservative treatment. Despite widespread metastases even to the liver, the patient is well and active more than six years after breast cancer was first diagnosed. Treating such advanced cases may be rewarding at times.

A clinical study of caesarean section at the University Teaching Hospital (C.H.U.) Yaounde (1982-1989).

During the period extending from January 1982 to December 1989, we delivered 9,637 women at the University Teaching Hospital (C.H.U.), Yaounde, Cameroon. Seven hundred and forty-one (7.69 pc) of these patients underwent caesarean section (CS) Most of them were in the 20-30 year age group and of low parity (0-4). Foetal distress, cephalopelvic disproportion (CPD), and malpresentation were the commonest indications for abdominal delivery. Elective repeat sections were usually done for CPD. Most of the operations were carried out by qualified staff and maternal and foetal outcome were satisfactory especially for a Third World institution dealing mainly with higher risk pregnancies.

Double primary malignancies in patients with gynaecological cancers.

The diagnosis of double primary cancers may be enhanced by greater clinical awareness and interest in such patients. A retrospective study involving the analysis of patient files and operative registers was carried out at the University Hospital Centre (UHC), Yaounde, Cameroon. Thirteen cases of double primary cancers, each involving at least one gynaecological malignancy, were managed over a nine year period at the University Hospital Centre. Nine different cancer associations were identified. There was a preponderance of cervical cancer, reflecting the high prevalence of this malignancy in our environment. Apart from the association between cervical and breast cancers that occurred in four patients, and cervical and large bowel cancers that occurred in two patients, no other preferential cancer association were observed. A patient with a gynaecological malignancy requires a thorough initial evaluation and life long follow-up in order to diagnose any possible second primary malignancy.

A clinico-pathological study of ovarian tumors in Yaounde-Cameroun.

During the period January 1984 to December 1989, we treated 128 patients with ovarian neoplasms. 82.04% patients had benign tumors while the remaining 17.96% had ovarian cancer. Epithelial tumors were the commonest histological type (67.2%) followed by teratomas (17.19%). Most patients were of low parity, with 31.70% of patients with benign tumors and 11.11% of cancer patients, presenting also with infertility. An unfortunate feature of this study, as in most others from developing countries, is that patients since survival in such cases is a function of clinical stage and histologic type. One hundred and seventeen patients were treated by surgery (91.4%). Chemotherapy was used as an adjunctive treatment in 65.22% of cancer cases.

[Pheochromocytoma and pregnancy. Apropos of a case]. / Phéochromocytome et grossesse. A propos d'un cas.

Pregnancy complicated by pheochromocytoma is rarely reported; fewer than 150 cases in the published literature, while their diagnosis during the antepartum period is even more rare; fewer than 50 documented cases. The risk to the mother and fetus is considerable but early diagnosis and treatment markedly reduce infantile and maternal mortality. A case of pheochromocytoma during pregnancy is reported in which a favorable prognosis was noted for both mother and child.

[Anatomical-clinical presentation and prognostic factors in cancers of the cervix at the General Hospital of Yaounde]. / Presentations anatomo-cliniques et facteurs pronostiques des cancers du col uterin a l'hôpital General de Yaounde.

The objective of this work was to search for and precise all the facts related to clinical anatomo and the prognosis capable of individualising the sick in our midst. We proposed to analyse 111 files of cases treated for the cancer of the uterine neck in the gynaecology services and cancerology-radiotherapy in the General Hospital, Yaounde. All the facts related to the clinical anatomo presentations of the patients were noted as well as the therapeutic results in accordance with the facts and the technical means of treatment. All these facts have been compared to the ones of the literature. We established that the clinical anatomo presentation of the cases in our series is comparable to the one of the literature taking into account the previous history, the general state, the symptoms and the clinical signs. On the other hand, it differs relatively by the important proportion of the young, the long diagnosis delay, the importance of the extensive stages and the additional prognosis factors in relation with the inadequacy of technical means of treatment. In conclusion, a lucid reorientation of our policy to fight against cancers in general and of cancer of the uterine neck in particular that takes into account the reality of the data based on the clinical and prognosis facts of our patients is needed.

[Treatment of early T1 small T2N breast cancers. Our experience at the Yaounde General Hospital. 21 cases]. / Traitement des cancers du sein aux stades précoces T1 petit T2 N-notre experience a l'Hôpital Général de Yaoundé. A propose de 21 cas.

From February 1989 through February 1993, a group of 23 patients suffering from T1 mammary carcinoma small T2 N-MO was treated in the radiotherapy department of the Yaoundé General Hospital, according to a simplified procedure. A first conservative surgery of tumorectomy type (3 cases) and quandrantectomy type (4 cases) was carried out, followed by a postoperative irradiation. In 14 cases, a Patey type radical surgery preceded a local/regional radiotherapy. The general treatment was made up of only a hormonotherapy without chemotherapy. After a 4-year decline, there were 5 cases--i.e. 23.8%--of ganglionic and/or metastatic relapse. In the light of research data, we are analysing the reasons for these unexpected therapeutic failures in this group of tumor considered as favorable prognosis. We raised the problem of the inability of the prognosis factors, presently defined by means of histological and biological factors, to detect all the especially aggressive cancers. We carried out a general review of the new factors defined essentially from molecular and genic bases. We offered an approximative solution which makes it possible to by-pass the technological difficulties in having access to the new factors.

[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.

[Outcome of delivery at extreme ages of reproductive life]. / Devenir de l'accouchement aux âges extrêmes de la vie reproductive.

BACKGROUND: Deliveries in adolescents and in elderly are separately known as associated with high foetal and maternal risks. The purpose of this study was to test the hypothesis that the outcome of deliveries might be comparable in these distinct age groups. POPULATION AND METHODS: The deliveries of 99 adolescents aged 16 and under were compared with that of 183 women aged 40 years and above with respect to complications of the delivery and the outcome of pregnancy. Data collection was retrospective using delivery room registers from 01/01/1991 to 31/12/2000. RESULTS: Some risks were comparable in both groups as delivery by caesarean section, intra uterine growth retardation, and stillbirth. Other risks were significantly higher in teenagers as post-term delivery, premature delivery, and neonatal foetal distress. The risk of macrosomia was significantly higher in aged women. CONCLUSION: There are risks that are similar in both extremes of age. Other risks are higher particularly in teenagers or in aged women. A common prenatal care unit can be used for these two categories of population, but a few different practices will have to be considered according to the specific age group.

Conservative treatment of ectopic pregnancy in a sub-Saharan African setting.

In the sub-Saharan African setting, laparotomy for salpingectomy is the common method of treatment for ectopic pregnancy (EP). The objective of this retrospective study was to find out how common EP is treated conservatively in the Yaounde Gynaeco-Obstetric and Paediatric Hospital, Cameroon. Of the 281 patient files analysed, 126 patients (44.8%) were treated conservatively and successfully for EP. Of these, 86 (68.2%) had received conservative surgical treatment while 40 (31.8%) had non-surgical treatment. Salpingostomy was the conservative surgery for 79.1% of the cases. According to the publications available for the sub-Saharan setting, the rate of conservative management of EP at the Yaounde Gynaeco-Obstetric and Paediatric Hospital, Cameroon is high. We recommend that this rate should be improved so that, eventually, the conservative treatment methods of EP become routine.

Geographic Distribution of Childbirth among Adolescents in Cameroon from 2003 to 2005.

Objective. To determine the frequency and the trend of adolescents (10-19 years) in childbirth within a period of 3 years in referral maternity units in Cameroon. Method. Descriptive and retrospective study for a 3-year period (2003-2005) in referral maternity units headed by a qualified Obstetrician-Gynecologist. We analyzed the trend and geographic distribution of 8222 adolescent deliveries over 3 years. Epi Info 3.5 software was used for data analysis. Chi square test for trend was used to assess the contribution of adolescent deliveries over years. The trend was considered significant if P < .05. Results. During the period of the study, there was a total of 8387 deliveries. We excluded 165 women because of lack of information about age. We therefore included a total of 8222 adolescent deliveries. Overall, the contribution of adolescents to deliveries ranged from 6.87% to 26.51%, depending on the region with a national mean of 14.23%. Adolescents aged 16 or less contributed to 2.82% of deliveries while those aged from 17 to 19 contributed to 11.41%. The contribution of adolescents to deliveries decreased significantly over 3 years (P < .0001). Conclusion. The study underscores the importance of Public Health programs in strengthening maternity services for adolescents in Cameroon while taking into consideration geographic differences.