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.

[The new HemoCue system Hb 301 for the haemoglobin measurement in pregnant women]. / Evaluation du nouvel appareil HemoCue Hb 301 dans le dosage de l'hémoglobine chez des femmes enceintes camerounaises.

The performance of the HemoCue apparatus in the diagnosis of anaemia in pregnancy was evaluated using the HemoCue Hb 301 and the HemoCue Hb 201+ apparatus. The HemoCue Hb 201 + was considered as the reference method in this study. Two hundred and thirty six pregnant women attending the University Teaching Hospital in Yaoundé (Cameroon) were included in the analysis. Anaemia was defined as haemoglobin < 11 g/dL in pregnant women during the first and the third trimester of pregnancy and as <10. 5 g/dL during the second trimester of pregnancy. With the reference method, anaemia was present in 17.7% of pregnant women compared to 11% using the HemoCue 301 method. The sensitivity, specificity, positive and negative predictive values for the HemoCue 301 method were respectively 61.9%, 100%, 100% and 92.3%. A strong correlation was shown with a Pearson's coefficient of 0.98. Using the Bland and Altman method for assessing agreement between two methods, the 95% (+/- 2SD) distribution of Hb levels about the mean was not much spread (0.06 - 0.52) though it was positive, with slightly higher Hb levels in the HemoCue Hb 301 method, compared to the reference method. Considering the study of the precision, coefficient of variation of the two methods were similar. It may be concluded that the HemoCue Hb 301 method compared to the HemoCue Hb 201+ method has acceptable sensitivity and is very specific in the diagnosis of anaemia in the Cameroonian pregnant woman. Although it gives slightly higher values, it is precise and exact in measuring Hb levels.

Spontaneous uterine rupture during pregnancy: case report and review of literature.

Rupture of a gravid uterus is a surgical emergency. Predisposing factors include a scarred uterus. Spontaneous rupture of an unscarred uterus during pregnancy is a rare occurrence. We hereby present the case of a spontaneous complete uterine rupture at a gestational age of 34 weeks in a 35 year old patient. The case was managed at the University Teaching Hospital of Yaounde (Cameroon). She had past history of two uterine curettages. She presented with abdominal pain of sudden onset. After ultrasound scan, uterine rupture was diagnosed and an emergency laparotomy done. The entire amniotic sac was found in the peritoneal cavity with a rupture of the uterine fundus. Spontaneous uterine rupture occurs when there is an upper segment uterine scar. This case report shows that past history of curettage is a risk factor for the presence of uterine scar.

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.

[Simple technique for autologous transfusion in ruptured ectopic pregnancy: Report of six cases managed at the Yaoundé University Hospital in Cameroon]. / Autotransfusion dans la grossesse extra-utérine rompue : description d'une méthode simplifiée À propos de six cas reçus au CHU de Yaoundé, Cameroun.

Ruptured ectopic pregnancies are life-threatening emergencies, especially in developing countries, where many patients do not consult until rupture, sometimes with the patient already in hemorrhagic shock. In this situation, immediate blood transfusion is essential. Homologous blood products are not always available. Furthermore, homologous transfusion carries the risk of transmitting viruses such as HIV and hepatitis B and C. Autologous transfusion (intraoperative blood salvage) may thus be helpful. The authors present 6 cases of autologous transfusion performed at the Yaounde University Hospital (Cameroon) and recommend this method in developing countries where good quality blood cannot always be obtained rapidly.

Eagle-Barrett syndrome: occurrence and outcomes.

OBJECTIVE: To examine the occurence and outcomes of African babies born with features of Eagle-Barret syndrome at a tertiary health centre. DESIGN: Case series. SETTING: University Teaching Hospital, Yaounde, Cameroon. SUBJECTS: Patients were identified through a retrospective review of obstetric records of mothers admitted at the centre within the period 1984 to 1996 inclusive. A total of eleven cases were identified over a period of thirteen years. RESULTS: The most prominent associated defects consisted of clubfoot, pulmonary hypoplasia, Potter's facies, imperforate anus and arthrogryposis. None of our patients survived the perinatal period. CONCLUSION: Our study indicates the need for the establishment of a prenatal and cytogenetic infrastructure in Cameroon to enhance early detection of congenital malformation and chromosomal aberrations. In the meantime, early detection of foetuses with Eagle-Barret syndrome using ultrasound could facilitate timely institutions of antenatal management options and lead to favourable birth outcomes of affected babies.

[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.

Prune belly syndrome and associated malformations. A 13-year experience from a developing country.

A retrospective investigation was conducted to describe clinical features and birth outcomes among babies with prune belly syndrome detected ante-natally and at birth at the University Teaching Hospital in Cameroon. A total of 11 cases were identified over a period of 13 years, and the majority of affected fetuses were male (10 of 11). Most of the mothers were less than 30 years of age, had singleton pregnancies, and about two-thirds were complicated by placenta praevia, genital infections, preeclampsia, and anaemia associated with hookworm infestations. The most prominent findings related to prune belly syndrome among our patients were clubfoot (45%), pulmonary hypoplasia (27%), Potter facies (27%), imperforate anus (27%), and arthrogryposis (18%). About two-thirds of the affected pregnancies did not reach the age of viability either due to voluntary termination (three of seven cases) or spontaneous abortion (four of seven cases). Of the remaining four viable pregnancies, two cases each of stillbirth and neonatal death were recorded. Among pregnancies that were not voluntarily terminated (n = 8), multiple concomitant anomalies and bilateral renal lesions were apparently the cause of fetal/infant death in the majority of cases (75%). In conclusion, Cameroonian babies with prune belly syndrome presented with clinical features that were comparable to those observed in developed nations.

[Fetal ultrasound biometry in a Cameroonian population: study of femur length]. / Biométrie foetale ultrasonore sur une population Camerounaise: étude de la longueur du fémur.

The length of the fetal femur was measured by fetal ultrasonography in Cameroonian population as a preliminary step in constructing local curves for fetal growth. This prospective cross-sectional study was conducted in 3 centers in Yaoundé, Cameroon over a period of one year. A total of 803 pregnant women (mean age, 27.15 years) knowing the exact date of the last menstrual period (LMP) were included. Based on ultrasound findings demonstrating a single fetus with normal development. Gestational age ranged from 12 to 42 weeks of amenorrhea (WOA). The mean length of the femur increased from 16.61 +/- 2.25 mm at 13 WOA to 75.36 +/- 4.85 mm at 42 WOA. There was a good correlation with gestational age and findings reported in the literature. Curves obtained using these data were compared with those in the literature. In most cases femur lengths measured in Cameroonian fetuses were slightly longer than European standards throughout pregnancy.

[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.

Indications and maternofetal outcome of instrumental deliveries at the University Teaching Hospital of Yaounde, Cameroon.

Instrumental deliveries are believed to be associated with increased maternal and, especially, fetal morbidity and mortality. Hence, it is less practiced in many developing countries. The aim of this retrospective study, conducted between 1 January 2007 and 31 December 2008, was to assess the prevalence, indications, neonatal wellbeing and maternal complications of instrumental deliveries. Of 3623 vaginal deliveries, 84 (2.3%) instrumental deliveries were conducted. The most common indication was a prolonged second stage of labour. Fetal wellbeing, measured by the Apgar score, was good and was similar in the group who had forceps delivery and that of the vacuum extraction delivery group. Maternal complications, usually minor, were vaginal and perineal tears. Instrumental delivery should be encouraged and taught in order to reverse the rising caesarean section rate.

Vaginal delivery after caesarean section: a propective study of 146 cases.

We report on a series of 146 cases of vaginal delivery after previous Caesarean section conducted between 1993 and 2002 at the University Teaching Hospital, Yaounde (Cameroon). During the period under review 945 cases of Caesarean section were done out of a total of 9 439 deliveries (10 %). Delivery was spontaneous in 141 cases whereas in 5 cases it was assisted by vacuum extraction. In 13 cases Caesarean section was carried out after failure of trial of labour. Maternal mortality, resulting from pulmonary embolism, was observed in 1 case. We conclude that strict selection of patients who had previous Caesarean section for trial of labour renders vaginal delivery a safe alternative to Caesarean section.

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.

[Optimal time for labor induction in premature rupture of fetal membranes after the 37th week of pregnancy]. / Zur Frage des optimalen Zeitpunktes der Geburtseinleitung beim vorzeitigen Blasensprung nach der 37. Schwangerschaftswoche.

Object of the analysis were 298 births with premature rupture of membranes. Authors examine the complications of birth dependent of time between premature rupture of membranes and beginning of labour; they compare their own results with such of known investigations. In respect to infection morbidity there are stated significantly differences between delivery with and without premature rupture of membranes only when the interval between rupture of membranes and beginning of labour were long; when this interval was less than 6 hours, the infection morbidity even seems to be lower. The same fact authors stated generally for all multiparae. Significantly differences are also stated in respect to frequency of operative deliveries. The fact, that in cases of premature rupture of membranes near term--that's to say: by mature fetus--birth-throes are released, is advantageous; authors conclude, that a time of 5 hours after rupture of membranes is optimal for induction labour.

[Rate of prematurity and perinatal mortality in the Yaoundé (Cameroon) University Gynecologic Clinic 1982-1992> An analysis of 680 cases]. / Frühgeburtenrate und perinatale Mortalität an der Universitätsfrauenklinik Yaoundé (Kamerun) von 1982-1992. Eine Analyse von 680 Fällen.

The authors made an analysis of perinatal mortality on 680 cases of premature births recorded between 1982 and 1992 in the CHU maternity, Yaoundé (Cameroon). During this period, 13,555 births were recorded. The frequency of premature births stood at 5%. The most important etiological factors responsible for these 680 premature cases were depicted as malaria infection and anemia (22.2%), premature rupture of the membranes (13%), multiple pregnancies (11.9%), preeclampsia (10.2%), antepartnal bleeding (5.7%), and urogenital infections (5.0%). The perinatal mortality rate was 16.7% (114 cases). There were 37 cases of antepartual foetal deaths (5.4%), 24 cases of intrapartual foetal deaths (3.2%) and 31 cases of neonatal deaths (4.5%). Perinatal mortality reduced with an increase in the gestation period and the weight of the foetus. The authors noted with astonishment that perinatal mortality was twice as high in cases of non ruptured membranes (19.5%) when compared to premature ruptures of the membrane (10.2%). A plus 30 minutes duration of the expulsion phase was estimated to be a factor that increases perinatal mortality. Breech presentation with a 32.8% perinatal mortality, when compared to cephalic presentation (7.5%), portrays an important risk factor in premature births. Perinatal mortality of premature babies in cases of spontaneous births is two time higher (16.2%) than in cases of caesarean section (7.8%).

[Fetal risk factors in twin pregnancies. Critical analysis of 265 cases]. / Les facteurs de risque foetal dans les accouchements gémellaires. Une analyse critique de 265 cas.

The authors report their critical analysis of perinatal mortality concerning 265 twin pregnancies collected between 1982 and 1993 in the Maternity Unit of the Yaoundé (Cameroon) Teaching Hospital Group. There were a total of 14,277 deliveries during this period. The twin pregnancy rate was 1.8 per cent. Delivery was spontaneous in 89.6 per cent of cases and by cesarean section in 10 per cent of cases. In 3 cases the second twin was delivered by section after spontaneous delivery of the first twin. Perinatal mortality evaluated at 6.9 per cent (37 cases) was analysed according to fetal risk factors such as gestational age, type of delivery, fetal presentation, birth weight, birth rank and the time interval between birth of the first and second twin. Perinatal mortality of premature twins with 25 fetal deaths accounted for approximately 2/3 of the fetal deaths in this series. Twenty-two cases of fetal deaths seen in the group of second twins accounted for more than half of all fetal mortality. The time interval between the two births was an important factor in the fetal prognosis of the second twin. There were 14 cases of death of the second twin for a time interval longer than 20 minutes as compared with 8 fetal deaths for an interval of 20 minutes or less. Breech presentation was associated with abnormally high fetal mortality (16 cases). Our conclusion is that improved perinatal mortality in twin pregnancies must be sought by preventing prematurity. Breech presentation is a factor of poor prognosis, in which it is important to widen indications for prophylactic cesarean section aimed at improving fetal prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Perinatal mortality of newborns with birth weights above 2,500 g and delivered from breech presentation (author's transl)]. / Zum Problem der perinatalen Mortalität bei Beckenendlagenkindern mit Geburtsgewichten über 2500 g.

An account is given of the problem of delivery from breech presentation, with reference being made to an analysis of childbirths over the last 14 years (1965 through 1978). -- Since the rate of premature births from breech presentation was found to be much higher than that generally recordable from vertex presentation, the gap being roughly by factor 4, reference in this paper has been restricted to children with birth weights above 2,500 g, defined as "mature" in a WHO recommendation, with the view to establish comparability between the data given in this paper, on the one, hand and the birth record on the basis of vertex presentation, on the other. -- Evidence is provided, by the example of 604 newborns delivered from breech presentation, that their intrapartum and postpartum mortality -- generally referred to as "purified" perinatal mortality, does not differ from figures quoted for comparable cases of vertex presentation. -- Another point made is that the vaginal route of delivery, except for complete extraction, is by no means necessarily inferior to caesarean section. Reduction of perinatal mortality, including morbidity, is considered to depend primarily on adequate labour monitoring. -- Taking into due consideration the considerable increase in maternal mortality and morbidity, the authors feel that the indications followed for termination of labour by caesarean section should be identical with those applicable to vertex presentation. -- The conclusion is drawn that delivery from breech presentation is a problem of premature birth rather than of positional abnormality.

[Prolapse of umbilical cord - new aspects (author's transl)]. / Einige neue Aspekte zum Nabelschnurvorfall.

In an evaluation of more than 20,000 births, 39 recorded cases of prolapse of the umbilical cord were investigated in greater detail for the risk of perinatal mortality and morbidity. Particular attention was given to several variants of breech presentation in comparison to vertex presentations as well as to the time of rupture. The interval between diagnosis of prolapse of the umbilical cord and termination of birth was also in the focus of interest.-The authors concluded that the overall definition of "breech presentation" was quite inadequate and should be replaced, at least, by differentiation between real breech presentation and combined breech-footling presentations, in order to make allowance for the highly differentiated risks involved.-Therefore, a demand is made for strict differentiation of approach in key with presentation. Delivery should be terminated immediately in cases of prolapse of the umbilical cord in concomitance with real breech presentation or vertex presentation, whereas no direct time pressure existed in cases of combined breech-footling presentation.-The approach taken to all kinds of breech presentation, above all real breech presentation, should be identical with that taken to vertex presentation for adequately programmed delivery which has been a growing demand.-All conclusions proposed are discussed in great detail and substantiated as well as supported by comprehensive literature data.

[Frequency of breech presentation during pregnancy and on full term (author's transl)]. / Zur Häufigkeit von Beckenendlagen im Verlauf der Schwangerschaft und zum Zeitpunkt der Geburt.

The causes underlying the relationship between breech presentation and premature birth were studied, with reference to the premature birth discussion which has assumed sizeable dimensions in the obstetric community. -- An evaluation of 785 ultrasonographic findings from pregnant women has shown breech presentation to be just as frequent as vertex presentation up to the 24th week of pregnancy. The former, consequently, should be considered as physiological. The frequency of breech presentation was found to go down continuously only beyond the 24th week and to drop below five per cent, after the 35th week of pregnancy to reach eventually the figure usually recorded at birth. These observations were found to be in good agreement with what has been reported by other authors. -- The authors of this paper were struck by surprise, when they found that the breech presentation figure, in the context of 997 premature births, was, with high significance, below the level usually recordable from unimplanted pregnancy. -- The above findings are discussed in great detail. Preliminary suggestions are made regarding possible interpretations. Yet, further target-oriented studies are required.