Factors associated with intrapartum stillbirth in a tertiary teaching hospital in Burkina Faso.

Introduction: Intrapartum stillbirth is an indicator of health and community development. Objective: To identify the risk factors associated with intrapartum stillbirth in a tertiary teaching hospital in Burkina Faso. Patients and methods: A case-control study conducted from January 1 to August 30, 2019. Cases were defined as patients admitted to Yalgado Ouedraogo teaching hospital (YOTH) with a live fetus of at least 28 weeks' gestation and who gave birth to an intrapartum stillborn, a fetus delivered without any signs of life in the first minute postpartum. Controls were defined as patients who delivered a live newborn. Study controls were gradually recruited and matched to cases. For each case, two controls were recruited and matched according to criteria such as delivery route and day of delivery. Data were cleaned in Epidata and exported to Stata for analysis. Variables with a p < 0.05 significance level in the multivariable regression were retained. Odds ratio (OR) and 95% confidence intervals are reported. Results: Eighty-three intrapartum stillbirths were documented among a total of 4,122 deliveries, a stillbirth rate of 20.1 per 1,000 births. There was a statistically significant association between intrapartum stillbirth and prior caesarean section (p = 0.045), multiparity (p = 0.03), the receipt of antenatal care (ANC) by a nurse (p = 0.005) and the disuse of the partogram (p = 0.004). We did not find a significant association between the number of ANC consultations performed (p = 0.3), whether membranes were ruptured at admission (p = 0.6), the duration of labor (p = 0.6) and intrapartum fetal death. Multivariate analysis showed that patient referral to another heath facility (OR: 3.33; 95% IC: 1.56, 7.10), no obstetric ultrasound performed (OR: 3.16; 95% IC: 2.11, 4.73), birth weight less than 2,500 g (OR: 7.49; 95% IC: 6.40, 8.76) were significantly associated with intrapartum stillbirth. Conclusion: Specific interventions must be taken to identify these risk factors of intrapartum stillbirth in order to ensure better and appropriate management.

[A case of large Mucinous Cystadenoma of the Ovary at the Regional Teaching Hospital of Ouahigouya (Burkina Faso)]. / Un cas de volumineux Cystadénome Mucineux de l'ovaire au Centre Hospitalier Universitaire Régional De Ouahigouya (Burkina Faso).

Introduction: A benign tumor of middle-aged women, mucinous cystadenoma accounts for about 20% of tumors of the ovary. It can reach very large sizes. Clinical observation: We report the case of a 42-year-old patient received for a voluminous abdomino-pelvic mass. The examination found a soft, rounded, fairly mobile abdomino-pelvic mass going up to the level of the xiphoid appendix with a light skin and collateral venous circulation. Imaging showed a circumscribed fluid formation occupying the abdomino-pelvic cavity of 40.1 x 29 x 25.7 cm developed at the expense of the ovary. A laparotomy brought to light a voluminous cyst at the expense of the left ovary with fluid content cowardly adhering to the abdominal wall and intimately to the left proboscis. The uterus and right adnexa were unremarkable. We performed a left adnexectomy with satisfactory hemostasis taking away the cyst. The adnexectomy piece weighed 13.5 kg. The surgical follow-ups were simple. Anatomo-pathological examination confirmed a mucinous cystadenoma of the ovary. Conclusion: Mucinous cystadenoma of the ovary is a benign tumor which can reach very large volumes. Its treatment is surgical and the follow-ups are usually simple.

[Clinical and therapeutic aspects of sexual violence received at CHU Yalgado Ouedraogo, Burkina Faso)]. / Aspects cliniques et therapeutiques des violences sexuelles reçues au centre hospitalier et universitaire (CHU) Yalgado Ouedraogo, Burkina Faso.

INTRODUCTION: Sexual abuse is a health problem that needs to be adequately and comprehensively managed. A preventive strategy must be conducted to deter potential abusers. The purpose of the study was to describe the cases of sexual abuse received in the Department of Gynecology and Obstetrics at Yalgado Ouedraogo University Hospital. PATIENTS AND METHOD: It was a retrospective and descriptive study covering a period from January 1, 2009 to December 31, 2013.The study involved victims of sexual violence received in the obstetrics and gynecology department of Yalgado OUEDRAOGO Hospital and whose files were usable. RESULTS: The average age of alleged victims was 16 years, ranging from 03 years to 32 years. Rape was the most frequent reason for consultation (93.1%). It was practiced nightly, usually in the residences. The most common genital lesion was vulvar lacerations (17.8%). The most frequent of non-gynecological lesion was scratches (10.9%).The victims' support was essentially medical and surgical. The short-term prognosis was favorable (100%). Psychological support was marginal.

INTRODUCTION: Les violences sexuelles constituent un problème de santé dont la prise en charge doit être adéquate et globale. Une stratégie préventive doit être menée afin de dissuader les potentiels agresseurs. Le but de l'étude était de décrire les cas de violences sexuelles reçus dans le Département de gynéco-obstétrique du Centre Hospitalier Universitaire Yalgado Ouédraogo (CHUYO). PATIENTES ET MÉTHODE: Il s'est agi d'une étude rétrospective à visée descriptive couvrant une période allant du 1er janvier 2009 au 31 décembre 2013. L'étude a concerné les présumées victimes de violences sexuelles reçues dans le département de gynécologie obstétrique du CHUYO et dont les dossiers étaient exploitables. RÉSULTATS: La moyenne d'âge des présumées victimes était de 16 ans avec des extrêmes allant de 03 ans à 32 ans. Le viol était le motif de consultation le plus fréquent (93,1%) et se déroulait nuitamment, généralement dans les domiciles. La lésion génitale la plus fréquente était les déchirures vulvaires (17,8%). La lésion non gynécologique la plus fréquente était les égratignures (10,9%).La prise à charge des victimes était essentiellement médico-chirurgicale. Le pronostic à court terme était favorable (100%). La prise en charge psychologique était marginale. CONCLUSION: Les violences sexuelles restent une préoccupation bien que sa fréquence soit faible. Ce fléau touche essentiellement les adolescentes.

Aspects cliniques et therapeutiques desviolences sexuelles reçues au centrehospitalier et universitaire (CHU)Yalgado Ouedraogo, Burkina Faso

Introduction:Les violences sexuelles constituent un problème de santé dont la prise en charge doitêtre adéquate et globale. Une stratégie préventive doit être menée afin de dissuader les potentielsagresseurs. Le but de l'étude étaitde décrire les cas de violences sexuelles reçus dans le Département de gynécoobstétrique du Centre Hospitalier Universitaire YalgadoOuédraogo (CHUYO).Patientes et méthode:Il s'est agi d'une étude rétrospective àvisée descriptive couvrant une période allant du 1er janvier 2009 au 31 décembre 2013.L'étude a concerné les présumées victimes de violences sexuelles reçues dans le département de gynécologie obstétrique du CHUYO et dont les dossiers étaient exploitables.Résultats: Lamoyenne d'âge des présumées victimes était de 16 ans avec des extrêmes allant de 03 ans à 32 ans. Le viol était le motif de consultation le plus fréquent (93,1%) et se déroulait nuitamment, généralement dans les domiciles.La lésion génitale la plus fréquente était les déchiruresvulvaires(17,8%). La lésion non gynécologique la plus fréquente était les égratignures (10,9%).La prise à charge des victimes était essentiellement médico chirurgicale.Le pronostic à court terme était favorable(100%). La prise en charge psychologique était marginale.Conclusion:Les violences sexuelles restent une préoccupation bien que sa fréquence soit faible. Ce fléau touche essentiellement les adolescentes

Diagnosis and management of a giant ovarian cyst in the gravid-puerperium period: a case report.

BACKGROUND: Giant ovarian cyst is very rare in gravid-puerperium period. It is a cause of a maternal-fetal morbidity. We report a case of a giant benign ovarian cyst in gravid-puerperium period which was diagnosed and managed in a hospital of a low-resource country. CASE PRESENTATION: Data were collected by historical review, clinical examination, laboratory investigations, imaging examination, and by histopathological study of the excised surgical specimen. It is the case of a 25-year-old woman who was third gravida and third para with unknown pathological history. After she had given birth through vagina, a giant ovarian cyst, unknown during pregnancy, was diagnosed. A left oophorectomy carrying the cyst was performed after laparotomy in Yalgado Ouedraogo University Hospital Center of Ouagadougou (Burkina Faso). The cyst was 42 cm long and weighed 19.7 kg. The histology of the operative specimen revealed serous cystadenoma of the ovary. The postoperative course was uneventful. CONCLUSION: This case reports that vaginal delivery is possible with a giant ovarian cyst associated with pregnancy. Surgical management of the cyst can be performed in the postpartum with satisfaction.

Dengue infection during pregnancy in Burkina Faso: a cross-sectional study.

BACKGROUND: Dengue fever is prevalent in the world; in recent years, several outbreaks occurred in West Africa. It affects pregnant women. We aimed to assess the consequences of dengue fever on pregnant women and their fetuses during dengue epidemic in Burkina Faso. METHODS: We conducted a cross-sectional study from November 1, 2015 to January 31, 2017 in 15 public and private health facilities in Ouagadougou, using secondary data. Immunochromatographic rapid test Duo detecting specific antibodies, immunoglobin M/G and /or dengue non structural antigen1 virus was used to diagnose dengue cases. RESULTS: Out of 399 (48%) women registered during the study period, 25 (6%) were pregnant. The average age of pregnant women was 30 years, with 18 and 45 years as extremes. The main symptoms were fever (92%) and headache (92%). Nine patients (36%) had severe dengue characterized by bleeding (16%), neurological symptoms (16%) and acute respiratory distress (8%). Eight (32%) of the 25 women had early miscarriage and 8 (32%) women gave birth to viable fetuses. Among those with viable babies, 5 (20%) presented post-partum hemorrhage and 3 (12%) presented early delivery. The main fetal complications included 3 cases of acute fetal distress (12%). One case of maternal death (4%) and 4 cases of neonatal mortality (44.5%) were notified. CONCLUSION: Dengue fever occurring during pregnancy increases maternal and neonatal mortality. Its severe complications require specific monitoring of pregnant women until delivery.

[Cancer of the vulva: Diagnostic stages, treatment and survival in a country with limited resources (Burkina Faso)]. / Cancer de la vulve : stades diagnostiques, traitement et survie dans un pays aux ressources limitées (Burkina Faso).

INTRODUCTION: Vulvar cancer is rare and belatedly diagnosed in Africa. We describe its diagnostic stages, therapeutic and evolution features in a country with limited resources. METHODOLOGY: Forty-seven cases of vulvar cancer diagnosed between 2013 and 2018 in Burkina Faso, were analyzed retrospectively. The diagnostic stages, therapeutic and evolution terms were considered. Survival was calculated through the Kaplan Meier Method and compared using the Logrank technique. RESULTS: Stages IA and IB accounted for 10.6%. Radiotherapy was not available and chemotherapy was done in 9 cases. Full vulvectomy with bilateral inguino-femoral dissection was performed in 11 cases. Average survival was 41 months with a median of 52 months. The difference in survival according to the diagnostic stages were highly significant statistically (P=0.000). DISCUSSION: Cancer of the vulva is rare and raises major therapeutic difficulties in countries with limited resources. Surgery is the only affordable weapon. Evolution would be better if radiochemotherapy was possible. CONCLUSION: Radiochemotherapy cannot be done due to the lack of a radiotherapy unit and the high cost of cytotoxics. Surgery is largely palliative and/or mutilating. Survival is modest. An early diagnosis could help promote conserving treatments.

Transfusion practices in the care of pregnant women with sickle cell disease in Ouagadougou.

OBJECTIVE: To study the contribution of blood transfusion management in the improvement of maternal and perinatal outcomes in pregnant women with sickle cell disease in Ouagadougou. METHODS: A cross-sectional retrospective study with data collected from February 2012 to January 2014 was used. Patients were differentiated into three groups: patients with at least one exchange transfusion, patients who received blood transfusion, and patients who did not receive any transfusion. Data were collected from patients' patient care documents. RESULTS: One hundred and sixty-four patients were included, of whom 53 were in the first group, 32 in the second group, and 79 in the third group. Maternal complications in the last trimester of pregnancy were significantly less important (P=0.000) in the first group (58.5%) than in the second (78.5%) and third group (91.1%). The same trend was observed for postpartum maternal mortality (5.7%; 12.5%; 12.6%; P=0.009). Fetal complications such as preterm birth and early neonatal death were lower in the first group (15.1%; 1.8%) than in the second (40.6%; 23.1%) and third group (32.9%; 7.6%). CONCLUSION: Prophylactic blood transfusion is an important part of the management of pregnant patients with sickle cell disease.

Interventions to improve the use of long-acting reversible contraceptive methods at primary health centers in Burkina Faso.

OBJECTIVE: To assess the effects of strengthening family planning capacity on the uptake of long acting reversible contraceptive (LARC) methods at two primary health centers. METHODS: Between April 2016 and March 2017, the Society of Gynecologists and Obstetricians of Burkina Faso (SOGOB) increased the capacity of two primary health centers in Ouagadougou, Burkina Faso, to offer LARC methods by training staff and providing family planning equipment and commodities. Uptake of LARC methods was compared between the year preceding the intervention and the year during the intervention. RESULTS: Within a year, the number of new users of family planning increased 2.8-fold from 2936 new users before the intervention to 8267 during it. The rate of new users of contraception increased 1.9-fold (14.9% vs 28.1%; P<0.001) for all LARC methods, 2.4-fold for intrauterine contraceptive devices (IUCDs), and 1.7-fold for subdermal contraceptive implants. The proportion of new users of the copper IUCD younger than 25 years was higher during the intervention than before it (57.2% vs 46.9%; P=0.026). CONCLUSION: The SOGOB's family planning intervention resulted in an increase in the use of LARC methods at the two primary health centers.

[Parietal suppurations after cesarean section at the Yalgado Ouédraogo University Hospital, Burkina Faso: epidemiological clinical, therapeutic and prognostic aspects]. / Les suppurations pariétales post-cesariennes au Centre Hospitalier Universitaire Yalgado Ouedraogo, Burkina-Faso: aspects epidemiologiques, cliniques, thérapeutiques et pronostiques.

Surgical site infections are frequent in developing countries. Cesarean section is one of the most common surgery among women in the world. This study aims to analyse the epidemiological, clinical, therapeutic and prognostic aspects of parietal suppurations after cesarean section in the Department of Gynecology and Obstetrics at the Yalgado Ouédraogo University Hospital in order to reduce their occurrence. We conducted a descriptive cross-sectional study over a period of 6 months, from 1st April 2015 to 30th September 2015. Out of 1998 cases of cesarean section, seventy patients had parietal suppurations, corresponding to an incidence of 3.5%. The average age of patients was 26.2 ± 6.1 years; the patients were predominantly housewives (77%). Emergency cesarean section was performed in all patients. Suppuration was mainly diagnosed in the 1st week (60%). Staphylococcus aureus was detected in 37.8% of cases. Second abdominal wall surgery was necessary in 34.3% of cases. Outcome was favorable in all patients. Parietal suppuration after cesarean is common. Second surgery is sometimes necessary. Further studies should be conducted to better identify factors favoring this disease in order to significantly reduce their incidence and therefore improve maternal prognosis.

[A 36 weeks heterotopic pregnancy discovered incidentally at the Regional University Hospital of Ouahigouya]. / Une grossesse heterotopique de 36 semaines de decouverte fortuite au centre hospitalier Universitaire Regional de Ouahigouya (Burkina Faso).

Heterotopic pregnancy is a rare entity, its development up to term is exceptional. We report a case of heterotopic pregnancy of fortuitous discovery during a caesarean section performed in a 26-year-old female patient received for abdomino-pelvic pain on suspected twin pregnancy of 33 SA. No obstetric ultrasound had been performed before admission. Two ultrasound ultrasounds have objectified an intrauterine twin pregnancy with hydramnios. A caesarean section at 36 weeks indicated for twin pregnancy with hydramnios and severe anemia was performed during which we discovered an intrauterine pregnancy and an abdominal pregnancy with insertion of the placenta at the level of the broad left ligament with adhesion on the left annex, Omentum and small handles. Newborns did not require any special care outside the classical essential care. The first intrauterine had a weight of 2650 g and the second abdominal of 2000 g. The postoperative sequences were simple.

La grossesse hétérotopique est une entité rare, son développement jusqu'à terme est exceptionnel. Nous rapportons un cas de découverte fortuite chez une patiente de 26 ans, reçue pour douleurs abdomino-pelviennes sur grossesse présumée gémellaire de 33 SA. Aucune échographie obstétricale n'avait été réalisée avant son admission. Deux échographies tardives ont objectivé une grossesse gémellaire intra utérine avec hydramnios. Une césarienne à 36 semaines indiquée pour grossesse gémellaire avec hydramnios et anémie sévère a été réalisée au cours de laquelle nous avons découvert une grossesse intra-utérine et une grossesse abdominale avec insertion du placenta au niveau du ligament large gauche avec adhérence sur l'annexe gauche, l'épiploon et les anses grêles.Les nouveaunés étaient bien portant. J1 intra utérin avait un poids de 2650 g et J2 abdominal de 2000g. Les suites ont été simples.

Une grossesse hétérotopique de 36 semaines de découverte fortuite au centre hospitalier universitaire régional de Ouahigouya (Burkina Faso)

Nous rapportons un cas de découverte fortuite chez une patiente de 26 ans, reçue pour douleurs abdomino-pelviennes sur grossesse présumée gémellaire de 33 SA. Aucune échographie obstétricale n'avait été réalisée avant son admission. Deux échographies tardives ont objectivé une grossesse gémellaire intra utérine avec hydramnios. Une césarienne à 36 semaines indiquée pour grossesse gémellaire avec hydramnios et anémie sévère a été réalisée au cours de laquelle nous avons découvert une grossesse intra-utérine et une grossesse abdominale avec insertion du placenta au niveau du ligament large gauche avec adhérence sur l'annexe gauche, l'épiploon et les anses grêles.Les nouveau-nés étaient bien portant. J1 intra utérin avait un poids de 2650 g et J2 abdominal de 2000g. Les suites ont été simples

A full term abdominal pregnancy with an isthmic tubal implantation of the placenta.

BACKGROUND: Abdominal pregnancy is defined as the partial or total insertion of the embryo into the abdominal cavity. It is rare, and can evolve towards the full term if it is not recognized in the early pregnancy. It carries a high risk of maternal-fetal morbidity and mortality. CASE PRESENTATION: We report a case of a 22 year-old gravida IV, para II with an asymptomatic and undiagnosed abdominal pregnancy presumed full term, in a context of health centers under-equipment. She had attended 5 routine antenatal care, but had not performed any ultrasound scan. She had been transferred from a medical center to the Hospital of Ouahigouya (Burkina Faso) for bowel sub-obstruction and intrauterine fetal death, with failure of labor induction. On admission, the hypothesis of uterine rupture or abdominal pregnancy with antepartum fetal demise was considered. A laparotomy was then performed, where an abdominal pregnancy was discovered, and a dead term baby weighing 3300 g delivered. The placenta which was implanted into the ruptured isthmus of the left fallopian tube was removed by salpingectomy. Postoperative follow-up was uneventful. CONCLUSION: This case report exposes the necessity for the practitioner to think about the possibility of abdominal pregnancy in his clinical and sonographic practice, irrespective of the gestational age, mainly in contexts where there is under-equipment of the health centers.

Maternal Mortality at the Dori Regional Hospital in Northern Burkina Faso, 2014-2016.

BACKGROUND: Maternal mortality is of considerable magnitude. It is particularly relevant to developing countries, including those in Sub-Saharan Africa. The aim of this work was to study the cases of maternal deaths in the Dori Regional Hospital, Burkina Faso in the Sahel region, by analyzing the epidemiological aspects of these deaths in order to guide decision-making. METHODS: This was a descriptive cross-sectional study which spanned the period from January 1, 2014 to December 31, 2016. Cases of maternal death and live births that occurred in the hospital during this period were collected by documentary review. RESULTS: A total of 141 maternal deaths and 2,626 live births were recorded with a maternal mortality ratio of 5,369 for 100,000 live births. In 99 (72.20%) cases, death occurred in the postpartum. A home delivery had been reported in 33.70% of cases. Direct obstetric causes were found in 72.10% of cases. They were mainly represented by infections (32.40%) and hemorrhages (23%). Anemia was the indirect cause of death in 25 women (17.80%). The delay in health care access and the lack of blood products contributed to maternal deaths in 64.50% and 26.20% of cases. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: An intensification of awareness-raising messages about the importance of the rapid use of health care is necessary. Also, systematic audits of maternal deaths in the care environment and in the community would make it possible to clarify the determinants of maternal mortality in the Sahel region and to provide adequate solutions.

Bilateral Tubal Pregnancy without Known Risk Factor.

Spontaneous bilateral ectopic gestation is very rare. The authors report a case diagnosed and taken care of at Yalgado Ouedraogo Teaching Hospital, Ouagadougou. It was a 30-year-old patient with no known pathological history. She had presented at the obstetric emergencies with a state of hypovolemic shock by haemoperitoneum with digestive disorders, pelvic pain, vaginal bleeding, and a mention of delayed menstruation. The ultrasound coupled with the urinary immunological pregnancy test confirmed the diagnosis of ruptured ectopic pregnancy and a bilateral form was suspected. A laparotomy in emergency confirmed the diagnosis of bilateral ectopic gestation with a right ampullary unruptured pregnancy and a left isthmic ruptured gestation. A bilateral salpingectomy was performed and counseling was made for the use of medical help of procreation in case of future need of pregnancy.

Effects of an intervention initiated by a national society to improve postabortion care in rural facilities in Burkina Faso.

OBJECTIVE: To evaluate the results of an intervention by the Societé de Gynécologues et Obstétriciens du Burkina (SOGOB) to improve postabortion care (PAC) in rural areas of Burkina Faso. METHODS: From June 1, 2012, to May 31, 2013, SOGOB increased capacity for PAC by providing training in health care and equipment to 45 rural health facilities. Performance in PAC in the year before intervention (June 1, 2011, to May 31, 2012) was compared with that in the year following intervention (June 1, 2013, to May 31, 2014). RESULTS: The number of cases of incomplete abortion managed within a year increased from 1812 before the intervention to 2738 afterwards. Before capacity building, none of the health facilities was using misoprostol for management of incomplete abortion. After capacity building, misoprostol was used in 805 (29.4%) cases. The use of inappropriate methods to empty the uterus decreased (27.5% [498/1812] vs 1.4% [38/2738]; P<0.001). The frequencies of uterine perforation and pelvic infection also decreased (P≤0.01 for both). In the year after implementation, 2035 (78.3%) of 2600 women had taken up a family planning method before leaving the facility. CONCLUSION: SOGOB's intervention has improved the quality of PAC in rural health facilities in Burkina Faso.

Respectful maternity care in three health facilities in Burkina Faso: the experience of the Society of Gynaecologists and Obstetricians of Burkina Faso.

The Society of Gynaecologists and Obstetricians of Burkina Faso (SOGOB) conducted a project to reinforce skills in respectful maternity care among its members and health workers at three facilities. The participatory process allowed health workers to self-diagnose quality of care, recognize their own responsibility, propose solutions, and pledge respectful care commitments that were specific for each unit. Key commitments included good reception; humanistic clinical examination; attentive listening and responsiveness to patient needs; privacy, discretion, and confidentiality; availability; and comfort. These commitments can potentially be modified after each evaluation by SOGOB. Poor working conditions were found to negatively impact on quality of care. High staff turnover, frequent technical malfunctions, and inadequate infrastructure were identified as issues that require future focus to ensure improvements in quality of care are sustainable. Programs that aim to improve the maternity experience by linking good practice with humanistic care merit rollout to all healthcare facilities in Burkina Faso.