Abdominal pregnancy with a live newborn in a low-resource setting: A case report.

Abdominal pregnancy is defined as pregnancy anywhere within the peritoneal cavity, exclusive of tubal, ovarian, or broad ligament locations. It is a rare form of ectopic pregnancy with high morbidity and mortality for both the mother and the fetus. Diagnosis can be frequently missed in low-resource settings because of poor antenatal healthcare provision, low socioeconomic patient status as well as lack of adequate medical resources. Clinical diagnosis can be difficult and ultrasound scan is helpful during the early stages of gestation but can be disappointing thereafter. A case of abdominal pregnancy in a 25-year-old woman, who presented at 26 weeks of gestation with severe abdominal pain not relieved by any medication, is reported. An emergency laparotomy was undertaken as her vital signs deteriorated. An abdominal pregnancy was found and a live neonate delivered. Ministries of health in developing countries should ensure routine access to ultrasound in early pregnancy. Obstetricians should bear in mind that abdominal pregnancy can present late in gestation.

Hysterosalpingographic, ultrasonographic and clinical profile of infertile women in Butembo, Eastern Democratic Republic of Congo.

Introduction: infertility is a reproductive health issue in modern society. In developing countries, ultrasonography and hysterosalpingography (HSG) are first-line exams investigating infertility in women. It is a highly reported issue in Africa and is linked to abnormalities diagnosed by medical imagery investigations. Our research aimed to evaluate ultrasonography and HSG usage in female infertility investigation in eastern DR Congo, and to point out the most frequent lesions in infertile women in this area. Methods: it was a cross-sectional research. It included 1024 patients in four equipped hospitals with HSG and ultrasonography, who consulted from January 1st, 2019 up to December 31st, 2021. Data were collected from consultation dossiers and imagery protocols. Results: of 1024 patients, the mean age was 30.85±5.05 years, 41.79 % (n=428) had primary infertility and 57.71% (n=591) had secondary infertility with parity ranges 1.28±1.25, abortion 1.17±1.33. HSG usage rate was 26.85% (n=275) whereas ultrasonography was 66.01%(n=749). The prevalent diagnosed lesions were uterine myomas 10.51 % (n=71), polycystic ovary syndrome (PCOS) 8.28%(n=56), endometrial dysplasia 7.99% (n=54), ovarian cysts 5.03% (n=34) at ultrasonography and tubal obstructions 53.45 %(n=147), hydrosalpinx 4.73% (n=13), cervical impotence 3.27% (n=9), uterine synechias 2.55%(n=7), müllerian abnomalies 2.55%(n=7), uterine retroversion 2.18% (n=6) at HSG. History of upper genital infection was a risk factor aOR= 3.71, 95%CI 1,55-8,88; p <0.001 for tubal obstruction to HSG. Conclusion: regarding the high prevalence of tubal and uterine abnormalities in infertile women of eastern DR Congo, ultrasonography, and HSG should be more performed exams in clinical practice in low-income countries.

The Challenges of Managing Ovarian Cancer in the Developing World.

Ovarian cancer has high morbidity and mortality rates among cancers of the reproductive system. The disease typically presents at late stage when the 5-year relative survival rate is only 29%. Similarly, access to prevention, early diagnosis, treatment, and palliative care for cancer-related disease is insufficient. The availability of cancer treatments in Africa is especially poor. Case. A 17-year-old lady, nulliparous, was admitted with complaint of abdominal swelling and loss of weight and a huge left ovarian cyst revealed by ultrasound scan. Laparotomy was done, and a mass which resembled a hemorrhagic solid tumor was found. Grossly, the left ovarian mass measured 15.0 × 20.0 × 8.0 cm and a left salpingectomy was performed. Two months later, she came back with lower limb swelling progressively increased in a week with vulvar edema, with a palpable mass. She was discharged on request by her relatives for traditional medicine. One year later, she passed on in an unrevealed picture. The management of ovarian cancer is too challenging in low-resource countries, from hospital settings to the communities with poor cancer awareness. It is therefore imperative that healthcare resources, policies, and planning focus to be coordinated in a rational way.

Ebola in the Eastern Democratic Republic of Congo: One Health approach to infectious disease control.

The Democratic Republic of Congo (DRC) is facing its tenth outbreak of Ebola virus disease (EVD), in North-Kivu and Ituri provinces. This is the second most deadly EVD outbreak in history, after the one that occurred in West Africa in 2014. The DRC Ministry of Health (MoH), supported by the World Health Organization (WHO) and a range of regional and international partners, are implementing EVD response plans in these affected areas such as screening of suspect cases at points of entry, case detection, contact tracing, laboratory testing, case management and infection prevention and control, safe and dignified burials, ring vaccination (this involves vaccination of infected individuals, direct contacts of infected individuals and contacts of their contacts), and therapeutics, community mobilization and free access to healthcare services. Despite these efforts, there has been a sharp rise in the number of confirmed cases within the identified affected areas, and due to a number of challenges unique to DRC, there has been an expansion in the geographical extent of transmission. The significance of the proximity of these regions to wildlife and the Virunga National Park is questionable in the EVD transmission dynamics. The close interaction between human, animal, and environmental factors, in combination with high population movement due to regular rebel attacks in these regions, suggest the need for the integration of the One Health approach in the holistic response plans for control and prevention of EVD. This paper seeks to highlight the implications and importance of a One Health-based approach into the infectious diseases control program implementation in DRC.

Older age and higher parity are associated with nonuse of the partograph at Mbarara Regional Referral Hospital, Uganda.

OBJECTIVE: To determine the frequency of partograph use, the proportion of mothers with partographs completed to standard, the completeness of recorded parameters, and factors associated with nonuse at Mbarara Regional Referral Hospital (MRRH), Uganda. METHODS: A retrospective review of medical records from mothers admitted to MRRH's postnatal ward between October 2016 and March 2017. Partograph use and whether it had been completed to standard were analyzed. RESULTS: Of 527 study participants, 409 (77.6%) records contained a partograph, of which only 17 (4.2%) had been completed to standard. Parameters most commonly completed to standard were monitoring of cervical dilatation (n=41, 10%), fetal heart rate (n=21, 5.1%), and uterine contractions (n=18, 4.4%). Age older than 30 years (prevalence ratio 1.73; 95% CI, 1.14-2.64) and parity greater than or equal to five (prevalence ratio 1.88; 95% CI, 1.19-2.98) were associated with nonuse of the partograph. Birth outcome was recorded in 98.8% (n=404) of partographs. CONCLUSION: Appropriate use of the partograph to monitor mothers in labor was extremely low; most common use was to record birth outcomes. Older mothers and those with higher parity were less likely to have their labor monitored using a partograph and should be targeted for partograph interventions.

Spontaneous Massive Vulvar Edema in Pregnancy: A Case Report.

Spontaneous massive vulvar edema in pregnancy is unusual and a cause for concern. This condition should be taken seriously since it might be caused by some conditions such as preeclampsia, diabetes, vulvovaginitis, severe anemia, and neoplasms. We report a case of massive vulvar edema in a 15-year-old primigravida following tocolysis therapy at 33 weeks of gestation. Other causes of vulvar edema were excluded. The vulvar edema appeared spontaneously after tocolysis and rapidly increased in size, associated with severe vulvar pains. The vulvar edema resolved progressively with antibiotics, corticoids, and analgesics. The patient delivered by spontaneous vaginal delivery a term live newborn with an unremarkable postpartum period. The aim of this report is to alert clinicians that conservative attempts could be considered for vulvar edema complicating tocolysis.

Prevalence and Factors Associated with Hydatidiform Mole among Patients Undergoing Uterine Evacuation at Mbarara Regional Referral Hospital.

OBJECTIVE: We sought to determine the prevalence of and factors associated with hydatidiform molar gestations amongst patients undergoing uterine evacuation at Mbarara Regional Referral Hospital (MRRH), Mbarara, Uganda. METHODS: This was a cross-sectional study carried out from November 2016 to February 2017. All patients admitted for uterine evacuation for nonviable pregnancy were included. The study registered 181 patients. Data were collected on sociodemographics, medical conditions, obstetrics, and gynecological factors. The evacuated tissue received a full gross and histopathologic examination. Cases of pathologically suspected complete hydatidiform mole were confirmed by p57 immunohistochemistry. Data were analyzed using STATA 13. RESULTS: The prevalence of hydatidiform mole was 6.1% (11/181). All detected moles were complete hydatidiform moles, and there were no diagnosed partial hydatidiform moles. Clinical diagnosis of molar pregnancy was suspected in 13 patients, but only 69.2% (9/13) were confirmed as molar pregnancies histologically. Two cases were clinically unsuspected. Factors that had a significant relationship with complete hydatidiform mole included maternal age of 35 years and above (aOR 13.5; CI: 1.46-125.31; p=0.00), gestational age beyond the first trimester at the time of uterine evacuation (aOR 6.2; CI: 1.07-36.14; p=0.04), and history of previous abortion (aOR 4.3; CI: 1.00-18.57; p=0.05). CONCLUSION: The prevalence of complete hydatidiform mole was high at 6.1%. Associated risk factors included advanced maternal age (35 years and above), history of previous abortions, and gestational age beyond the first trimester at the time of evacuations. RECOMMENDATIONS: We recommend putting in place capacity to do routine histopathological examination of all products of conception especially those at high risk for a molar gestation either by clinical suspicion or by risk factors including advanced maternal age, advanced gestational age, and history of previous abortion because of high prevalence of complete mole.

Association between Prior Chlamydia trachomatis Infection and Ectopic Pregnancy at a Tertiary Care Hospital in South Western Uganda.

BACKGROUND: Increase in the number of ectopic pregnancy is attributed to increase in the incidence of pelvic infections. Chlamydia trachomatis is responsible for most of the sexually transmitted bacterial infections. If undetected and untreated, the infection can ascend to the upper genital tract and cause pelvic inflammatory disease (PID) and related sequelae (ectopic pregnancy and tubal factor infertility). OBJECTIVE: To determine the association between prior Chlamydia trachomatis infection and ectopic pregnancy at Mbarara Regional Referral Hospital (MRRH). METHODS: This was an unmatched case-control study carried out at MRRH involving 25 cases and 76 controls. Serological evidence of prior chlamydial infection was determined by testing for the presence of Chlamydia immunoglobulin G antibodies in their blood. Logistic regression was used to determine the association between prior Chlamydia trachomatis infection and also the factors associated with ectopic pregnancy. The significant level of <0.05 was used. Results. Chlamydia antibodies were found in 60% of patients with ectopic pregnancy and 26.3% of the controls (p=0.002). The presence of Chlamydia antibodies was associated with a fourfold risk of ectopic pregnancy. CONCLUSION: There was a strong association between prior Chlamydia trachomatis infection and ectopic pregnancy.