Prolonged abdominal pregnancy incidentally discovered during cesarean section: a case report.

BACKGROUND: Abdominal pregnancy is a rare medical condition that is still missed in developing countries due to inadequate medical facilities. The clinical indicators manifest in various forms and are nonspecific, making it challenging to diagnose and often leading to delayed detection. However, obstetric ultrasound serves as an essential tool in early detection. Our objective was to share our experience dealing with this condition and emphasise the importance of early ultrasound diagnosis through efficient pregnancy monitoring in our regions. CASE PRESENTATION: 35-year-old Black African woman who had ten months of amenorrhea sought consultation due to an absence of active foetal movements. Her pregnancy was of 39 weeks with fetal demise which was confirmed following clinical examination and ultrasound. She underwent cesarean section in view of transverse position of fetus. During cesarean section, the fetus was found within the abdominal cavity with the placenta attached over the left iliac fossa including surface of left ovary. The uterus and right adnexa were within normal limits. A 2600 g macerated fetus with placenta and membranes were extracted without any complications. The maternal outcome was successful. CONCLUSIONS: Abdominal pregnancy remained an inadequately diagnosed condition in developing countries. It is imperative to increase awareness among pregnant women regarding high-quality prenatal care, including early obstetric ultrasound, from conception. Meanwhile, healthcare professionals should receive continuous training and the technical platform modernised. To ensure accurate diagnosis, the location of the gestational sac must be identified for every pregnant woman during their initial ultrasound appointment.

Youssef's syndrome, a rare complication of caesarean section: A case report.

INTRODUCTION AND IMPORTANCE: Youssef's syndrome or vesico-uterine fistula is an abnormal communication between the bladder and the uterus. It complicating of dystocic delivery, caesarean section and uterine rupture. The prevalence is globally 1-4 % of all obstetric fistulas. In Niger, it accounts for 6.4 % of iatrogenic urogenital fistulas. The best treatment is transvesical or transperitoneal surgery to close the bladder and uterus separately, with or without retaining the uterus. CASE PRESENTATION: We report a case of Youssef's syndrome secondary to caesarean section for uterine rupture in a 32-year-old woman. She consulted in our department for urinary incontinence occurred in the postoperative period. The diagnosis was made on clinical examination using the methylene blue test that is the only diagnosis method available in our setting. Treatment was initially medical with a bladder catheter until uterine involution (six weeks), followed by surgical cure using the Chassar-Moir technique. DISCUSSION: Youssef's syndrome accounts 1-4 % in general population, 6.4 % in west Africa and 5,2 % in Niger. Various management were reported: Medical treatment, surgical treatment via transvesical, retroperitoneal and transperitoneal routes that remains the most indicated method and, cystoscopic fulguration and laparoscopic treatment that have recently been proposed. CONCLUSION: This study reminds practitioners to be more vigilant in preventing this complication during any pelvic surgery by ensuring: careful release of vesico-uterine adhesions, bladder leakage test and careful repair of any bladder wounds followed by postoperative bladder drainage.

Textiloma complicating myomectomy: A case report.

INTRODUCTION AND IMPORTANCE: Textiloma or gossypiboma is a rare complication of pelvic surgery. It can mimic both, clinically, and radiologically an abscess, or a tumor, thus, making its diagnosis difficult and late. It can lead to a high morbidity and mortality rate for the patient and engages the surgeon's civil liability. CASE PRESENTATION: We report a case of textiloma following a myomectomy in a 42 year old patient treated in our department. Textiloma was diagnosed three years after myomectomy. Treatment consisted of a second laparotomy to remove the textiloma without complication. DISCUSSION: Incidence of textiloma varies from 1/833 to 1/32.672 but more often encountered in African surgical practice. Systematic counts of instruments, sponges and needles is not yet usual in our operating room. Through the analysis of this case, we call on surgeons to be more vigilant in order to avoid this serious medical error. CONCLUSION: The aim of this study was to describe the intraoperative errors that led to the occurrence of the textiloma, depict the diagnostic difficulties of textiloma, and the medico-legal implications in a tertiary hospital in Niger.

Bicornuate uterus and pregnancy: ambiguity diagnosis (a case report).

The frequency of uterine malformations is estimated in the general population to be between 1 and 4%. The bicornuate uterus accounts for about half of uterine abnormalities. The conception of a pregnancy and its evolution to term on this uterine abnormality is rare. During pregnancy, this malformation is asymptomatic and may go unnoticed in the absence of prenatal care. Ultrasound is essential for the diagnosis, which is often difficult in an environment of socio-economic precariousness and low technical facilities. We present the diagnostic difficulties, the therapeutic aspects and the obstetric prognosis of an unusual case of a unicervical bicornuate uterus revealed during a laparotomy which is both exploratory and diagnostic. Treatment consisted of close monitoring until 38 weeks when the patient underwent a scheduled cesarean section.

[Prognosis of pregnancy among married child students in Niamey, Republic of Niger]. / Pronostic de la grossesse chez les mineures mariées en cours de scolarisation à Niamey, République du Niger.

INTRODUCTION: the purpose of this study was to determine the frequency and to evaluate maternal and perinatal prognosis during pregnancy and childbirth among married child students in the city of Niamey. METHODS: we conducted a case-control study of gestants and parturients at the Issaka Gazobi Maternity Hospital in Niamey over the period January 2018-December 31, 2018. Child students (<18 years) were compared to students aged 18-27 years. Maternal sociodemographic parameters and maternal and perinatal mortality were analyzed. The usual statistics and logistic regression were used to analyze the results. The significance level was set at p <0.05. RESULTS: the frequency of delivery among child students was 3.06%. Minors attended prenatal follow-up (46.7% vs 41.9%) more diligently than adults. Cesarean section (ORa=2 [1.0-3.0]) eclampsia (ORa=2 [1.0-4.4]), episiotomy (ORa=2[1.2-1.8]) and neonatal depression (p <0.05 (10.6% vs 5.8%)) were higher among minors than among adults. Perinatal mortality was high in both groups. CONCLUSION: our results are close to those described in other European and African studies. The differences in obstetric and perinatal risks seem to be related to socio-demographic factors of child mothers. These should be taken into account in any approach to the prevention of pregnancy complications in minors.

Sublingual misoprostol versus standard surgical care for treatment of incomplete abortion in five sub-Saharan African countries.

BACKGROUND: In low-resource settings, where abortion is highly restricted and self-induced abortions are common, access to post-abortion care (PAC) services, especially treatment of incomplete terminations, is a priority. Standard post-abortion care has involved surgical intervention but can be hard to access in these areas. Misoprostol provides an alternative to surgical intervention that could increase access to abortion care. We sought to gather additional evidence regarding the efficacy of 400 mcg of sublingual misoprostol vs. standard surgical care for treatment of incomplete abortion in the environments where need for economical non-surgical treatments may be most useful. METHODS: A total of 860 women received either sublingual misoprostol or standard surgical care for treatment of incomplete abortion in a multi-site randomized trial. Women with confirmed incomplete abortion, defined as past or present history of vaginal bleeding during pregnancy and an open cervical os, were eligible to participate. Participants returned for follow-up one week later to confirm clinical status. If abortion was incomplete at that time, women were offered an additional follow-up visit or immediate surgical evacuation. RESULTS: Both misoprostol and surgical evacuation are highly effective treatments for incomplete abortion (misoprostol: 94.4%, surgical: 100.0%). Misoprostol treatment resulted in a somewhat lower chance of success than standard surgical practice (RR = 0.90; 95% CI: 0.89-0.92). Both tolerability of side effects and women's satisfaction were similar in the two study arms. CONCLUSION: Misoprostol, much easier to provide than surgery in low-resource environments, can be used safely, successfully, and satisfactorily for treatment of incomplete abortion. Focus should shift to program implementation, including task-shifting the provision of post-abortion care to mid- and low- level providers, training and assurance of drug availability. TRIAL REGISTRATION: This study has been registered at clinicaltrials.gov as NCT00466999 and NCT01539408.

Management of multicentric lesions of the lower genital tract.

OBJECTIVES: To report management and outcome of multicentric lesions of the lower genital tract. To define risk factors of recurrence. STUDY DESIGN: Retrospective review of multicentric dysplasias treated in our colposcopic clinic between 1996 and 2003. Multicentric dysplasias included CIN with VAIN and/or VIN. After primary treatment, follow-up was colposcopic, cytologic and virologic. RESULTS: Forty-four patients presented multicentric lesions out of 998 patients referred for CIN (4.4%). The average age was 36.8 years. Immunologic disorders were present in 20.4%. Ninety-one percent had cervicovaginal or cervicovulvar lesions, only 9% had three sites of genital dysplasia. 53.3% of lesions were concomitant. 79.5% of CIN were high grade, 62.5% of VAIN low grade and 62.5% of VIN high grade. Therapeutic modalities were as follows: conization for CIN (70.4%), CO2 laser for VAIN (33.3%) and surgery for VIN (41.7%). Forty patients were followed and had at least one post-treatment cytologic control; 55% of them had residual disease. Out of the 23 patients with at least two negative controls after treatment, 43.5% presented recurrence. Risk of recurrence was not statistically bound to such parameters as tabagism, immunologic disorder, high grade lesions, non-surgical treatment, and persistence of HPV infection after treatment. CONCLUSION: Multicentric dysplasias are associated with high rate of residual lesion and recurrence. Management of these lesions require long term follow-up.

Prolapse of neovagina created with labia minora: a case report.

Prolapse of a neovagina created in patients with congenital vaginal aplasia is rare. A 55-year-old woman with a neovagina was referred for management of complete prolapse and stress urinary incontinence. At the age of 19 she had undergone surgery for creation of a neovagina using the labia minora. She accepted vaginal surgical treatment to correct her prolapse. A posterior intravaginal slingplasty was successfully performed, associated with tension-free vaginal tape through the obturator foramens. There is no other case of prolapse of a labia minora neovagina described in the literature. The common procedures were not adapted in this case. Indeed, the vaginal tissues were extremely fragile, making the dissection more difficult. The vaginal approach sounded interesting to us to correct this prolapse.

Accuracy of visual screening for cervical neoplasia: Results from an IARC multicentre study in India and Africa.

Visual inspection-based screening tests, such as visual inspection with 4% acetic acid (VIA) and with Lugol's iodine (VILI), have been proposed as alternatives to cytology in mass screening programs. To date, there is only limited information on the accuracy of these tests in detecting High-grade Squamous Intraepithelial Lesions (HSIL). Eleven cross-sectional studies involving 56,939 women aged 25-65 years were conducted in Burkina Faso, Congo, Guinea, India, Mali and Niger to evaluate the accuracy of VIA and VILI performed by health workers. A common protocol and questionnaire was used. For final diagnosis, all women were investigated with colposcopy and biopsies were taken when necessary. Data from the studies were pooled to calculate sensitivity, specificity and predictive values of the tests for the detection of HSIL. Of the screened women, 16.1% and 16.4% were positive on examination using, respectively, VIA and VILI; 1,063 were diagnosed with HSIL. The pooled sensitivity, specificity, positive and negative predictive values for VIA were 76.8% (95% CI: 74.2-79.4%), 85.5% (95% CI: 85.2-85.8%), 9.4% (95% CI:8.8-10.8%) and 99.5% (95% CI:99.4-99.6%), respectively. The values were 91.7% (95% CI: 89.7-93.4%), 85.4% (95% CI: 85.1-85.7%), 10.9% (95% CI: 10.2-11.6%) and 99.8% (95% CI:99.7-99.9%), respectively for VILI. The range of sensitivity and specificity for VIA was 56.1-93.9% and 74.2-93.8%, respectively, between studies and were 76.0-97.0 % and 73.0-91.3% for VILI. VILI had a significantly higher sensitivity than VIA in detecting HSIL, but specificity was similar. VILI appears to be a more accurate visual test for use in screening and treatment programs in low-resource settings.