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.