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Outcome of Pregnancies Among Sickle Cell Patients Admitted to Cotonou University Hospitals (Benin) from 2008 to 2018
Dangbemey Djima Patrice,
Tognifode Veronique,
Azonbakin Simon,
Tchiakpe-Enialoko Nicole,
Aboubakar Moufalilou,
Ogoudjobi Mathieu,
Lokossou Symphorose,
Nzikou Venance,
Tshabu-Aguemon Christiane,
Hounkpatin Benjamin,
Tonato-Bagnan Josiane,
Denakpo Lewis
Issue:
Volume 8, Issue 6, November 2020
Pages:
154-160
Received:
4 September 2020
Accepted:
21 September 2020
Published:
30 October 2020
Abstract: Objective: Study the fetal-maternal and neonantal prognosis of sickle cell pregnancies managed in Cotonou’s hospitals (R. Benin). Material and methods: This is a descriptive study on retrospective data from January 2008 to December 2018. The maternities of the Lagoon Mother and Child Hospital and University (CHU-MEL) center and of the CNHU/HKM gynecology and obstetrics university clinic had served as a framework. Complete patients records were analyzed. Included were pregnant women or delivered at 28 weeks of amenorrhea (AW) or beyond, sickle cell disease SS or SC confirmed by hemoglobin electrophoresis. Sociodemographic, clinical, therapeutic, and fetal-maternal and neonatal prognosis were analyzed. EPI DATA 3.1 and SPSS 2.0 software were used to analyze our data. The difference is significant for a p-value ≤ 5%. Ethical and professional standards and rules were respected. Results: The delivery of a patient suffering from sickle cell disease represented 0.82% of births. The SS phenotype was observed in 27.3% (n=105) versus 72.7% (n=279) of SC (p=0.000). A history of obstetric complications was noted in 56.8% (n=218). The course of the current pregnancy was marked by obstetric complications in 97.4% and the most important were: the threat of premature delivery (28%) and the vaso-occlusive crisis (19.5%). The caesarean was performed in 92% of sickle cell patients. Premature delivery was observed in 60% with 6.3% very premature (28-33AW). It was registered 91% (n=352) live births, 48% (n=169) hypotrophs, 60% premature, 1.1% (n=4) intrapartum deaths and 8% (n=4) intrapartum deaths and 8% (n=31) deaths in utero. Perinatal mortality represented 9%. The after-effects of childbirth were complicated in 12% (n=46). The puerperal infections (32.6%), hypertension (28.2%) and its complications and severe anemia (19.2%) were the most common complications. Five (5) maternal deaths were deplored, ie a mortality rate of 1420 maternal deaths per 100,000 live births. Conclusion: In Benin, pregnancy and delivery of sickle cell disease are at high risk of fetal, maternal and neonatal mortality. Caesarean section was almost routine in this group. The practice of transfusion exchange or bleeding may improve prognosis.
Abstract: Objective: Study the fetal-maternal and neonantal prognosis of sickle cell pregnancies managed in Cotonou’s hospitals (R. Benin). Material and methods: This is a descriptive study on retrospective data from January 2008 to December 2018. The maternities of the Lagoon Mother and Child Hospital and University (CHU-MEL) center and of the CNHU/HKM gyne...
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Obesity and Endometrial Cancer: Increase in Frequency over a Period of 44 Years
Alfonso Torres Lobaton,
Rosalva Barra Martinez,
Elisa Paola Jimenez Arroyo,
Juan Carlos Oliva Posada,
Carla America Suarez Juarez,
Fred Morgan Ortiz
Issue:
Volume 8, Issue 6, November 2020
Pages:
161-165
Received:
7 October 2020
Accepted:
19 October 2020
Published:
30 October 2020
Abstract: To draw attention to the increase in the frequency of endometrial cancer (CE) in recent decades and its association with overweight and obesity in a highly specialized institution. Retrospective study of patients with EC treated in the Oncology Service (OS) General Hospital of Mexico (GHM), in the years 2000 to 2017, obtaining information related to some risk factors and their classification. The data were compared with a previous study from the years 1966-1993. Of the record of 1,045 EC treated during the studied time of 44 years, 785 corresponded to the period 2000-2017 and 260 to the previous report, which meant an increase of 200% for this disease. Of gynecological cancers, the EC figures increased from 17.9% in 2010-2011 to 29.4% in 2016-2017 (p=0.0001). Overweight and obesity were in 572/785 (72.8%) of the current series vs. 120/260 (46.1%) of the previous series (p<0.05). An increase of 19% to 28% was found in women younger than 48 years when comparing the periods 2000 - 2009 vs. 2010-2017 (p=0.011); 119/389 classified as stage I, (30.5%) had risk factors for tumor recurrence and 378/898 (42.0%) had advanced malignancies. An increase in CE reported in this series and its association with overweight and obesity, may highlight the public health problem that this association represents in our country.
Abstract: To draw attention to the increase in the frequency of endometrial cancer (CE) in recent decades and its association with overweight and obesity in a highly specialized institution. Retrospective study of patients with EC treated in the Oncology Service (OS) General Hospital of Mexico (GHM), in the years 2000 to 2017, obtaining information related t...
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Clinical Presentation of Patients Admitted with Retained Placenta: Study in Dhaka Medical College Hospital, Dhaka, Bangladesh
Jesika Rizvi Tamanna,
Nahid Sultana,
Joynab Akhter,
Fakhria Alam,
Farhana Dewan
Issue:
Volume 8, Issue 6, November 2020
Pages:
166-173
Received:
8 July 2020
Accepted:
26 October 2020
Published:
4 November 2020
Abstract: Introduction: Retained placenta is one of the causes of postpartum haemorrhage in Bangladesh as it is worldwide and a common problem faced by the department of obstetrics. Objective: To determine the clinical presentation of patients admitted with retained placenta at the Dhaka Medical College Hospital, Dhaka, Bangladesh. Material & Methods: This was a cross-sectional study which was carried out in the department of Obstetrics and Gynaecology, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh, during the study period from January 2010 to June 2010. A total number of 50 cases were selected for the study. The data were collected by pre-designed questionnaire; relevant information was collected by direct interview of patients and relatives. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 16.0 for Windows (SPSS). Results: Mean age was found 27.04±3.48 years with range from 20 to 36 years. Home delivery was found in 31 (62.0%). Mean duration of retained placenta was found 3.0±0.58hrs with range from 2.30 to 4.3hrs. Mild per vaginal bleeding was found 4 (8.0%), Moderate P/V bleeding was 42 (84.0%) and severe bleeding was 4 (8.0). Regarding past history, patients with myomectomy was found 1 (2.0%), cesarean was 3 (6.0%). H/O retained placenta was 9 (18.0%). H/O MR was 24 (48.0%) and D&C was 18 (36.0%). Primi para was found 2 (4.0%) and multi para was 48 (96.0). Moderate anaemia was found 41 (82.0), normal temperature was 49 (98.0%), mean pulse was 91.0±8,13 beats/min mean systolic BP was found 91.9±6.81 mmHg and mean diastolic BP was 57.6±5.55mmHg. From P/A examination of the study patients it was found that, atonic uterus was 29 (58.0%), tenderness was 2 (4.0%), more than three fourth 76% was with full urinary bladder, mean height of uterus was 22.24±1.6 weeks. Moderate per vaginal bleeding was 41 (82.0%), vaginal full with clot was 41 (82.0%) and OS was open in 46 (92.0%). Mean Hb% was found 8.25±0.85 gm/dl with range from to 7 to 9.2gm/dl. Conclusion: The incidence and severity may be decreased by health education, women empowerment and the provision of facilities for essential obstetrics services by high skilled health care providers in ensuring a properly conducted delivery with discharged after timely effective management.
Abstract: Introduction: Retained placenta is one of the causes of postpartum haemorrhage in Bangladesh as it is worldwide and a common problem faced by the department of obstetrics. Objective: To determine the clinical presentation of patients admitted with retained placenta at the Dhaka Medical College Hospital, Dhaka, Bangladesh. Material & Methods: This w...
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Restriction of Episiotomy: Obstetrical Indications and Perineal Prognosis in Two Maternity Wards in Brazzaville (Republic of Congo)
Buambo Gauthier Regis Jostin,
Ele Elenga Varel Pirnet,
Potokoue Mpia Samantha Nuelly,
Mokoko Jules Cesar,
Itoua Clautaire,
Iloki Leon Herve
Issue:
Volume 8, Issue 6, November 2020
Pages:
174-178
Received:
18 October 2020
Accepted:
28 October 2020
Published:
9 November 2020
Abstract: Objective: In December 2018, new recommendations from the National College of French Obstetrician Gynaecologists restricted obstetric indications for episiotomy to only instrumental delivery, to avoid the occurrence of obstetric lesions of the anus sphincter. In our maternity wards, episiotomy is still performed liberally in the face of high-risk perineal situations, without significant reduction in perineal tears. This is how the present study set itself the objective of evaluating the impact of a restrictive practice of episiotomy on the perineum. Methods: Before-after non-experimental evaluative study, conducted from March 1 to August 30, 2019, in two maternity hospitals in Brazzaville, comparing according to a 1/1 ratio, after matching age and parity, 300 parturient with a high situation perineal risk of episiotomy having benefited from a procedure restricting episiotomy to 300 others who did not benefit. The two groups were evaluated: the percentage of episiotomy, the percentage, and the degree of perineal tears. The effect of the restriction was assessed by calculations of the difference in absolute risk (DR), reduction in relative risk (RRR) and the number of subjects required to treat (NST). Results: Parturient with high perineal risk had a median age of 23 years (18-28) and were primiparous (0-1.5). The high perineal risk situations were dominated in the two groups by the maternal indications concerning parity (nulliparity: 40% vs 63%) and the perineum (scar: 51% vs 60%); followed by macrosomia (25% vs 38%) and prematurity (25% vs 16%) as fetal indications. The episiotomy was performed in all cases of instrumental forceps extraction (1.3% vs 5%). The restrictive practice of episiotomy was effective in 96% of cases with 69.8% of intact perineum vs 19%. It had a protective effect on the perineum, making it possible to avoid the occurrence of 82 episiotomies (DR=-82% [-93, -70]; RRR=95%) and 50 perineal tears (DR=-50% [-66, -34]; RRR=63%) for 100 parturient. To avoid an episiotomy and a perineal tear, the restriction procedure must be applied to an average of 1.2 parturient (NST=-1.2) and two parturient (NST=-2), respectively. Conclusion: It is entirely possible to opt for a restrictive practice of episiotomy in our maternities by rigorously and meticulously evaluating the perineal risks and by respecting the procedures for protecting the perineum during childbirth.
Abstract: Objective: In December 2018, new recommendations from the National College of French Obstetrician Gynaecologists restricted obstetric indications for episiotomy to only instrumental delivery, to avoid the occurrence of obstetric lesions of the anus sphincter. In our maternity wards, episiotomy is still performed liberally in the face of high-risk p...
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The Impact of Iron and Folate Adherence on the Prevalence of Anaemia in Pregnant Nigerian Women
Akinola Oyekemi Ifeoluwapo,
Uwaibi Noel,
Nwagu Marcellinus Uchechukwu,
Ohenhen Victor,
Egbo Ojevwe Harrison,
Erhabor Osarenokemen Julie,
Omozuwa Eghosasere Sunday,
Omokhua Gabriella,
Adeyemi Oluwafemi
Issue:
Volume 8, Issue 6, November 2020
Pages:
179-185
Received:
27 October 2020
Accepted:
5 November 2020
Published:
11 November 2020
Abstract: Introduction: The impact of adherence to taking prescribed medications for chronic illnesses has been widely studied with a view to understanding its role on disease burden. This has been extrapolated to the physiologic pregnancy state, where women are expected to take haematinics due to their susceptibility to anaemia. The prevalence of anaemia in pregnancy is reportedly high with more burden on developing countries. This has led to the recommendation of iron and folate supplements for women during pregnancy. Methods: We set out to determine the level of adherence (and deterrents) to taking iron and folate supplements as well as the prevalence of anaemia in pregnant women (18-45 years old) attending antenatal care at the Stella Obasanjo Women and Children Hospital (SOWCH) and the Central Hospital in Benin City, Nigeria between July-December, 2019. An association between occurrence of anaemia and adherence level was also assessed. Results: 400 pregnant women participated in this study. The mean age (±SD) of the study population was 30±4 years, mean gestational age (±SD) was 31±5 weeks. Majority of the women (82.0%) were in their third trimester, 17.5% and 0.5% in second and first trimesters respectively. Total adherence scores obtained ranged from 0-8, with 63.5% being non-adherent to taking their iron and folate supplements. Factors that influenced adherence positively were higher income (p=0.00) and being employed (p=0.01). Top three identified reason for non-adherence were forgetfulness to take prescribed supplement (62.5%), feeling too bored to take supplements daily (44.3%) and unavailability of supplements (38.0%). The mean Hb (±SD) was 10.9±1.1g/dl. The prevalence of anaemia in pregnancy was 46.8%, with mild (43.8%) and moderate (3.3%) forms only. Of the non-adherent group, 69.7% were anaemic versus 30.3% of the adherent group. There was an association between the occurence of anaemia and non-adherence to taking supplements (p=0.01). Conclusion: There is a high level of non-adherence to taking iron and folate, prevalence of anaemia, and an association between them. Benefits of adherence to these supplements should be reinforced to women of child bearing age.
Abstract: Introduction: The impact of adherence to taking prescribed medications for chronic illnesses has been widely studied with a view to understanding its role on disease burden. This has been extrapolated to the physiologic pregnancy state, where women are expected to take haematinics due to their susceptibility to anaemia. The prevalence of anaemia in...
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Abdominal Wall Endometriosis: Purpose of a Case and Review of Literature
Sonia Oliva,
Daniel Correa López,
Brayan Molano
Issue:
Volume 8, Issue 6, November 2020
Pages:
186-190
Received:
6 October 2020
Accepted:
29 October 2020
Published:
16 November 2020
Abstract: Endometriosis of the abdominal wall is defined as the presence of superficial ectopic endometrial tissue to the parietal peritoneum, whose origin may be associated with previous gynecological surgical procedures. Its prevalence is low, around 0.03%, being the first isolated case in our institution, its report and bibliographic review was necessary. The following paper is a case report and a brief bibliographic literature review. Endometriosis is defined as the presence of endometrial glands and stroma outside the uterine cavity. The definition includes injuries that may or may not be related to previous surgical procedures. It is associated with cesarean section in 57% and hysterectomy in 17%. We present the case of a 37 years old female patient, with a history of three previous cesarean sections 3, 6 and 10 years ago; who presented a clinical picture of a sensation of a mass in the abdominal wall, accompanied by cyclical pain and mass growth related to menstrual periods. Abdominal ultrasound reported a heterogeneous vascularized 4x5cm mass. She underwent surgery at our institution where an endometrial mass was evidenced that infiltrated the rectus abdominis, later the diagnosis was confirmed with the histopathological study. Abdominal endometriosis is a rare entity in medical practice. A high index of suspicion should be considered in the case of a woman who presents with disabling abdominal pain located in the abdominal wall, with a history of previous gynecological surgical procedures. This pathology can be confused with many other surgical entities; for this reason, resorting to paraclinical studies can be essential in the diagnostic certainty.
Abstract: Endometriosis of the abdominal wall is defined as the presence of superficial ectopic endometrial tissue to the parietal peritoneum, whose origin may be associated with previous gynecological surgical procedures. Its prevalence is low, around 0.03%, being the first isolated case in our institution, its report and bibliographic review was necessary....
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An Ovarian Steroid Cell Tumor with High Levels of CA-125 in Sanglah General Hospital: A Rare Case Report
David Eriandi Ginting,
Putu Doster Mahayasa
Issue:
Volume 8, Issue 6, November 2020
Pages:
191-194
Received:
5 November 2020
Accepted:
17 November 2020
Published:
24 November 2020
Abstract: Background: Ovarian steroid cell tumors are rare tumors of the ovary characterized by steroid cell proliferation. These sex-hormone secreting tumors raise many differential diagnoses related to hyperandrogenism. Although most of these tumors are benign and slow-growing, approximately 25 – 43% of cases are clinically malignant. Case: We herein report a case of 30 years old woman with ovarian steroid cell tumor, not otherwise specified (NOS) with primary infertility. The patient presented with hirsutism and abdominal enlargement due to massive ascites during hospital admission. The blood test result showed significantly increased CA-125. Transabdominal ultrasound revealed a 7.81 x 4.94 cm tumor of the left adnexa. The patient underwent left salpingo-oophorectomy and responded well to the surgery. Conclusion: This case report presents a unique case of ovarian steroid cell tumor, NOS with findings of massive ascites, hirsutism, and a high level of CA-125. The findings were never associated with this type of tumor. The steroid cell tumor and its ascites could mechanically irritate the mesothelium that causing overexpression of CA-125. Surgery remains as the first-line treatment of this case. Adjuvant chemotherapy should be done based on the histologic type of the tumor and its surgical stage. Tumor marker decreased after surgery was done and patient remains alive and free of disease after a period of 2 years.
Abstract: Background: Ovarian steroid cell tumors are rare tumors of the ovary characterized by steroid cell proliferation. These sex-hormone secreting tumors raise many differential diagnoses related to hyperandrogenism. Although most of these tumors are benign and slow-growing, approximately 25 – 43% of cases are clinically malignant. Case: We herein repor...
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Consensus on Management of Dermatophytosis and Vulvovaginal Infections in Non- Pregnant and Pregnant Females
Sanjiv Kandhari,
Piyush Prabhat,
Madhu Rengarajan,
Sunil Dogra,
Chitra Nayak,
Dibyendu Banerjee,
Jayashree Sridhar,
Mukesh Patil,
Neena Singh,
Pondicherry Gopinath,
Ratna Talukdar,
Vishalakshi Viswanath
Issue:
Volume 8, Issue 6, November 2020
Pages:
195-210
Received:
11 November 2020
Accepted:
25 November 2020
Published:
16 December 2020
Abstract: There has been an increasing prevalence of dermatophytosis among the females in India, over the last 5-6 years. Similarly an increase in the occurrence of vulvovaginal infections has also been observed. The recommendations from existing guidelines do not focus on these infections in females and provide optimal outcomes in real world setting. Hence, the aim of the present consensus was to formulate recommendations based on current clinical experience to address these infections. A multispecialty panel of 12 members consisting of 7 gynecologists and 5 dermatologists participated in the pursuit of obtaining consensus by modified Delphi process. All the panelists formulated questionnaire after critical review of literature. Four rounds of questionnaires containing a total of 63 questions were floated through Google docs survey and responses were marked by all the panelists. Agreement for a given question/statement as ≥75% was set to achieve consensus. Out of the 63 questions/statements, consensus was obtained on diagnosis and treatment of dermatophytosis and VVI in non-pregnant and pregnant females, in 61 statements. The panel also formulated treatment algorithm for dermatophytosis and VVI. The present consensus will provide a guidance to the clinicians in India regarding management of dermatophytosis and VVI in pregnant and non-pregnant females in the current scenario of therapeutic challenges in both the infections.
Abstract: There has been an increasing prevalence of dermatophytosis among the females in India, over the last 5-6 years. Similarly an increase in the occurrence of vulvovaginal infections has also been observed. The recommendations from existing guidelines do not focus on these infections in females and provide optimal outcomes in real world setting. Hence,...
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Uterine Torsion Diagnosed at the Time of Laparotomy for a Planned Cesarean Section at Term
Ninni Filippo,
Guiggi Ilaria,
Landucci Edi,
Masoni Stefano,
Tosi Veronica,
Abate Sergio
Issue:
Volume 8, Issue 6, November 2020
Pages:
211-213
Received:
7 October 2020
Accepted:
26 October 2020
Published:
31 December 2020
Abstract: Background: Uterine torsion is defined as the rotation of the uterus more than 45 degrees around its long axis. The angle of rotation is usually 180 degrees, although, in the literature, there are reported cases of uterine torsion up to 720 degrees. This is a rare complication of pregnancy but associated with significant mortality and morbidity. Etiology still remains unclear and clinical diagnosis may be challenging. Symptoms can be absent or few and nonspecific as in chronic conditions or catastrophic such in case of acute presentation associated with acute abdomen. Final diagnosis is usually made at the time of laparotomy or even after delivery. In the literature, bilateral plication of round ligaments is proposed to prevent recurrences. However, there are no validated guidelines for the management of uterine torsion in pregnancy. Case: We present a 33-year-old, gravida 2 para 1. She had a previous vaginal delivery and no medical known conditions. She was admitted for a planned caesarian section at 39 weeks of gestation for breech presentation. After a difficult delivery of a healthy female neonate with normal Apgar scores and cord pH levels, a spontaneous derotation of the uterus of 180 degrees was observed. Giving the absence of pelvic anomalies, we chose to not perform any additional preventive surgical procedure. The patient was discharged on 3rd postoperative day. Finally, no complications were observed at the two-months postpartum visit. Conclusion: Uterine torsion in pregnancy is an uncommon pathology but potentially life threatening that obstetrician should be aware of. Occasionally, imaging can be helpful, but diagnosis is mostly made during surgery. In case of irreducible torsion, delivery can be made with a transverse incision in the lower posterior uterine segment. Bilateral plication of round ligaments, as previously described by other authors, may be evaluated as a taylored treatment in case of extreme uterine torsion and other pelvic anomalies, in order to prevent the recurrence of the torsion.
Abstract: Background: Uterine torsion is defined as the rotation of the uterus more than 45 degrees around its long axis. The angle of rotation is usually 180 degrees, although, in the literature, there are reported cases of uterine torsion up to 720 degrees. This is a rare complication of pregnancy but associated with significant mortality and morbidity. Et...
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