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Maternal Death before Admission to the Sylvanus Olympio University Hospital Center (CHU SO): Epidemiological and Etiological Aspects

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Advances in Reproductive Sciences 2024年第4期12卷 205-212页

作者： Baguilane Douaguibe Sitou Togbonou Dédé Régina ajavon Pankéyédou Tongou Department of Obstetrics Gynecology University of Lom Lom Togo Department of Obstetrics Gynecology University of Kara Kara Togo

Background: In Togo, the maternal mortality rate in 2017 was estimated at 396/100,000 live births. Maternal death before admission is an increasingly growing phenomenon in the gynecology-obstetrics clinic of the CHU SO. No epidemiological data is available on the subject. Objective: Determine the epidemiological and etiological profiles of a pregnant, parturient, or woman who has given birth dead before or within 10 minutes of her admission. Methods: This was a descriptive cross-sectional study from January 1, 2014, to December 31, 2021. All maternal deaths occurring before admission and within 10 minutes of admission to the clinic were included in the study of gynecology and obstetrics at CHU SO. The data were processed by Epi info version 7 software. Results: In total, 654 maternal deaths, including 153 maternal deaths before admission, were recorded, corresponding to 23.4% of all maternal deaths. The median age was 30.2 years. 37.2% of women were uneducated. 41.2% were resellers. 79.1% of women were cohabiting. 47.1% of women had performed less than 3 ANC. 43.8% of the women who died had completed their ANC in a medical center. 54.3% by a midwife, 37.3% by unqualified personnel. 62.7% of deaths occurred postpartum and 36.3% during pregnancy. 79.1% were referrals. 88.9% of the women who died arrived in a non-medical taxi car. Among the 57 patients who died during their pregnancy, 40.3% were carrying a pregnancy of 28 to 36 weeks, and 36.3% were full-term pregnancies. Among the 96 women who died postpartum, 93.3% had given birth vaginally. Among the 121 referrals, 34.7% came from a birthing center, 56.2% were referred by a state midwife and 30.6% by unqualified personnel;46.3% were referred without a reference form, 94.3% were referred without venous access. In 10.7%, the reason for evacuation was bleeding from the delivery, with an average evacuation time of one-hour 5minutes. 60.3% of women who died had an evacuation delay of more than one hour. 94.8% of patients

关键词： Maternal Death Before Admission Reference CHU SO

Abdominal Pain and Fever Indicative Postpartum Ovarian Vein Thrombosis: A Case Report

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Open Journal of Obstetrics and Gynecology 2021年第10期11卷 1378-1385页

作者： k. E. Logbo-Akey D. R. ajavon k. B. M’Bortche P. kambote A. S. Aboubakari k. Akpadza Department of Gynecology and Obstetrics CHU Kara University of Kara Kara Togo Gynecology and Obstetrics Department of CHR Tomdé University of Kara Kara Togo Clinic of the Togolese Association for Family Welfare University of Lome Lome Togo Department of Gynecology and Obstetrics CHU Lome University of Lome Lome Togo

Introduction: OVT is rare, with an incidence of 0.05% to 0.18% and occurring preferentially in postpartum period. Any delay in management may compromise the patient’s vital prognosis. Observation: We report a case of a 34-year-old patient, G2P3, who delivered twins by cesarean section at 39 weeks of amenorrhea. She presented abdominal pain and fever on the 4th day of postpartum. Biological tests showed a biological inflammatory syndrome and a positive blood culture with gram-positive Staphylococcus. After 72 hours of antibiotics with no clinical or biological improvement, a CT scan revealed a 12 mm thrombus in the lumen of the right ovarian vein’s connection to the inferior vena cava. Antibiotic treatment was continued, associated with an anticoagulant. The evolution was been favorable. Conclusion: Rare and serious pathology, the diagnosis is made using medical imaging. The outcome is generally favorable with antibiotic therapy and anticoagulant therapy.

关键词： Abdominal Pain Fever Post Partum Ovarian Vein Thrombosis

Cervico-Isthmic Pregnancy on Cesarean Scar Successful Treated with Methotrexate, Mifepristone and Misoprostol: A Case Report

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Open Journal of Obstetrics and Gynecology 2021年第9期11卷 1229-1235页

作者： k. E. Logbo-Akey D. R. ajavon k. B. M’bortche P. Y. kambote A. S. Aboubakari k. Akpadza Gynecology and Obstetrics Department of kara University Hospital University of Kara Kara Togo Gynecology and Obstetrics Department of CHR Tomdé University of Kara Kara Togo Togolese Association of Family Well-Being Planning Center (ATBEF) University of Lomé Lomé Togo Gynecology and Obstetrics Department of Sylvanius Olympio University Hospital University of Lomé Lomé Togo

Introduction: Cervico-isthmic pregnancy is rare, and serious because of its hemorrhagic complication. Its management varies according to the teams. Observation: We report a case of cervico-isthmic pregnancy on a cesarean scar. This is a 35-year-old, G2P2, who consulted for bleeding from the 1st trimester of pregnancy. k80358912">The clinical examination found a minimal uterine bleeding. The diagnosis was made by a vaginal ultrasound which found a cervico-isthmic implantation of the pregnancy on the caesarean scar. A protocol of Mifepristone and Misoprostol followed by administration of a single dose of 1 mg/kg of Methotrexate was performed. Cure was obtained 1 month after treatment by negativation of plasma HCG. No bleeding complications were noted. A follow-up ultrasound performed 2 months later showed a uterine vacuity and the presence of an isthmocoele. It was in fact a pregnancy that had implanted in the isthmocoele. Conclusion: Cervico-isthmic pregnancy is rare. His treatment is not codified. Drug management was successful.

关键词： Cervico-Isthmic Pregnancy Medical Treatment Methotrexate

Fœtal Death in Utero: Maternal Epidemiological and Prognostic Aspects at Sylvanus Olympio Teaching Hospital in Lomé

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Open Journal of Obstetrics and Gynecology 2019年第4期9卷 511-520页

作者： Baguilane Douaguibe A. S. Aboubakari A. Bassowa D. ajavon T. ketevi k. E. Logbo-Akey B. Baramna k. Fiagnon k. Akpadza Gynecology and Obstetrical Service CHU Campus Lomé Togo Gynecology and Obstetrical Service CHU Kara Togo Gynecology and Obstetrical Service CHU-SO Lomé Togo

The fetal death In Uterus is relatively a common problem in developing countries. In Africa, the rate of deaths varies from one hospital to another. We wanted to evaluate the prevalence, to describe the epidemiological aspects, etiologies and maternal prognosis associated with fetal deaths in Uterus in 2017 at Sylvanus Olympio Teaching Hospital in Lomé. Patients and methods: This was a retrospective descriptive study conducted from January 1st to December 31st, 2017. We have included all pregnant cases received and treated on the spot for in uterus deaths as defined by the World Health Organization. Medical termination of pregnancy records, intrapartum deaths, less than 22 amenorrhea weeks’ pregnancies and complications of abortion were not included. Results: The fetal death rate in uterus was 3.64%. The multigravida and multiparous were respectively 49% and 41%;the referees were 51%, 28% evacuated;21% came on their own. The gestational age of 28 - 37 weeks was 39% and 17% had no prenatal consultation. The analysis has revealed that high blood pressure, preeclampsia, and retroplacental hematomas were the main etiologies associated with fetal deaths in uterus. Conclusion: In uterus fetal deaths remain common in our country. The main causes were hypertension disorders of pregnancy. There were also some unknown causes which could be related to economic or cultural reasons. For instance, autopsies of in uterus deaths and placental anatomopathology examination are not performed because of culture.

关键词： Fetal Death in Uterus Etiology Maternal Prognosis

Practice of Obstetrical Hysterectomy at the Sylvanus Olympio University Hospital Center: Indications and Maternal Prognosis

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Open Journal of Obstetrics and Gynecology 2023年第10期13卷 1730-1737页

作者： Baguilane Douaguibe Dédé Régina ajavon komi Migbenya Pakienyedou Tongou Francis Bararmna-Bagou Romario Mawougbe Samadou Aboubakari Service de gynécologie obstétrique du CHU Sylvanus Olympio Lomé Togo Service de gynécologie obstétrique du CHU kara Kara Togo

Obstetric hysterectomy is a surgical procedure most often performed in a context of extreme emergency in an obstetric environment. The incidence of obstetric hysterectomy is differently expressed around the world. In the CHU-SO maternity ward, hemorrhagic obstetric emergencies are common. The extreme urgency in which patients are admitted, the insufficiency of the technical platform, associated with the challenge of the availability of blood products, often leads to performing an obstetric hysterectomy for hemostasis. It is responsible for high maternal morbidity and mortality. Since 2000 no study has been carried out on this practice in the service. Objective was to describe the practice of obstetric hysterectomy at the CHU-SO and specifically to determine the prevalence, the prognostic factors to be able to act to reduce maternal mortality. Method: A descriptive, cross-sectional, and analytical study was carried out at the Gynecology-Obstetrics clinic of the CHU-SO;from January 1, 2021, to June 30, 2022. All hysterectomies performed in an obstetric emergency context (during pregnancy, perpartum or postpartum) in the department were included in our study. We did not include cases of obstetric hysterectomies outside the SO hospital or planned non-obstetric hysterectomies. Results: We recorded 75 cases of obstetric hysterectomy and 15,625 deliveries (0.48%). The average age was 32.89 ± 5.93. The age group between 30 and 35 years old was the most affected with a rate of 37.33%. Labor and third trimester hemorrhage were the main reasons for admission, patients were referred in 80% of cases. The average parity was 3.25 ± 1.92 with utmost of 0 and 11. The pauciparous (41.67%) and multiparous (32%) were the most affected. The indications frequently found were uterine atony (44%);uterine rupture (33.33%). Subtotal inter adnexal hysterectomy was performed in 94.67%. General anesthesia practiced in 69%. They were all polytransfuses. Three poor prognostic factors were observe

关键词： Obstetric Hysterectomy Indications Maternal Prognosis CHU-SO

In Utero Fetal Death: Epidemiological and Management Aspects at the Sylvanus Olympio University Hospital (CHU SO) in Lomé

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Open Journal of Obstetrics and Gynecology 2024年第11期14卷 1695-1701页

作者： komlan Alessi Andele Ameyo Ayoko ketevi Baguilane Douaguibe Aquila Bassowa Dédé Régine Diane ajavon Abdoul Samadou Aboubakari koffi Akpadza Department of Gynecology and Obstetrics Sylvanus Olympio University Hospital Center Lom Togo Department of Gynecology and Obstetrics Campus University Hospital Center Lom Togo Department of Gynecology and Obstetrics Regional Hospital Center Kara Togo Department of Gynecology and Obstetrics Kara University Hospital Center Kara Togo

Introduction: The occurrence of intrauterine fetal death (IUFD) is a traumatic event not only for the mother and her family but also for the obstetric team. IUFD is a common event. Objective: the aim of our study is to describe the epidemiological, diagnostic and management aspects of IUFD at the Sylvanus Olympio University Teaching Hospital (CHU SO), Lomé. Methodology: It was a descriptive cross-sectional study with retrospective data collection process that concerned cases of IUFD from January 1st 2023 to December 31, 2023 at CHU SO. Results: The hospital prevalence of IUFD was 2.43%. The mean age of the mothers was 30.6 ± 6 years. The Multigestures represented 32.52% and primiparous women represented 29.72%. Pregnant women were referred in 88.11% of cases;47.55% had done at least 4 antenatal care visits and 4.20% had a history of IUFD. The etiological factors of IUFD were preeclampsia in 28.67% of cases, retroplacental hematoma in 28.67% and premature rupture of membranes in 4.55% of cases. Misoprostol was used for artificial induction of labor in 57.14% of cases and the delivery route was vaginal in 75.87% of cases. Conclusion: The frequency of IUFD is high and its reduction remains a challenge in low-income countries.

关键词： In Utero Fetal Death Fetal Death Togo

Review of Maternal Deaths over 3 and a Half Years at the kara University Hospital Center, Northern Togo: About 65 Cases

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Open Journal of Obstetrics and Gynecology 2024年第5期14卷 682-692页

作者： Logbo-Akey kossi Edem Dédé Régine Diane ajavon kambote Yendoubé Tenete Assiaham Douaguibe Banguilane Agoro Sibabe Aboubakari Abdoul-Samadou Dé partement de Gyn&#233cologie-Obst&#233trique Universit&#233 de Kara Kara Togo Hopital Mè re-Enfat SOS Kara Kara Togo Dé partement de Gyn&#233cologie-Obst&#233trique Universit&#233 de Lom&#233 Lom&#233 Togo Direction ré gionale de la sant&#233 Kara Togo

Objective: To analyze maternal deaths, identify causes and dysfunctions leading to these deaths in order to contribute to the implementation of strategies to reduce maternal mortality at CHU kara. Method: Cross-sectional descriptive study involving 65 cases of maternal deaths recorded at CHU-kara from January 1, 2018 to June 30, 2021. Results: Our study focused on 65 cases of maternal deaths recorded at the maternity ward of CHU-kara. The average age was 30 years, with a range of 15 to 45 years. They were mostly housewives (52.3%), uneducated (38.5%), multiparous (41.5%), and referred (86.2%). The causes were mainly direct obstetric causes (81.54%), with preeclampsia and its complications (28.30%) and immediate postpartum hemorrhage (20.75%) being the most common. However, uterine rupture (20.5%) and post-abortion sepsis (16.4%) were the most lethal etiologies. Delayed evacuation (46.43%), inadequate transportation (91%), and insufficient prenatal care (72.31%) were the dysfunctions before referral. Within the CHU kara, delays in management (58.46%), unavailability of blood and labile products (18%), and insufficient monitoring were the dysfunctions identified. Ninety-five point four percent (95.4%) of the deaths were preventable. Conclusion: The magnitude of intrahospital maternal deaths, the various dysfunctions observed in the occurrence of maternal deaths before referral/evacuation and within the hospital highlight the importance of effectively implementing recommendations from audits in the fight against maternal mortality. The majority of the deaths were preventable (95.38%).

关键词： Review of Maternal Deaths CHU kara Togo

Ovarian Dysgerminoma Associated with Pregnancy: A Case Report from the Sylvanus Olympio University Hospital Center

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Open Journal of Obstetrics and Gynecology 2021年第7期11卷 830-835页

作者： Baguilane Douaguibe Bingo k. M’Bortche Tina Ayoko ketevi Akila Bassowa Dede ajavon T. Dare Francis Baramna-Bagou komi A. Migbegna Abdoul Samadou Aboubakari koffi Akpadza Department of Gynecology and Obstetrics Sylvanus Olympio University Hospital Center Lomé Togo Togolese Association of Family Well-Being Planning Center (ATBEF) Lome Togo Department of Gynecology and Obstetrics Campus University Hospital Center Lomé Togo Department of Gynecology and Obstetrics University Hospital Center Kara Togo Department of Pathology University Teaching Hospital of Lomé Lomé Togo

Background: Dysgerminoma is a germ cell tumor of the ovary usually found in young women. It represents 1% to 2% of all ovarian cancers. The preoperative diagnosis is generally difficult. The surgery and the pathology study are therefore essential for the diagnosis, and optimal management. The incidence of pregnancy with dysgerminoma is extremely low. The treatment and management during pregnancy often jeopardize the materno-fetal prognosis. We report a case of ovarian dysgerminoma in an 18-year-old pregnant woman. Observation: Patient was an 18-year-old, female with no known past medical history, who presented to the emergency room at 29 weeks + 3 days pregnancy with dyspnea and a voluminous uterus (height 42 cm). An ultrasound showed an active pregnancy, and a large vascularized, finely echogenic, multi-partitioned, thick-walled liquid ovarian tumor. Ca125 was 231.5 IU/ml. Ovarian dysgerminoma was suspected. The surgery and the pathology study of the surgical specimen confirmed the suspected diagnosis. Patient died on postoperative day 8. Conclusion:

关键词： Dysgerminoma Young Pregnancy Adnexectomy

Giant Breast Hamartoma: A Case Report in Togo

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Open Journal of Radiology 2018年第1期8卷 30-36页

作者： Bidamin N’timon Tchin Darré Massaga Dagbé Pihou Gbandé Abdoulatif Amadou Mazamaesso Tchaou Lantam Sonhaye Samadou Aboubakari Dédé ajavon Akila Bassowa Lama kègdigoma Agoda-koussema komlanvi Adjenou Department of Radiology University Teaching Hospital of Kara Kara Togo Department of Pathology Sylvanus Olympio University Teaching Hospital of Lomé Lomé Togo Department of Radiology Sylvanus Olympio University Teaching Hospital of Lomé Lomé Togo Department of Radiology Campus University Teaching Hospital of Lomé Lomé Togo Department Obstetrics and Gynecology University Teaching Hospital of Kara Kara Togo

We report the case of a 50-year-old patient, who was explored in mammography, ultrasound and CT for a large painful mass of the right breast that had been evolving for 30 years and gradually increasing in size. There was a typical “sausage slice” appearance with clear center macrocalcifications on the mammogram;an aspect of “breast in the breast” on ultrasound. The scanner had made it possible to specify the dimensions of the mass, which measured 21.4 cm in height;18.6 cm wide and 9.5 cm thick. Histology after exeresis noted the adenolipofibromatous nature of the mass.

关键词： Mammography Ultrasound Hamartoma Togo