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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

Obstetric Emergencies at the kara University Hospital Maternity Ward: Sociodemographic, Etiological and Prognostic Aspects

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Open Journal of Obstetrics and Gynecology 2024年第1期14卷 69-76页

作者： Logbo-Akey kossi Edem Bassowa Akila ketevi Tina kambote Yendoubé Patchidi kibandou Amewouho kofi ajavon Dédé Régina Aboubakari Abdoul-Samadou Service de Gynécologie-Obstétrique CHU Kara Université de Kara Kara Togo Service de Gynécologie-Obstétrique CHU Campus Université de Lomé Lomé Togo Service de Gynécologie-Obstétrique CHU Sylvanus Olympio Université de Lomé Togo Faculté des sciences de la santé Université de Lomé Lomé Togo Service de Gynécologie-Obstétrique CHR Tomdé Université de Kara Togo

Introduction: Obstetric emergencies are common throughout the world and more particularly in developing countries where they are responsible for high maternal-fetal mortality and morbidity. Objective: Study obstetric emergencies in the maternity ward of kara University Hospital. Method: Retrospective and descriptive study from April 1, 2022 to March 30, 2023, carried out in the Obstetrics and Gynecology Department of kara University Hospital. Results: Eight hundred and thirty-five (835) obstetric emergencies were recorded out of 2215 admissions, i.e. a frequency of 37.7%. The average age of the patients was 26.7 with a range of 14 and 45 years. They were primigravidas (36.7%) and nulliparous (38.7%), referred (84.7%) and came from rural areas (72%). Emergencies occurred in the 3rd trimester in 74.1% and in parturients (54.1%). Preeclampsia (27%), cessation of progression of labor due to feto-pelvic disproportion (12.4%), postpartum hemorrhage (7.5%) constituted the main obstetric emergencies. In 44.8%, the delivery was carried out vaginally. Magnesium sulfate was the most used drug, i.e. 30.1%;followed by antihypertensive medications in 28.1%. Blood transfusion was performed in 24.3%. The evolution was simple in 90.9%. The maternal fatality rate was 1.6%. The perinatal case fatality rate was 12.3%. Conclusion: Obstetric emergencies are common, dominated by preeclampsia, stopping progress of labor and postpartum hemorrhages. They are responsible for high morbidity and mortality.

关键词： Obstetric Emergency kara University Hospital

Female Contraception: Comparative Study of Biometrics and Vascularization of the Uterus at Sylvanus Olympio University Hospital (Togo)

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Open Journal of Obstetrics and Gynecology 2024年第1期14卷 162-174页

作者： Dédé Régine Diane ajavon Metoukam Andrée Josiane Douaguibe Baguilane ketevi Améyo Ayoko Logbo Akey kossi Edem kambote Yendoube M’bortche Bingo Amadou Abdoulatif Aboubakari Abdoul Samadou Faculty of Health Sciences University of Kara Kara Togo Faculty of Health Sciences University of Lomé Lomé Togo Service de gynécologie obstétrique du CHU Sylvanus Olympio Lomé Togo

Female contraception uses both hormonal and non-hormonal methods. The aim of the study is to determine the impact of female contraception on uterine vascularisation and the endometrium. Method: It was a descriptive comparative study with an analytical aim. It took place at the University Clinic of Obstetrics Gynaecology and the Radiology and Medical imaging Department of Sylvanus Olympio University Hospital in Lomé over a two-month period from May 15, 2023 to July 15, 2023. Group 1 included women using a modern contraceptive method and group 2 women not using a modern contraceptive method. Epidata 3.1 and R 4.0.4 software were used to process the data. Results: Each group included 50 women. There were no significant differences in uterine and endometrial biometrics. All women on contraception had their zone 1 vascularized, without vascularisation of zone 2, without significant difference with women without contraception The pulsatility index was greater than 3 in 51% (n = 51) of women, including 62.7% (n = 32) of women without contraception and 37.3% (n = 19) of women on contraception, with a statistically significant difference (p = 0.009). Conclusion: Contraceptive methods do not influence the biometry of the uterus. However, uterine artery Doppler indices can predict abnormal uterine bleeding.

关键词： Contraception Endometrium Uterine Artery Doppler

Obstetric References in Disadvantaged Environments: Case of References to the University Hospital Center of kara, in Northern Togo

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Open Journal of Obstetrics and Gynecology 2024年第2期14卷 267-277页

作者： kossi Edem Logbo-Akey Bassowa Akila kofi Mawoulé Améwouho ketevi Tina Yendoubé Pierre kambote Dédé Régine Diane ajavon Baguilane Djoauguibe Abdoul-Samadou Aboubakari koffi Akpadza Service de Gynécologie-Obstétrique CHU Kara Togo Service de Gynécologie-Obstétrique CHU Campus Lomé Togo Service de Gynécologie-Obstétrique CHU Sylvanus Olympio Lomé Togo Service de Gynécologie-Obstétrique CHR Tomdé Kara Togo

Introduction: References are frequent and most often carried out in emergency situations. The objective of this study was to describe the epidemiological and clinical profile of obstetric referrals to the CHU-kara. Methodology: This was a retrospective cross-sectional descriptive study conducted from September 1, 2022, to February 28, 2023, at CHU-kara, focusing on obstetric referrals to the Gynecology-Obstetrics department. Result: 828 patients were referred for obstetric reasons out of 1295 admissions, representing a frequency of 63.9%. The average age was 25.04 years. They were primigravida (38.3%), unemployed (62.7%). Motorcycles were the main means of transportation, accounting for 53.1% of cases. The average distance to reach the referral center was 31.6 km, covered in an average of 71 minutes. In 40.7% of cases, patients had less than 4 prenatal consultations and were referred in peripartum (56.6%) for pre-eclampsia (14%), post-term pregnancy (11.8%), dystocia (10.5%). Eighty-six point nine percent (86.9%) of the referred patients were able to deliver during their stay in the department, of which 61.7% had vaginal deliveries. The maternal and perinatal mortality rates were 0.7% and 14.9%, respectively. Conclusion: Obstetric referrals to kara University Hospital are frequent during the perpartum period and are often carried out by motorbike.

关键词： Obstetric Referral Epidemiology Prognosis CHU-kara

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

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

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

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

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