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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

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review of Maternal deaths in Two Health regions of Togo: About 69 Cases (Epidemiological and Sociodemographic Aspects)

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Open Journal of Obstetrics and Gynecology 2023年第10期13卷 1722-1729页

作者： Baguilane douaguibe dédé régina ajavon Wahabou Koffi Pakieyendou Tongou Yendoutie Kambote Francis Bararmna-Bagou romario Mawougbe Samado Aboubakari Obstetrics and Gynecology department of Sylvanus Olympio University Hospital Lomé Togo Obstetrics and Gynecology department of Kara University Hospital Kara Togo

Introduction: Maternal mortality is a public health problem. It is common in hospitals in Togo. From 401 per 100,000 live births in 2013, in 2017 we are 396 per 100,000 live births. despite several programs ranging from subsidized caesarean section (CArMA) yezou (assistance for pregnant women), the establishment of maternal death reviews in maternity wards to compensate for avoidable causes;we are seeing preventable maternal and fetal deaths in our hospitals. No study on these reviews has been done since its establishment. The objective of our study was to determine the frequency of reviews of maternal deaths, the epidemiological, sociodemographic aspects and the causes of these reviewed maternal deaths. Method: This was a descriptive and cross-sectional, multicenter study lasting four and a half years, from the 1st of January 2018 to the 30th of June 2022, relating to the review of maternal deaths in three reference hospitals of two health regions of south Togo. Any maternal death occurring in one of these hospitals during the study period was included in this survey. The data collected using a collection sheet were analyzed using Epi Info version 7 software. results: during the study period, the maternal mortality ratio in the three hospitals was 722.3 per 100,000 live births. Only 12.2% of maternal deaths were reviewed in the three hospitals. The patients were young with an average age of 29.9 years, housewives (71%), uneducated (21.7%). The causes of maternal deaths were dominated by direct obstetric causes (89.7%). The main cause was hemorrhage (72.5%), the main cause being immediate postpartum hemorrhage (50.7%). Conclusion: This study shows that the maternal mortality ratio still remains high in our country with a low frequency of maternal death reviews. Young, poor, uneducated women are the most affected by these deaths, the main cause of which remains hemorrhage. Preventive measures deserve to be taken at all levels with a view to redu

关键词： Maternal death review Cause Togo

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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

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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

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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

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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

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Physico-Chemical Characterization of Wood Ash for Agronomic Purposes

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Journal of Agricultural Chemistry and Environment 2024年第2期13卷 235-250页

作者： Ayi Kévin ajavon Bassaï Magnoudéwa Bodjona diyakadola dihéénane Bafai Laboratory Waste Management Treatment and Recovery (GTVD) Faculty of Sciences University of Lome Lome Togo

The oil refinery of the food products company SOPAL, located in the port area of TOGO, produces an average of 200 kg of eucalyptus wood ash per day. This ash is stored in large quantities within the premises of the refinery, without any disposal solution. The aim of this study is to identify the physico-chemical properties of SOPAL’s wood ash for agronomic valorization. Physico-chemical analyses reveal the presence of major and secondary elements such as potassium (15.71 g/kg dM), phosphorus (27.90 g/kg dM), calcium (9.76 g/kg dM), magnesium (0.03 g/kg dM), sodium (1.24 g/kg dM), iron (1.49 g/kg dM) and manganese (7.82 g/kg dM). The pH is alkaline (12.97) with fairly high conductivity (24.10 mS/Cm). Heavy metals identified are cobalt (0.19 mg/kg dM), cadmium (0.10 mg/kg dM), lead (1.14 mg/kg dM), copper (19.77 mg/kg dM) and nickel (12.82 mg/kg dM). The results show that the ash contains considerable amount of major and secondary elements for agronomic uses.

关键词： Industry Wood Ash Heavy Metals Valorization

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Maternal deaths after Obstetrical referral and/or Evacuation to the Obstetrics Gynecology Clinic of the Sylvanus Olympio University Hospital Center, Togo

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Advances in reproductive Sciences 2023年第2期11卷 37-45页

作者： Ameyo Ayoko Ketevi Bidilukinu Katende Akila Bassowa Komlan Alessi Andele Baguilane douaguibe dédé régine diane ajavon Abdoul Samadou Aboubakari Koffi Akpadza department of Gynecology-Obstetrics Faculty of Health Sciences University of Lome Lomé Togo department of Gynecology-Obstetrics Faculty of Health Sciences University of Kara Kara Togo

Introduction: Maternal death or maternal mortality is “the death of a woman occurring during pregnancy or within 42 days of termination, regardless of duration or location, for any specific cause or aggravated by pregnancy or its management, but neither accidental nor fortuitous. Methods: This was a descriptive and analytical cross-sectional study carried out from January 1st, 2021 to April 30th, 2022 at the Obstetrics Gynecology Clinic of the Sylvanus Olympio University Hospital Center (SOUHC). results: we noted 86 cases of maternal deaths after referral/evacuation i.e. a maternal mortality rate hospital of 555 maternal deaths per 100,000 LB. The average age of the patients was 31.1 ± 6.3 years with extremes of 15 and 45 years. In 33.7% of cases our patients were resellers. Multiparas represented 33.7% of the sample, they had performed less than three antenatal consultations. Postpartum hemorrhage was the reference reason in 33.7%. In 74.4% of cases, the patients referred had arrived by taxi. In 87.9% of cases, the patients had died of direct obstetric causes. Immediate postpartum hemorrhage accounted for 44.6% of cases and anemia, 36.4%. There is a statistically significant association between the availability of blood product and the avoidability of maternal death after obstetrical referral and/or evacuation (p value = 0.0188 0.05). Conclusion: determining responsibility for maternal death is not always easy. There is an urgent need to strengthen the policy of reducing maternal mortality in Togo. This remains possible by developing communication strategies and a solid referral/counter-referral system.

关键词： Maternal death reference Counter reference Togo

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Cystic degeneration of Uterine Leiomyoma Misdiagnosed as Ovarian Malignancy: A Case report

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Open Journal of Obstetrics and Gynecology 2023年第4期13卷 745-751页

作者： Kossi Edem Logbo-Akey Kignomon Bingo M’bortche Pierre Yendoubé Kambote Kibandou Noe Patidi dédé régine diane ajavon Abdoul-Samadou Aboubakari 1department of Gynecology and Obstetrics of the University Hospital of Kara University of Kara Kara Togo department of Gynecology and Obstetrics of the University Hospital of Kara University of Kara Kara Togo Togolese Association for Family Welfare (ATBEF) Clinic University of Lomé Lomé Togo department of Gynecology and Obstetrics of the University Hospital Sylvanus Olympio University of Lomé Lomé Togo department of Gynecology and Obstetrics of the regional Hospital Center of Tomdé University of Kara Kara Togo

Background: Massive cystic degeneration of the uterine myoma might mimic an ovarian tumor, especially a malignant ovarian tumor, causing misdiagnosis. We present a case of a woman with marked cystic degeneration of a uterine leiomyoma mimicking an ovarian neoplasm. Case: A 65-year-old woman (gravida 6, para 6) visited us due to an abdominal tumor. Clinical examination and radiology exploration suggested the presence of an ovarian tumour. The patient underwent a total abdominal hysterectomy with bilateral adnexectomy. Histopathology confirmed a final diagnosis of a degenerated leiomyoma. The patient’s postoperative course was uneventful and she was discharged on her 5th post-operative day. Conclusions: When a patient has a huge abdomino-pelvic mass, mimicking an ovarian tumor, cystic degeneration of uterine myoma should be considered as a differential diagnosis.

关键词： Leiomyoma Cystic degeneration Ovarian Tumor

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Epidemiological and Prognostic Aspects of Obesity and Pregnancy in the Gynecology-Obstetrics department at the Sylvanus Olympio University Hospital Center (CHU SO) in Lomé

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Open Journal of Obstetrics and Gynecology 2023年第1期13卷 88-96页

作者： Komlan Alessi Andele Ameyo Ayoko Ketevi Baguilane douaguibe Akila Bassowa dédé régine diane ajavon Kodjo Fiagnon Abdoul Samadou Aboubakari Koffi Akpadza department of Gynecology and Obstetrics Sylvanus Olympio University Hospital Center Lome Togo department of Gynecology and Obstetrics Campus University Hospital Center Lome Togo department of Gynecology and Obstetrics Regional Hospital Center Kara Togo department of Gynecology and Obstetrics Kara University Hospital Center Kara Togo

Introduction: Obesity and pregnancy is a major public health problem worldwide, both maternal and fetal. Objective: This is to describe the epidemiological and prognostic aspects of obesity and pregnancy in the gynecology-obstetrics department at the Sylvanus Olympio University Hospital Center (CHU SO) in Lomé. Methodology: This was a descriptive cross-sectional study concerning obesed pregnant women. The survey was conducted from the 1st to the 30th of June 2022 at the CHU SO. results: We enrolled 55 obese pregnant women. The frequency of obesity and pregnancy was 5.14%. resellers were represented at 41.8%. The average age was 31 years old. As risk factors, 85.5% claimed to have a fatty diet and 76% did not practice sports. The gestational pathologies found during pregnancy were hypertension in 47.4% of cases, preeclampsia in 24.6% and gestational diabetes in 7%. Caesarean section was the way of delivery in 63.6% of cases and those who gave birth vaginally presented a tear of the soft tissues in 85% of cases. Birth weight was abnormal (low weight and excess weight) in 61.8% of cases. Conclusion: The association between obesity and pregnancy constitutes an important risk factor for the mother and the fetus.

关键词： Obesity Pregnancy CHU SO Togo

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