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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-Ak.y D. R. Ajavon k. B. M’bortche P. Y. k.mbote A. S. Aboubak.ri k. akpadza Gynecology and Obstetrics Department of k.ra 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. k.0358912">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. Aboubak.ri A. Bassowa D. Ajavon T. k.tevi k. E. Logbo-Ak.y 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 week.’ 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 week. 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 unk.own 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

Obstetric References in Disadvantaged Environments: Case of References to the University Hospital Center of k.ra, 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： k.ssi Edem Logbo-Ak.y Bassowa Ak.la k.fi Mawoulé Améwouho k.tevi Tina Yendoubé Pierre k.mbote Dédé Régine Diane Ajavon Baguilane Djoauguibe Abdoul-Samadou Aboubak.ri k.ffi 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-k.ra. Methodology: This was a retrospective cross-sectional descriptive study conducted from September 1, 2022, to February 28, 2023, at CHU-k.ra, 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 k., 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 k.ra University Hospital are frequent during the perpartum period and are often carried out by motorbik..

关键词： Obstetric Referral Epidemiology Prognosis CHU-k.ra

Outcome of Pregnancies under Cupper Intrauterine Device: Experience of 10 Cases Collected at the Principal Clinic of the Togolese Association of Family Well-Being Planning Center (ATBEF)

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Open Journal of Obstetrics and Gynecology 2022年第7期12卷 616-623页

作者： Bingo k.gnomon M’bortche k.ssi Edem Logbo-Ak.y Tina Ayok. k.tevi Baguilane Douaguibe Francis Baramna-Bagou Abdoul-Samadou Aboubak.ri k.ffi akpadza Principal Clinic of the Togolese Association of Family Well-Being Planning Center (ATBEF) Lomé Togo Department of Gynaecology-Obstetrics The University Hospital Kara Kara Togo Department of Gynaecology-Obstetrics The University Hospital Sylvanus Olympio Lomé Togo

Aims: Although the copper intrauterine device (Cu-IUD) is an effective contraceptive device, cases of pregnancy under the Cu-IUD have been reported. We here report 10 women who got pregnant under this condition, with special reference to etiologies and pregnancy outcomes. Methodology: We analyzed all women who got pregnant under Cu-IUD at ATBEF Main Clinic from July 1, 2015 to June 30, 2020. Results: We retrieved 10 patients. The durations of Cu-IUD use were 3 months to 6 years. The etiologies were poor insertion;migration and spontaneous expulsion. The occurrence of pregnancy was poorly accepted by the women: 20% of women considered it was due to the providers’ incompetence. Of the 10 pregnancies, 5 women had given vaginal birth spontaneously;2 induced abortions, 2 spontaneous abortions and 1 ectopic pregnancy. The contraceptive method adopted after pregnancy was jadelle implants in 8 cases and spousal vasectomy in 2 cases. Conclusion: The prevention of IUD pregnancies may require adequate insertion time, insertion technique and follow-up.

关键词： Contraception Pregnancy Etiologies Outcome Lomé

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 Ayok. k.tevi Bidiluk.nu k.tende Ak.la Bassowa k.mlan Alessi Andele Baguilane Douaguibe Dédé Régine Diane Ajavon Abdoul Samadou Aboubak.ri k.ffi 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

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： k.mlan Alessi Andele Ameyo Ayok. k.tevi Baguilane Douaguibe Ak.la Bassowa Dédé Régine Diane Ajavon k.djo Fiagnon Abdoul Samadou Aboubak.ri k.ffi 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

Determinants of Home Birth in the Community of Dagbati in Togo

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Open Journal of Obstetrics and Gynecology 2022年第6期12卷 520-527页

作者： Améyo Ayok. k.tevi Ak.la Bassowa Bidiluk.nu k.tende Dédé Régine Diane Ajavon Adjo Sylvie Biwuh Alessi Andele Abdoul-Samadou Aboubak.ri k.ffi akpadza Department of Gynecology-Obstetrics Sylvanus Olympio Teaching Hospital Lome Togo Department of Gynecology-Obstetrics Campus Teaching Hospital Lome Togo Department of Gynecology-Obstetrics Regional Hospital Center Kara Togo Department of Gynecology-Obstetrics Kara Teaching Hospital Lome Togo

Introduction: Home birth or unassisted birth means for a woman to mak. the decision to give birth at home, not alone in absolute terms, but without professional assistance, be it that of a midwife, a doctor or any other person with midwifery qualifications. Methods: This was a descriptive cross-sectional study conducted from November 04th to December 21st, 2019 and from August 17th to August 21st, 2020, in the community of Dagbati, in 33 women who gave birth at home, received at the USP of Dagbati and during advanced strategies;who were registered or not in the delivery register of USP Dagbati and who agreed to participate in the survey freely and in an informed manner. Results: Of the 48 deliveries that took.place in the locality during our study period, 33 took.place at home, with a rate of 68.7%. The average age of the women giving birth was 26.33 years with extremes of 15 and 47 years. In 42.4% of cases, they were farmers. Twenty-seven women who gave birth had farmer spouses (81.9%). The distance between their house and the health center was greater than 2 k. in 78.8% of cases. Among the reasons for giving birth at home, the lack.of financial means was mentioned in 60.6%. In 63.6%, the family had assisted the women in giving birth. Conclusion: Home birth is still a reality in our communities, despite the increased number of health facilities. The sensitization of the population, the improvement of the conditions of accessibility to the health center, the quality of obstetric care, and also, the improvement of the living conditions of women will surely allow a total abandonment of home births.

关键词： Home Births Dagbati Determinants Parturient Togo

k.owledge, Attitudes of Pregnant Women and Practices of Women Who Have Recently Given Birth on Contraception in the Immediate Postpartum Period at Principal Clinic of the Togolese Association of Family Well-Being Planning Center (ATBEF)

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Open Journal of Obstetrics and Gynecology 2022年第1期12卷 67-80页

作者： Bingo k.gnomon M’bortche Francis Baramna-Bagou Baguilane Douaguibe k.ssi Edem Logbo-Ak.y Dédé Regina Ajavon Tina Ayok. k.tevi Ak.la Bassowa Abdoul-Samadou Aboubak.ri k.ffi akpadza Principal Clinic of the Togolese Association of Family Well-Being Planning Center (ATBEF) Lomé Togo Department of Gynecology-Obstetrics of the CHU Sylvanus Olympio Lomé Togo Department of Gynecology-Obstetrics of the CHU k.ra Kara Togo Department of Gynecology-Obstetrics of the CHU Campus Lomé Togo

Back.round: The use of modern contraceptive methods contributes to the reduction of maternal and neonatal mortality. The initiation of a contraceptive method in the immediate postpartum period is one of the strategies to avoid missing out on contraceptive opportunities. This strategy will reduce the unmet need for contraception which is still high in the country. Objective: To describe the knowledge and attitudes of pregnant women and the practices of women who have given birth about immediate postpartum contraception. Methodology: This was a cross-sectional and descriptive study conducted at the main clinic of ATBEF from 20th March to 20th October 2020. Our study included pregnant women whose gestational age was greater than or equal to 37 weeks of amenorrhea who came for prenatal consultation or for any other consultation and then gave birth in the center. Data collection was based on a survey form. Data analysis and entry was done with the Epi info 2000 version 6.04 software. The parameters studied were: socio-demographic characteristics, knowledge and attitudes of pregnant women about contraception in the immediate postpartum period, and contraceptive practices of the women who gave birth. Results: During the study period, 201 women were selected for the survey. The average age of the respondents was 26.2 years. They were nulliparous in 41.3% of cases. Our respondents had k.owledge of modern contraceptive methods in 82.10% of cases. About 59.2% of the respondents had an unfavourabl

关键词： Contraception Postpartum Pregnant Women Delivered Women Lomé

Indications for Cesarean Section in a Tertiary Center in Togo

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Open Journal of Obstetrics and Gynecology 2022年第4期12卷 276-284页

作者： Ameyo Ayok. k.tevi Dédé Régine Diane Ajavon k.djo Dela Agbewornu Baguilane Douaguibe Ak.la Bassowa Bidiluk.nu k.tende Alessi Andele k.djo Fiagnon Abdoul Samadou Aboubak.ri k.ffi akpadza Department of Gynecology and Obstetrics Sylvanus Olympio University Hospital Center Lome Togo Department of Gynecology and Obstetrics Regional Hospital Center Kara Togo Department of Gynecology and Obstetrics Campus University Hospital Center Lome Togo Department of Gynecology and Obstetrics Kara University Hospital Center Kara Togo

Objectives: The objective of this study was to evaluate the indications for cesarean section (CS) and some related characteristics in Sylvanus Olympio University Hospital Center in Togo. Methods: We analyzed all CS performed from January 1, 2020 to December 31, 2020. Results: Total number of 8676 women were delivered, of which 4583 were by CS (52.8%), emergent vs. planned;69.6% vs. 30.4%. Acute fetal asphyxia was the leading indication (25.4%), followed by pre-eclampsia/eclampsia (17.3%), and pelvic anomalies (12.2%). Analysis showed that 51% of cases had definite indications for CS, whereas in remaining cases, CS was performed for non-definite-indications. Conclusion: CS should be done based on definite indications. We must tak. an effort to educate this in this area, which, avoiding unnecessary CS, might reduce the CS rate in this area.

关键词： Caesarian Section Indications Togo