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Maternal Hospital Mortality in Cotonou: Incidence, Care-Associated Adverse Events and Causes

Open Journal of Obstetrics and Gynecology 2023年第10期13卷 1688-1698页

作者： Djima Patrice Dangbemey Cedric Bigot ogourindé mathieu ogoudjobi Moufalilou Aboubakar Raoul Atade Paterne Kpoviessi Hounkpatin Benjamin Christiane Tshabu-Aguemon Josiane Angeline Tonato-Bagnan Justin Lewis Denakpo Facultty of Health Sciences Abomey-Calavi University Abomey-Calavi Benin Gynecology-Obstétrics Department Hospital and University Center for Mother and Child Lagune Cotonou Benin University Clinic of Gynecology and Obstetrics of the CNHU-HLM Cotonou Benin Nursing and Midwifery Training Institute University of Parakou Parakou Benin

Introduction: Despite the many efforts made to combat preventable maternal deaths, these still remain high in Benin. It was therefore important to revisit the causes but especially the adverse events associated with care (EIS) in maternity. Objective: Determine the incidence, adverse events associated with care and causes of intra hospital maternal mortality in cotonou. Methods: This was a cross-sectional maternal mortality review study with retrospective data collection. It covered all cases of maternal death recorded between 2017 and 2021 in two (2) reference university maternities in Cotonou. Adverse events associated with care and the patient were analyzed using the maternal death audit grid validated for Benin. SPSS.26 software was used for data analysis. Results: The in-hospital maternal mortality ratio in Cotonou was 2028 maternal deaths per 100,000 live births in 2021. Only 7.2% (n = 36) of deaths were audited. The deceased mothers were 29.8 ± 7.4 years old, with no fixed monthly income in 82.7% (n = 420). Serious adverse events associated with care were: delay in decision to refer in 37% (n = 188), non-medical referral in 85.8% (n = 436) of cases, inadequate pre-referral treatment in 25.7% of cases. In receiving maternities, delay in diagnosis and inappropriate treatment at the receiving maternity were noted respectively in 22.9% and 28.6% of cases of maternal death. The direct causes of maternal death were dominated by serious obstetric hemorrhage in 43.9% (n = 223). As for the indirect causes, they were dominated by anemia excluding obstetric hemorrhages in 21.5% (n = 109). Conclusion: The in-hospital maternal mortality ratio was very high in Cotonou. The main cause was severe obstetric hemorrhage. There were several serious healthcare-associated adverse events whose correct management would significantly reduce the incidence of maternal deaths.

关键词： Maternal Mortality Adverse Events Care Cotonou

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Epidemiology and Clinical Signs of Gynecological Cancers in an African Country South of the Sahara: Case of the Republic of Benin in 2022

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Open Journal of Obstetrics and Gynecology 2023年第12期13卷 2021-2032页

作者： Djima Patrice Dangbemey Raoul Atade Mahublo Vinadou Vodouhe Ameyo Ayoko Ketevi Samiath Bakary ogourindé mathieu ogoudjobi Moufalilou Aboubakar Simon Azonbakin Christiane Tshabu-Aguemon Benjamin Hounkpatin Angeline Tonato-Bagnan Justin Lewis Denakpo Faculty of Health Sciences University of Abomey-Calavi Cotonou Benin Nursing and Midwifery Training Institute University of Parakou Parakou Benin Faculty of Health Sciences University of Lomé Lomé Togo

Introduction: Gynaecological cancers are the deadliest of the women’s cancers in the Republic of Benin. Late diagnosis is the most common reason. Objective: This paper aims to describe the epidemiological characteristics, and clinical and pathological signs of gynaecological cancers treated in the Republic of Benin between 2018 and 2022. Patients and Methods: This was a cross-sectional, descriptive, retrospectively collected study of patient data treated between 2018 and 2022 in two university gynaecology departments in Cotonou. All gynaecological cancers that have histological evidence were included. The epidemiological, clinical and pathological characteristics of the cancers were assessed. Results: Cervical, endometrial and ovarian cancers were the most common in the proportions of 62.0%, 24.1%, 12.0% and 1.8% respectively. The mean age at diagnosis was 54 years. The victims were uneducated and had low economic power in 81% and 85% of cases, respectively. The consultation was late in 82.1% of cases. Metrorrhagia, postmenopausal metrorrhagia and pelvic cluster headache were the common reasons for consultation for cervical, endometrial and ovarian cancer, respectively. Diagnosis was late in 66.7% (n = 71). The most common histological types were squamous cell carcinoma, endometrioid adenocarcinoma, and serous cystadenocarcinoma for cervical, endometrial, and ovarian cancers, respectively. Conclusion: Gynaecological cancers were common and their consultation time was delayed. The diagnosis was made at the advanced stage and there were several reasons for this.

关键词： Gynaecological Cancers Epidemiology Signs Benin

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Prognostic Factors for Eclamptics in Intensive Cares of Two University Teaching Hospitals in Cotonou, Benin

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Journal of Biosciences and Medicines 2023年第12期11卷 142-151页

作者： Ahounou Ernest ogoudjobi mathieu Camara Amadou Yalla Akodjenou Joseph Assouto Epiphanie Koco Houénoukpo Zoumènou Eugène National University Hospital Center Hubert Koutoukou Maga (CNHU-HKM) Cotonou Benin University of Abomey-Calavi (UAC) in Bénin Cotonou Benin Mother and Child University Hospital Center Lagune (CHU-MEL) Cotonou Benin University Hospital Center of Donka Conakry Guinea Université Gamal Abdel Nasser de Conakry in Guinée Conakry Guinea

Introduction: In Benin, the maternal mortality rate remains high and one of the main causes is preeclampsia in its complicated forms, including eclampsia. For this, treatment is most often provided in an intensive care unit by a multidisciplinary team involving obstetricians and intensive care doctors. Objective: To determine the prognostic factors of eclamptics treated in intensive care units in two university teaching hospitals in Cotonou. Patients and Method: The study was transversal descriptive and analytical with prospective collection of data from May 1 to July 31, 2022, in the intensive care units of CHU-MEL and CNHU-HKM in Cotonou. The sampling was non-probability with exhaustive recruitment of all cases of eclampsia managed in hospital intensive care units. Clinical, therapeutic and evolutionary data were studied. Data analysis was done with Epi info 7.***.1.0 software. Results: Fifty-five eclamptics were included. The incidence was 12.39%. The average age of eclamptics was 24.67 ± 1.41 years, with a reference rate of 85.45%. Primigravidae represented 52.73%. A history of eclampsia and/or high blood pressure (14.54%) was associated with mortality. Cesarean section was indicated in 85.45% and general anesthesia, was the technique used in 95.75% of cases. Eclamptic status was found in 36.37% of patients. Other poor prognostic factors were Glasgow score of less than nine (9.09%), shock (7.27%), mechanical ventilation (58.18%) and complications. Mortality was 16.36%. Conclusion: The mortality of eclamptics in the intensive care units of CHU-MEL and CNHU-HKM was high. Poor prognostic factors were a history of preeclampsia or pregnancy-induced hypertension, severity of eclampsia and complications.

关键词： Preeclampsia Prognostic Factors Resuscitation

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Retrospective View of Two Years of Colposcopy Practice in a Gynecologic Clinic in Cotonou

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Open Journal of Obstetrics and Gynecology 2017年第2期7卷 226-234页

作者： Mèdessè Véronique Tognifode Justin Lewis Denakpo Moufalilou Aboubakar Luc Brun mathieu ogoudjobi Symphorose Lokossou Angeline Tonato Bagnan René Xavier Perrin University-Affiliated Hospital of the Department of Ouémé-Plateau (CHUD-OP) Porto Novo Benin University-Affiliated Hospital for Children and Mothers (CHU-MEL) Cotonou Benin Anatomopathology Unit of the University-Affiliated Hospital of the Department of BORGOU (CHUD/B) Parakou Benin

Objective: To analyse the colposcopy results at the Gynaecological Clinic of Houéyiho. Patients and methods: Retrospective, descriptive and analytical studies were conducted by the Clinic of Houeyiho in Cotonou from January 2013 to December 2015. Results: 440 women were received in colposcopy including 251 (57%) referred by health workers for VIA (Visual Inspection with Acétique Acid)/VILI (Visual Inspection with Lugol’s Iodine) abnormalities, forty-seven (47) for abnormal smears (10.7%), thirty-eight (38) for metrorrhagia (8.6%). 10% of cases were mainly concerned with post-therapeutic monitoring (six colposcopies of the vagina fundus after hysterectomy for cervical cancer and four after conization). The average age of patients is 41 years within plus or minus 5 years. Forty (40) cases of Grade 1 Atypical Transformation, twenty-nine (29) cases of Grade 2 Atypical Transformation including two (2) cases of leukoplakia (1 post-conization for CINIII, 1 in a HIV+ patient), ten (10) cases of Grade 1 Atypical Transformation/Grade 2 Atypical Transformation association were recorded. A colposcopy biopsy was performed in 95 patients meaning 21.6% of patients. Five biopsies were realized for a cervical neoplasia suspicion and were sent to Pasteur Cerba laboratory in France for the sake of efficiency and rapidity of results. In Grade 1 Atypical Transformation, 66.6% of CIN1 and condylomata plana were noted. Nevertheless, a case of mucinous adenocarcinoma with metaplasia has been discovered in a TAG1 with a 23-year old patient. In Grade 2 Atypical Transformation, the histology reveals 44.4% of CIN 1, 40.7% of severe dysplasia and 11.1% of carcinomas. Conclusion: The colposcopy may be a good screening method with a good colpo-histology agreement in Cotonou. But it’s relatively expensive (20.000 CFA francs) and the reduced number of colposcopists restricts its use in Benin.

关键词： Colposcopy Cervical Smear Precancerous Lesions Histology Benin

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Vaginal Touch versus Transvaginal Ultrasound in the Management of Threatened Preterm Labour at the University Hospital Center of Porto-Novo (Benin)

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Open Journal of Obstetrics and Gynecology 2017年第11期7卷 1141-1149页

作者： ogourinde mathieu ogoudjobi Christiane Tshabu-Aguemon Megnisse S. H. S. Lokossou M. Veronique Tognifode Moufalilou Aboubakar Gounou Didier Komongui Joseph Lanwassonou Angéline Tonato Bagnan Antoine Lokossou Issifou Takpara René-Xavier Perrin Faculty of Health Sciences University of Abomey-Calavi Cotonou Benin

Objective: To evaluate the risk of preterm delivery with vaginal touch in opposition with transvaginal ultrasound in pregnant women who present signs and symptoms of threatened preterm labour. Methods: A prospective study was conducted with descriptive and comparative aims at the University Hospital of Porto-Novo, Benin Republic between 1 March and 31 August 2016. Every pregnant woman admitted to the emergencies of the maternity between 28 and 34 of WA (weeks of amenorrhoea) and attended for preterm delivery risk with intact membranes was included. The risk of preterm delivery was evaluated using vaginal touch and ultrasound examination of cervical length. Results: The risk of preterm delivery was obvious and identical with the cervical dilatation ≥2 cm when the vaginal touch was applied [RR 2.34 IC 95% (1.71 - 3.20)] and ultrasound examination of cervical length - 4.16)]. The cervix obliteration was not statistically linked to preterm delivery. The ultrasound examination of cervical length had a better sensitivity (87.76%) and a negative predictive value (81.54%) against 59.18% and 74.68% respectively for cervical dilatation at vaginal touch. Bishop score also had a better specificity with the one of the ultrasound examination of cervical length (79.11% vs. 33.54%) whereas both of them had almost identical negative predictive value (81.17% vs. 81.54%). Conclusion: Vaginal touch was also as relevant as transvaginal ultrasound while evaluating the risk of preterm delivery. For the lack of ultrasound in emergency rooms, a good physical examination would be sufficient by its own to decide of an adequate management when there is a threat of preterm delivery.

关键词： Threat of Preterm Delivery Vaginal Touch Transvaginal Ultrasound Comparison

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