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Complete Hydatidiform Mole at Menopause: A Case Report from Panzi Hospital, Bukavu, Democratic Republic of Congo

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Open Journal of Obstetrics and Gynecology 2024年第7期14卷 1010-1017页

作者： Julien Bwama De-Joseph Kakisingi Mibi Nsenga Bin Musa Jeff Andrea Mbozi Déborah Kambonesa Salire Dieudonné Kakusu Christine Amisi Tina Aroni Toto Tchass Chasinga Baharanyi Denis Mukwege Mukengere olivier nyakio ngeleza Department of Gynaecology-Obstetrics Faculty of Medicine and Community Health Evangelical University in Africa Bukavu Democratic Republic of Congo Gynaecology-Obstetrics Department Panzi General Referral Hospital Bukavu Democratic Republic of Congo Saint Vincent Hospital Bukavu Democratic Republic of Congo Medical Imaging Department Panzi General Referral Hospital Bukavu Democratic Republic of Congo Anatomopathology Department Panzi General Referral Hospital Bukavu Democratic Republic of Congo Panzi Foundation Bukavu Democratic Republic of Congo Department of Gynaecology-Obstetrics Faculty of Medicine Official University of Bukavu Bukavu Democratic Republic of Congo Department of Gynaecology-Obstetrics Faculty of Medicine University of Kindu Kindu Democratic Republic of Congo

Gestational trophoblastic disease is an abnormal proliferation of trophoblastic tissue during pregnancy. It occurs in women of childbearing age, although a few cases have also been observed in post-menopausal women, although it is extremely rare in the latter. Here we describe a rare case of complete hydatidiform mole in a 56-year-old female patient who presented with genital bleeding combined with nausea and vomiting and a gravid uterus 16 cm in height. The ultrasound findings and the increase in serum β-HCG to 182566.00 mIU/ml suggested a diagnosis of complete hydatidiform mole. Given the post-menopausal state and the future risk of post-molar gestational trophoblastic neoplasia, we opted for total hysterectomy without preservation of the adnexa via a transabdominal approach, followed by antimitotic treatment with methotrexate. The uterus measured 18.45 cm × 11.18 cm with intra cavitary vesicles. Microscopic examination showed chorionic villi of variable size and shape, most of which were dilated and oedematous, associated with trophoblastic cell proliferation and haemorrhage suggestive of complete benign hydatidiform mole. Follow-up showed a consistent decrease in serum β-HCG levels and no evidence of residual disease. A suspicion of gestational trophoblastic disease should be borne in mind when evaluating a patient with peri- or post-menopausal bleeding to avoid delay in diagnosis and treatment.

关键词： Complete Hydatidiform Mole Menopause β-HCG Panzi Bukavu DRC

Maternal-Fetal Pregnancy Complications of in Minors Raped with or without Physical Restraint in Eastern Democratic Republic of Congo

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Open Journal of Obstetrics and Gynecology 2023年第1期13卷 1-12页

作者： Kiminyi Kalunga Eloge Ilunga-Mbaya Raha Maroy Yoyu Tunangoya Jonathan nyakio ngeleza olivier Faculty of Medicine Evangelical University in Africa (UEA) Bukavu Democratic Republic of the Congo General Reference Hospital of Panzi South-Kivu Bukavu Democratic Republic of the Congo Faculty of Medicine University of Kinshasa Kinshasa Democratic Republic of the Congo Department of Medical Works and Research Christ Church of Congo Goma Democratic Republic of the Congo

Introduction: Pregnancy resulting from rape is a public health and sexual and reproductive health issue, especially among minors. Rape can be perpetrated with or without physical restraint. The objective of the present study is to highlight the prevalence of physical coercion leading to pregnancy and the associated maternal-fetal complications. Methodology: This was a comparative descriptive and analytical cross-sectional study of complications associated with post-rape pregnancy by physical restraint among minors who were treated at the General Reference Hospital of Panzi over a two-year period from June 2020 to June 2022. A total of 140 minor survivors of violence with pregnancy were included in the study. Data were collected using a questionnaire, coded and analyzed in Excel and XLSTAT version 2014. Results: The prevalence of physical constraints was 65%. After mulltivariate analyses, denial of pregnancy (ORa: 9.64 95% CI: 1.1 - 81.2;p-value: 0.0370), attempted abortion (ORa: 56.1 95% CI: 1.5 - 2027.6;p-value: 0.0278) and agitation during delivery (ORa: 88.7 95% CI: 4.5 - 1715;p-value: 0.0030) were the complications associated with pregnancy in minors who experienced physical restraint rape. In addition, BMI was a factor in reducing the risk of physical restraint rape at the ORa of 0.5054 [0.3;0.8];p 0.006). Conclusion: Pregnancy among minors is a reality and occurs in a situation of physical coercion in the eastern Democratic Republic of Congo. These pregnancies are often associated with complications that require an intensive management system since they can jeopardize the maternal-fetal prognosis of minors.

关键词： Post-Rape Pregnancy Minor Associated Complications Eastern DRC

Characteristics and Obstetrical Outcomes of Post-Rape Pregnancies among Adolescent Girls in Post Conflict Context in Eastern DR Congo

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Open Journal of Obstetrics and Gynecology 2023年第5期13卷 882-895页

作者： Kiminyi Kalunga nyakio ngeleza olivier Raha Maroyi Eloge Ilunga-Mbaya Bwama Julien Kalala Kanyinda Luc Dénis Mukwege Faculty of Medicine Evangelical University in Africa (UEA) Bukavu Democratic Republic of the Congo Faculty of Medicine University of Kinshasa Kinshasa Democratic Republic of the Congo International Center for Advanced Research and Training South Kivu Democratic Republic of the Congo

Introduction: In conflicts such as the Democratic Republic of the Congo, sexual violence is systematically perpetrated against children and adolescent girls. Unwanted pregnancy is one of the complications with a myriad of consequences for the victim, the newborn, and society. This study aims to draw up characteristics and obstetrical outcomes of post-rape pregnancies of victims under 18 years old treated at Panzi General Referral Hospital (PGRH) in Eastern DR Congo. Methods: A single-centre prospective descriptive study was conducted at PGRH over two years (June 2020 to June 2022). This study included 140 adolescent girls who became pregnant post sexual assault. They were followed from confirmation of pregnancy to delivery. Sociodemographic, psycho-affective and clinical parameters were recorded and analyzed using XLSTAT 2014 software. Results: 76.4% came from rural areas, with a median age of 16 [13-17]. Pregnancy was continued in 50.7% and terminated in 20%. The victims were casual acquaintances of the perpetrators in 33.6% and unknown in 26.4%. 57.9% attended regular antenatal consultations. 74.3% had an individual birth plan/preparation for labor, with the primary route of delivery being vaginal (69.3%). The frequency of caesarean sections was 30.7%. Some psychological symptoms were identified during labor in 52.9% like agitation (10.7%) and hypersensitivity (8.6%). Conclusion: Pregnancy post rape is a public health problem affecting adolescents between 13 and 17 years of age. These pregnancies require closer follow-up with multi-disciplinary shared care, including psychology, obstetrics, and community input, to improve mother and newborn antenatal, intrapartum, and postpartum outcomes. In addition, long-term psychological sequelae of these pregnancies can be mitigated through supportive care in this high-risk period.

关键词： Sexual Violence Pregnancy Adolescent Victims Complications Prognosis Perpetrators Profile

Epidemiological and Cytopathological Profile of Dysplastic Lesions of the Cervix in South-Kivu/Dr Congo

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Open Journal of Obstetrics and Gynecology 2021年第2期11卷 162-182页

作者： nyakio olivier Kibukila Fabrice Tambwe Albert Kakudji Prosper Kalenga Prosper Kakoma Jean Baptiste Department of Gynecology and Obstetrics Faculty of Medecine Evangelical University in Africa (EUA) Bukavu Democratic Republic of the Congo Denis MUKWEGE Excellence Center Bukavu Democratic Republic of the Congo Department of Gynecology-Obstetrics Faculty of Medicine University of Lubumbashi Bukavu Democratic Republic of the Congo Department of Surgery Faculty of Medecine Official University of Bukavu (UOB) Bukavu Democratic Republic of the Congo Department of Surgery Faculty of Medecine University of Burundi Bujumbura Burundi

Background: Cervical cancer is one of the most common cancers in women in the world. The recrudescence of dysplastic lesions is increasing, especially in developing countries, because of the absence of screening. The objective of this work is to determine the prevalence of dysplastic lesions of the cervix in women who are sexually active in South Kivu province. Methods: It was a cross-sectional, descriptive and analytical study of 625 women who came for gynecological consultation, all of whom had cervical-uterine Pap smears, during the period from January 1st, 2017 to December 31st, 2018 at Panzi General Referral Hospital (South Kivu, DR Congo). Data analysis was done using Epi Info software version 7. Results: The median age of the respondents was 34 years, 47.0% of them were married, and 59.0% had a low socio-economic level. The majority had first sexual intercourse between the ages of 15 and 20 (67.5%), a number of former sexual partners estimated at 1 - 5 (87.8%), did not use tobacco (97.4%) and did not use contraception (78.1%). Pap smear was normal in 82.88% of cases, inflammatory in 2.4% of cases and with cytologic abnormalities in 14.72% of cases. Rates of dysplastic lesions were significantly higher among women aged ≥35 years (p = 0.0245), brides (p = 0.0183) and nulliparas (p = 0.0042). Multivariate analysis revealed the adjusted OR (95% CI) statistically insignificant (p Conclusion: Cervical cancer remains a real scourge in the world, especially in sub-Saharan Africa, where the diagnosis is often made when the pathology is at its stage alm

关键词： Dysplasic Lesions Cervix South Kivu DRC

Socio-Demographic Factors, Clinical Characteristics and Maternal Prognosis of Hypertensive Disorders in Pregnancy at Panzi General Referral Hospital

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Open Journal of Obstetrics and Gynecology 2023年第5期13卷 860-873页

作者： Mushera Aganze Alain Musese Nguru Marie Constance Julien Bwama Botalatala Mbozi Andrea Andre Nakalonge Raha Maroyi Kenny olivier nyakio Department of Obstetrics and Gynaecology Panzi General Referral Hospital Bukavu Democratic Republic of the Congo School of Medicine and Public Health Evangelical University in Africa Bukavu Democratic Republic of the Congo The University Peace Centre Bukavu Democratic Republic of the Congo

Background: Hypertensive disease in pregnancy is an important cause of morbidity, long-term disability, and maternal and neonatal mortality. The aim is to determine the socio-demographic characteristics and maternal prognosis of these women with Hypertension during pregnancy. Material and Method: We conducted a cross-sectional study, we interview patients and after discussion we transcripts in a database in Excel software before analysis with SPSS version 20.0 and Stata 14.0 The qualitative variables have been summarised by the Percentage and the quantitative variables will be summarised by Means and Standard Deviation. The associations of the variables were calculated by Pearson’s chi-square test with a significance level set at a p-value Result: The average age of the patients was 30.33 ± 7.020 years, 92.1% were married, 79.8% lived in urban areas, most of the patients were overweight (43%), 92.1% of them had monofetal pregnancies, 36% were multiparous, 34.2% had a previous history of preeclampsia in pregnancy and 14% were known to have hypertension. Pre-eclampsia was the most frequent form of hypertension in pregnancy with 73.68% of cases and represents 84.8% of severe forms of hypertension in pregnancy, 53.4% of the patients delivered vaginally. Eclampsia was the most frequent complication in our patients with 31.7% frequency and among the socio-demographic parameters, age and body mass index were significantly associated with maternal complications. Conclusion: Maternal age and body mass index are important socio-demographic factors associated with the occurrence of maternal complications in women with hypertensive disorders in pregnancy.

关键词： Hypertensive Disorders Maternal Prognosis Socio-Demographic Factors Panzi General Referral Hospital

The Place of Human Papillomavirus Test in the Screening of Intraepithelial Lesions of Cervix in South-Kivu Province, DR Congo

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Open Journal of Obstetrics and Gynecology 2021年第9期11卷 1125-1132页

作者： olivier nyakio Fabrice Kibukila Bertin Kasongo Tchass Chasinga Gad Murenzi Albert Tambwe Prosper Kakudji Prosper Kalenga Jean Baptiste Kakoma Department of Gynecology and Obstetrics Evangelical University in Africa (UEA) Bukavu DR Congo Department of Gynecology Panzi General Reference Hospital Bukavu DR Congo Department of Gynecology-Obstetrics Faculty of Medicine University of Lubumbashi Lubumbashi DR Congo Department of Surgery Official University of Bukavu (UOB) Bukavu DR Congo Department of Surgery University of Burundi Bujumbura Burundi Provincial Health Division Bukavu DR Congo Department of Anatomopathology Panzi General Reference Hospital Bukavu DR Congo Rwanda Military Hospital Kigali Rwanda

Introduction: Human papillomavirus (HPV) infection remains the most common cause of cervical intraepithelial neoplasia. The objective of this study is to evaluate the sensitivity and predictive value of the HPV test associated with the cervico-uterine smear in the screening of cervical intraepithelial neoplasia in our environment. Methodology: This is a descriptive cross-sectional study of 625 women who consulted in the department of gynecology for cervical cancer screening, of whom 300 received an HPV test;during the period from January the 1st to December 31st, 2018 at Panzi general reference hospital (South-Kivu, DRC). Data analysis was done using Epi Info version 7 software. Results: For all respondents (n = 625), the cervico-uterine smear was normal in 82.88%, inflammatory in 2.4% of cases and with cellular atypia in 14.72%. The HPV test was positive in 87 respondents against 213 negatives cases, i.e. a prevalence of HPV of 29% [95% CI: 23.9% - 34.5%]. Among women with precancerous lesions, 27.6% had HPV infection;among those with normal smears, 29.3% of them had HPV infection;however, this difference was not statistically significant. Patients with dysplastic lesions, 31.3% had genotypes with very high carcinogenic potential;and for those with a normal Pap smear, 45.1% had genotypes with very high carcinogenic potential;however, this difference was also not statistically significant. Conclusion: The human papillomavirus test remains a very important indication cation in the detection of cervical intraepithelial neoplasia, its sensitivity remaining clearly superior to that of cytology, especially for high grade lesions.

关键词： Human Papillomavirus Screening Cervix South-Kivu

Associated Factors with Vaginal Delivery on a Uni- or Bi-Scar Uterus in a Low-Resource Setting

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Open Journal of Obstetrics and Gynecology 2023年第3期13卷 499-515页

作者： Kongwa Madoli Eloge Ilunga-Mbaya Raha Maroyi Neema Nadine Omari Mukanga Denis Mukwege nyakio olivier Dieudonné Sengeyi Mushengezi Amani Department of Gynecology and Obstetrics Panzi General Referral Hospital School of Medicine of Evangelical University of Africa Bukavu Democratic Republic of the Congo Department of Obstetrics and Gynaecology Kinshasa University Clinic University of Kinshasa Kinshasa Democratic Republic of the Congo SVS Statistics Department Panzi General Referral Hospital Bukavu Democratic Republic of the Congo

Introduction: Delivery in a scar uterus is one of the most debated topics in obstetrics. The objective was to determine the uterine test and the maternal-fetal outcome in patients with uni- and bi-scared uterus who received the uterine test at Panzi General Referral Hospital. Methodology: This is a cross-sectional study with a prospective collection of patients who delivered on a uni- or bi-scareduterus at Panzi Hospital, between January 1, 2021 and August 1, 2022. Results: The average age of the patients was 27.09 years, with an age range of 25 - 34 years, they were mostly married (88.3%), with secondary educational level (60.4%). Pauciparous women, with a history of previous caesarean delivery once, represented respectively 52.2%;7.2% of parturients with an intergenital space equal to 18 months. 63.9% were overweight, 58.6% had undergone more than three ANC sessions. We noted statistically significant associations between modes of admission, water sac, type of membranes rupture, uterine height and success of uterine test (p 0.05). We did not find significant associations between parturient age, gestational age, intergestational interval, pregnancy term, surgical history, number of ANC performed, number of previous caesarean sections, number of newborns. We did not record any cases of maternal death but one case of perinatal death with 0.9% in this study. Conclusion: A good selection of patients with uni- or bi-scared uterus would allow the reduction of the fetomaternal morbidity during the uterine test.

关键词： Uterine Test Prognosis Uni- and Bi-Scared Uterus Panzi Hospital

Profile of Pregnant Women and Success of the Uterine Test on a Uni or Bi-Scar Uterus at the Maternity Ward of Panzi Hospital, in the Democratic Republic of the Congo

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Open Journal of Obstetrics and Gynecology 2023年第7期13卷 1151-1162页

作者： Prosperine Kongwa Madoli olivier nyakio Raha Maroyi Éloge Ilunga-Mbaya Gloire Mwenze Julien Bwama Botalatala Omari Mukanga Dieudonné Sengeyi Mushengezi Amani Department of Gynecology and Obstetrics Panzi General Referral Hospital Evangelical University in Africa Bukavu Democratic Republic of the Congo Department of Gynecology and Obstetrics University Hospital of Kinshasa University of Kinshasa Kinshasa Democratic Republic of the Congo SVS Statistics Department Panzi General Referral Hospital Bukavu Democratic Republic of the Congo

Introduction: Trial of labor after a previous cesarean section (TOLAC) is a method that requires strict monitoring to decrease the cesarean section (CS) rate and improve the maternal and neonatal prognosis. The objective is to determine the profile and outcome of patients with one and two previous CSs who performed TOLAC at Panzi General Referral Hospital. Methodology: This is a cross-sectional study with a prospective collection of data of 111 patients with one and two previous CSs at Panzi Hospital from January 2021 to August 2022. Statistical Package for the Social Sciences SPSS version 23 software was used to analyze the collected data. The percentages of categorical variables were summarized in a frequency table. The mean or median with standard deviation was used to summarize quantitative variables. Results: The overall success rate of the TOLAC was 64%, with 63.8% following one previous CS and 64.3% following two CSs. The mean age of the patients was 27.09 years, with an age range of 25 - 34 years. They were mostly pauciparous (52.2%), married (88.3%), with a high school education (60.4%). The inter-delivery interval > 18 months was noted (64.1%) and overweight in 63.9%. More than three antenatal consultations were performed (58.6%). We found a mean gestational age of 38 (34 - 41) weeks. The perinatal mortality rate was 0.9%. However, we did not record any cases of maternal mortality during the study period. Conclusion: TOLAC after one and two previous CS is implemented in the maternity Unit of Panzi Hospital for well-selected patients. In addition, the success rate is similar after TOLAC with an acceptable maternal-neonatal prognosis.

关键词： One Previous Caesarean Panzi General Referral Hospital Trial of Labor after Cesarean Section Two Previous Caesarean Vaginal Birth after Cesarean Sec-tion

Frequency of Cervix Dysplasia in Women with Prolapsed Uterus: Cross-Sectional Descriptive Study at Panzi General Referral Hospital

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Open Journal of Obstetrics and Gynecology 2023年第7期13卷 1142-1150页

作者： Nadine Neema Rukunghu olivier nyakio Eloge Ilunga-Mbaya Chasinga Baharanyi Tchass Kongwa Madoli Dieudonné Kakusu Julien Bwama Botalatala Eric Munguakonkwa Ntagereka Denis Mukwege Faculty of Medicine Evangelical University in Africa Bukavu Democratic Republic of the Congo Panzi General Referral Hospital Bukavu Democratic Republic of the Congo Department of Gynaecology and Obstetrics Faculty of Medicine University of Kinshasa Kinshasa Democratic Republic of the Congo

Introduction: According to the WHO (January 7, 2022), cervical cancer is the second leading cause of cancer death worldwide among women of childbearing age. However, cervical cancer is highly preventable and treatable due to its well-known disease history which goes through several detectable pre-cancerous phases with available treatments. There are very few data on the prevalence of dysplastic lesions of the cervix in the Democratic Republic of the Congo. Panzi General Referral Hospital is a care center for women with genital prolapse, and our study aimed to determine the prevalence of dysplastic lesions of the cervix in this particular population. Methodology: This is a cross-sectional study of all women aged ≥ 18 years who consulted at the HGR Panzi from September 01 to December 31, 2022, diagnosed with uterine prolapse and who consented to the study. Results: The mean (±SD) age of the patients was 47.44 (±14.42) years and the majority (67.7%) of them were aged 40 and over. For all of the respondents, the Pap smear was normal in 62.6% and inflammatory in 2% of cases, while cytological abnormalities, which were found in 35.4% of cases, including 12.1% of lesions high-grade dysplastic (HSIL), i.e. 12 out of a total of 99 women examined. Conclusion: Women with uterine prolapse are twice as likely to develop dysplastic lesions as the general female population. A screening and management program for these lesions is essential in our preoperative protocol at the HGR Panzi and at the national level in general.

关键词： Cervical Dysplasia Uterine Prolapse Panzi General Hospital DRC