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Per-Partum Anaemia and Missed Post-Partum Haemorrhage in Low Resources Settings

Open Journal of Obstetrics and Gynecology 2018年第14期8卷 1557-1568页

作者： Valere Salomon Mve Koh Claude C. Noa Ndoa Julius Dohbit Sama Raoul Tefee II philipe nana njotang University of Yaoundé I Yaoundé Cameroon University Teaching Hospital of Yaoundé Yaoundé Cameroon Centre Hospitalier de Recherche et d’Application en Chirurgie Endoscopique et Reproduction Humaine (CHRACERH) Yaoundé Cameroon Gynaeco-Obstetric and Paediatric Hospital of Yaoundé Yaoundé Cameroon Central Hospital of Yaoundé Yaoundé Cameroon

Background: Post-partum haemorrhage is the leading cause of maternal death throughout the world, and anaemia is one of its indirect causes. Anaemia during labour increases the risk of PPH and may lead to maternal mortality even after moderate PPH. Undiagnosed PPH and post-partum anaemia increases the risk of late maternal death in the community. The aim of this study was to assess the prevalence of anaemia on admission for labour, the occult early post-partum haemorrhage and the magnitude of post-partum anaemia in a low resource setting. Methods: This was a longitudinal study. We included pregnant women in labour. Haemoglobin concentration was measured on admission (H0), then 24 hours (H24) and 48 (H48) hours later. The post-partum blood loss was estimated by delta haemoglobin, using the criteria of M. Driessen et al. Results: We recruited 245 pregnant women. The mean age was 27.0 ± 6.0 years. The mean hemoglobin concentration was 11.7 ± 1.9 g/dl, the frequency of anaemia was 30.6% and was related to ethnicity (P = 0.042) gestational age (p < 0.001) marital status (p = 0.014) and the inter pregnancy time space (p = 0.001). Twenty-two-point two percent had post-partum haemorrhage among which 40% were undiagnosed. The mean blood loss was 375 ml and post-partum anaemia rate was 44.5%. Conclusion: Anaemia on admission was related to socio-demographic characteristics. The frequencies of anaemia during labour, missed PPH and undiagnosed post-partum anaemia were high. Haemoglobin concentration on admission for labour and after delivery, reliable method to assess PPH should be mandatory, to better identify per and post-partum anemia, and the management of PPH, in low income environments.

关键词： Haemoglobinometer Per-Partum Anaemia

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Outcome of delivery in nulliparous teenagers aged less than 17 years: the cameroon university centre hospital experience

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Open Journal of Obstetrics and Gynecology 2011年第2期1卷 47-52页

作者： Pierre Marie Tebeu Inoussa Nsangou Philippe nana njotang Paul Théodore Tjek Biyaga Anderson Sama Doh Joseph Nelson Fomulu 不详

In a previous study at the Yaoundé-Cameroon University Centre Hospital, we found that delivery at extreme ages of reproductive health was associated with several fetal and maternal risks. We conducted this study aimed at testing the hypothesis that deliveries by teenagers were associated with increased risk. Data collection was retrospective from delivery room registers at between 01/01/1996 and 31/12/2000. Data were collected in singleton pregnancies. The identification of each nulliparous woman aged less than 17 years was followed by that of 4 nulliparous women aged 20 - 29 years following her in the order of delivery. Since it was possible to have consecutive nulliparous teenage pregnancies before four deliveries in women in their twenties, we finally compared 65 cases of teenagers delivery with 218 cases of delivery in women aged 20 - 29 years. The difference was considered significant if p value was less than 0.05. Odd ratio with 95% confidence interval was used to measure the effect of age on the major outcomes. At univariate analysis, the risk of delivery by caesarean section for teenagers (21.5%) was significantly high compared to women in their twenties (11.5%), (OR: 2.1;95%CI: 1.0 - 4.1;p = 0.041). Similar observation was found for stillbirth delivery with 12.3% by teenagers compared to 5.0% by women in their twenties (OR: 2.7;95%CI: 1.0 - 7.1;p = 0.044). The risk of premature delivery by teenagers (30.8%) was also significantly increased compared to women in their twenties (12.4%) (OR: 3.6;95%CI: 1.8 - 7.1;p = 0.0002). After adjustment for different factors associated with the occurrence of several risks, only pre term delivery remained significantly increased at teenage (OR: 3.7;95%CI: 1.8 - 7.6;p = 0.003). These findings underscore the importance of public health programs in preventing the pregnancy in teenagers, and in developing age-appropriate intervention.

关键词： Adolescent Delivery Risk

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Epidemiologic Profile of Maternal Deaths in Two Referral Hospitals in Cameroon

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Open Journal of Obstetrics and Gynecology 2016年第6期6卷 365-372页

作者： Philip njotang nana Felix Essiben Julius Dohbit Sama Elisabeth Medoua Koh Koh Morfaw Lifanji Filbert Eko Eko Jeanne Fouedjio Agnes Esiene Robinson Enow Mbu Department of Obstetrics and Gynecology Faculty of Medicine and Biomedical Sciences (FMBS) The University of Yaoundé I Yaoundé Cameroon Department of Obstetrics and Gynecology Yaoundé Central Hospital Yaoundé Cameroon Department of Obstetrics and Gynecology Yaoundé Gyneco-Obstetric and Pediatric Hospital Yaoundé Cameroon Faculty of Medicine and Biomedical Sciences (FMBS) The University of Yaoundé I Yaoundé Cameroon Department of Obstetrics and Gynecology Bamenda Regional Hospital Bamenda Cameroon Department of Anesthesia and Reanimation Faculty of Medicine and Biomedical Sciences (FMBS) The University of Yaoundé I Yaoundé Cameroon

Introduction: Our objective was to compare the epidemiologic profile of maternal mortality in two structures serving as referral levels of care in Cameroon. Methodology: This cross-sectional, comparative study took place at the maternities of the Yaoundé Central Hospital (YCH) and the Bamenda Regional Hospital (BRH) from December 1st 2014 to May 31st 2015, a 6 months’ period. The medical records of deceased women over 5 years, from January 2010 to December 2014, were collected. We calculated the MMR (Maternal mortality rate) and studied the causes and risk factors associated with maternal death. The Epi info software 3.5.4 was used to analyze data with a significance level of P < 0.05. Results: The maternal mortality ratio (MMR) was 964 and 247 per 100,000 live births for YCH and BRH, respectively. More deaths occurred within the aged group range 20 to 34 years, 76.8% at YCH and 64.7% at BRH. At YCH, 70.7% of these patients were referrals versus 32.4% at BRH. Complication from abortion was often implicated at BRH (P = 0.007;OR = 0.31;CI = 0.13 - 0.74). Others causes were hemorrhage (YCH = 43.4%;BRH = 35.5%), hypertensive diseases (YCH = 17.2%;BRH = 14.7%) and infections (YCH = 8.1%;BRH = 17.6%). At YCH time elapsed from admission to death was <3 h (P = 0.005;OR = 6.63;CI = 1.49 - 29.5). Conclusion: Both hospitals have similar causes of maternal deaths, differing only in the context within which the deaths occurred. Improving access to good quality health care, satisfying unmet needs for family planning, availability of blood products and the establishment of health insurance could decrease the maternal mortality rate.

关键词： Maternal Mortality Causes Maternal Death Referral Hospital Cameroon

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Obstetric Complications Due to Female Genital Mutilation (FGM) at N’Djamena Mother and Child Hospital (Chad)

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Open Journal of Obstetrics and Gynecology 2015年第14期5卷 784-788页

作者： Lhagadang Foumsou Richard Norbert Nglalé Jeanne Fouedjio Gédéon Ndakmissou Bray Madoué Gabkika Sadjoli Damthéou Philip njotang nana Abdoulaye Sépou Department of Gynecolgy and Obstetric Faculty of Human Health Sciences University of N’Djamena N’Djamena Chad Department of Gynecolgy and Obstetric Faculty of Health Sciences University of Bangui Bangui Central African Republic Department of Gynecolgy and Obsteric Faculty of Biomedical Sciences and Medicine University of Yaounde I Yaounde Cameroon

Background: Female genital mutilation (FGM) or female circumcision is all procedures involving partial or total removal of the external female genital organ or other injuries to the female genital organ whether for cultural or any other non-therapeutic reasons. Female genital mutilation causes numerous complications. Four in such cases multiplies obstetric complications. The aim of this study was to identify obstetric complications due to FGM. Patients and Material: We conducted a comparative prospective case-control study for three months, from January 1st to March 31st, 2014 in the maternity of N’Djamena Mother and Child. It focused on identifying neonatal and/or maternal complications during childbirth due to FGM. The study population consisted of pregnant women at term admitted for delivery labor. All parturients had to present the same sociodemographic and clinical profiles. A history of FGM was the main distinguishing criterion. Results: During the study period, we recorded 312 births to women with genital mutilation, among 1905 deliveries, representing a prevalence of 16.4%. One hundred ninety-one cases of circumcised women responding to the inclusion criteria were selected. Most of these women were between the ages of 20 and 29. The extreme age group was 15 and 39 (with a mean of 24.5 years). FGM was significant in age group over 20 years (Khi2 = 10.8;OR = 2.6 [1.4 - 4.9];P = 0.001). The type II of FGM which removed a part of the clitoris and the adjacent labia minora represented 64.40% patients in the group of women with FGM. Perinea laceration was the frequent maternal complication among parturient with FGM (Khi2 = 9.8;OR = 2.2 [1.4 to 3.6];P = 0.0007). FGM type III was associated with a high proportion of maternal complication (Khi2 = 11.2;OR = 7.3 [1.97 - 31.6];P = 0.0001). Still births were significantly higher in the group of parturient with FGM (11.5%, P = 0.015). Conclusion: Female genital mutilation is a common cultural practice in our country;it co

关键词： Female Genital Mutilation Childbirth Maternal-Fetal Complication N’Djamena (Chad)

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Maternal and Fetal Outcomes Following Labour at Term in Singleton Pregnancies with Meconium-Stained Amniotic Fluid: A Prospective Cohort Study

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Open Journal of Obstetrics and Gynecology 2018年第9期8卷 790-802页

作者： Julius Sama Dohbit Evelyne M. Mah Felix Essiben Edmond Mesumbe Nzene Esther U. N. Meka Pascal Foumane Joel Noutakdie Tochie Benjamin Momo Kadia Felix A. Elong Philip njotang nana Department of Obstetrics and Gynecology Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroon Gynaeco-Obstetric and Pediatric Hospital Yaounde Cameroon Central Hospital of Yaounde Yaounde Cameroon Department of Surgery and Anesthesiology Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroon Foumbot District Hospital Foumbot Cameroon Faculty of Health Sciences University of Buea Buea Cameroon

Background: Meconium stained amniotic fluid (MSAF) is frequently encountered in obstetric practice. Literature on the subject is still poorly documented in the African setting. Objective: The aim of this study was to determine the maternal and fetal outcomes in case of meconium stained amniotic fluid observed during term labour. Materials and Methods: We conducted a prospective cohort study enrolling all consenting pregnant women with term singleton fetus in cephalic presentation admitted for labour with ruptured fetal membranes in the maternity units of the Yaoundé Central Hospital (YCH) and the Yaoundé Gynaeco-Obstetric and Pediatric Hospital (YGOPH) of Cameroon between December 2014 and April 2015. The exposed grouped was considered as participants having MSAF, while the non-exposed group comprised those with clear amniotic fluid (CAF). The two groups were monitored during labor using the WHO partograph, and then followed up till 72 hours after delivery. Variables studied included the colour and texture of amniotic fluid as well as maternal and fetal complications. Data was analyzed using Epi-info version 3.5.4. The chi-square and Fischer’s exact tests were appropriately used to compare the two groups. A p-value less than 5% was considered statistically significant. Results: 2376 vaginal deliveries were recorded during the study period among which MSAF was observed in 265 cases, hence a prevalence rate of MSAF of 11.15%. Among these cases of MSAF, 52.1% was thick meconium and 47.9% was light meconium. Maternal morbidity was high in the group with MSAF;these included: Higher proportions of caesarean delivery (RR = 2.35 p -4) and prolonged labor (RR = 3 p -4). In this same group, the incidences of chorioamnionitis and puerperal sepsis were low (0.94% and 0.70% respectively), although there was a three-fold higher risk that was not statistically significant (RR = 3, P = 0.31). Fetal and neonatal outcomes were poorer in the MSAF group compared to the CAF group. The c

关键词： Meconium Stained Amniotic Fluid Labour Maternal and Neonatal Outcomes

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