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Reproductive health needs of physical handicapped females in Kinshasa, DR Congo

Open Journal of Obstetrics and Gynecology 2013年第1期3卷 180-183页

作者： Tandu-Umba Barthélémy Sukama tandu Yves Department of Obstetrics and Gynecology University Clinics Kinshasa DR Congo

Objective: Our study is intended to evaluate mobility impairment’s level in adult females, their sociodemographic status, knowledge, and practices related to reproductive health in order to provide healthcare givers and policy makers with tools to meet appropriate needs of these vulnerable persons in Kinshasa, DR Congo. Study design: A cross-sectional descriptive study from March 20th 2012 throughout July 20th 2012 concerned 138 physical (non mental) disabled attendees of 7 centers for disabled adults in Kinshasa, DR Congo. Concerns about extend of the disability focused on parts of the body concerned, functional capacity (self walking, crutches, prosthesis, wheel-chairs) and manual freedom. Participants were interviewed using open-ended questions about sociodemographic status, knowledge, and practices related to reproductive health. Issues concerned included age at menarche, age at first sex experience, marital status, education level, employment status, obstetric history, sex abuse, birth control and sexual transmitted diseases. For statistic analysis OR (CI at 95%) was calculated to seek for possible association between physical impairment and parturition’s characteristics. Results: The mean age of the study group (31.1 ± 5.7 years) ranged from 15 to 40 years. Most were affected by legs and the majority (69.1%) needed crutches or wheelchair for moving. Only 21 (15.2%) were married, most (15) of them with a disabled colleague. Mean parity and gravidity were 2.78 ± 2.3 (range 0 - 11) and 3.4 ± 2.5 (range 0 - 12), respectively. Sex experience was initiated at 17.5 ± 3.7 years (range of 12 - 35), 13 (9.4%) had experienced rape, and 37 (26.8%) had (illegally) aborted. Of the 117 women who had had a child 82 (70.7%) had vaginal delivery. In 24 of 34 cesarean sections fetopelvic disproportion or protracted pelvis was the main indication (68.6%), the risk for cesarean section being somewhat related to involvement of 2 legs. Data concerning the issue of knowledge and practices related to reproductive health were very l

关键词： Sex and Reproduction Disabled Women in Kinshasa Psycho-Social limitations

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Neonatal Infection among Women with Prior Premature labor

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Open Journal of Obstetrics and Gynecology 2015年第15期5卷 833-838页

作者： Tandu-Umba Barthélémy Kalonji Tshianyi David Department of Obstetrics and Gynecology University Clinics Kinshasa DR Congo

Objectives: Since studies demonstrate that neonates born to mothers having been cared for premature labor will suffer from congenital neonatal sepsis, we aimed to evaluate the prevalence and main risk factors of neonatal infection among mothers having experienced a prior premature labor. Methods: This was a cross sectional study carried out from January 1st throughout 31st December, 2013 at the university clinics of Kinshasa. It concerned all delivered women at term having been cared for premature labor prior to giving birth a live newborn. Maternal variables of interest were: parity, gestation, age, intrapartum fever, malaria, urogenital infection during the last 2 weeks before delivery (UGI), premature rupture of membranes (PROM), cervical cerclage, meconium-stained amniotic fluid (MSAF) and the way of delivery. For neonates attention was paid on gestational age, birth weight, admission at neonatal intensive care unit (ANICU) and infection as stated within three days after birth. T-test and Chi-square were used where appropriate. logistic analysis was used to determine the risk for maternal variables to induce neonatal infection (OR and CI), the significance stated at p lts: Fifty two mother-infant couples were recruited. Of these 19 neonates were infected (prevalence of 36.5%). Mean age, gestational age and birth weight were 30.19 ± 5.32 years, 37.2 ± 2 weeks and 2638 ± 588 g, respectively. Infected neonates had their gestational age and birth weight significantly lower whilst proportion of ANICU higher than that on non infected. Prematurity, PROM, UGI, prior cerclage and MSAF were significantly more frequent in couples with neonatal infection. Prematurity, birth weight lusion: The prevalence of neonatal infection was very high. Prematurity, birth weight l UGI were found to enhance the risk by 3 to 4 times.

关键词： Prior Premature labor Maternal Urogenital Infection Neonatal Infection Risk Factors

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Effect of maternal alcohol consumption on gestational diabetes detection and mother-infant’s outcomes in Kinshasa, DR Congo

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Open Journal of Obstetrics and Gynecology 2011年第4期1卷 208-212页

作者： Tandu-Umba Barthélémy Mbangama Muela Andy Mbungu Mwimba Roger Department of OB-GYN University Clinics

Objectives: Since it has been suggested that moderate alcohol drinking would increase insulin sensitivity, which could benefit Gestational Diabetes Mellitus (GDM), the study aimed at evaluating alcohol consumption during pregnancy, and seeing whether this consumption influences GDM detection and maternal/perinatal outcomes. Study design: Women with already known diabetes and those with multiple pregnancy were excluded. All other pregnant women attending antenatal care unit of the university clinics, Kinshasa, DR Congo during the period from 1 March throughout 31 October 2010, were invited at 24-week gestation to enroll in O’Sullivan blood glucose testing and if eligible in 100-gram oral glucose tolerance test. Alcohol consumption, risk factors for GDM, and general characteristics such as age, parity, gestity, BMI, fat mass were registered. Diagnosed GDM was first treated with diet and exercise, thereafter with Metformin, and if necessary with insulin. For other (normal) women data remained blinded until confinement. Maternal and infant’s adverse outcomes such as maternal urinary infection, preeclampsia, cesarean section, intrauterine growth retardation, birth weight percentile 90 in our milieu), Apgar score at the first minute lder dystocia or other birth injury, neonatal hypoglycemia and fetal alcohol syndrome (FAS) were compared and analyzed according to GDM diagnosis as well to alcohol status. Results: Up to 240 pregnant women accepted to enroll into the study. Alcohol consumption concerned 78 (32.5%) of the women, most of them (61 = 25.42%) being heavy consumers. Risk factors for GDM and Physical and blood glucose characteristics were alike (p not significant) in both consumers and non consumers, except for history of HTA in the family that was significantly more frequent (p = 0.02) among drinkers. GDM’s prevalence was 9%. No adverse outcome was more prominent in any subgroup, except Apgar score < 7 at the first minute that was more frequent (p = 0.038) among neonates of GDM mothers. No FAS, neither

关键词： Pregnancy Alcohol Consumption GDM Mother-Infant’s Outcomes

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Maternal and perinatal outcomes of induction of labor at term in the university clinics of Kinshasa, DR Congo

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Open Journal of Obstetrics and Gynecology 2013年第1期3卷 154-157页

作者： barthélémy tandu-umba Robert laala Tshibangu Andy Mbangama Muela Department of Obstetrics and Gynecology University Clinics Kinshasa DR Congo

Objective: This paper aims at assessing outcomes following induction of labor and characteristics likely to predict vaginal delivery. Study design: This is a descriptive retrospective cohort study including all women with singleton pregnancies who delivered at term in the university clinics of Kinshasa, DR Congo, from January 01, 2006 until December 31, 2010. Induction was initiated regardless of cervical status. Methods of induction included: oxytocin perfusion, vaginal Misoprostol, intracervical insertion of the Foley catheter and amniotomy. Results of induction were compared in terms of failure of labor, cesarean section, fetal distress, and neonatal distress. logistic regression was used to seek for independent contributing factors for adverse outcomes. Results: During the period of the study 115 patients at term (3.2%) were concerned with induction of labor. Means for maternal age, gestational age and weight at confinement were 30.5 ± 5.7 years, 37.95 ± 1.54 weeks and 69.3 ± 15.1 kg, respectively. The mean parity and gravidity were 2.4 ± 1.9 and 2.9 ± 1.9, respectively. The mean Bishop score was 6.2 ± 1.5 at the first induction, with 66 women (57.3%) having less than 7. Indications for induction were: preeclampsia (52 = 54.1%), premature rupture of membranes (34 = 29.5%), post term (17 = 14.6%), gestational diabetes (5 = 4.3%), stillbirth (5 = 4.3%), polyhydramnios (3 = 2.6%) and cardiopathy (1 = 0.8%). Methods of induction at the first attempt included: oxytocin (86 = 74.7%), vaginal misoprostol (20 = 17.3%), transcervical Foley catheter balloon (14 = 12.1%), and amniotomy (1 = 0.8%). Failure to induce uterine contraction at the first attempt was noted in 9/115 (7.8%) women. Vaginal delivery occurred in 78 (66.9%) women, and cesarean section in 34 (29.6%). The majority of cesarean sections were performed at the primary induction, most of them (29/34 = 85.3%) in women with bad Bishop score. Failure of induction was more likely to occur in association with high maternal weight (OR 6.8;CI 1.2 - 39.7), and some

关键词： Induction of labor Failure of Induction Maternal and Perinatal Outcomes Kinshasa

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Baseline Iron Status and Indices of Oxidative Stress in a Cohort of Pregnant Women in Kinshasa, DR Congo

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Open Journal of Obstetrics and Gynecology 2018年第14期8卷 1476-1486页

作者： Andy Muela Mbangama Tandu-Umba Barthélémy Mbungu Mwimba Roger Department of Obstetrics and Gynecology University Clinics of Kinshasa Kinshasa DR Congo

Objective: To determine baseline iron and oxidative status in a cohort of pregnant women before iron supplementation in our setting. Background: Screening of iron deficiency before supplementation during pregnancy has been scarce. Therefore, following routine iron supplementation confounding results might be found in outcomes of groups of patients considered. Taking in account that body/serum iron status is reportedly linked to maternal oxidative status, we aimed to associate assessment of baseline iron and oxidative status of women in need of oral supplementation during pregnancy. Methods: This is a cross-sectional study concerning 74 women attending antenatal care at the University Clinics of Kinshasa from September 2017 throughout June 2018, with a singleton pregnancy not exceeding 19 weeks, regardless of age and parity. Variables of the study included sociodemographic and anthropometric ones along with parameters of iron status (hemoglobin, hematocrit, ferritin, serum iron, transferrin and iron saturation capacity). Oxidative status was assessed using superoxide dismutase (SOD) and uric acid as antioxidants, while oxidant agents were oxidized lDl and blood glucose (beside serum iron and ferritin). According to local standards anemia was defined as hemoglobin 10 g/l and pathologic serum ferritin as 15 ng/ml. For statistical calculations we used t-test, chi-square test and Pearson’s correlation test, the significance being stated at p ≤ 0.05. Results: At recruitment (15.9 ± 1.7 9 week gestational age) mean hemoglobin value of the overall study group was 10.3 ± 1.5 g/dl. Anemia was diagnosed to 39 women that represented 52.2% of the study group, most of anemic women belonging to low socioeconomic sub-group (69.2% vs 29%;P l parasitosis was significantly higher among anemic women (61.5% vs 34.3%;P < 0.02

关键词： Iron Status Oxidative Stress Pregnant Women Kinshasa

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Iron and Oxidative Status Following Routine Iron Supplementation: Reflection on Pregnancy Outcomes in a Cohort of Women in Kinshasa, DR Congo

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Open Journal of Obstetrics and Gynecology 2019年第5期9卷 582-596页

作者： Andy Mbangama Muela barthélémy tandu-umba Roger Mbungu Mwimba Department of Obstetrics and Gynecology University Clinics of Kinshasa Kinshasa Congo

Background: Anemia during pregnancy is associated with oxidative stress, which might expectedly provoke harmful consequences on maternal and perinatal outcomes. Use of iron in women during pregnancy improves maternal hematologic parameters, while likely to worsen oxidative status. Objectives: Our study thus aimed to assess adverse outcomes on all women having been routinely iron supplemented during pregnancy. Methods: This is a prospective observational cohort of 74 pregnant women with singleton pregnancy whose baseline iron and oxidative status along with variations throughout pregnancy have been recently assessed at university clinics of Kinshasa, DR Congo. Obstetrical adverse outcomes were assessed according to the diagnosis of anemia and oxidative stress considered at recruitment, at 28 - 32 weeks of gestation and at term. For statistical calculations, we used t-test, chi-square test, ANOVAR and regression, the significance being stated at p lts: Complications significantly associated with anemia at the beginning of pregnancy were acute fetal distress (OR = 3.9, p low birth weight or lBW (OR = 3.4, p l hypoglycemia (OR = 3, p l diabetes mellitus or GDM (OR = 3.8, p l hypoglycemia (OR = 4.7, p ly associated with GDM (OR = 9.2, p l hypoglycemia (OR = 3, p ?As of oxidative stress diagnosed at recruitment, significant associations were found with PROM (OR = 9, p < 0.02), cesarean section (OR = 3.7, p < 0.05), prematurity (OR = 6.

关键词： Routine Iron Supplementation Iron and Oxidative Status Pregnancy Outcomes Kinshasa

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Routine Iron Supplementation during Pregnancy: Its Reflection on Iron and Oxidative Status in a Cohort of Pregnant Women in Kinshasa, DR Congo

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Open Journal of Obstetrics and Gynecology 2019年第1期9卷 98-115页

作者： Andy Muela Mbangama barthélémy tandu-umba Roger Mwimba Mbungu Department of Obstetrics and Gynecology University Clinics of Kinshasa Kinshasa DR Congo

Background:?Due to maternal and fetal physiologic demand, the rate along with amplitude of anemia is expected to rise over pregnancy. The iron and oxidative status also are expected to vary accordingly. It is thus assumed that iron supplementation will somewhat modify the profile observed in markers of iron and oxidative status of our series. Objectives: We aimed to measure variations of indices of iron and oxidative status of iron supplemented women over pregnancy. Methods: This is a prospective observational cohort of 74 pregnant women with singleton pregnancy whose baseline iron and oxidative status have been recently assessed at University Clinics of Kinshasa, DR Congo. Women with anemia (Hb le the others received preventive iron supplementation (160 mg/day). Iron was associated with 15 mg folate/day. Nutritional iron intake was measured through a 24-hour recall using a questionnaire of common foods, including stuffs and habits likely to impede iron absorption. Biological parameters of iron and oxidative status included hemoglobin, hematocrit, ferritin, serum iron, transferrin, superoxide dismutase or SOD, uric acid, oxidized lDl and blood glucose. For statistical calculations we used t-test, chi-square test, ANOVAR and regression, the significance being stated at p Results: Trimester wise evolution of hematologic status in anemic women shows a rise in values of hemoglobin (+average 1 gr/dl) and hematocrit (+3%) throughout pregnancy, with significant change only between recruitment and 28 - 32 weeks. In non anemic women a significant decrease was observed, although levels remained normal. For ferritin (7.5 - 53 ng/ml from recruitment to term) and transferrin (107 - 157 g/l), significant rise was found in anemic women from recruitment to 28 - 32 weeks, while in non anemic notable change occurred only for transferrin (133 - 204 g/l). Serum iron significantly increased (53 - 83 μg/dl) from recruitment to 28 - 32 weeks in anemic w

关键词： Iron Supplementation Pregnancy Iron And Oxidative Status Kinshasa

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Rationale of a Cohort Study on Risk of Obstetrical Outcomes Associated with Iron Supplementation during Pregnancy

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Open Journal of Obstetrics and Gynecology 2018年第6期8卷 598-609页

作者： Andy Muela Mbangama barthélémy tandu-umba Roger Mwimba Mbungu Department of Obstetrics and Gynecology University Clinics of Kinshasa Kinshasa DR Congo

Background: Anemia is one of the most widely prevalent disorders, affecting the lives of almost half a billion women of reproductive age, contributing to over 100,000 maternal and almost 600,000 perinatal deaths (mostly through pre-term delivery, low birth weight) each year. Increased risk of infant mortality and reduced cognitive development and reduced energy levels which affect productivity in adults are cited. During pregnancy increased requirements, inadequate intake of iron and other micronutrients and parasitic (malaria, hookworm) as wells as bacterial (mostly urinary tract) infections are the main causes. In order to reduce such maternal and neonatal burden, it has been worldwide admitted to adopt cost-effective preventive interventions during pregnancy, including iron-folic acid supplementation, de-hookworming medication and anti-malarial prevention or treatment. Intestinal absorption of iron is limited by a lot of factors including bioavailability, iron status of the woman, substances accompanying or contained in diet, chelating agents such as diet fibers or calcium salts. Any supplementation put additional constraint in terms of absorption. Unabsorbed iron is known to have pro-oxidant properties likely to induce production of free radicals. These in turn might induce oxidative stress accountable for in generation of many obstetrical outcomes. This potential link between oxidative stress resulting from free radicals hyperproduction induced by non absorbed iron and harmful maternal/perinatal conditions is rarely questioned by searchers. Objectives: To determine overall (food and supplemented) iron consumption, iron and oxidative status in a cohort of pregnant women and to seek associations between findings and adverse obstetrical outcomes. Methods: At the University Clinics of Kinshasa, we designed a protocol for a prospective cohort study dealing with clinical and biochemical parameters of oxidative stress among pregnant women iron supplemented. Women with a single pregnancy not exceeding 19 weeks witho

关键词： Obstetrical Outcomes Iron Supplementation Oxidative Stress

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Trends of Macrosomia at University Clinics of Kinshasa

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Open Journal of Obstetrics and Gynecology 2018年第3期8卷 263-272页

作者： Mbangama-Muela Andy Mulumba Kapuku Sylvain Tozin Rahma Rachid lumaya Ambis Joelle Tandu-Umba Barthélémy Mbungu Mwimba Roger lokomba Bolamba Vicky Mbanzulu Pita Damien Department of Obstetrics and Gynaecology University ClinicsKinshasaDR Congo

Context. The prevalence of macrosomia varies through the world according to racial and ethnic factors, life style and importance of non communicable diseases (maternal obesity, diabetes-gestational and type 2), post-term gestation and multiparity. At the University Clinics of Kinshasa (UCK), 30 years ago, the frequency of macrosomia was 2.4%. Objectives. To update data on the frequency of macrosomia at UCK, regarding variations in maternal anthropometrics (obesity) and socio-demographic factors. Methods. A cross-sectional study was conducted at UCK from 1 January 2007 to 31 December 2016. Mothers who delivered babies weighing at least 4000 g were included in this study. Results. The frequency of macrosomia was 3.7%. Trend shows a variation of this frequency over time with lowest frequency (2.1%) in 2012 and highest (5.3%) in 2009. The mother average age and parity were 32.3 ± 5.4 years and 3 ± 2, respectively. Pregnancies were complicated by polyhydramnios (48%) and gestational diabetes (19.7%). Caesarean section was performed in 60.5% cases, mainly for macrosomia (47.8%) and 81.6% of newborns had constitutional macrosomia. Adverse obstetrical outcomes of macrosomia were dominated by caesarean section (28.9%), lacerations of birth canal (23%) and neonatal distress (9.2%). Conclusion. Macrosomia remains a constant finding at UCK, and is associated with maternal, fetal and neonatal adverse outcomes. Trend shows a variation of the frequency over time between 2.1% and 5.3%.

关键词： Macrosomia Adverse Obstetrical Outcomes University Clinics of Kinshasa

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Maternal Stress and Pregnancy Outcomes

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Open Journal of Obstetrics and Gynecology 2014年第7期4卷 361-370页

作者： barthelemy tandu-umba Donatien K. Dedetemo Gilbert l. Mananga Department of Neurology Neuropathology Center University of Kinshasa Kinshasa Democratic Republic of Congo Department of Obstetrics and Gynecology University Clinics of Kinshasa Kinshasa Democratic Republic of Congo

Aims of the study: To seek for magnitude of stress conditions among pregnant women, the clinical profile of stressed pregnant women and the potential of stress on adverse maternal and perinatal outcomes in Kinshasa. Methods: This is a multicentre 6-month case-control study dealing with consenting women having given birth at 13 biggest maternities of Kinshasa, the capital of DR Congo. Mother-infant pairs were considered cases (obviously stressed women) and controls (light or not stressed women) at the end of data processing according to their perceived stress scores (PSS). Stress events, potential stress factors and maternal general and physical characteristics were registered along with maternal and perinatal outcomes. Odds ratios calculation allowed finding influence of stress on occurrence of adverse outcomes. Results and conclusions: Our study concerned 1082 women whose 57.1% (n = 618) qualified as the stressed. General characteristics found significantly different between stressed and non-stressed women were marital status (the married and widowed more frequent among the stressed), instruction level (the educated more frequent among the stressed), socioeconomic status (the elevated more frequent among the stressed) and religion status (both the traditional and new charismatic more frequent among the stressed). Obstetric risk factors were similar in both groups that were different only according to stress factors, whether emotional (relationships) or pregnancy (preciousness) related. The 3 most prominent stress factors were parent’s death (p 0.000), tension in family (p 0.000) and tension in couple (p 0.003). All expectedly compensating factors appeared significantly more frequent among stressed women. As of organic pregnancy outcomes infection, gastritis, hypertensive disorders and preterm labor were maternal ones significantly more frequent among stressed women. All non-organic outcomes (insomnia and depression) were significantly predominant among stressed women. In offspring, prematurity, low birth weight

关键词： Maternal Stress Maternal Outcomes Perinatal Outcomes Sub-Saharan Africa DR Congo

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