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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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Excessive Weight Gain during Pregnancy and Prognosis of Childbirth in Douala (Cameroun)

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Open Journal of Obstetrics and Gynecology 2019年第2期9卷 242-250页

作者： Henri Essome valere mve koh Michel Ekono Merlin Boten Jean Paul Engbang Matio Bewekedi Pascal Foumane Douala Laquintinie Hospital Douala Cameroon Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon University Hospital Center of Yaoundé Yaoundé Cameroon Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon Gyneco-Obstetrics and Pediatric Hospital of Yaoundé Yaoundé Cameroon

The objective was to describe the maternofetal outcome of childbirth in women with excessive weight gain during pregnancy. We conducted a cross-sectional analytical study over a period of 03 months in the Obstetrics Department of Laquintinie Hospital in Douala (HLD). Our study population consisted of any pregnant in labor or waiting for a caesarean section. We compared two groups of pregnant women with excessive weight gain during pregnancy (exposed) and those without excessive weight gain during pregnancy (unexposed). We recorded 240 pregnant women who gave birth at the HLD maternity, 59 of whom had excessive weight gain during pregnancy, which gave us a proportion of 24.6%. The only sociodemographic characteristic associated with excessive weight gain during pregnancy was the married marital status of the pregnant women (OR: 2.0 (1.1 - 3.8) P = 0.023). Pregnant women with maternal complications associated with excessive weight gain had an average elevated uterine height of 35.4 (P = 0.007). The increase in caesarean section rate (P = 0.094) and the onset of pregnancy-related hypertension (HTA) showed differences close to significance (P = 0.063). Mean birth weight was higher (P = 0.023) in pregnant women with excessive weight gain during pregnancy. Ultimately, excessive weight gain during pregnancy has deleterious effects on the course of pregnancy and childbirth. It promotes the onset of pregnancy HTA and macrosomia.

关键词： Excessive Weight Gain Pregnancy Maternofoetal Outcome

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Kaolin Clay Consumption and Pregnancy:Prevalence,Hematological Consequences and Outcome of Labour in the Douala

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Open Journal of Obstetrics and Gynecology 2017年第12期7卷 1166-1173页

作者： Henri Essome Jean Paul Engbang Gaella Penda Ndedi mve koh valere Merlin Boten Pascal Foumane DieudonnéAdiogo Douala Laquintinie Hospital DoualaCameroon Faculty of Medicine and Pharmaceutical Sciences The University of DoualaDoualaCameroon Yaounde University Health Center YaoundéCameroon Faculty of Medicine and Biomedical Sciences The University of Yaoundé IYaoundéCameroon Gynecological-Obstetric and Pediatric Hospital of Yaoundé YaoundéCameroon

Objective: To determine the prevalence, haematological repercussions and prognosis of childbirth in the event of consumption of kaolin during pregnancy. Materials and Methods: It was a study over a period of 3 months at the Laquintinie Hospital Douala. It compared two groups of women, one of whom had consumed kaolin during pregnancy (exposed group) and the other had not consumed it (non-exposed group). Results: A total of 342 women were included in our study, 121 (35.4%) of whom had consumed kaolin during pregnancy. Women exposed to this consumption (P < 0.05) after univariate analysis were those of pregnant women from the Far North (OR = 3.37, CI: 1.29 - 8.79, P = 0.013), single (OR = 1.65, CI = 1.05 - 2.59, P = 0.029), those with primary education (OR = 2.25, CI = 1.06 - 4.79, P = 0.035) and those with HIV (OR = 2.75, IC = 1.02-7.43, P = 0.045). Consumption was more frequent in the first trimester of pregnancy (37%) and in the third quarter (34%), at a predominantly weekly rate (47.9%). The most frequently cited reasons were envy (82%), and nausea (45%). This consumption was associated with a risk of premature delivery (RR = 2.26, IC = 1.27 - 4.05, P = 0.001), yellowish amniotic fluid (RR = 4.66, IC = 1.81 - 11, P = 0.001), birth weight < 2500 g in newborns (RR = 1.72, IC = 3.36 - 9.56, P = 0.025), but increased the probability of delivery (RR = 1.94, IC = 0.96 - 3.90, P = 0.039). For the hematological aspect, the occurrence of anemia (RR = 1.55, IC = 0.97 - 2.31, P = 0.003) and a decrease in mean hemoglobin concentration (RR = 1.29, IC = 0.83 - 2.03, P = 0.041) were associated with kaolin in pregnancy. After multivariate logistic regression, the complications included premature delivery, yellowish colour of the amniotic fluid and decreased hemoglobin. Conclusion: The use of kaolin is a frequent feeding behavior in pregnancy, mainly motivated by envy, which nevertheless presents serious maternal and fetal complications.

关键词： Kaolin Pregnancy Anemia Prognosis Childbirth Douala

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Risk Factors for Prematurity among Neonates from HIV Positive Mothers in Cameroon

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World Journal of AIDS 2011年第1期1卷 1-7页

作者： Jean Taguebue Francisca Monebenimp Walter Zingg valere mve koh Annie H. Atchoumi Alain Gervaix Ekoe Tetanye 不详

Objective: Human immunodeficiency virus (HIV) infection is the most important chronic health condition among women in childbearing age in sub-Saharan Africa. There is sparse data about socio-economic factors in the context with adverse outcome in pregnancy. The objective of the study was to identify such factors for prematurity, low birth weight (LBW) and intrauterine growth retardation (IUGR) in infants born to HIV-positive women in Cameroon. Methods: The study was done in Yaoundé between December 2001 and November 2007. Neonates born to HIV-positive mothers were monitored and clinical data as well as socio-economic factors were tested for association with prematurity, LBW and IUGR. Findings: In total, 264 neonates were analyzed. More prematurity occurred when mothers attended less than 4 prenatal care visits (OR [95% CI]: 2.7 [1.21-6.05];p=0.015). HIV-classification >1 resulted in more IUGR (OR [95% CI]): 3.15 [1.4-7.4];p=0.01) and LBW (2.20 [1.1-4.6];p=0.03). Single women were more likely to attend 4 prenatal care visits or more (OR [CI95%]: 2.4 [1.6-3.4];p<0.001);higher education resulted in better compliance with anaemia prophylaxis (OR [CI95%]: 3.0 [1.5-5.8];p=0.002) and antimalaria prophylaxis (OR [CI95%]: 2.1 [1.4-3.3];p<0.001);and was associated with early HIV diagnosis (p=0.003). Conclusion: Prenatal care improves outcome in pregnancy of HIV-positive women. Single mothers compared to women in family settings are more likely to attend prenatal care visits, and HIV was diagnosed earlier in pregnancy in this population. More effort should be put to address women in family settings to early diagnose HIV and to increase compliance with prenatal care.

关键词： neonates HIV pregnancy prematurity low birth weight intrauterine growth retardation Cameroon Africa education

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Caesarean Section in African Setting: Current Situation, Problematic and Qualitative Approaches at Laquintinie Hospital (Douala, Cameroon)

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Open Journal of Obstetrics and Gynecology 2019年第10期9卷 1392-1406页

作者： Essome Henri mve koh valere Engbang Jean Paul Boten Merlin Essiben Felix Tocki Toutou Grace Foumane Pascal Mboudou Emile Telesphore Laquintinie Hospital of Douala Douala Cameroon Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon University Teaching Hospital Yaoundé Yaoundé Cameroon Faculty of Medicine and Biological Sciences of Yaoundé University of Yaoundé 1 Yaoundé Cameroon Gynaeco-Obstetrics and Paediatric Hospital of Yaoundé Yaoundé Cameroon Gynaeco-Obstetric and Paediatric Hospital of Douala Douala Cameroon Central Hospital of Yaoundé Yaoundé Cameroon.

Background: Quality control of care aims to reduce or eliminate unnecessary care and to improve the quality of those who are useful both in their indication and in their implementation. Objective: We conducted this study to assess the rate of caesarean section, the rate of irrelevant indications, materno-foetal morbidity and mortality, biases in the management in order to suggest corrective approaches. Methods: It was a cross-sectional study conducted in the gynaeco-obstetrics department of the Laquintinie Hospital of Douala over a period of 4 months from January 1 to April 30, 2017. We included all pregnant women who had a caesarean section and who gave consent to our study as well as new-borns from these caesareans. We excluded caesarean deliveries from other health structures and referred to Laquintinie Hospital due to morbid operative follow-up. The variables collected were grouped under 3 main headings: socio-demographic data, clinical data and post-operative follow-up. Results: A total of 281 caesarean sections were performed out of a total of 967 deliveries;a caesarean section rate of 29.06% in 4 months. After data mining, 250 caesarean sections were included in the study because 31 cases of caesarean deliveries were unusable. Referred pregnancies accounted for 46.8% of the total population and the most common reason for referral was stationary labour (23% of cases). All caesareans were performed by the gynaeco-obstetricians. Women who had caesarean deliveries were informed by the operator of the surgical procedure in 28.4% of cases and 27.6% were notified of the indication for surgery. The operative kit was present in 98% of cases. The operating room was available in 93% of cases. Caesareans were performed mostly in an emergency context (91.2%) with a median turnaround time of 214 minutes (3 h 56 mins). Mechanical dystocia was the major indication in our series (21.2%) and 29 indications were irrelevant (11.6%). Intraoperative complications occurred in 3.2%

关键词： Caesarean Section Practical Laquintinie Cameroon

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HIV+ Status and Cervical Cancer: Cytological Aspects of Cervical Smear in Cameroon Setting

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Open Journal of Obstetrics and Gynecology 2020年第1期10卷 76-84页

作者： Essome Henri Engbang Jean Paul Ekono Michel Roger Nana Njamen Theophile mve koh valere Boten Merlin Tocki Toutou Grace Fewou Amadou Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Laquintinie Hospital Douala Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Faculty of Medicine and Biomedical Sciences University of Yaounde 1 Yaoundé Cameroon

Introduction: The early detection of precancerous lesions being very important for the preventive management of cervical cancer, we felt it was important to identify these lesions on potential backgrounds including HIV-positive (HIV+) women to suggest control strategies of cervical cancer in Cameroon. Objective: To determine the prevalence of precancerous lesions in women infected with the human immunodeficiency virus (HIV), to investigate the determinants of the HIV and cervical cancer association, and to make recommendations regarding cervical cancer screening in these patients of the city of Douala. Methodology: Our study was a case-control cross-sectional study from July 2017 to December 2017 (6 months) including 108 women among which 34 HIV+ matched with 74 HIV-. HIV serology was done using the complete HIV enzygnost test. Cervical smears for cytological lesions were fixed to the cyto-fixator and then stained by the Papanicolaou technique and read under an optical microscope. The cervical smear slides for viral excretion were fixed with a methanol-acetone mixture of equal volume;HPV testing was done by the indirect immune-peroxidase technique using P16 protein. The excretion of HSV type 1 & 2 was investigated by the indirect immunofluorescence technique using the Simplex Virus type 1 & 2 Rabbit anti-Herpes from DAKO (France). Results: The two groups of women were compared with the chi square test with a significance threshold of P 0.05. The average age was 40.07 with extremes of 21 and 71 years and a standard deviation of 9.99. Of the 34 HIV+ patients, 23 had an abnormal cervix compared to 36 cases of abnormal cervix among HIV- with a statistically significant difference (P = 0.006649). 12 cases of dysplasia were observed in the 34 HIV+ women and distributed as follows: 0% of mild dysplasia, 18.92% of moderate dysplasia and 13.51% of severe dysplasia. In HIV- women we detected 6 cases of dysplasia including 1.35% of mild dysplasia, 4.05% of moderate dysplasia a

关键词： HIV HPV Dysplasia Cervical Cancer

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Hematological Profile and Risk Factors of Anemia in Pregnant Women: A Cross Sectional Descriptive and Analytical Study in Douala Cameroon

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Open Journal of Obstetrics and Gynecology 2019年第7期9卷 968-980页

作者： Essome Henri mve koh valere Esuh Esong Lucas Penda Ida Calixte Claudia Melioge Ngalame Tocki Toutou Grace Albert Same Ekobo Carole Else Eboumbou Moukoko Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Department of Obstetrics and Gynecology Laquintine Hospital of Douala Douala Cameroon Faculty of Medicines and Biomedical Sciences University of Yaounde I Yaounde Cameroon Department of Obstetrics and Gynecology University Teaching Hospital Yaounde Yaounde Cameroon Department of Paediatrics Laquintinie Hospital of Douala Douala Cameroon

During pregnancy, the hematological system undergoes numerous changes so as to meet up with the demands of the developing fetus and placenta, with major alterations in blood volume and this differs with women from different regions. The aim of this study was therefore to assess the hematological parameters and risk factors for anemia among pregnant women according to different trimesters of pregnancy in Douala, Cameroon. Methods: A cross-sectional study was conducted from February to May 2017, and all pregnant women who attended antenatal visits during our study period and who suited our inclusion criteria were recruited. The study was carried out in the antenatal care Unit of the Douala Laquintinie Hospital (DLH). A pretested questionnaire was used for the necessary data collection. Venous blood was collected from each of these women to perform a Complete Blood Count (CBC) test using an automated hematological analyzer (URIT 3010). Data were analyzed using XLSTAT 2007 and Stata version 11 software. Results: The mean age of the participants was 28 (SD = 5 years). The prevalence of anemia among pregnant women was 22% with a majority (18.4%) of these women being mildly anemic. Mean Hemoglobin values were significantly higher among women in first trimester compared to the third (12.1 ± 0.9 g/dl vs 11.8 ± 1.3 g/dl;p = 0.043). There was also a significant change in mean hematocrit (HCT) values between the first and second trimester (32.8% ± 2.5% vs 31.4% ± 2.9%, p = 0.004) and between the first and third trimester (32.8% ± 2.5% vs 30.8% ± 3.5%, p -4). RBC count value was higher in the first trimester than in the second trimester (3.7 ± 0.3 × 1012/L vs 3.5 ± 0.4 × 1012/L, p -4) and in the third trimester (3.7 ± 0.3 × 1012/L vs 3.5 ± 0.4 × 1012/L, p = 0.001). After a multivariate analysis, the following categories of women had more odds of developing anemia;women between the age range of 30 - 35 (OR = 2.81, 95%CI: 1.16 - 6.81, p = 0.023), women in the second trimester of p

关键词： Hematological Profile Pregnant Women Anemia Risk Factors Cameroon

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The Problem of Traditional African Pharmacopoeia in Obstetrics: Use of Plants for Utero-Tonic Purposes and Materno-Fetal Outcome in Douala (Cameroon)

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Open Journal of Obstetrics and Gynecology 2019年第11期9卷 1464-1476页

作者： Essome Henri mve koh valere Nana Njamen Theophile Boten Merlin Ekono Michel Roger Penda Ida Calixte Tocki Toutou Grace Halle Ekane Gregory Foumane Pascal Mboudou Emile Telesphore Faculty of Medicine and Pharmaceutical Sciences of Douala University of Douala Douala Cameroon Laquintinie Hospital of Douala Douala Cameroon Faculty of Medicine and Biomedical Sciences of Yaounde University of Yaounde Cameroon Yaoundé Teaching Hospital Yaounde Cameroon Faculty of Health Sciences of Buea University of Buea Buea Cameroon Douala General Hospital Douala Cameroon Yaoundé Gyneco-Obstetrics and Pediatric Hospital Yaounde Cameroon Gyneco-Obstetric and Pediatric Hospital of Douala Douala Cameroon

Introduction: The use of traditional preparations for the induction or acceleration of labor remains a common practice in our country in particular and in Africa in general with sometimes derogatory outcomes for the mother and the fetus. Goal: The objective was to assess immediate maternal and neonatal outcomes in women who reported having used the traditional pharmacopoeia for utero-tonic purposes. Methodology: We conducted a multi-centric cross- sectional study with prospective data collection in the maternities of the Laquintinie Hospital, Bonassama District and Nylon Hospitals. It took place over a period of seven months, from 1st October 2016 to 31st April 2017. This included all women who reported having used the unconventional pharmacopoeia for utero-tonic purposes before or after contractions started. The student and Chi-square tests were interpreted at the statistical threshold of 5% and the 95% confidence intervals. Results: We recruited 168 cases, 68.5% of the 245 women interviewed. The mean age was 27.1 ± 0.41 years;55% of our respondents had a secondary level of education;80% of them were admitted at term and 43% were multiparous. Nulliparity predisposed to traditional pharmacopoeia use (RR = 1.55, CI = 0.79 - 3.03) but primiparity reduced this risk (RR = 0.4, CI = 0.24 - 0.926). Stimulation of labor was the first indication in 85% of women, the rectal evacuation enema was the main route used (67%). The majority of plants used were those of the families Asteraceae, Anthericaceae, and Malvaceae. In per partum, 42% had a brilliant dilatation;there was a statistically significant association between the occurrence of dynamic dystocia (CI = 0.28 - 1.54, p = 0.006) and the risk of perineal tear (RR = 3.13, CI = 1.68 - 5.85;p = 0.007). The APGAR score at 5 min of life was less than 7 in 64% of cases (p = 0.027). The caesarean section rate was 69%. Conclusion: Traditional products with uterotonic effects are frequently used and unregulated with its corollary o

关键词： Utero-Tonic Plants Hyperkinesia Fetal Distress Caesarean Section

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