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Epidemiology and Prognosis of Retroplacental Hematoma in a Maternity Ward at a Regional Hospital Center in Southern Senegal

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Open Journal of Obstetrics and Gynecology 2019年第2期9卷 149-157页

作者： Babacar Biaye Omar Gassama mame diarra ndiaye Gueye Moussa Diallo Aminata Niass Mor Cisse Alassane Diouf Jean Charles Moreau Gynecological and Obstetric Clinic University Hospital Aristide Le Dantec Dakar Senegal

Objectives: To study the epidemiological profile and the prognosis of the retro-placental hematoma (HRP) at the maternity ward at Kolda Regional Hospital Center. Materials and methods: This was a retrospective descriptive cross-sectional study conducted over a period of 11 years: from January 1st, 2006 to December 31st, 2016, at Kolda Regional Hospital Center. It included all patients admitted for HRP during this period. The studied parameters concerned sociodemographic characteristics, gynecological obstetrical history;clinical, therapeutic and prognostic data (non-inclusion or exclusion criteria). The data were collected from medical records, the delivery room and the surgery room registers using a collection sheet developed for this purpose. The statistical analysis of the variables studied was done with the software Epi-info 3.5. For the qualitative variables, we calculated the frequencies and for the quantitative variables, we studied the distributions. Results: During the study period, 15,343 were recorded deliveries and we carried out the diagnosis of HRP in 301 patients (1.97%). The average age of the patients was 24 years with an average parity of 4.8 deliveries. Almost all the patients (87.5%) were evacuated and half had delivered by caesarean section. Maternal and fetal deaths were 7% and 72.1%, respectively. Uterine atony accounted for 21.2% of complications. One third of the cases of uterine atony had resulted in a hysterectomy. The average duration of hospitalization was 6 days. Conclusion: The retro-placental hematoma is a serious medico-obstetric emergency. It is burdened with high maternal and fetal morbidity and mortality in developing countries.

关键词： Retro-Placental Hematoma Mortality Kolda

Is Laparoscopy Still Necessary in the Management of Tubal Infertility?

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Open Journal of Obstetrics and Gynecology 2021年第2期11卷 63-69页

作者： Abdoul Aziz Diouf Moussa Diallo mame diarra ndiaye Aminata Niass Mamour Guèye Gnaza Tchindebe Anna Dia Magatte Mbaye Alassane Diouf Pikine National Hospital Center Dakar Senegal Philippe Maguilen Senghor Health Center Dakar Senegal

Objectives: To compare between hysterosalpingography (HSG) and laparoscopic findings in patients tested for infertility and thereby to determine the significance of the latter examination. Methods: This was a descriptive study performed in two Gynecology departments in the Dakar (Senegal). Included were 84 patients with suspicious tubal-infertility who underwent HSG followed by laparoscopy. The Kappa (K) statistics was used to clarify the concordance between HSG vs. laparoscopy findings. Results: Kappa concordance between HSG and laparoscopy showed the followings: 0.08 for proximal tubal obstructions (poor agreement), 0.40 for distal tubal obstructions (moderate agreement), and -0.08 for peritoneal adhesions (no agreement). Laparoscopy revealed pelvic adhesions in 84% of cases, pelvic endometriosis in 12% of cases, and apparently normal tubes in 12%. According to the distal tubal operability score, 16.6% of the lesions were classified as stage 4 and 23.8% at stage 1. Conclusion: HSG and laparoscopy findings did not agree in patients with tubal infertility, and thus, laparoscopy should be employed, especially when HSG showed abnormal findings. HSG has a low diagnostic value in adhesions.

关键词： Hysterosalpingography Laparoscopy Infertility Pelvic Adhesions

Audit of Obstetric Medical Evacuations at Youssou Mbargane DIOP Hospital in Rufisque, Dakar-Senegal

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Open Journal of Obstetrics and Gynecology 2019年第8期9卷 1092-1102页

作者： Moussa Diallo Omar Gassama mame diarra ndiaye Mamour Gueye Astou Coly Niassy Diallo Aissatou Mbodji Abdoul Aziz Diouf Magatte Mbaye Department of Obstetrics and Gynecology National Hospital of Pikine sis Camp Thiaroye Dakar Senegal

Objectives: To assess the quality of the obstetric evacuation system at the Youssou Mbargane Diop Hospital in Dakar. Methods: Our study was conducted at the Hospital of Youssou Mbargane DIOP in Rufisque, a district about 26 km from downtown Dakar. This was a qualitative and evaluative descriptive study in the form of operational research aimed at improving the quality of obstetrical evacuations and resolving problems through a dynamic and team approach. It was carried out within the framework of the AQUASOU project (Improvement of Quality and Access to Emergency Obstetric Care in French). A liaison sheet was completed at the arrival of each evacuated patient, prospectively during the period from December 24 2006 to July 10 2008. The epidemiological characteristics were, origin of the evacuated, the evacuation conditions, evacuation patterns and therapeutic data. The data were collected through an Excel database developed for this purpose. The analysis was done using the Epi-Info version 6.0 software. Results: The frequency of evacuations was 23.2%. The average age of our patients was 25.3 years with extremes of 14 years and 48 years. More than half of the evacuees (59%) came from the Sanitary District of Rufisque. The majority of evacuations were made in a taxi (76.5%). An ambulance was used in 190 cases (20.6%). Seated transport was performed in 78% of cases. The transfer was medicalized in almost one-third of cases (29.3%). A liaison sheet was established during the transfer of patients in 77% of the cases. Evacuations were related to hemorrhage in 23.3%, dystocia in 22.2%, and fetal-adnexal anomaly in 17.3% of cases. No treatment was instituted before evacuation in 56% of evacuees. 48.5% of the evacuees had received treatment beyond. Conclusion: The poor quality of obstetric evacuations seems to be a brake on the decline in maternal and neonatal mortality in Senegal. Training and retraining of health personnel would improve maternal-fetal and neonatal morbidity a

关键词： Obstetrical Evacuation Morbidity Mortality AQUASOU

The Caesarean Section in Dakar: Indications and Analysis Prognosis

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Open Journal of Obstetrics and Gynecology 2019年第9期9卷 1213-1220页

作者： Moussa Diallo Marie Edward Faye Dieme Omar Gassama Astou Coly Niassy Diallo mame diarra ndiaye Gueye Jean Charles Moreau Service de Gynécologie-Obstétrique Centre Hospitalier National de Pikine Sis Camp de Thiaroye Dakar Sénégal Clinique Gynécologique et Obstétricale de l’Hopital Aristide Le Dantec Dakar Sénégal

The objective of this study was to analyze the indications of cesarean sections performed in a Level II clinic and to evaluate early maternal and neonatal outcome in the context of decentralization of obstetric and emergency newborn care. Material and Method: This was a retrospective descriptive and analytical study conducted at the maternity CSNC over a period of 12 months from 1 July 2010 to 30 June 2011. It included all women in childbirth by caesarean section and excluded patients admitted for management of complications of cesarean section performed in another structure. Results: During the study period, 595 caesarean sections were performed on a total of 4410 births, a rate of 13.5%. The average age of patients was 27 years. The mean parity was 2. The patients came from them even 55%. They were admitted with a single uterine scar in 28.40% of cases and bi-scar in 25.4% of cases. A pathology was associated with pregnancy in 31.6% of cases. These pathologies were dominated by vascular and renal syndromes (75.5%), anemia (13.8%) and the obstacles previa (10.1%). Caesarean sections were performed in 517 patients in emergency. The technique of Misgav Ladach was the most common 75.1%. The average hospital stay was 4.2 days with extremes of 0 and 15 days. Postoperative maternal mortality was 0.34%. Operative follow-up was simple in 98.3% of patients. Two patients (0.34%) died after surgery. In 92.4% of the cases, the newborns were alive. The Apgar score in the first minute was favorable (greater than or equal to 7/10) in 503 newborns (95.1%) and unfavorable (less than 7/10) in 47 cases (8.55%). At the fifth minute, he was favorable in 98.5% of the cases. Overall stillbirth was 72.26‰ with a total of 43 stillbirths including 3 macerated stillbirths. Conclusion: Cesarean section is by far the most accomplished action in gynecology and obstetrics. Its ease of implementation and low cost, and of course his results in terms of reduction of maternal-fetal morbidity and mor

关键词： Cesarean Section Indication Misgav Ladach Maternal and Fetal Prognosis

Efficacy and Risk Factors Associated to Resistance to Single-Agent Chemotherapy in Low-Risk Gestational Trophoblastic Neoplasia

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Open Journal of Obstetrics and Gynecology 2016年第1期6卷 50-55页

作者： Mamour Gueye mame diarra ndiaye-Gueye Serigne Modou Kane-Gueye Fatou Niass Dia Aissatou Thiam Sr. Elisabeth Diouf Jean Charles Moreau Gynecologic and Obstetric Clinic Aristide Le Dantec Teaching Hospital Cheikh Anta Diop University Dakar Senegal

Objectives: This study aimed to assess efficacy of intramuscular methotrexate 8-day protocol in the treatment of low-risk gestational trophoblastic neoplasia and also identify prognostic factors associated with treatment failure, necessitating second line chemotherapy. Methods: This study was performed at Gynaecologic and Obstetric Clinic of Dakar Teaching Hospital, the reference Centre of Gestational Trophoblastic Disease in Senegal. At the beginning of 2011, patients were followed according to FIGO’s recommendations. From 2011 to 2014, we diagnosed 88 low-risk gestational trophoblastic neoplasia (GTN) patients (WHO score < 7). Low-risk patients started their treatment with methotrexate (MTX) based on the 8-day protocol consisting of 1 mg/kg MTX in combination with 0.1 mg/kg folinic acid (FA) every other day. Resistance to treatment was the main outcome. We studied the association of different prognostic factors included in the World Health Organisation (WHO) scoring system and resistance to the initial single agent chemotherapy. Results: Eighty-eight patients were diagnosed for GTN during the study period. Average age was 31 years. The antecedent pregnancy was molar in 98.1% of cases. Seventy-four patients underwent remission after single agent-chemotherapy. Resistance rate to single-agent chemotherapy was 15.9% (14 patients). Nine of them achieved remission after second line chemotherapy. WHO score was significantly associated with the risk of resistance to single-agent chemotherapy. Other variables included in the WHO as age, antecedent pregnancy, pre-treatment hCG, tumour size and FIGO stage were not significantly associated with resistance. We report five fatal cases. Conclusion: The 8-day protocol consisting of 1 mg/kg MTX in combination with 0.1 mg/kg folinic acid (FA) every other day is effective for women with LRGTN. The only significant prognostic factor for failure is pretreatment WHO score. We highly recommend the use of this protocol particularly in de

关键词： Gestational Trophoblastic Neoplasia Chemotherapy International Federation of Gynecology and Obstetrics Resistance

Relation between Obstetric Outcome and Parity

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Open Journal of Obstetrics and Gynecology 2019年第6期9卷 894-903页

作者： Helene Warde Chami Mamour Gueye mame diarra ndiaye Mouhamadou Wade Aliou Diouf Abdoulaye Diakhate Simon Birame Ndour Ndama Niang Magatte Mbaye Gynaecologic and Obstetric Clinic Aristide Le Dantec Teaching Hospital Cheikh Anta Diop University Dakar Senegal

Objectives: To evaluate the prognosis of obstetric complications by parity in a suburban center in Dakar. Patients and Method: We conducted a retrospective and prospective, cross-sectional study that evaluated all women admitted to the Philippe Maguilen Senghor Health Center for the management of their pregnancy (childbirth, abortion, ectopic pregnancy), whether they were primiparous or multiparous. The data for this study covered a 66-month period, from January 1, 2012 to June 30, 2017. Data were entered into our E-perinatal computer database. They were then extracted and analyzed first on Microsoft Excel 2016 and then on SPSS 24, Windows version. Results: Between January 2012 and June 2017, we’ve registered 27,441 patients including 25,905 deliveries, 1415 abortions and 121 ectopic pregnancies. Direct obstetric complications involved 14.1% of our patients. 12.1% multiparous and 17.3% primiparous had at least one direct obstetric complication of World Health Organization (WHO). Antepartum haemorrhage, uterine rupture, ectopic pregnancy, and abortion complications were more common in multipara, whereas prolonged and obstructed labor, preeclampsia, and eclampsia were more common in primiparous women. Postpartum haemorrhage occurred at substantially equal frequencies in both parity groups. We had not found any case of sepsis. Conclusion: Our study confirms that primiparity is a factor that may lead to obstetric complications. However, while some complications were more common in the primiparous, others were exclusive to multiparous when we did not expect it. We also recommend continuing this work by singling out multiparas and large multiparas, in order to better understand the obstetric prognosis linked to parity.

关键词： Direct Obstetric Complications Primiparous Multiparous

Assessment of a Database Management System in a Mammogram Unit of a Radiologic Department in Fann Teaching Hospital (Senegal)

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International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2017年第4期6卷 401-409页

作者： Mamour Gueye Awa Sadikh Badiane Sokhna Ba Diop Mamadou Ly mame diarra ndiaye Gueye Abdoulaye Dione Diop Abdoulaye Ndoye Diop Marame Fall Gynecologic and Obstetric Clinic Aristide Le Dantec Teaching Hospital Dakar Senegal Department or Radiology Fann Teaching Hospital Dakar Senegal

Objectives: To evaluate a medical data management system of a mammogram unit in a department of Radiology. Methods: This is a qualitative and quantitative assessment study in Fann Teaching Hospital between April 2014 and June 2015 one year after its implementation. The quantitative component consisted of the audit of the database to determine the socio-demographic characteristics of patients and the results of mammograms. The qualitative component assessed users’ experience. For analysis, quantitative data were extracted and transferred to Microsoft Excel. For scale variables, we calculated the averages and extremes. For qualitative variables, we established percentages. Results: During the study period, 433 patients underwent mammograms. The average age of patients was 48 years. The completion rate maintained above 85% was below 26% in the first two months of use. As to the completeness given examinations, it was still above 83%. The results of mammogram examinations were normal in the majority of cases: 96% for the right breast and 95.2% for the left breast. All users had a favourable opinion about the database. The reasons were better work organization, comprehensiveness, accessibility and standardization of information about the patient and especially the immediate availability of statistics. For 60% of these health professionals, complaints related to the use of the software were the time-consuming of filling data. Conclusion: This study mainly describes the perception of health professionals on the computerization of radiological examinations. It offers some advantages, proposes improvements and opens avenues for reflection on the globalization of the computerization of patient records in Radiology.

关键词： Electronic Medical Records Database Mammogram Radiology Dakar

Rate of Obstetrical Complications and Medical Interventions in Low-Risk Patients: A Cohort Study in Dakar, Senegal

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Open Journal of Obstetrics and Gynecology 2022年第8期12卷 842-848页

作者： Aissatou Mbodji Mamour Gueye Mouhamadou Wade Assia Bourragat mame diarra ndiaye Simon Birane Ndour Philoméne Aissatou Diedhiou Mohamadou Nazir Sylla Diomaye Sene Magatte Mbaye Philippe Maguilen Senghor Health Center Dakar Senegal Cheikh Anta Diop University Dakar Senegal Gaston Berger University Saint-Louis Senegal

Background: “Low-risk” pregnancy is defined as a pregnancy that develops physiologically in a healthy woman and remains healthy. In practice, “low-risk” pregnancies are defined by excluding high-risk pregnancies. Objectives: Evaluate the rate of complications and medical interventions in “low-risk” pregnant women. Methods: This was a retrospective cohort study assessing the risk of obstetrical complications and medical interventions in low-risk patients from January 2010 to December 2020 at Philippe Maguilen Senghor Health Center in Dakar, Senegal. Results: There were 10,979 low-risk patients out of a total of 52,768, accounting for 20.8%. As medical interventions, episiotomy was performed in 27.5% and cesarean section in 8.7%. Acute fetal distress was observed in 4.1%. A low Apgar score at the fifth minute was observed in 1.89% (whereas it was 3.49% in high risk patients). Newborn-resuscitation was performed in 10.7%. Neonatal mortality was 5‰. Conclusion: Low-risk pregnancies are not without “risk”, and thus care-givers should prepare for risks even at dealing with low risk patients.

关键词： Risk Delivery Obstetric Complications Senegal

Report of a New Case of Interlocking Heads in a Breech-Vertex Twin Delivery: A Conversation with My Residents

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Open Journal of Obstetrics and Gynecology 2021年第1期11卷 40-47页

作者： Mamour Gueye Mouhamadou Wade Aissatou Mbodji mame diarra ndiaye Ndiémé Mbaye Mor Talla ndiaye Rahadat Ibrahim Amadou Lamine Cisse Aliou Djiby Dia Aliou Cisse Moussa Diallo Omar Gassama Ousmane Thiam Magatte Mbaye Philippe Senghor Health Center Cheikh Anta Diop University Dakar Senegal

“Locked twins” is a rare event occurring in about 1 in every 1000 twin births. A 21-year-old primigravida with a 31-week twin pregnancy was admitted for delivery. The head of the first twin was locked to the chin of the second twin at the top of the symphysis pubis. Caesarean section was performed allowing the delivery of both dead twins. Twins gestations with first twin in the breech presentation raise index of suspicion of potential locked twin. However, management of such situation is controversial with most authors and colleges recommending caesarean section to avoid interlocking heads. We report another rare case of interlocking heads and bring up the topic about management of breech-first twin deliveries.

关键词： Interlocking Heads Breech Presentation Twins Recommendations