Obstetric Gynecology Department Research Articles

Drug allergies interpretation based on patient’s history alone may have therapeutic consequences in hospital setting

Background and aim. Adverse drug reactions (ADRs) are common events in medical practice, representing a matter of concern for both outpatient and in hospital care. Understanding and management of ADRs depend on their mechanism and clinical picture, which are complex and highly heterogeneous. Drug hypersensitivity reactions (DHRs) are immunologically-mediated ADRs, which are considered allergies after demonstrating evidence of either drug-specific antibodies or T-cells. The correct diagnosis of a drug allergy in hospital setting is essential for the outcome of treated disease and for the patient future in terms of therapeutic needs. Patients may be labeled as being drug allergic, based on their history and vague symptoms that do not correspond to a true allergic reaction. The aim of our study was to evaluate consequences of drug allergy labelling of female patients hospitalized in the department of obstetrics and gynecology from a university hospital during one year, in terms of medical attitude and therapeutic approach. Method and Results. We found that 159 out of 2395 patients hospitalized in the obstetrics-gynecology department declared a history of drug allergy on admission, but only 3 patients had medical documents and adequate recommendations from the allergist. Hospital medical attitude was significantly influenced in all declared allergic patients, mainly in terms of antimicrobial and anti-inflammatory therapy. Conclusion. We concluded that overestimation of drug allergies in hospital care has important consequences in terms of current and future recommended therapy that should be based on standardized allergist evaluation. Keywords: drug allergies, hospital setting, patient’s history, therapeutic errors.

SPONTANEOUS PLATELET AGGREGATION IN THIRD TRIMESTER PREGNANCY AT ADAM MALIK HOSPITAL, MEDAN

Spontaneous Platelet Aggregation (SPA) is a condition when spontaneously platelet aggregate in plasma left in a tube at room temperature for 2-3 hours without adding any agonists. It is not entirely sure why this phenomenon happens. Pregnant females have a more tendency of hypercoagulability. Nevertheless, SPA demonstrates hyper aggregation of platelet and not the coagulation pathway. So far, there is no report regarding this phenomenon in pregnant females. This study aimed to find out whether pregnant females, especially in the third-trimester of the pregnancy, had the tendency of SPA. This cross-sectional study was established in the Department of Clinical Pathology and Department of Obstetrics-Gynecology, Adam Malik General Hospital in Medan between January–March 2016. Twenty-six females were included. Ultrasonography (USG) was used to know the age of pregnancy. From 26 females in this study, 10 were pregnant females in the third-trimester of pregnancy while 16 others were normal non-pregnant females as controls, with a mean age of 29.2±2.78 years old and 36.5±4.63 years old. There were significant differences between platelet aggregation using ADP agonist in pregnant females and controls (p <0.01). In the median Tmax 10%, there were no significant differences between platelet aggregation without ADP agonist in pregnant females and controls after 3 hours (p >0.05). Hyper aggregation and hypercoagulability in the third-trimester pregnancy tend to develop SPA. Even though there are only mild signs and symptoms, it can be an arising risk of thrombus.

Blood Transfusion Practices at the Gynecology-Obstetrics Department of the Sylvanus Olympio University Hospital in Lomé: A Study of 254 Cases

Objective: To describe blood transfusion practices in obstetric at the Sylvanus Olympio University Hospital in Lomé. Patients and method: Prospective, cross-sectional and descriptive study, conducted from 1 June 2017 to 31 May 2018 at the gynecology-obstetrics department. The study focused on transfused pregnant, parturient and delivered women. Study parameters were sociodemographic, clinical, therapeutic and prognostic. Results: 252 patients, aged 16 to 49 with an average age of 30.4 years, referred in 74% of cases. Hemorrhage was observed in 238 cases (94.4%) and anemia in 14 cases (5.6%). Blood transfusion was urgently used in 89.7% of cases and hemorrhagic abortion was the main indication. Blood group O+ (34.5%) was the most used and blood products were obtained after two hours in 81% of cases. Conclusion: Blood transfusion is often performed urgently and for bleeding. But the Gynecology-Obstetrics department does not have any blood in reserve, whereas the Sylvanus Olympio University Hospital collection and distribution station covers less than 10% of the needs.

Prenatal diagnosis of multicystic dysplastic kidney: about 18 cases

La dysplasie rénale multikystique (DRMK) correspond à l'expression clinique la plus fréquente des “Congenital Abnormalities of Kidney and Urinary Tract (CAKUT)”. Son étiopathogénie reste discutée et l'hypothèse obstructive est généralement admise. L'échographie obstétricale représente le moyen de référence pour son diagnostic anténatal et qui nécessitera la recherche d'autres malformations associées. Une prise en charge anténatale repose principalement sur la surveillance échographique de l'évolution de la grossesse et de la pathologie, de l'apparition d'autres anomalies et de la quantité du liquide amniotique. L'objectif est de rapporter l'expérience du Service de Gynécologie-Obstétrique 2 du CHU Hassan II de Fès afin de: préciser l'épidémiologie de la DRMK; rapporter la pertinence de l'échographie obstétricale dans le diagnostic positif et étiologique; décrire les aspects échographiques; établir un suivi des grossesses et évaluer l'évolution de la pathologie; écrire les modalités de surveillance et de prise en charge anténatales; rapporter l'évolution en postnatal et établir un pronostic.

Factors of Low Birth Weight Risk in the Department of Gynecology-Obstetrics of the Ignace Deen National University Teaching Hospital in Conakry, Guinea

Introduction: The underweight at birth is recognized as a major cause of morbidity and mortality in childhood. Objective: To identify maternal and obstetric sociodemographic factors associated with low birth weight. Patients and Methods: This is a retrospective study of analytical type that examined the records of women who gave birth in the Obstetrics and Gynecology department of Ignace Deen National University Teaching Hospital from 1st December 2016 to 30th April 2017. The analysis was made with the R version 3.3.1 software. We did a univariate and multivariate analysis. Outcomes: Out of the 1633 live births of single pregnancies that occurred during the study period, 109 children were born with a low weight (<2500 g) corresponding to a rate of 6.7%. In univariate analysis, we found a significant association between low birth weight and maternal single status (p = 0.019), maternal weight less than 60 kg (p = 0.038), primary parity (p = 0.018), maternal history of abortion (p = 0.001), history of preterm birth (p < 0.001), arterial hypertension (p < 0.001), anemia (p < 0.001) and malaria (p < 0.001). In multivariate analysis, the variables associated with low birth weight were: history of preterm delivery with OR of 8.5 [1.8 - 40.1], history of abortion (OR = 4.4 [1.4 - 13.9]), malaria (OR = 23.8 [6.1 - 92.5]), anemia (OR = 11.8 [3.7 - 38.2]) and high blood pressure (OR = 5.4 [1.6 - 17.9]). Conclusion: The decrease in frequency of low birth weight in Guinea will be done by improving the quality of prenatal care with an emphasis on screening, prevention and treatment of malaria, anemia and high blood pressure during pregnancy, prevention of abortion and premature birth.

Maternal Prognosis During Childbirth of 111 Newborns Macrosomes at Chu Sylvanus Olympio

Objective: To determine the maternal prognosis during macrofen delivery at Sylvanus Olympio CHU. Method and framework: This was a descriptive cross-sectional study that took place in the Obstetrics Gynecology department of the University Hospital Center of Sylvanus Olympio University Hospital in Lome. June 30, 2017 over a period of 5 months. The statistical analysis was done using the software: Microsoft Excel. Results and discussion: Of 3468 deliveries recorded during the study period, 111 resulted in macrosomes, a macrosomia frequency of 3.2%. The highest incidence was observed among parturients in the 26-30 age group at 38.7%. Delivery occurred spontaneously vaginally in 30%, caesarean section in 20%, forceps 1.5%. Maternal complications were: perineal tears (2.2%), delivery hemorrhage (2.2%), cervical tears (0.5%). These complications are more frequent in case of non-prenatal monitoring of pregnant women. Conclusion: Since fetal macrosomia is a real public health problem because of its strong association with infant morbidity and mortality, such a detailed study of children born with excess weight would make it possible to detect the most important factors in order to improve their health. management of this gravido-puerperal pathology in our African environments

Uterine Rupture: Epidemiological Aspects, Etiologies and Maternal-Fetal Prognosis in the Obstetric Gynecology Department of the Donka CHU Conakry National Hospital, Guinea

Objectives: The objectives of this work were to calculate the frequency of the uterine rupture, to describe the epidemiological profile, to identify the etiologies and to establish the maternal prognosis and foetal. Methodology: It was about a descriptive survey with compilation of the data in two phases: a retrospective spreading on one period of 6 years and the other forecasting of 1 one year achieved to the service of Obstetric Gynecology of the hospital National Donka, Fallen from Conakry, Guinea. Results: We recorded 24.030 childbirths of which 188 cases of uterine rupture either a frequency of 0.78, which represents an uterine rupture for 128 childbirths. The epidemiological profile was the one of a woman of 24 to 28 years (31.91%), housewives (69.14%), without prenatal follow-up (47.87%), big multipare (37.76%) and evacuees (78.78%). The motives of consultation have been dominated by the hemorragie (95.74%). The rupture was of transverse type in the majority of the case (63.82%). The hysterorraphy was the most performed surgical procedure which is 85.10% followed by the total sub hysterectomy in 10.63%. The newborns of birth weight superior or equal to 4000 g represent 25.53%. The maternal morbidity has been dominated by the anemia of the postpartum (60%). We recorded a rate of maternal letalite of 12.76%. The maternal deaths were due to the hemorrhage in 78.57%. The living newborns endured a respiratory distress in 9.57% and those stillborn represent 87.23%. The etiologies of uterine rupture were dominated by fetal-pelvic disproportions 48.93% followed by an iatrogenic uterine rupture 22.33%. Conclusion: The reduction of this uterine rupture rate would pass by the recentered prenatal consultation offered, the one of obstetric cares and complete neonataux of emergency, the discount to level of the beneficiaries of the basic structures so that they can discover the cases in time susceptible to drag a rupture to evacuate better in time and the promptness in the hold in charge since the admission of the emergencies in the structures of superior level.

Endometrial Hyperplasia: Epidemiological Profile of Patients and Anatomical and Clinical Aspects of Lesions at Conakry University Hospital

Summary: Estimate the incidence of endometrial hyperplasia according to socio-demographic parameters and the type of lesions histological. Methodology: This was a retrospective, and 15-year descriptive study from January 1, 2000 to December 31, 2014 conducted at the Department of Anatomy and Pathological Cytology of the National Hospital Donka in collaboration with the obstetric gynecology departments of the Conakry University Hospital. Results: We collected 296 cases of malignant and benign endometrial hyperplasia in 15 years, accounting for 37% of all endometrial biopsy curettages examined. The age group 47 to 56 years was the most affected (81 cases) or 27, 36%. The mean age was 53.6 years with extremes of 27 and 83 years. Metrorrhagia was the main reason for consultation (206 cases), i.e. 69.59%. The suspicion of endometrial hyperplasia by physicians was the most frequently diagnosed circumstance (149 cases) or 50.33%. Biopsy curettage was the most frequently used method (176 cases), is 59.45%. Histological endometrial lesions of atypical complex adenomatous hyperplasia (79 cases) represented 26.69%. Benign behavior was most frequently observed in (235 cases) or 79.39%. Conclusion: Endometrial hyperplasia is an endometrial lesion whose atypical histological types represent the borderline lesions between benignity and malignancy.

Bacteriology of Healthcare-Associated Infections in the Gynecology and Obstetrics Department of CHU Gabriel Tour&amp;#233;

Introduction: Healthcare-associated infections (HAIs) are a public health issue. An infection is said to be associated with the care if it occurs during or after the care of a patient, and if it was neither present nor incubation at the beginning of the care. Objective: The purpose of this work was to study the bacteriology of infections associated with obstetric care in the gynecology-obstetrics department of CHU Gabriel Touré. Patients and Methods: This is an epidemiological, descriptive, analytical study conducted in the gynecology-obstetrics department of the CHU Gabriel Touré, from April 11th, 2016 to August 29th, 2016 (5 months). Data collection focused on the clinical and laboratory characteristics of healthcare-associated infections in patients during their hospitalization. Included in the study were any patients hospitalized in the Gynecology and Obstetrics Department who agreed to participate in the study. The criteria used to diagnose the associated infection were those of the Atlanta CDC. Operative wound monitoring was done up to the 30th postoperative day. Results: We have recorded 200 patients, out of whom 138 were operated on and 23 cases of bacterial infection associated with care (11.50%). The average age of the patients was 32.52 years ± 13.36 years against 29.36 years ± 10.28 years for the patients who did not present the infection. Seven point five percent of the evacuated patients had an infection associated with care. The most common types of infection were surgical site infection (60.86%), urinary tract infection (26.08%), endometritis and sepsis with 13.04% each. The isolated organisms were all resistant to Amoxicillin, to Amoxicillin + Clavulanic acid (88.88%) and to Ciprofloxacin (77.77%). The average duration of hospitalization for patients who developed the infection was 14.70 days. The lethality was 1.50%. The average cost of management of patients who developed the surgical site infection was 119,837 FCFA. Conclusion: The bacterial infections associated with the care remain frequent in our service and dominated by the infections of the operating site. Isolated organisms were all resistant to amoxicillin in 88.88% case ciprofloxacin.

Maternal mortality associated to cesarean section at the sylvanus olympio university hospital: incidence, causes and risk factors

Caesarean section increases the risk of maternal death Objective: To describe the causes and risk factors for maternal deaths related to caesarean section. Patient and methods: A retrospective and descriptive study, conducted at the Gynecology-Obstetrics Department of Sylvanus Olympio University Hospital in Lomé, from January 1st, 2011 to December 31st, 2017. The study concerned patients who died during cesarean section or within 42 days who followed this caesarean section. Study variables were epidemiological data (frequency, age, educational level), clinical (indication of caesarean section), therapeutic (type of anesthesia, associated surgical procedure) and prognosis (caesarean section delay, cause of death). Results: The caesarean section rate was 42.3% and the maternal death rate was 0.3%. The majority of patients were 20 to 34 years old (68%). Patients lived in concubinage in 76% of cases and were illiterate in 17% of cases. Patients were referred in 74.7% of cases and caesarean section was performed urgently in 97.3% of cases for severe preeclampsia/Eclampsia in 60% of cases. Caesarean section was performed in the hour in 26.7% of cases. Patients died during cesarean section in 5.3% of cases and after caesarean section in 94.7% of cases. Postpartum haemorrhage, in 44% of cases and complications of preeclampsia, in 42.7% of cases were the leading causes of post-caesarean maternal death.

Associations of Socioeconomic Factors,Nutrients Intake,and Gut Microbiota of Healthy Pregnant Women in the Third Trimester with Gestational Weight Gain

Objective To investigate the associations of socioeconomic factors,nutrients intake,and gut microbiota of healthy pregnant women in the third trimester with gestational weight gain (GWG).Methods We recruited 98 pregnant women in the third trimester who had received antenatal care in the Department of Obstetrics Gynecology,Peking Union Medical College Hospital from October,2015 to May,2016. We collected socioeconomic information through a structured questionnaire covering age,ethnicity,height,pre-pregnancy weight,and education. Nutritional status of these pregnant women was assessed by a 24-hour dietary intake recall. The participants were provided with collective tubes for faecal sample collection at home;their weight before the delivery was recorded. The pre-pregnancy weight and GWG were classified according to World Health Organization body mass index (BMI) standard for adults and the Institute of Medicine GWG guidelines (2009),respectively. The gut microbiota of the participants were analyzed using a whole-metagenome shotgun sequencing method.Results Insufficient and excessive GWG accounted for 15.3% and 50.0% of the cohort,respectively. Appropriate GWG level was associated with intakes of fat (F=3.113,P=0.049),carbohydrates (F=3.750,P=0.027),and dietary fiber (F=4.499,P=0.014) but not with age (F=2.495,P=0.088),ethnicity (Χ 2=0.065,P=0.968),education (Χ 2=0.827,P=0.661),or pre-pregnancy BMI (F=0.121,P=0.887). Compared with the participants with appropriate GWG,those with excessive GWG had significantly higher abundance of Akkermansia muciniphila,Atopobium parvulum,and Alistipes indistinctus as well as lower abundance of Lactobacillus rhamnosus,Weissella unclassified,Eubacterium ventriosum,Ruminococcus torques,and Bacteroides uniformis. Compared with the participants with appropriate GWG,those with insufficient GWG had significantly higher abundance of Dialister invisus,Alistipes unclassified,Peptoniphilus harei,Escherichia unclassified,Parvimonas unclassified,Campylobacter ureolyticus,Lactobacillus crispatus,and Fusobacterium nucleatum and lower abundance of Eubacterium ventriosum.Conclusions Abnormal GWG is common in pregnant women. GWG is significantly associated with gut microbiota as well as with nutritional factors including fat,carbohydrate,and dietary fiber intake.

The Difference of Integrin ανβ3 Expression, Leukemia Inhibitory Factors and Superoxide Dismutase Serum Concentration in the Provision of Kebar Extract (Biophytum petersianum Klotczh), Metformin, and Their Combination to Mouse models of Endometriosis

Background: In endometriosis there is a decrease in endometrial receptivity. Kebar and Metformin grasses are expected to improve the condition of endometrial receptivityObjective: To find out whether there is any effect of giving Kebar grass extract and metformin on endometrial receptivity Methods: The study was designed by using a simple experimental randomization. It was conducted in Obstetrics Gynecology Department - Faculty of Medicine Diponegoro University and Faculty of Veterinary Medicine Airlangga University. Sample calculation was employed. The study was done within five groups including control group with normal mice, group of endometriosis mouse models given placebo, group of endometriosis mouse models given Kebar grass extract, group of endometriosis mouse models given metformin, and group of endometriosis mouse models given the combination of Kebar grass – metformin extract. The examination materials of ανβ3 integrin and Leukemia Inhibitory Factors were taken from the uteri of the mice and measured by the Rammele Scale Index (Immuno Reactive Score), while the Superoxide Dismutase examination using ELISA was derived from mice serum. These examinations were performed by two veterinariansResults: The expression of ανβ3 integrin was significantly higher in the group of mouse models given Kebar grass extract as well as the combination of Kebar and metformin grass extracts (p &lt;0.05) rather than in the group of endometriosis mouse models with no treatment, whereas LIF expression was significantly higher in the group given Kebar grass extract, metformin and combination of both extracts (p &lt;0.05). Serum SOD levels remained the same.Conclusion: The expressions of ανβ3 Integrin and LIF are higher due to the provision of Kebar grass extract as well as the combination of Kebar grass and metformin extracts

Impact analysis of clinical scenarios on patient safety culture in obstetrical environment: An intervention study in Sousse, Tunisia

Introduction According to the World Health Organization (WHO), every year millions of people are exposed to adverse events (AEs) resulting from medical devices. A growing body of evidence supports their rate is associated with healthcare professionals’ attitudes toward safety. The purpose of the study was to evaluate the impact of training on patient safety culture of midwives in obstetrical unit. Material and methods We have proceeded to a prospective interventional study in 2016 with one group, which included midwives practicing in the delivery room in the department of obstetrics-gynecology, in university hospital Farhat Hached, Sousse, Tunisia. A French version of “Hospital Survey on Patient Safety Culture” (HSOPSC) was used for measuring safety culture. The training program consisted of two workshops with scenario's analysis. The questionnaire was used before and after the two training sessions. Results Sixteen volunteer midwives were included. The comparison of the total scores’ section (mean of the percentage of positive responses to sections’ items), at pre- and post-training, showed a significantly increased score regarding the section D from 7 ± 0.8 to 9 ± 1 (P = 0.017). However, the score of section F decreased significantly from 34 ± 11.5 to 26.5 ± 12 (P = 0.03). In addition, the level of the Dimension 2 “Frequency of event reporting” enhanced significantly from 0.3/3 to 1/3 (P = 0.025) and only item C5 “In the department, we discussed errors’ prevention methods” had a significant increase in the number of positive responses, from 2 to 9 (P = 0.016). Conclusion Our study has shown that training can improve the culture of safety. However, the magnitude of impact varies among different safety culture sections and dimensions. In other hand, we observed poorly developed dimensions of safety culture.

Situation Socio-Demographique, Culturelle Et Comportement Nutritionnel Des Femmes Enceintes En Consultation Prenatale Au Chu De Cocody-Abidjan (Cote d’Ivoire)

The objective of this work is to evaluate the socio-demographic and cultural status, and the nutritional behavior of pregnant women received in medical consultation at the Gynecology-Obstetrics Department of the University Hospital Center of Cocody-Abidjan (Côte d'Ivoire). A survey was conducted on a cohort of 504 pregnant women attending antenatal clinics in the period from August 26, 2015 to February 23, 2017. The survey method consisted of collecting information on socio-demographic, cultural and nutritional status, pregnant women, from a survey card. The results showed that these women, whose age varies between 15 and 44 years, are predominantly Ivorian, with 49.23 % of them belonging to the Akan ethnic group. Burkinabe women represent more than half of non-Ivorian women. The Christian women represent 68.25 %, against 29.76 % of Muslim women. Of those surveyed, 82.14 % are single, 82.54 % are literate, compared to 17.86 % married and 17.46 % illiterate. Living conditions have revealed that 3-room apartment buildings are the most inhabited, and many of them enjoy the amenities of a modern home. At the nutritional level, 1.19 % of respondents followed a diet recommended by a doctor and 31.35 % have dietary prohibitions. 0.99 % of this study population regularly consume alcohol. Food groups such as breads, cereals, starchy foods and pulses are the most consumed (68.06 %); meat is more consumed than fish. Fresh fruits and vegetables are less present in the dietary habits of these respondents. From this study, it could be concluded that the respondents have a satisfactory sociodemographic situation. However, civil marriage is not a proof of marital stability. The percentage of divorced could give an indication of this stability, although in Côte d'Ivoire, customary marriage is the most recognized by the community. Finally, in Côte d'Ivoire, eating habits are often known. But it is a good and balanced diet that the population often ignores.

Screening and management of HIV infection in pregnant women in Dakar.

To assess the feasibility and results of the implementation of systematic HIV screening of pregnant women and antiretroviral (ARV) treatment for those found to be HIV-positive and their newborns at the IHS Gynecology-Obstetrics Department in Dakar, Senegal. This cross-sectional prospective study took place in 2014-1016 and examined the results of screening pregnant women for HIV during their prenatal consultations and treating those found to be HIV-positive and their infants with ARV. HIV screening was routinely proposed to the 1616 pregnant women attending antenatal clinics, and 93.9% accepted. The test was positive for 5 of these women, for an HIV prevalence of 0.3% of pregnant women. In addition, another 23 HIV-positive pregnant women were referred to the IHS for their prenatal care and delivery, for a total of 28 women with HIV. Their mean age was 30 years, their mean parity 1.6, and all had HIV-1. Triple therapy was initiated for all HIV-positive pregnant women, in line with the WHO guidelines' "B + option", currently adopted by Senegal. During follow-up, only 35.7% of the women had access to a viral load assay. The outcome of pregnancy was favorable in 91.6% of cases; 72.2% of the women had vaginal deliveries. All live-born infants were given antiretroviral prophylaxis at birth. The mode of breastfeeding used was mainly exclusive protected breastfeeding (72.2%). During postnatal follow-up, 2 of the 17 live-born infants were lost to follow-up, and 15 had PCR testing for HIV, which was positive in only 1 case, for a transmission rate of 6.6%. The systematic offer and performance of HIV testing in all pregnant women is feasible and acceptable. Good organization of care can provide ARV treatment for all HIV-positive pregnant women and their newborns. The accessibility of viral load testing and of PCR screening for neonates still requires improvement.

Conservative Management of Placenta Accreta of Seven Cases

Introduction: Placenta accreta is a potentially life threatening obstetrical condition. The incidence has increased. Diagnosis before delivery allows multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality. Prenatal ultrasonography is used to support the diagnosis and guide clinical management leading probably to favorable outcomes. Actually a conservative option which includes leaving all or part of the placenta in situ when fertility preservation is desired is recommended. Methods: We retrospectively reviewed the medical records of all patients diagnosed with placenta accreta in gynecology-obstetrics department of the university hospital Mohammed the VI of Marrakesh; Morocco; from January the first 2014 to January the second 2016. Results: We found seven cases. We described: The epidemiological characteristics, risk factors, management of placenta accreta, outcomes and prognosis. The incidence of placenta accreta was 1/3847 deliveries. The mean term of delivery was 35 weeks. We have adopted a successful conservative treatment in six cases (71.4%). The radical treatment was adopted in one patient initially admitted for severe post-partum hemorrhage; the prognosis was good in 85.7% cases. Conclusion: Conservative management of placenta accreta is a safe and efficient and is an interesting alternative for hysterectomy.

Surgical Activities in the Gynecology-Obstetrics Department of the Teaching Hospital Yalgado-Ou&#233;draogo of Ouagadougou: Assessment of One Year of Practice from January 1&lt;sup&gt;st&lt;/sup&gt;, 2015 to December 31&lt;sup&gt;st&lt;/sup&gt;, 2015

Objective: The objective of our study was to study the surgical activities carried out in the gynecology-obstetrics department of the CHU-YO (Teaching Hospital Yalgado Ouédraogo) from January 1st 2015 to December 31st, 2015. Patients and Methods: This dealt with a cross-cutting descriptive and analytic study with retrospective data collection. Our study has included the female patients who underwent surgery in the operating room and whose medical records were usable. Results: 45% of female patients admitted in the concerned department underwent a surgery. The average age of patients was estimated at 28.02 years ±7 years with extremes of 13 years and 80 years. Obstetrical surgery has involved 89.9% of cases. Female patients have received a loco-regional anesthesia in 92.7% of cases. Emergency surgical operations accounted for 88.8% and caesarean section was the main surgical operation carried out in 87.1% of cases. The mortality rate of the overall surgical operations was 1.04%. Conclusion: A better availability of labile blood products is more likely to reduce the mortality rate of surgical operations under the threshold of 1%.

CONTRACEPTION DE LONGUE DUREE : EXPERIENCE D’UN HOPITAL DE REFERENCE A DAKAR ENTRE 2014 ET 2016

Objectives: Our objective was to conduct a situational analysis of the supply and use of long-term contraceptive methods in a reference hospital in Dakar. Methodology: This was a retrospective study of clients who received long-term contraception at the Gynecology-Obstetrics Department of the Institute of Social Hygiene between January 2014 and June 2016. Results: The epidemiological profile of clients was that of an average woman of 26 years, married (91.8%), pauciparous (53.6%), literate (65.5%) with at least one living child (95, 7%). The most common long-term contraceptive method was the Progestin Implant (81.2%) followed by the Copper Intrauterine Device (IUD) (18.8%). Few clients had previous contraceptive experience (15.5%); they predominantly used progestin- only injectable contraception (75%). Minor side effects were reported by 32.6% of clients during follow-up. These included small bleeding (41.8%), weight gain (20.2%), pelvic pain (16.5%), amenorrhea (15.8%) and headache (5.7%). These side effects have been adequately addressed by providers through counseling and drug usein accordance with the protocols contained in the national reference documents. With a decline of 6 to 30 months, 89% of clients are still active, 3.6% are lost to follow-up and 6.6% have changed their method. Conclusion: Longterm contraception is increasingly used at the Obstetric Gynecology Department by clients seeking family planning. The progression of use of the Implant is very satisfactory ; but efforts must be made to better reposition the IUD. Keywords : Contraception. Implants. Intrauterine device.

Alcohol-based hand rub and incidence of healthcare associated infections in a rural regional referral and teaching hospital in Uganda (\u2018WardGel\u2019 study)

BackgroundGood hand hygiene (HH) practice is crucial to reducing healthcare associated infections (HAIs). Use of alcohol-based hand rub (ABHR) at health facilities is strongly recommended but it is limited in Uganda. Data on the practice of HH and the incidence of HAIs is sparse in resource-limited settings. We conducted a quasi-experimental study to evaluate HH practices of health care providers (HCPs) utilizing locally made ABHR and the incidence of HAIs.MethodsHH compliance among HCPs and the incidence of HAIs were assessed at Mbale Regional Referral Hospital, a teaching hospital in rural Uganda. Inpatients from the obstetrics/gynecology (OBGYN), pediatric and surgical departments were enrolled on their day of admission and followed up during their hospital stay. The baseline (pre-intervention) phase of 12-weeks was followed by a 12-week intervention phase where training for HH practice was provided to all HCPs present on the target wards and ABHR was supplied on the wards. Incidence of HAIs and or Systemic Inflammatory Response Syndrome (SIRS) was measured and compared between the baseline and intervention phases. Multivariate survival analysis was performed to identify associated variables with HAIs/SIRS.ResultsA total of 3335 patients (26.3%) were enrolled into the study from a total of 12,665 admissions on the study wards over a 24-week period. HH compliance rate significantly improved from 9.2% at baseline to 56.4% during the intervention phase (p < 0.001). The incidence of HAIs/SIRS was not significantly changed between the baseline and intervention phases (incidence rate ratio (IRR) 1.07, 95% CI: 0.79 – 1.44). However, subgroup analyses showed significant reduction in HAIs/SIRS on the pediatric and surgical departments (IRR 0.21 (95% CI: 0.10 – 0.47) and IRR 0.39 (95% CI: 0.16 – 0.92), respectively) while a significant increase in HAIs/SIRS was found on the OBGYN department (IRR 2.99 (95% CI: 1.92 – 4.66)). Multivariate survival analysis showed a significant reduction in HAIs/SIRS with ABHR use on pediatric and surgical departments (adjusted hazard ratio 0.26 (95% CI: 0.15 – 0.45)).ConclusionsTo our knowledge, this study is one of the largest studies that address HAIs in Africa. During the 24-week study period, significant improvement in HH compliance was observed by providing training and ABHR. The intervention was associated with a significant reduction in HAIs/SIRS on the pediatric and surgical departments. Further research is warranted to integrate HAIs surveillance into routine practice and to identify measures to further prevent HAIs in resource limited settings.Trial registrationClinicalTrials.gov NCT02435719, registered on 20 April, 2015 (retrospectively registered).

Corneal pachymetric particularities during hypertensive pregnancies. A clinical study

While pregnant, a female patient may develop anterior pole pathology related to gestation, especially associated with gestational induced hypertension (GIH) or preeclampsia. We studied 26 female patients (19 to 41 years old) admitted in the Obstetrics-Gynecology Department from the Emergency University Hospital of Bucharest, with gestations ranging from 28 to 39 weeks, from which 15 patients had a form of GIH or preeclampsia. These patients were consulted in the Ophthalmology department and pachymetry measurements were documented. Our results showed that, as the gestation evolves, the cornea becomes thinner, as well as in normal pregnant women as well as in GIH (p<0.05). Furthermore, there was a negative correlation between arterial diastolic blood pressure and corneal pachymeter values in GIH patients. Therefore, the anterior pole pathology in general and corneal thickness in particular, may become an important predictive factor for subtle, sometimes risky, ocular or retinal pathologic processes.