Maternal Prognosis Research Articles

Placental Abruption in the Obstetrics and Gynecology Service of Regional Hospital Center of Ouahigouya: Epidemiological, Clinical Ant and Therapeutic Aspects about 89 Cases Collected from 1<sup>st</sup> January 2013 to 31<sup>st</sup> December 2015

Objective: To study epidemiological, clinical ant therapeutic aspects of placental abruption in the service of obstetrics and gynecology of regional hospital center of Ouahigouya. Methods: We conducted a cross-sectional study scheduled for 3 years, from 1st January 2013 to 31st December 2015. Data were collected from patients’ folder, theater register and maternity delivery register. Results: We recorded 5791 deliveries, out of which 89 were placental abruption cases giving a rate of 1.54% of deliveries. The women most affected were whose with age ranging 25 - 30 years (30.33%), the nulliparous women (32.58%), the married women (83.52%) and whose with bad antenatal clinic attendance (54.6%). The clinical aspect was most often complete: nil fetal heart rate (82.00%), hypertony uterine (79.90%) and vaginal bleeding (74.20%) were the most signs found. Spontaneous vaginal delivery has been made in 64.04%. Maternal prognosis was dominated by a morbidity linked by an anemia in 53.90%. Maternal lethality was 2.20%. Fetal newborn-death was 88.80%. Conclusion: Placental abruption represents an obstetrical and medical emergency by its start of brutal installation, its unforeseeable character and its materno-fetal consequences. Only a tacking of risk populations, precocious of diagnosis and a speed management in surgical and medical unit allow improving the prognosis of this disease.

Severe gestationnal hypertrygliceridemia

Background: Severe hypertriglyceridemia is a rare condition in pregnancy and usually occurs in the third trimester. It is often multifactorial, threatens maternal and fetal prognosis and expose the mother to its major complication: acute pancreatitis. It justifies urgent care based primarily on dietary measures and fetal extraction. Aim of the study: We report a case of severe, non-genetic, non-familial, pregnancy-induced hypertriglyceridemia. Case report: A 34-year-old woman, with no particular medical history, presented to the hospital in her third pregnancy, for suspected preeclampsia in a preterm labor context. It was about a monochorionic diamniotic twin pregnancy at 30 weeks of amenorrhea, irregularly followed but all her antenatal screening tests were normal. A full blood count taken was noted to be grossly lipemic. A fasting blood specimen showed elevated cholesterol and triglyceride. Serum analysis revealed normal glucose, amylase, lipase, and thyroid stimulating hormone. The hyperlipidemia was controlled by a low-fat diet. The plasma lipid levels quickly decreased. The patient delivered by c-section at 31 WA. During postpartum, the plasma lipid levels regressed to normal after one month. Conclusions: The severe HTG during pregnancy is a rare condition that can be detected with a blood sample when its appearance is milky. Dietary remains the essential therapeutic measure.

Thyroid Cancer in Pregnancy.

Owing to the young median age of diagnosis, thyroid cancer in women can coincide with pregnancy and affect its management. The evaluation of a thyroid nodule in pregnant women is similar to that in nonpregnant women, but special consideration must be taken for the impact of a cancer diagnosis and its sequelae in pregnancy. The initial comprehensive exam for pregnant and nonpregnant women includes evaluation of the biochemical function and structure of the thyroid gland, and then fine-needle aspiration biopsy of any suspicious nodule. Management diverges after biopsy and diagnosis, as pregnancy affects timing of thyroidectomy and radioiodine exposure. Owing to the indolent nature of differentiated thyroid cancers, surgery can often be delayed to the immediate postpartum period without change in recurrence or mortality rate. However, for more aggressive thyroid cancers or if the patient wishes to pursue surgery during pregnancy, a discussion about maternal health, fetal risk, and disease prognosis is needed between the physician and patient. This review serves to discuss the evaluation of the thyroid nodule and management of thyroid cancers in the pregnant population, as well as address thyroid cancer surveillance in pregnant women with a previous history of thyroid cancer.

Pregnancy outcomes in women with tuberculosis: a 10-year experience from an Indian tertiary care hospital.

Our study sought to determine the characteristics of antenatal patients with tuberculosis (TB) and their pregnancy outcomes. Case records of 50 antenatal women with extra-pulmonary and pulmonary TB at a tertiary centre in India were compared to 150 antenatal women not suffering from TB, for adverse medical, obstetric and neonatal outcomes. The prevalence of TB was 1.16 per 1000 deliveries. Of these, 62% had extra-pulmonary TB. There were two maternal deaths. TB in pregnancy was associated with a five times higher risk of prematurity and three times higher risk of intrauterine growth restriction than the norm. Maternal prognosis depends on the complications of tuberculosis and treatment compliance.

Rapid Fatal Progression of Cervical Cancer during Pregnancy Treated by Neoadjuvant Chemotherapy

Cervical cancer is the most commonly diagnosed gynaecological malignancy in pregnant women. The prognosis of this cancer does not seem to be influenced by the pregnancy. However, the cancer management comes into competition with maternal and foetal outcomes, especially during the 2nd trimester of pregnancy. Challenging issues lie in the cervical screening during pregnancy, the evaluation of lymph node status and the indication of neoadjuvant chemotherapy to avoid foetal prematurity without comprising maternal prognosis.

Maternal-fetal prognosis in HELLP syndrome in a level 3 maternal-fetal care centre

The purpose of this study was to evaluate the maternal and perinatal outcome and prognosis in pregnant women with HELLP syndrome.Medical records of eligible pregnant women with HELLP syndrome were reviewed retrospectively. Patients were evaluated in terms of maternal complication, as well as the types of delivery. Perinatal outcome were evaluated in terms ofApgar score, birth weight, respiratory distress syndrome, and neonatal intensive care unit admission.The leading maternal complications associated with HELLP syndrome were the following: severe preeclampsia, eclampsia, placental abruption, acute pulmonary edema, acute kidney failure, disseminated intravascular coagulation syndrome, and immediate maternal death. The most prominent neonatal outcomes associated with HELLP syndrome were: antenatal fetal death, intrauterine growth restriction, prematurity.The management and delivery of the patients with HELLP syndrome must take place in a tertiary referral maternal and fetal care centre.

Acute cholecystitis in pregnancy. A case report

Cholelithiasis is a multifactorial disease who affects women at reproductive age. Acute cholecystitis is the second most common non-obstetrical emergency in pregnancy. The early symptoms of the acute cholecystitis resemble to the common symptoms of pregnancy, delaying the diagnosis and therapy and worsening both maternal and foetal prognosis. Immediate laparoscopic cholecystecomy is the best choice for treatment, lowering the maternal risk and improving foetal outcome. We present a case of a first trimester pregnant woman, 3 years after bariatric surgery, diagnosed with acute cholecystitis, successfully resolved by a multidisciplinary team. Keywords: acute cholecystitis, bariatric surgery, pregnancy, laparoscopy

Amniotic fluid embolism

Amniotic fluid embolism (AFE) is one of the catastrophic complications of pregnancy in which amniotic fluid, fetal cells, hair, or other debris enters into the maternal pulmonary circulation, causing cardiovascular collapse. Etiology largely remains unknown, but may occur in healthy women during labour, during cesarean section, after abnormal vaginal delivery, or during the second trimester of pregnancy. It may also occur up to 48 hours post-delivery. It can also occur during abortion, after abdominal trauma, and during amnio-infusion. The pathophysiology of AFE is not completely understood. Possible historical cause is that any breach of the barrier between maternal blood and amniotic fluid forces the entry of amniotic fluid into the systemic circulation and results in a physical obstruction of the pulmonary circulation. The presenting signs and symptoms of AFE involve many organ systems. Clinical signs and symptoms are acute dyspnea, cough, hypotension, cyanosis, fetal bradycardia, encephalopathy, acute pulmonary hypertension, coagulopathy etc. Besides basic investigations lung scan, serum tryptase levels, serum levels of C3 and C4 complements, zinc coproporphyrin, serum sialyl Tn etc are helpful in establishing the diagnosis. Treatment is mainly supportive, but exchange transfusion, extracorporeal membrane oxygenation, and uterine artery embolization have been tried from time to time. The maternal prognosis after amniotic fluid embolism is very poor though infant survival rate is around 70%.

Transfusion strategy for patients with severe postpartum hemorrhage: a retrospective study of 47 cases

IntroductionL’hémorragie du post-partum est la principale cause de morbi-mortalité maternelle dans le monde. La prise en charge est multidisciplinaire. La stratégie transfusionnelle est capitale jouant un rôle majeur dans le pronostic maternel. L’objectif de ce travail a été de déterminer le rapport PFC/CGR lors de la prise en charge des hémorragies graves du post-partum.MéthodesUne étude Etude rétrospective sur une période de 4 ans (2009-2012) a été réalisée dans un centre de maternité de référence de niveau III du centre-Est tunisien. Elle a inclut les parturientes admises pour une hémorragie sévère du post-partum définit par la nécessité d’une transfusion de plus de 04 CGR durant les 3 premières heures ou de plus de 10 CGR durant les 24 premières heures de prise en charge.RésultatsNotre étude a inclut 47 parturientes. Le diagnostic de l’HPP a été fait devant un saignement vaginal dans 28 cas et suite à une césarienne dans 19 cas. En préopératoire le taux d’Hb a été de 6.3 g/dl. Le rapport transfusionnel (PFC/CGR) a été de 1/0.7.ConclusionAu cours de notre prise en charge, le rapport transfusionnel a été plus élevé que les recommandations récentes de la littérature stipulant une administration précoce et massive de PFC avec un ratio PFC/CGR compris entre 1/2 et 1/1. L’administration du fibrinogène (Fbg) et de l’acide tranexamique doit être précoce. L’emploi du facteur VII activé recombinant (rFVIIa) doit rester une solution ultime de prise en charge.

A Case of Intestinal Obstruction in Pregnancy Diagnosed by MRI and Treated by Intravenous Hyperalimentation.

Intestinal obstruction in pregnancy is rare and is mainly caused by prior pelvic surgery. We herein report a case of intestinal obstruction in a pregnant female with a history of laparoscopic myomectomy, who presented with hypogastric pain, abdominal distension, and vomiting at 26 weeks of gestation. A simple intestinal obstruction was diagnosed by MRI. Conservative treatments, including intravenous hyperalimentation and the placement of an ileus tube, were provided and her abdominal symptoms improved for 14 days. After restarting oral intake, she had no abdominal symptoms. She gave birth to a 2,146 g female infant by caesarean section at 37 weeks and 1 day of gestation. Although an area of cicatrization, which was thought to have been the starting point of the occlusion that caused the intestinal obstruction, was found, the excision of the small intestine was not necessary. Her postoperative course was uneventful. Intestinal obstruction requires a prompt diagnosis and aggressive intervention may be necessary to minimize the morbidity and mortality associated with this rare complication of pregnancy. MRI can be safely used during pregnancy to diagnose intestinal obstruction and intravenous hyperalimentation may improve the maternal and fetal prognoses.

Preventive Exchange Blood Transfusion in Pregnant Women with Sickle Cell Disease: Maternal and Perinatal Prognosis in a Country with Limited Resources, Burkina Faso

Context: In pregnant women with sickle cell disease, the management with exchange transfusion could be useful in improving the prognosis of mother and child by reducing the level of hemoglobin S less than 40%. Objective: To analyze the maternal and perinatal outcome during the program of the exchange transfusion in pregnant women with sickle cell disease. Patients and Methods: We conducted a prospective study over a period of 18 months. Pregnant women with a major form of sickle cell disease were included. A manual blood exchange transfusion was performed monthly. We monitored the occurrence of maternal and perinatal morbidity during the follow-up. Results: A total of 42 pregnant women with sickle cell disease were monitored. The frequency of infectious episodes and vaso-occlusive crisis was significantly reduced, respectively from 47.6% and 83.3% before the beginning of the blood exchanges transfusion to 11.9% and 16.7% during blood exchanges transfusion program. All newborns were alive at birth with an Apgar score higher or equal to 7 at the 5th minute. The rate of admission of the newborns at neonatal intensive care unit was 9.3%. Maternal mortality was estimated at 7.1% and there was no early neonatal mortality. Conclusion: Prophylactic exchange transfusion reduces infections and the reoccurrence of vaso-occlusive crisis, which has an impact on perinatal prognosis.

Ebola in Obstetric Environment: By the Way of 3 Cases to the Service of Obstetric Gynecology of the Hospital National Donka, Fallen of Conakry

The Ebola Virus Disease is a very infectious viral pathology; late diagnosis in the pregnant women aggravated the prognosis and exposed health care providers. Our objective is to make known this pathology for a more precocious diagnosis in the obstetric environment. We are reporting three clinical cases, respectively, an in utero death, a hemorrhage and an eclampsia. Triggering birth, the C-section, the blood transfusion, the maternal and neonatal resuscitation were done. Eighty three contacts were recorded among health providers without any contamination case. The maternal, fetal and neonatal prognosis was fatal in these three cases.

Management of Full Term Births in Women with Prior Cesarean Section in a University Maternity of Cotonou-Benin (CUGO/CNHU-HKM) in 2015

Introduction: Increased prevalence of uterus with prior cesarean sections is due to rising rate of cesarean births worldwide. Birth management after a prior cesarean section is a challenging issue, since medical practices are divergent. Objectives: Analyze pregnancy outcome and management of childbirth from a uterus with one cesarean scar. Setting and method: It was an observational, descriptive and cross-sectional study carried out from December 15, 2014 to September 14, 2015 in the University Clinic of Gynecology and Obstetrics (CUGO) of the National University Teaching Hospital (CNHU-HKM) of Cotonou. It involved 132 female patients. The data were analyzed with Epi Info 7 software. Results: The prevalence of childbirth on uterus with one prior C-section is 7.57%. Patients' mean age was 30 years. Most of them were admitted for second childbirth. Most pregnancies were singleton ones (94.70%). The interval between cesarean section and current childbirth is higher than 24 months in most cases (83.76%). The rate of uterine contraction is low (29.55%); the same applies to the one of vaginal birth (25%). The main indications for repeat cesarean section were narrowing of the pelvis (19.19%), acute fetal distress (14.14%) and renal vascular diseases (11.11%). The maternal and perinatal prognosis for vaginal birth had been better than the one of repeat cesarean section. Conclusion: The challenging issue of childbirth management in women with one prior C-section is still a matter of concern in Cotonou. Some efforts still have to be made to improve technical medical equipment so as to extend the indications for uterine contraction during labor, thereby contributing to reduce the rate of repeat cesarean section.

Macrosomie fœtale à Lubumbashi: facteurs de risque et pronostic maternel et périnatal

IntroductionLa macrosomie fœtale est habituellement définie par un poids de naissance supérieur ou égal à 4000 grammes. L'objectif de cette étude est de déterminer la fréquence de la macrosomie, d'identifier les facteurs étiologiques et d’évaluer le pronostic maternel et périnatal.MéthodesIl s'agit d'une étude cas-témoins menéeau sein des maternités de 10 hôpitaux généraux de référence de la ville de Lubumbashi en République Démocratique du Congoentre le 1er décembre 2013 et le 31 mars 2014. Les accouchées ont été réparties en deux groupes, en fonction du poids de naissance de leurs nouveau-nés: groupe I (≥4000 grammes ou plus) et groupe II (2500 à 3500 grammes). Les caractéristiques maternelles, l'environnement obstétrical ainsi que le pronostic maternel et périnatal ont été étudiés et comparés dans les deux groupes. Les données ont été analysées à l'aide du logiciel Épi info version 7.1. Les différences étaient jugées significatives pour un seuil de p<0,05.RésultatsAu total, 668 mères et leurs nouveau-nés ont été inclus dont 167 macrosomes et 501témoins. L'incidence de la macrosomie fœtale était de 5,7%. Comparativement aux mères de témoins, nous avons trouvé que les mères des nouveau-nés macrosomes étaient plus âgées, multipares, multigestes, obèses, diabétiques et avaient antérieurement donné naissance à un macrosome. Les taux de césarienne et de délivrance pathologique étaient significativement élevés chez les mères de macrosomes que chez celles de témoins. Lesexe masculin était significativement plus prédominant chez macrosomes que chez les témoins. La dystocie des épaules étaitenregistrée uniquement dans le groupe des macrosomes.ConclusionLa prévalence de l'accouchement d'un macrosome à Lubumbashi est de 5,7%. La macrosomie est souvent à l'origine de complications maternelles et périnatales. La réduction de ces dernières passe par une meilleure connaissance des facteurs de risque et un dépistage précoce.

Specificity of Brucellosis In Pregnancy: Presentation of Two Cases and Review of Literature

In pregnant women, brucellosis may have different clinical aspects, but there are no specific signs of the disease and in all cases the maternal and fetal prognosis may be involved. We report two cases of brucellosis-infected pregnant women. In the first, the diagnosis and the treatment were early and the evolution was favorable with term delivery of a healthy newborn. In the second the pregnancy was complicated by a premature delivery at 32 weeks of gestation. On the occasion of these two observations, we made a literature review to clarify the clinical features of this infection during pregnancy as well as its therapy specificities.

Adipokine Serum visfatin level in pregnancy induced hypertension and uncomplicated pregnancy.

Background and Objectives:Hypertensive disorder in pregnancy is the significant disease that badly affects the maternal and fetal prognosis and lead to higher mortality and morbidity in the prenatal period. Visfatin, potentially a new adipokine has emerged having high contribution in pathogenesis of pre-eclampsia. The objective of the study was to find the level of Visfatin in pregnancy induced hypertension and normal pregnant women.Methods:This study was carried out in tertiary care hospitals, Peshawar from March-October 2014. A total of 234 pregnant women (gestational age >20 weeks) were included in the study with distribution as Preeclampsia (PE=86), Eclampsia (E=74) and control (N=74). Blood was taken for measuring Visfatin level by Enzyme Linked Immunosorbent Assay (ELISA) technique. SPSS version 19 was used for statistical analysis. Student’s t test was performed to evaluate the mean differences in patients and control.Results:Serum level of visfatin was significantly higher in pregnancy induced hypertension when compared with control (P value<0.001).: Comparisons of mean value of visfatin with age group of 21-40 years, body mass index (BMI), primary parous and parity 2-4, gestational age of >36 weeks and both systolic and diastolic blood pressure were highly significant in pregnancy induced hypertension when compared with control (p value<0.001).Conclusion:Pregnancy induced hypertensive women showed increased level of serum Visfatin than normal pregnant women.

A retrospective study of obstetric hysterectomy in a tertiary care hospital

Background: Obstetric hysterectomy is a life-saving procedure sometimes required for conditions such as postpartum hemorrhage and ruptured uterus. It is sometimes associated with both maternal and perinatal mortality. Objective: To evaluate the incidence, indication, mortality, or morbidity associated with emergency obstetric hysterectomy in a tertiary care hospital. Materials and Methods: The case records of all women who underwent emergency obstetric hysterectomy between January 2012 and December 2014 (a period of 3 years) were studied. Result: Of the total 8317 deliveries in a span of 3 years of the study period, 2036 underwent cesarean delivery (rate of 24.4%). A total of 33 obstetric hysterectomies were performed with a rate of 0.39% or 1 in 252 deliveries or 3.9 per 1000 deliveries. Most were in the age group of 21–30 years (19 cases, 57.6%). Majority of the patients were of second, third, or fourth parity (87.8%), 26 patients were unbooked. Most common causes of hysterectomy were rupture uterus due to obstructed labor, and morbid adherent placenta. There was no maternal mortality. Of the 33 deliveries, 18 (54.5%) resulted in perinatal mortality. Most common adverse event postsurgery was fever (30.3%), although 54.5% had no problems postsurgery. Conclusion: Most common indications for emergency obstetric hysterectomy are ruptured uterus and morbid adherent placenta. It is associated with good maternal prognosis and significant perinatal mortality. This could be avoided by good antenatal care and careful selection of patients for cesarean delivery as it has immense impact on both present and future child bearing.

VOLVULUS DU CÔLON PELVIEN DU PERI-PARTUM : A PROPOS DE 2 CAS

Volvulus of the pelvic colon peripartum is a rare situation in the peri-partum. Aim: to discuss the pathophysiological, diagnostic and therapeutic aspects, from two observations. Observation: there were two observations. The first was a patient of 30 years, 3rd movement, 3rd bullet, admitted to the emergency room for an occlusive syndrome, the waning of a normal delivery, after a pregnancy to term. Surgical exploration revealed a volvulus of the sigmoid colon without necrosis and she has received intervention Bouilly-Volkmann. The second was a patient of 41 years, gesture 10th, 9th bullet, admitted to the emergency occlusive syndrome with fever, on a continuing pregnancy. The exploration revealed a volvulus of the sigmoid colon with necrosis and gravid uterus. She has received a cesarean section with extraction of a newborn viable and Hartmann procedure. Conclusion: peripartum volvulus is an extremely rare clinical situation and is delayed care may initiate maternal and fetal prognosis. Keywords: volvulus; sigmoid colon; syndrome occlusif. Peripartum.

Fetal heart rate abnormalities associated with uterine rupture: a case–control study: A new time-lapse approach using a standardized classification

ObjectiveThe aim of this study was to identify fetal heart rate abnormalities (FHRA) in the two hours preceding uterine rupture during trial of labor after a previous C-section compared with successful vaginal birth after cesarean controls. Study designA multicenter case–control study was conducted from 2006 to 2012. Fetal heart rate tracings of the two-hour period preceding delivery were segmented, anonymized and independently classified by two obstetricians according to a standardized grid based on FIGO guidelines (4 grades: 1 – normal, 2 – intermediate, 3 – abnormal, 4 – preterminal). Each case of uterine rupture was matched to 2 controls.Survival curves were generated for both groups using the Kaplan–Meier method to analyze the occurrence of each FHR category across time. ResultsDuring the study period, 39,773 patients gave birth. 2649 involved women with a previous C-section (6.6%). A total of 33 uterine rupture/scar dehiscence cases occurred (0.08% of all births), of which 22 were included. These were matched to 44 controls.FIGO grade-3 FHRA were significantly associated with uterine rupture in the hour preceding its diagnosis: odds ratios were 4.1 (95% CI 1.2–14.0), 4.3 (95% CI 1.4–13.0) and 3.7 (95% CI 1.2–11.3), in the 60–40min, 40–20min and last 20min before childbirth, respectively. Agreement between the two reviewers (Cohen's kappa) was 84% (CI 95%: 0.79–0.89). ConclusionIn the hour preceding uterine rupture, there are often significant FHRA. This leads us to consider the possibility of an earlier C-section when faced with grade-3 FHRA, before the onset of terminal bradycardia jeopardizing maternal and fetal prognosis.

Eclampsia at the University hospital Yalgado of Ouagadougou (Burkina Faso) from 1 April 2013 to 31 March 2014

The objective of this study was to describe the epidemiological, clinical, therapeutic and prognostic aspects of the eclampsia in the obstetrics and gynecology department at the University Teaching Hospital Yalgado Ouedraogo of Ouagadougou. It has been a descriptive crosssectional study over a period of 12 months from 1 April 2013 to 31 March 2014. The main criterion for inclusion in our sample was the occurrence of seizures in a pregnant more than 20 weeks of gestation or recently delivered with elevation of blood pressure and the presence of albumin in the urine. The patients were followed from the onset of the crisis until hospital discharge. Data were collected and analyzed using Epi Info 3.5.1. The significance level of 5% was used for data comparison. We identified 203 cases of eclampsia for 6063 deliveries that to say a frequency of 3.3%. The average age of patients was 27.5 years [14-46]. In socio-demographic terms, patients were housewives in 62.5% of cases, the average rate of the past-deliver number was 4.2 [0-11] and 47.7% of patients were living as married. Clinically, they were referred in 72.4% of cases and were initially admitted into the service for elevation of blood pressure in 40.3% of cases. The mean gestational age was 31.5 weeks [23-41]; diastolic blood pressure exceeded 110 mmHg in 63.1% of cases. Therapeutically, all the patients benefited from a treatment based in anticonvulsant by magnesium sulfate and antihypertensive therapy by nicardipine, clonidine or alpha-methyl-dopa. Maternal prognosis was marked by significant morbidity in 46 cases (22.6%) and mortality in 13 patients that to say a fatality rate of 6.4%. The fetal one was dominated by a perinatal lethality in 31.5% of the cases. Eclampsia is a major cause of maternal and perinatal mortality in the University Teaching Hospital of Ouagadougou. The adoption of strategies for screening during antenatal consultations and early management should contribute to the reduction of the mortality in the mother and child couple in Burkina Faso.