The Hidden Side of the Story between the Placenta and Preeclampsia: Preliminary Results of a Prospective Cohort of Pregnant Women in Cameroon

Introduction: Pre-eclampsia is a complication of pregnancy that generally occurs in the third trimester. It is associated with a maternal and foetal mortality rate of around 27%. In view of the grim picture painted by this condition for both mother and newborn, studies have been carried out into the early detection of patients at risk of developing pre-eclampsia. These make it possible to introduce pregnancy-specific monitoring and preventive strategies to reduce the incidence of the condition. Objective: To establish the link between placental ultrasound characteristics and the onset of pre-eclampsia. Methodology: A multicentre prospective cohort study was conducted in two hospitals in Yaoundé, namely the Yaoundé Gynaecological Obstetrics and Paediatrics Hospital and the Nkolndongo Health and Social Animation Centre, in the gynaecology and radiology departments over a period of 11 months, from October 2022 to August 2023. It included pregnant women who had undergone obstetric ultrasound between 12 and 18 weeks’ gestation. In addition to routine obstetric ultrasound, we performed obstetric Doppler measurements in these patients. The resistance index of the left and right uterine arteries, the umbilical artery and the placental volume were the characteristics sought. At the end of this examination, two groups were formed: cases (pathological Doppler group) and controls (normal Doppler group). Blood pressure and urine dipstick were taken at each antenatal visit until delivery, then during the immediate postpartum period and finally at 7 days, 21 days and 42 days after delivery. Results: Sixty-seven (67) patients were included. Of these, 35 (47.8%) had pathological Dopplers. Sixteen patients had arterial hypertension associated with proteinuria and were therefore labelled as pre-eclampsia (PE). This gives a prevalence of 23.9%. Fifteen (42.8%) of these patients belonged to the exposed group and one to the unexposed group. The mean IR of the pre-eclampsia patients was significantly higher than that of the patients without pre-eclampsia;respectively 0.74 ± 0.096 and 0.49 ± 0.097 for the right uterine arteries and 0.71 ± 0.13 and 0.52 ± 0.089 for the left uterine arteries. We found that an increase in the uterine artery resistance index was significantly associated with the onset of pre-eclampsia, with a relative risk of 13.7 and a p value Conclusion: Abnormal Doppler ultrasound between 12 and 18 weeks of amenorrhoea had good overall sensitivity for predicting pre-eclampsia. Among the Doppler indices, the uterine artery resistance index was the only one significantly associated with pre-eclampsia.

Predictive Factors for Pre-Eclampsia: A Case-Control Study in Two Hospitals in Yaounde

Introduction: Pre-eclampsia is a major cause of maternal and prenatal morbidity and mortality, that complicates 2% to 8% of pregnancies worldwide. The aim of this study was to determine the predictive factors for pre-eclampsia in two hospitals in the city of Yaoundé. Methods: A case-control study was conducted at the Gynaecology & Obstetrics department of the Yaoundé Gynaeco-Obstetric and Paediatric Hospital (YGOPH) and the Main Maternity of the Yaoundé Central Hospital (MM-YCH) from February 1 to July 30, 2022. The cases were all pregnant women presenting with pre-eclampsia. The control group included pregnant women without pre-eclampsia. Descriptive statistics followed by logistic regression analyses were conducted with level of significance set at p-value Results: Included in the study were 33 cases and 132 controls, giving a total of 165 participants. The predictive factors for pre-eclampsia after multivariate analysis were: primiparity (aOR = 51.86, 95% CI: 3.01 - 1230.96, p = 0.045), duration of exposure to partner’s sperm Conclusion: The odds of pre-eclampsia increased with primiparity, duration of exposure to partner’s sperm < 3 months, personal history of pre-eclampsia and maternal history of pre-eclampsia. Recognition of these predictor factors would improve the ability to diagnose and monitor women likely to develop pre-eclampsia before the onset of disease for timely interventions.

Pregnancy on Bicornuate Unicollis Uterus: Diagnosis, Management and Prognosis in Underprivileged Areas: About a Case, Yaoundé-Cameroon

Background: A bicornuate uterus is a relatively common and often asymptomatic congenital uterine malformation. Objective: The aim of this work is to highlight the diagnostic difficulty in this case, as well as its therapeutic and prognostic aspects. We report here the case of a young girl carrying a pregnancy on an undiagnosed unicollis bicornuate uterus, which was initially diagnosed as an unruptured ectopic pregnancy. Conclusion: The bicornuate uterus still poses diagnostic difficulties, especially in disadvantaged populations due to the poor accessibility of diagnostic means.

Epidemiologic Profile of Maternal Deaths in Two Referral Hospitals in Cameroon

Introduction: Our objective was to compare the epidemiologic profile of maternal mortality in two structures serving as referral levels of care in Cameroon. Methodology: This cross-sectional, comparative study took place at the maternities of the Yaoundé Central Hospital (YCH) and the Bamenda Regional Hospital (BRH) from December 1st 2014 to May 31st 2015, a 6 months’ period. The medical records of deceased women over 5 years, from January 2010 to December 2014, were collected. We calculated the MMR (Maternal mortality rate) and studied the causes and risk factors associated with maternal death. The Epi info software 3.5.4 was used to analyze data with a significance level of P < 0.05. Results: The maternal mortality ratio (MMR) was 964 and 247 per 100,000 live births for YCH and BRH, respectively. More deaths occurred within the aged group range 20 to 34 years, 76.8% at YCH and 64.7% at BRH. At YCH, 70.7% of these patients were referrals versus 32.4% at BRH. Complication from abortion was often implicated at BRH (P = 0.007;OR = 0.31;CI = 0.13 - 0.74). Others causes were hemorrhage (YCH = 43.4%;BRH = 35.5%), hypertensive diseases (YCH = 17.2%;BRH = 14.7%) and infections (YCH = 8.1%;BRH = 17.6%). At YCH time elapsed from admission to death was <3 h (P = 0.005;OR = 6.63;CI = 1.49 - 29.5). Conclusion: Both hospitals have similar causes of maternal deaths, differing only in the context within which the deaths occurred. Improving access to good quality health care, satisfying unmet needs for family planning, availability of blood products and the establishment of health insurance could decrease the maternal mortality rate.

Risk Factors for Breast Cancer: A Case-Control Study of 315 Women Followed in the Gynecology and Oncology Departments of Two University Teaching Hospitals in Yaounde, Cameroon

Introduction: Breast cancer is the most common cancer and the first cause of cancer-related deaths among women in Cameroon. The aim of the study was to investigate its risk factors for breast cancer at two University Teaching Hospitals in Yaoundé. Methodology: A case-control study was conducted for 5 months, from February 25th to July 25th 2015, at the Gynecology unit of the Yaoundé Gyneco-Obstetric and Pediatric Hospital (YGOPH) and the Medical Oncology unit of the Yaoundé General Hospital (YGH). One hundred and five patients with breast cancer (cases) were compared to 210 women who did not have breast cancer (controls). SPSS Version 18.0.0 software was used to analyze the data with a statistical significance considered at P-value 50 years (P three times per week (P = 0.002;OR = 2.14;CI = [1.33 - 3.45]), palm oil consumption > two times per week (P = 0.001;OR = 2.38;CI = [1.4 - 4.1]). After multivariate analysis, age > 50 years (aOR = 41.48;CI = [2.46 - 69.9]) and consumption of red meat > three times per week [aOR = 7.33;(1.49 - 36)] were the risk factors considered significant for breast cancer. Conclusion: Age > 50 years and red meat consumption are independent risk factors for breast cancer at the Yaoundé General Hospital and at the Yaoundé Gyneco-Obstetric and Pediatric Hospital.

Maternal and Perinatal Outcomes of Pregnant Women with Heart Disease in Three YaoundéReferral Hospitals

Heart disease in pregnancy is the cause of significant maternal and perinatal morbidity. We wanted to evaluate the maternal and perinatal outcomes of pregnant women with heart disease in Yaoundé, Cameroon. This was a cross sectional study with retrospective data collection of 45 pregnancies in 42 women with heart disease followed at three Yaoundé referral hospitals in Yaoundé, Cameroon from January 1st 2015 to December 31st 2020. We collected data on maternal obstetrical and perinatal outcomes. The frequency of pregnancies with heart diseases was 0.1%. The mean maternal age was 29.05 ± 6.5 years. At first antenatal visit, all patients were in class I (84.4%) and II (15.6%) of the New-York Heart Association (NYHA) functional class. Valvular heart disease (51.1%) was the most common type followed by cardiomyopathy (37.7%). Over half of the deliveries were vaginal (51.1%). A cesarean section was generally indicated for the usual obstetrical reasons (54.5%) and for heart disease (31.8%). Complications included 17 (37.7%) cases of heart failure, 6 (13.3%) cases of pulmonary edema, 2 (04.4%) cases of pulmonary embolism, 3 (06.6%) maternal deaths and 3 (06.3%) perinatal deaths, 14 (29.7%) premature births and 3 cases of (6.3%) intrauterine growth retardation. The maternal deaths were cases complicated by pulmonary edema and all had dilated cardiomyopathy. The maternal and perinatal outcomes of pregnant women with heart disease are marked in our environment by increased morbidity and mortality. Therefore, it is necessary to improve the prenatal, per partum and postpartum management of this high-risk group.

Experience of Analgesia during Labour in a Sub-Saharan Hospital Setting

The pain experienced during labour varies from one person to another. The objective of this study is to evaluate the experience of analgesia during labour in three maternity hospitals in Cameroon. Methodology: This was a cross-sectional analytical study conducted over 4 months, from 1 December 2019 to 31 March 2020, at the Yaoundé Gynaecological-Obstetric Hospital, the Yaoundé Central Hospital and the Douala General Hospital. We compared 35 parturients who delivered vaginally under analgesia and 79 parturients who delivered without analgesia. The data collected were compared using Chi 2 and Fischer tests with a significance level of P Results: Parturients aged 30 - 40 years (P = 0.03), public sector employees (P = 0.002) and private sector employees (P Conclusion: Analgesia delivery offers a better birth experience, however it may have negligible side effects.

Maternal and Fetal Outcomes Following Labour at Term in Singleton Pregnancies with Meconium-Stained Amniotic Fluid: A Prospective Cohort Study

Background: Meconium stained amniotic fluid (MSAF) is frequently encountered in obstetric practice. Literature on the subject is still poorly documented in the African setting. Objective: The aim of this study was to determine the maternal and fetal outcomes in case of meconium stained amniotic fluid observed during term labour. Materials and Methods: We conducted a prospective cohort study enrolling all consenting pregnant women with term singleton fetus in cephalic presentation admitted for labour with ruptured fetal membranes in the maternity units of the Yaoundé Central Hospital (YCH) and the Yaoundé Gynaeco-Obstetric and Pediatric Hospital (YGOPH) of Cameroon between December 2014 and April 2015. The exposed grouped was considered as participants having MSAF, while the non-exposed group comprised those with clear amniotic fluid (CAF). The two groups were monitored during labor using the WHO partograph, and then followed up till 72 hours after delivery. Variables studied included the colour and texture of amniotic fluid as well as maternal and fetal complications. Data was analyzed using Epi-info version 3.5.4. The chi-square and Fischer’s exact tests were appropriately used to compare the two groups. A p-value less than 5% was considered statistically significant. Results: 2376 vaginal deliveries were recorded during the study period among which MSAF was observed in 265 cases, hence a prevalence rate of MSAF of 11.15%. Among these cases of MSAF, 52.1% was thick meconium and 47.9% was light meconium. Maternal morbidity was high in the group with MSAF;these included: Higher proportions of caesarean delivery (RR = 2.35 p -4) and prolonged labor (RR = 3 p -4). In this same group, the incidences of chorioamnionitis and puerperal sepsis were low (0.94% and 0.70% respectively), although there was a three-fold higher risk that was not statistically significant (RR = 3, P = 0.31). Fetal and neonatal outcomes were poorer in the MSAF group compared to the CAF group. The complications included fetal heart rate abnormalities, low Apgar score at the 5th minute, need for neonatal resuscitation, neonatal asphyxia and neonatal infection which were significantly higher in the MSAF group (all p < 0.05). Meconium aspiration syndrome (MAS) was found in 2.34% of MSAF cases. Perinatal mortality was 2.34% and all cases of death occurred in the thick MSAF group. Conclusion: MSAF observed during labour is associated with increased perinatal morbidity and mortality. Its detection during labor should strongly indicate very rigorous intra partum and postpartum monitoring. This will ensure optimal management and reduction in the risks of complications.

Adolescent Sexual Behavior in an Urban Area of a Resource-Limited African Country, Cameroon

Introduction: The substantial changes that occur in adolescence may lead to sexual behaviors that adversely affect their health. We have described sexual patterns in adolescents in various neighborhoods of Yaounde in order to underscore the sexual challenges that they face. Methods: We carried out a cross-sectional descriptive study in District number V of Yaounde from August 1st to 31st 2018. To characterize their sexual lives, we surveyed 1800 adolescents between 10 and 19, and analyzed the data using SPSS version 25.0. Results: In our study, 1023 (56.8%) adolescents were female, and 777 (43.2%) were male. Most of the adolescents were between ages 18 and 19 years (25.4%), unmarried (93.1%), had a secondary level of education (81.9%) and lived with their families (87.3%). One-third of the adolescents (30.7%) were sexually active and 41.1% had multiple sexual partners. The average age of coitarche was 15.1 years. Among the females, 17.1% reported one prior pregnancy and 30.8% had one abortion. Most of the sexual encounters were heterosexual (82.6%) and 30.2% regularly used male condoms. 66.0% and 47.7% obtained information about sexuality primarily from social media and mass media, respectively. Conclusion: Sexual encounters in adolescents of District V of Yaounde were premature, mostly heterosexual and often unprotected. The consequences were an increased incidence of early pregnancies and abortions.