Comparative Study of Early Neonatal Complications between the First and Second Twin during Twin Vaginal Deliveries at the Yaounde Gynaeco-Obstetric and Pediatric Hospital, and the Yaounde Central Hospital

Introduction: Twin birth is the expulsion of two fetuses and their appendages out of the woman’s reproductive tract. It’s a high-risk delivery because of the high frequency of maternal, fetal and neonatal complications. Few studies exist on the comparative prognoses of twins. Our objective was to compare early neonatal complications in first and second twins. Methods: We carried out a cross-sectional prospective study from January 2 to April 30, 2020 (4 months) at the Yaounde Gynaeco-Obstetric and Pediatric Hospital, and the Yaounde Central Hospital. Data collected were analyzed using IBM SPSS version 23. Descriptive statistics were done in frequencies and percentages, means and standard deviations. Paired-sample student's t-test were used to compare means. McNemar’s Chi-square and Ficher’s exact tests were used to compare proportions. Statistical significance was set at p-values less than 0.05. Results: Of a total of 2183 deliveries during the study period, 43 (1.96%) were twin vaginal deliveries. Among the 43 women, 41 consented to have their newborns participate in the study. Overall, APGAR scores were better for the first twins at the first (p = 0.004) and fifth (p = 0.031) minutes than for the second twins. Although both twins had complications and that there were 4 neonatal deads of the second twin, there was no relationship between studied complications and the rank of the twin (p = 0.310). Conclusion: As the APGAR score seemed to be better for first twins, clinicians should pay more attention during twin births, in order to improve the prognosis of the second twin.

Prevalence, Aetiology, and Clinical Profile of Acute Abdomen in Pregnancy in Southwest Cameroon: A 5-Year Retrospective Study

Background: Acute abdomen is one of the commonest reasons for presentation at the emergency department. The physiologic changes of pregnancy increase the chances of developing acute abdomen. The global incidence of acute abdomen in pregnancy range from 1 in 500 to 1 in 635 pregnant women. In 2018, a study in Azerbaijan reported a prevalence of 25%. However, to the best of our knowledge, very few studies have been carried out on this subject in Cameroon. Objectives: To determine the prevalence, assess the aetiologies, and review clinical profile of acute abdomen in pregnancy in the Southwest Cameroon. Methods: We conducted a 5-year retrospective study at the Obst/Gyn and Surgical units of Kumba, Buea, and Limbe Regional Hospitals. We included all files of pregnant women that were admitted for acute abdomen within the study period (1st Jan 2017 to 31st Dec 2021). Data was collected using a structured checklist adapted from previous studies. Descriptive statistics and statistical testing was done using SPSS version 25.0. Chi-square was used to compare categorical variables. p Results: Over 14,106 pregnant women were admitted to the aforementioned hospitals within the study period. 335 (2.4%) met our inclusion criteria. The patients’ age ranged from 17 to 43 years. The mean age was 27 years. Acute abdomen was more frequent (65%) in the first trimester. Ectopic pregnancy was the commonest obstetric aetiology while appendicitis was the commonest non obstetric surgical aetiology. Abdominal pain and tenderness were the most common presentation. Conclusion: The prevalence of acute abdomen in pregnancy in the Southwest Cameroon is 10 times higher than the global prevalence. Our study also confirmed the numerous aetiologies and varied clinical presentations of acute abdomen in pregnancy. Hence a wake-up call for primary care physicians.

关于发行《世界卫生组织人类精液分析实验室技术手册》(第5版)的评论

祝贺各位编撰新版《世界卫生组织人类精液分析实验室技术手册》(简称手册)的作者。手册是推广男科学临床实践的重要工具。然而,手册中叙述的检测方法对预测男性生育力的作用有限,且无法揭示生育力低下的潜在原因。呼吁再次关注男性生育力诊断研究。生育能力应该视为一种连续性状,应放弃人为地将其分为有或没有生育力的做法。应以前瞻性研究数据为基础,开发出可预测生育力低下夫妇一年内妊娠可能性的流程,以指导今后复杂的治疗方案的制定。未来将期待建立检测不育潜在病理机制的方法,以开发个性化治疗手段。诸如氧化应激作用、细胞内调节功能缺陷及正在发展的蛋白质组学等前沿领域,均应进行相应的探索。

Comments on the release Laboratory Manual for the Human Semen of the 5th edition of the WHO Examination and Processing of

The authors of the World Health Organization Semen Analysis Manual are to be congratulated on producing a new edition; it is an essential tool to disseminate good practice in andrology. However, the tests described have poor prognostic power to predict a man＇s fertility and show little about the underlying causes of sub-fertility. This commentary urges a revival of research into the diagnosis of male fertility. It suggests that fertility should be regarded as a continuum and that the artificial binary division between fertile and infertile should be abandoned. Models to predict a sub-fertile couple＇s chance of conception in a year should be developed on the basis of prospective data. These models would allow for sophisticated decision making about management. The future lies in the identification of tests to detect underlying pathologies open to specific treatment. Leads such as oxidative stress, defects in the intracellular regulation and the developing field ofproteomics should be explored.

Effect of alcohol infusion ofCissus populnea root on testicular function and serum hormone of male Wistar rats

Objective:To examine the effect ofCissus populnea root on testicular function of male Wistar rats.Methods:Twenty albino male Wistar rats [(100.0 ±25.5) g] were selected into four groups randomly. The control group were administered 0.20 mL of distilled water while the other groups received 0.05 mL, 0.10 mL, and 0.20 mL/kg body weight of ethanol infusion. Oral administration was done using oropharyngeal cannula once daily for 14 days. Animals were thereafter sacrificed on day 15. Data obtained from this study were analysed using one-way analysis of variance (ANOVA) with multiple comparisons, post-hoc Tukey HSD was subsequently used and values atP<0.05 were considered statistically significant.Results:There were significant increases in serum testosterone, testes-body weight ratio, luteinising hormone and follicle stimulating hormone, respectively, compared with those in control group. Similarly, increase in acid phosphatase, alkaline phosphatase, protein, glycogen and cholesterol levels were more significant compared with those in control group.Conclusions:The findings of this study reveals enhanced secretions of the sex hormones and other indices at 0.05 mL/kg body weight administration ofCissus populnea root ethanol infusion. However, dosages exceeding 0.05 mL/kg body weight gradually depletes the level of reproductive indices assayed for in this current study. Therefore, caution must be taken when consuming ethanol infusion ofCissus populnea root above the dosages used in this current study.

Vulvar Dermatoses: Effect of a Synergistic Treatment with a Moisturizing and Healing Product on the Course of the Disease

Background: Vulvar dermatoses are inflammatory disorders of genital skin causing itch, burning, and plaques with overlying excoriation and linear fissures. Objective: To assess the effectiveness of a soft foam based on Tiab&reg;system (TF), complex of titanium micro crystals covalently bound with silver ions associated with hyaluronic acid, in the supportive treatment of lichen sclerosus (LS) and lichen simplex chronicus (LSC), the two common vulvar dermatoses. Method: 20 patients with the diagnosis of LS or LSC received an 4-week treatment, during which the subjects applied Mometasone furoate in the form 0.1% cream were treated with Mometasone furoate 0.1% cream in combination with TF once a day. Clinical symptoms (itching and burning) and signs (vulvar suface disruption) were documented at baseline and at the end of the four-week treatment. Results: There was a significant reduction of symptoms between the basal scores and the symptoms complaints at 4-week treatment. Moreover, a significant reduction of excoriations and linear fissures was observed. Conclusion: The present study shows that daily application of TF can be an effective adjunct for the treatment of vulvar dermatosis. The foam had not only a moisturizer action, it may also be associated with a reduction in epithelial disruption in the form of excoriations and fissures.

Updated Gestational Age Specific Birthweight Reference of Hong Kong Chinese Newborns and Comparison with Local and International Growth Charts

Background: Different gestational age specific birthweight reference charts have been produced for different populations and ethnic groups over different time periods, mostly based on birthweight data. This study aims to update birthweight references for Hong Kong (HK) Chinese newborns to provide norms for identification of small and large for gestational age (SGA and LGA) fetuses, and to verify whether there are significant differences compared to previously published local reference charts, as well as to other southern Chinese and international data. Methods: All singleton Chinese livebirths delivered in United Christian Hospital from 2012 to 2017 were retrospectively included. The smoothed birthweight centiles at each gestation were computed. The birthweight centiles were then compared with other reference charts. Results: A total of 25,508 livebirths between 24 and 42 completed weeks of gestation were enrolled in the final analysis. The mean birthweights of our cohort were largely similar to previous studies at each gestation, but the 10th and 90th centile ranges differed significantly, so that the proportion of babies that would be classified as SGA or LGA varied widely using cut-offs from different studies. Older local studies tend to under-estimate, while the international growth charts would over-estimate the proportion of SGA babies. Conclusions: Updating fetal growth curve references based on local data is essential to establish more precise definitions of SGA and LGA babies in clinical management. The use of international growth charts in our population may not be appropriate and requires further validation.

A Registry-Based Observational Study on the Maternal and Fetal Outcomes of COVID-19 Patients in Hong Kong,China

Objective:To report the clinical maternal and fetal outcomes of pregnant women with coronavirus disease 2019(COVID-19),along with any associated pregnancy complications,in Hong Kong,China,and to assess the impact of COVID-19 vaccination on these outcomes.Methods:This prospective registry-based observational study included pregnant women who were recruited through convenient sampling and had a laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection with a cycle threshold(Ct)value result available on admission to eight local hospitals in Hong Kong,China.Data on clinical symptoms,laboratory results,medical treatments,delivery timing and mode,and pregnancy complications were extracted from the Hospital Authority’s electronic medical record system.Maternal,fetal,and pregnancy outcomes were compared between unvaccinated pregnant women with COVID-19 and those who had received at least one dose of COVID-19 vaccine before diagnosis.Nonparametric continuous variables and categorical variables were analyzed using the Mann-Whitney U test and the Pearson’s chi-squared test respectively.A P value less than 0.05 was considered statistically significant.Results:A total of 164 pregnant women were included,of whom 78(47.56%)were nulliparous.COVID-19 was diagnosed before 28 weeks’gestation in 30(18.29%),while 134(81.71%)were diagnosed at or after 28 weeks’gestation.Sixty-two(37.80%)women received at least one dose of COVID-19 vaccine.There were no significant differences between vaccinated and unvaccinated groups in the time interval between COVID-19 diagnosis and delivery,the Ct value,and the gestational age at infection onset or delivery(P>0.05).The majority of women were symptomatic at diagnosis regardless of vaccination status 55(88.71%)in vaccinated group vs.78(76.47%)in unvaccinated group(P=0.052).Symptoms did not significantly differ between groups except for cough(62.90%vs.47.06%,P=0.049).The overall rate of severe COVID-19 in pregnant women was low.In total,5(3.05%)patients experienced severe COVID-19,with vaccinated patients more likely to receive low molecular weight heparin(LMWH)as part of their treatment(62.90%vs.42.16%,P=0.010).Ninety-two(56.10%)women had a spontaneous vaginal delivery,7(4.27%)had an instrumental delivery,and 44(26.83%)and 21(12.80%)underwent emergency and elective cesarean sections respectively.For fetal outcomes,14(8.48%)babieswere born preterm and four(2.65%of nonpreterm babies,n=151)had low birthweight.The median birthweight percentile was 52.18th.There were no statistically significant differences in pregnancy complications or fetal outcomes between vaccinated and unvaccinated groups.Conclusion:The overall rate of severe COVID-19 in pregnant women was low.COVID-19 vaccination did not significantly impactmaternal outcomes,except for the use of LMWH.Additionally,the study found no significant differences in fetal outcomes and pregnancy complications between vaccinated and unvaccinated individuals.

Cross-Sectional Survey of Views on COVID-19 and Its Vaccines Among Pregnant Women

Objective:The objective of this study is to evaluate the acceptance of pregnant women with regards to coronavirus disease 2019 (COVID-19) vaccination during pregnancy and to identify any significant changes in their anxiety and knowledge on COVID-19 compared to our previous study.Methods:This cross-sectional survey was performed in the antenatal clinics of United Christian Hospital and Tseung Kwan O Hospital of Hong Kong,China.Questionnaires were distributed to pregnant women for self-completion when attending follow-up from August to October 2021.Apart from basic demographic data,the questionnaire comprised of questions including knowledge on COVID-19 and its vaccines in pregnancy as well as attitudes and behaviors of pregnant women and their partners toward COVID-19.Continuous variables were analyzed by Student’s test and Levene’s test was used to confirm normal distribution and homogeneity of variance for continuous variables,whereas categorical variables were analyzed by the Chi-squared test or Fisher’s exact test as appropriate.AP value of <0.05 was considered to be statistically significant.Results:A total of 816 completed questionnaires were included for analysis.Pregnant women were less worried about COVID-19 in the current survey as compared to the last survey (393/816,48.2%vs.518/623,83.1%,P<0.001).Fewer pregnant women believed that pregnancy were more susceptible to contract SARS-CoV-2 as compared to the last survey (265/816,32.5%vs.261/623,41.9%,P<0.001).They have significant knowledge gap and concerns about COVID-19 vaccines.Nearly half of the participants believed that pregnant women cannot have COVID-19 vaccination (402/816,49.3%) and it is unsafe to fetus (365/816,44.7%).Around a third of women perceived that they were more prone to the side effects and complications of COVID-19 vaccines than the general population (312/816,38.2%) and did not recognize that maternal COVID-19 vaccination could effect transferral of antibodies to the fetus to promote postnatal passive immunity (295/816,36.2%).Most of them had not been vaccinated (715/816,87.6%) and only (12/715) 1.7% of them would consider vaccination during pregnancy.Conclusion:Despite the local and international recommendations for pregnant women to be vaccinated,the uptake of COVID-19 vaccines during pregnancy remained extremely low.Efforts should be made to effectively provide information about the safety and benefits of COVID-19 vaccines during pregnancy.There is an urgent need to booster vaccination rates in pregnant women to avoid excessive adverse pregnancy outcomes related to COVID-19.

Reproductive Outcome of Transcervical Uterine Incision in Unicornuate Uterus

Background： The pregnancy outcome of the unicornuate uterus is associated with an increased risk of miscarriage, cervical incompetence, and a number of obstetric complications. However, at present, there is no accepted treatment method for women with unicornuate uterus, other than expectant measures. The aim of this study was to evaluate the reproductive outcome of transcervical uterine incision （TCUI） in patients with unicornuate uterus. Methods： Thirty-three patients with unicoruuate uterus presented to our tertiary center tbr infertility or miscarriage. All 33 patients underwent TCUI and were followed up for 10-52 months. The pregnancy outcomes （first-trimester miscarriage, second-trimester miscarriage, preterm, term, intrauterine death, ongoing pregnancy, and live birth） before and after TCUI were compared by t-test. Results： Among 31 patients who attempted to conceive alter TCUI, twenty conceived including one terufination of pregnancy, one second-trimester miscarriage, one ectopic pregnancy, five preterm deliveries, 11 term delivery, and one ongoing pregnancy. There were 16 live births in total. There was significant reduction in the first-trimester miscarriage rate （t = 4.890; P 〈 0.001 ）, increase in term delivery （t = -3.288; P =0.002）, and live birth rates （t = -4.073; P 〈 0.001 ） after TCUI. Conclusion： TCUI appeared to improve the pregnancy outcome in women with unicoruuate uterus presenting with infertility or miscarriage.

Minimal volume vitrification of epididymal spermatozoa results in successful in vitro fertilization and embryo development in mice

This study compared three cryopreservation protocols on sperm functions, IVF outcomes, and embryo development. Epididymal spermatozoa cryopreserved using slow-cooling （18% w/v raffinose, RS-C） were compared with spermatozoa vitrified using 0.25 M sucrose （SV） or 18% w/v raffinose （RV）. The motility, vitality, and DNA damage （TUNEL assay） of fresh control （FC） spermatozoa were compared with post-thawed or warmed RS-C, RV, and SV samples. Mouse oocytes （n = 267） were randomly assigned into three groups for insemination： RV （n = 102）, RS-C （n = 86）, and FC （n = 79）. The number and the proportion of two-cell embryos and blastocysts from each treatment were assessed. Sperm motility （P 〈 0.01） and vitality （P 〈 0.05） were significantly reduced after vitrification compared with slow-cooled spermatozoa. However, DNA fragmentation was significantly reduced in spermatozoa vitrified using sucrose （15 - 1.8% [SV] vs 26 - 2.8% [RV] and 27 - 1.2% [RS-C]; P 〈 0.01）. Although the number of two-cell embryos produced by RS-C, RV, and FC spermatozoa was not significantly different, the number of blastocysts produced from two-cell embryos using RV spermatozoa was significantly higher than FC spermatozoa （P = 0.0053）. This simple, small volume vitrification protocol and standard insemination method allows successful embryo production from small numbers of epididymal spermatozoa and may be applied clinically to circumvent the need for ICSI, which has the disadvantage of bypassing sperm selection.