Maternal Deaths after Obstetrical Referral and/or Evacuation to the Obstetrics Gynecology Clinic of the Sylvanus Olympio University Hospital Center, Togo

Introduction: Maternal death or maternal mortality is “the death of a woman occurring during pregnancy or within 42 days of termination, regardless of duration or location, for any specific cause or aggravated by pregnancy or its management, but neither accidental nor fortuitous. Methods: This was a descriptive and analytical cross-sectional study carried out from January 1st, 2021 to April 30th, 2022 at the Obstetrics Gynecology Clinic of the Sylvanus Olympio University Hospital Center (SOUHC). Results: we noted 86 cases of maternal deaths after referral/evacuation i.e. a maternal mortality rate hospital of 555 maternal deaths per 100,000 LB. The average age of the patients was 31.1 ± 6.3 years with extremes of 15 and 45 years. In 33.7% of cases our patients were resellers. Multiparas represented 33.7% of the sample, they had performed less than three antenatal consultations. Postpartum hemorrhage was the reference reason in 33.7%. In 74.4% of cases, the patients referred had arrived by taxi. In 87.9% of cases, the patients had died of direct obstetric causes. Immediate postpartum hemorrhage accounted for 44.6% of cases and anemia, 36.4%. There is a statistically significant association between the availability of blood product and the avoidability of maternal death after obstetrical referral and/or evacuation (p value = 0.0188 0.05). Conclusion: Determining responsibility for maternal death is not always easy. There is an urgent need to strengthen the policy of reducing maternal mortality in Togo. This remains possible by developing communication strategies and a solid referral/counter-referral system.

Epidemiological and Prognostic Aspects of Obesity and Pregnancy in the Gynecology-Obstetrics Department at the Sylvanus Olympio University Hospital Center (CHU SO) in Lomé

Introduction: Obesity and pregnancy is a major public health problem worldwide, both maternal and fetal. Objective: This is to describe the epidemiological and prognostic aspects of obesity and pregnancy in the gynecology-obstetrics department at the Sylvanus Olympio University Hospital Center (CHU SO) in Lomé. Methodology: This was a descriptive cross-sectional study concerning obesed pregnant women. The survey was conducted from the 1st to the 30th of June 2022 at the CHU SO. Results: We enrolled 55 obese pregnant women. The frequency of obesity and pregnancy was 5.14%. Resellers were represented at 41.8%. The average age was 31 years old. As risk factors, 85.5% claimed to have a fatty diet and 76% did not practice sports. The gestational pathologies found during pregnancy were hypertension in 47.4% of cases, preeclampsia in 24.6% and gestational diabetes in 7%. Caesarean section was the way of delivery in 63.6% of cases and those who gave birth vaginally presented a tear of the soft tissues in 85% of cases. Birth weight was abnormal (low weight and excess weight) in 61.8% of cases. Conclusion: The association between obesity and pregnancy constitutes an important risk factor for the mother and the fetus.

Knowledge of Risk Factors and Means of Breast Cancer Screening by Women Seen in Gynecological Consultation at Sylvanus Olympio University Hospital-Lome Togo

Background: In Togo, awareness is very low and patients regularly present with advanced stages of breast cancer. Objective: Determine the knowledge of risk factors and means of breast cancer screening by women seen in gynecological consultation of the Sylvanus Olympio University Hospital (CHU SO). Methods: This was a descriptive cross-sectional study conducted at the gynecology-obstetrics clinic of the CHU SO of Lomé, from March 1 to July 15, 2022. Results: We surveyed 1,566 gynaecological outpatients. Six hundred (600) patients agreed to answer our questions freely, giving a participation rate of 38.3%. The average age of the respondents was 31.9 years old. In 25.5% of cases, the respondents were high school graduates. Five hundred and forty-five of the respondents, or 90.8% had already heard of breast cancer. The most frequent sources of information were medical staff in 34.1% of cases. The presence of nodule in the breast was cited as a clinical sign in 68.4% of cases, breast self-examination as a means of screening in 72.6% of cases, personal history of breast cancer in 51.7% of the cases has non-modifiable risks and smoking as a modifiable risk factor by 58.9% of the respondents. In 31% of cases, they performed breast cancer screening on their own. Breast self-examination was performed by 27.7% of them. Occupation and level of study were statistically associated with women’s knowledge of breast cancer. Conclusion: Most women recognize the existence of breast cancer but their knowledge about signs and risk factors remains low. Few of them, practice screening.

Ovarian Dysgerminoma Associated with Pregnancy: A Case Report from the Sylvanus Olympio University Hospital Center

Background: Dysgerminoma is a germ cell tumor of the ovary usually found in young women. It represents 1% to 2% of all ovarian cancers. The preoperative diagnosis is generally difficult. The surgery and the pathology study are therefore essential for the diagnosis, and optimal management. The incidence of pregnancy with dysgerminoma is extremely low. The treatment and management during pregnancy often jeopardize the materno-fetal prognosis. We report a case of ovarian dysgerminoma in an 18-year-old pregnant woman. Observation: Patient was an 18-year-old, female with no known past medical history, who presented to the emergency room at 29 weeks + 3 days pregnancy with dyspnea and a voluminous uterus (height 42 cm). An ultrasound showed an active pregnancy, and a large vascularized, finely echogenic, multi-partitioned, thick-walled liquid ovarian tumor. Ca125 was 231.5 IU/ml. Ovarian dysgerminoma was suspected. The surgery and the pathology study of the surgical specimen confirmed the suspected diagnosis. Patient died on postoperative day 8. Conclusion: Ovarian dysgerminoma is a rare malignant tumor, which must be suspected in case of complex ovarian mass of young women. When diagnosed during pregnancy, its management jeopardizes the materno-foetal prognosis.

Births at Home: About 411 Cases Collected in the Township of Hiheatro in the Southern Part of Togo

This was a cross-sectional and descriptive study conducted from January 2nd to march 30th 2019 in the township of Hihéatro in Togo. We included in the study, women who had given birth at least once at home and who accepted to undergo the survey. Data were collected, using a pre-planned and pre-tested survey sheet, by a team of four trained interviewers under the responsibility of a supervisor. Interviews were carried out in the homes of the respondents after obtaining their informed consent. The parameters studied were the number of births at home, socio-demographic characteristics, and reasons for births at home and maternal and fetal prognosis. 411 women gave birth at home in the township. The average number of births at home per woman was 2 with extremes of 1 and 7 births per woman. The average age of the women was 28.4 years with the extremes of 15 and 38 years. The 25 - 34 age group represented 67.1% of cases. The average parity of the patients was 2. Multiparas represented 59.8% of cases. The main reasons for giving births at home by the interviewees were insufficient financial means in 36% of cases and the lack of means of transport in 28% of cases. Maternal morbidity was marked by 14.1% perineal tear, 1.6% hysterectomy. Four hundred and eleven newborns were registered. Of these newborns, 4.4% were stillborn and 8.8% did not cry at birth. Free obstetric care and increased awareness on the importance of assisted deliveries will improve the maternal-fetal prognosis.

Indications for Cesarean Section in a Tertiary Center in Togo

Objectives: The objective of this study was to evaluate the indications for cesarean section (CS) and some related characteristics in Sylvanus Olympio University Hospital Center in Togo. Methods: We analyzed all CS performed from January 1, 2020 to December 31, 2020. Results: Total number of 8676 women were delivered, of which 4583 were by CS (52.8%), emergent vs. planned;69.6% vs. 30.4%. Acute fetal asphyxia was the leading indication (25.4%), followed by pre-eclampsia/eclampsia (17.3%), and pelvic anomalies (12.2%). Analysis showed that 51% of cases had definite indications for CS, whereas in remaining cases, CS was performed for non-definite-indications. Conclusion: CS should be done based on definite indications. We must take an effort to educate this in this area, which, avoiding unnecessary CS, might reduce the CS rate in this area.

Cervical Cancer Screening by Midwives in the Kara Region of Northern Togo: Knowledge, Attitudes and Practices

Introduction: cervical cancer is common with high mortality. It is diagnosed late in developing countries. Reducing mortality requires better knowledge and screening for cervical cancer. Objective: To study the knowledge, attitudes and practices of midwives in the Kara region of cervical cancer screening. Methods: Cross-sectional, descriptive study from January 2020 to June 2020 conducted with midwives from the Kara region. Results: Fifty midwives participated in the study. The average age was 32.46 years and the majority (92%) had less than 10 years work experience. Thirty seven (74%) said that cervical cancer was due to human papillomavirus oncogenes and 32% to know the two commonly used screening methods (cervical cytology and VIA/VILI). Only 30% and 8% respectively know the pace and target of screening. They had all expressed the desire to be trained and to carry out routine screening. All of the respondents had never practiced a cervical cytology, and only 01 had once practiced VIA/VILI. Conclusion: Midwives have little knowledge of uterine cancer screening and do not practice it. They express the need to be trained in order to popularize the practice.