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.

Knowledge, Attitudes of Pregnant Women and Practices of Women Who Have Recently Given Birth on Contraception in the Immediate Postpartum Period at Principal Clinic of the Togolese Association of Family Well-Being Planning Center (ATBEF)

Background: The use of modern contraceptive methods contributes to the reduction of maternal and neonatal mortality. The initiation of a contraceptive method in the immediate postpartum period is one of the strategies to avoid missing out on contraceptive opportunities. This strategy will reduce the unmet need for contraception which is still high in the country. Objective: To describe the knowledge and attitudes of pregnant women and the practices of women who have given birth about immediate postpartum contraception. Methodology: This was a cross-sectional and descriptive study conducted at the main clinic of ATBEF from 20th March to 20th October 2020. Our study included pregnant women whose gestational age was greater than or equal to 37 weeks of amenorrhea who came for prenatal consultation or for any other consultation and then gave birth in the center. Data collection was based on a survey form. Data analysis and entry was done with the Epi info 2000 version 6.04 software. The parameters studied were: socio-demographic characteristics, knowledge and attitudes of pregnant women about contraception in the immediate postpartum period, and contraceptive practices of the women who gave birth. Results: During the study period, 201 women were selected for the survey. The average age of the respondents was 26.2 years. They were nulliparous in 41.3% of cases. Our respondents had knowledge of modern contraceptive methods in 82.10% of cases. About 59.2% of the respondents had an unfavourable attitude towards the adoption of contraceptive methods in the immediate postpartum period. The main reason was adverse effects in 33.6%. Of the 82 women who had a favourable attitude, 29 women had adopted a contraceptive method after delivery, which corresponds to a rate of use of 14.4% of the respondents. The main reason for non-adoption of a contraceptive method after childbirth for those who had a favourable attitude was the opposition of the husband in 34%. Conclusion: Couple counselling during prenatal and postnatal care and intensified awareness raising on planning and ideal spacing of pregnancies for health will increase the number of contraceptive users in the immediate postpartum period.

Study of the Active Management of the Third Stage of Labor (AMTSL) in Four Maternity Hospitals in the Commune of Kara (Togo)

Introduction: Active management of the third period of labor (AMTSL) significantly prevents postpartum hemorrhage onset. Objective: To assess the practice of AMTSL in four maternity in the commune of Kara (Kara University Hospital Center, Kara Tomdè Regional Hospital Center, SOS Kara Mother-Child Hospital, and Adabaweré Peripheral Care Unit). Method: This was a cross-sectional descriptive study over four months, from January 28 to May 28, 2019. Two questionnaires were used for data collection: an observation and evaluation grid AMTSL practice and a questionnaire for providers. The grid was designed and adapted to the RPC repository model for emergency obstetric and neonatal care in Africa 2018. The data was processed using the Epi Info 7 software. Results: During the study period, 528 parturients were identified and 30 providers surveyed. No provider had received ongoing training in AMTSL. The practice of AMTSL was systematic at each delivery. The practice was correct in 45.8%. Factors associated with incorrect practice were relationship between caregiver-patient (p = 0.0005), placental examination (p = 0.0003), postpartum monitoring (p = 0.0001). Conclusion and Suggestion: The practice of AMTSL is systematic, but it was incorrect regardless of the provider’s qualification. Continuing education on AMTSL is necessary to prevent postpartum hemorrhage.

Determinants of Home Birth in the Community of Dagbati in Togo

Introduction: Home birth or unassisted birth means for a woman to make the decision to give birth at home, not alone in absolute terms, but without professional assistance, be it that of a midwife, a doctor or any other person with midwifery qualifications. Methods: This was a descriptive cross-sectional study conducted from November 04th to December 21st, 2019 and from August 17th to August 21st, 2020, in the community of Dagbati, in 33 women who gave birth at home, received at the USP of Dagbati and during advanced strategies;who were registered or not in the delivery register of USP Dagbati and who agreed to participate in the survey freely and in an informed manner. Results: Of the 48 deliveries that took place in the locality during our study period, 33 took place at home, with a rate of 68.7%. The average age of the women giving birth was 26.33 years with extremes of 15 and 47 years. In 42.4% of cases, they were farmers. Twenty-seven women who gave birth had farmer spouses (81.9%). The distance between their house and the health center was greater than 2 km in 78.8% of cases. Among the reasons for giving birth at home, the lack of financial means was mentioned in 60.6%. In 63.6%, the family had assisted the women in giving birth. Conclusion: Home birth is still a reality in our communities, despite the increased number of health facilities. The sensitization of the population, the improvement of the conditions of accessibility to the health center, the quality of obstetric care, and also, the improvement of the living conditions of women will surely allow a total abandonment of home births.

Medical Interruption of Pregnancy in the Second Trimester at the Principal Clinic of the Togolese Association of Family Well-Being Planning Center (ATBEF): About 25 Cases

Introduction: Medical termination of pregnancy is a therapy that considerably reduces the number of obstetrical complications that can lead to maternal death and the number of births of children with diseases or malformations that are incompatible with life. Objective: To study the practice of medical termination of pregnancy at the Principal Clinic of the Togolese Association of Family Well-Being Planning Center (ATBEF). Methodology: This was a retrospective and descriptive study conducted at the Principal Clinic of the Togolese Association of Family Well-Being Planning Center (ATBEF) covering the period from May 1st, 2012 to April 30th, 2021, i.e. a period of 9 years. All patients who underwent a medical termination of pregnancy during the study period and whose term of pregnancy was <28 weeks of amenorrhea were included in this study. Information was collected on a survey sheet from the patients’ clinical records, admission and hospitalisation registers, referral forms and operative report registers. Data were entered and analyzed using Excel, World and epi-info 7.2.2. The main variables studied were hospital frequency, diagnostic means, main indications, means of evacuation and maternal prognosis. Result: 25 patients were identified and represented 0.5% of deliveries. Fetal, maternal and obstetric causes were the main indications for medical termination of pregnancy in respectively 28%, 20% and 52%. Obstetrical ultrasound was performed in 100% of patients. These ultrasounds allowed us to determine fetal vitality and to find some fetal malformations (28%) and some anomalies in the fetal appendages (48%). Clinical examination alone was used to diagnose 24% of indications. In 68% of cases, the clinical examination and ultrasound were used to establish the indication. The most commonly used evacuation technique was medication in 88% of cases. Caesarean section was chosen for urgent cases in 12%. Uterine haemorrhage and post-abortion endometritis were the main complications. Conclusion: Medical termination of pregnancy is a delicate subject requiring multidisciplinary management. This series has allowed us to highlight our singularities, and will allow us to improve the management of our patients, in the prevention of haemorrhage and other complications.

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.

Delivery Outcome in Women with Major Sickle Cell Syndrome: A Comparative Study of the Homozygous Forms “SS” versus the Heterozygous “SC”

Objectives: To determine the prevalence of women who delivered in the two major sickle cell syndromes, “SS” and “SC”, and to identify maternal and early neonatal prognosis inherent to each form. Material and Methods: This is a comparative, descriptive and retrospective cross-sectional study of 226 files of women carrying major sickle cell syndrome (66 cases of “SS” form versus 160 cases of “SC” form), collected from May 2008 to May 2013 at the Gynecology and Obstetrics Clinic of the Sylvanus Olympio’s University Hospital of Lomé. Data were processed by Epi Info 6 software. For comparison of variables, the Chi-2 test of Fisher with significance as p < 0.05 has been used, so is the calculation of Odds Ratio with its confidence interval at 95%. Results: Carriers of the two major sickle cell syndromes represent 0.8% of all the deliveries during the study period. Caesarean section, especially prophylactic one, was the dominant mode of delivery. The SS forms have been exposed to have more vaso-occlusive crises (22.7% vs. 13.1%;p = 0.04, OR = 0.31), more blood transfusion (57.6% vs. 29.4%;p = 7 × 10-5, OR = 3.2) and more puerperal infections (p < 0.05). Acute chest syndrome was not related to any of the two forms of sickle cell disease (13.6% vs. 8.1%;p = 0.15). The maternal mortality rate and the perinatal mortality among SS form against SC form were not significant (respectively 15.1% vs. 8.7%;20.9% vs. 17.1%). Conclusion: Maternal and fetal complications were present in both forms of major sickle cell syndrome but the "SS" form gave exposure to greater maternal morbidity. Resuscitative measures in adults and newborns should be reinforced at the delivery time of these “at-risk-pregnancies”.

Women’s Preferential Contraceptive Methods in Publics’ Family Planning Centers in Lomé(Togo, West Africa): A Prospective Study of 734 Cases

Justification and Objectives: The reasons for the choice of contraceptive methods in Lomé were insufficiently documented. The current study aimed to identify preferential contraceptive methods in women in Lomé and the reasons for the choices. Materials and Methods: Prospective study conducted on 734 clients recruited in five family planning centers in the municipality of Lomé over a period of 3 months (30th September to 30th December 2005). Data were collected by direct interview and processed by Excel and Epi info 7 software. Results: Contraceptive methods preferred in descending order were: Medroxyprogesterone acetate injection (51.6%), Norethisterone enantate injection (17.3%), inert Intra Uterine Device (12.0%), Progestogen implants (11.0%), combined oral pills (8.03%) and spermicide jelly (0.1%). The main reasons for choices were the method’s reversibility (32.56%) and its long acting property;especially in illiterate women (p 10-10). Friends and medical staff counted for the choice in 9.26%. In 76.87% of cases, the husbands were reported to agree with the chosen methods. Conclusion: The choice of contraceptive methods in Lomé was mainly guided by the notion of reversibility and its long acting property. The focus should be put more on the quality of counselling towards women with low education level.

Ultrasound-Guided Core Needle Biopsy of Breast Lesions: Results and Usefulness in a Low Income Country

Background: Core needle biopsy (CNB) under ultrasound guidance is an accepted standard of care for the diagnosis of breast lesions. It is safe, cost-effective and minimally invasive compared with surgical excision. Objective: The aim of this study was to evaluate the CNB’s results regarding the procedure, complications, histopathological findings and their correlation with the imaging data and surgical histopathological findings. Method: A cross-sectional prospective and descriptive study of a consecutive series of ultrasound-guided CNB of breast lesions in women conduced from January 2015 to December 2016 at the Sylvanus Olympio university hospital of Lomé, in Togo. Results: There were 72 CNB performed under ultrasound guidance in women;from which 54 were retained for the study. The mean age was 44.9 years ± 9.8. 11.1% had a family history of breast cancer. Lesions were most often palpable (90.7%). They were located in the left breast in 54.7%. Lesions were categorized probably malignant or malignant (Birads 4 and 5) in 70.4% and probably benign (Birads 3) in 29.6%. Their mean size was 24.8 mm ± 7.6 at ultrasound. There were no major complications during the procedure. One CNB (1.9%) considered inconclusive was repeated. Histologically, invasive ductal carcinoma (61.1%) was the most common lesion. Fifty-three women underwent surgical procedure and histopathological confirmation. Ultrasound-guided CNB had a sensitivity of 97.5%, specificity of 100%, positive predictive value of 100%, negative predictive value of 92.8%, and an overall diagnostic accuracy of 98.1%. Breast Imaging Reporting and Data System (Birads) categorization had a sensitivity of 94.8%, specificity of 100%, positive predictive value of 100%, negative predictive value of 87.4%, and diagnostic accuracy of 96.2%. Conclusion: Ultrasound guided CNB represent accurate methods for the characterization of breast lesions, with high values of diagnostic accuracy, sensitivity, specificity and negative predictive value. It does not involve a major complication, even in tropical environments.

Giant Breast Hamartoma: A Case Report in Togo

We report the case of a 50-year-old patient, who was explored in mammography, ultrasound and CT for a large painful mass of the right breast that had been evolving for 30 years and gradually increasing in size. There was a typical “sausage slice” appearance with clear center macrocalcifications on the mammogram;an aspect of “breast in the breast” on ultrasound. The scanner had made it possible to specify the dimensions of the mass, which measured 21.4 cm in height;18.6 cm wide and 9.5 cm thick. Histology after exeresis noted the adenolipofibromatous nature of the mass.

High Blood Pressure and Pregnancy in a Hospital Environment in Lomé: Prognostic and Clinical Epidemiological Aspects

Objectives: Study the prognostic, clinical and epidemiological profile of high blood pressure and pregnancy association at the Sylvanus Olympio Teaching Hospital (CHU Sylvanus Olympio) of Lomé. Patients and Method: It is about a retrospective study that is carried out at the gynecology-obstetrics unit from January to December 2016. Pregnant women with High Blood Pressure after delivery were concerned. Results: In total, 767 pregnant women with High Blood Pressure out of 12107 were taken. The frequency of HBP-pregnancy association was 6.33%. The 21 to 30 bracket age was the most represented (53.71%). The most common risk factor was the overweight or over-obseness (41.98%). Other risk factors were the first delivery and maternal age superior to 30 years old. Common clinical cases described in the study are the same as a predominance of preeclampsia. Caesarean has been the common method of delivering with foetal complications of prematurity type, neonatal suffering and hypotrophy. Conclusion: HBP-pregnancy association is a public health concern with serious foetal maternal complications. The prevention of this association is of great importance.