Implementing uterine balloon tamponade(UBT)device for immediate postpartum hemorrhage management:Leveraging resource allocation and highlighting noteworthy experiences

Background The use of uterine balloon tamponade(UBT)devices for intrauterine packing and management of vaginal bleeding by uterine atony has shown promising results in improving the quality of care and reducing maternal mortality.Objective This report aims to provide an overview of progress made in implementing UBT devices in northern Cote d'Ivoire.Material and methods A four-year retrospective study was conducted in the North-East(163,645),North-Center(351,909),and North-West(57,983).In 2017,UBT was adopted by members of the healthcare system.Subsequently,5 national and 32 regional trainers have been trained.The training session was a theoretical and practical program with a low simulator.UBT is a male condom tied to a urinary catheter,filled with liquid.Positive outcomes included stopping bleeding,avoiding the need for surgery,and preventing maternal deaths(MD).In 2018,3,515 UBT devices were distributed.In 2019,monitoring tools and transmission circuits of the data were validated.In 2020,the collection of data and local manufacturing was launched.Results During the process,978 health workers,mainly midwife(52.0%)and nurses(32.2%)out of the 1,295 assigned were trained.The number of trained individuals decreased from 209 in 2019 to 160 in 2020.A total of 1,715 UBT devices were locally manufactured,adding to the existing gift of 5,080 devices,with total availability of 6,795.The distribution of devices increased from 2017 to 2019 but decreased in 2020.Success rates increased from 87.3%in 2017(365/418)to 95.0%in 2019(556/585)and slightly decreased in 2020 to 98.0%(681/695).Adverse outcomes(144/2,193),included MD(35/2,193)and medical evacuation to the surgical center(109/2,193).Conclusion The implementation of UBT in northern Cote d'Ivoire successfully reduced maternal death rates caused by immediate post-partum hemorrhage(IPPH).However,to ensure sustainability,further improvements are needed,including increased monitoring,ongoing training,and device availability.

Obstetrical specificities of Ivorian adolescent mothers on a single-center hospital series of 1040 cases

Overview and aim:The precocity of sexual intercourse among adolescent girls is a prominent source of unwanted pregnancy.Here,we aim to survey the past issues relating to the pregnancy,childbirth,and materno-fetal prognosis of Ivorian adolescent women.Methods:We conducted a retrospsective study with adolescent group(n=1040)versus young adult group aged 20 to 24(n=736)over three years from1st January 2016 to 31rd December 2018 at the Department of Obstetrics and Gynecology at the University of Abidjan-Yopougon Hospital.Maternal and fetal outcomes of the two groups were analyzed and compared by using Pearson's Chi2 tests and Fisher's exact tests,followed by multivariate analysis and logistic regression using Stata software version 20.Results:The average age of adolescent girls in our study was 17.45 years(SD=1.39)and a minimum of 12 years.Adolescents consulted less(P<0.0001)and later(P<0.0001)versus young adults aged 20 to 24.The proportion of adolescent girls(47.6%)versus young adults(39.1%)who had underwent caesarean section was significantly higher(P=0.0004).These adolescents were 3.5-fold more likely to develop hypertension and its complications in the postpartum period and 2.5-fold more likely to contract a postpartum infection.Maternal mortality was not significantly associated with adolescence(OR=0.52)(95%CI:0.22–1.19;P=0.0891).The risk of prematurity,early neonatal death,and neonatal admission were 2.02(95%CI:1.56–2.63;P<0.0001),1.55(95%CI:1.14–2.13;P=0.0040),and 1.73(95%CI:1.12–2.71;P=0.0097)in adolescence,respectively.Conclusion:Adolescent childbirth remains associated with a poor prognosis.

The delay, symptoms, and survival of Ivorian adolescent girls and young adults with uterine cervical cancer

Objective:To generate data on the nature and duration of cervical cancer symptoms,risk factors for delayed consultation,and diagnosis of adolescent and young adult groups in Cote d'Ivoire.Methods:This is a hospital-based cross-sectional study,conducted from July 2012 to May 2018,at the Department of Gynecology of the Yopougon teaching hospital in Cote d’Ivoire.The inclusion criteria were those who were under 40 years of age at the time of diagnosis with oral and written consent.Those whose information was more than 10%insufficient for the standards were excluded from the study.The survey files standardized anonymous pre-established data collected using medical records followed by phone calls.Results:The average age of the participants was 34±4.95 years with a minimum of 21 years.The mean parity per woman was 3.49±3.54.34.9%were HIV positive.The median patient delay was 122 days with a long delay in 84.62%of patients.The median time to total diagnosis was 209 days with a longer total delay in diagnosis of 87.18%.41%of patients honored their treatment,68.75%of which had received surgery,and 31.25%of which had received chemotherapy.The 5-year survival rate was 65%.Conclusion:The Ivorian health system must focus on primary and secondary prevention,the only guarantee to decrease the morbidity and mortality indicators linked to cervical cancer.