Emergency C-Section on Multi-Scar Uterus: Maternal and Fetal Prognosis at the Nianankoro Fomba Hospital in Segou, Mali

Background: Multi-scar uterus is a uterus with two or more scars due to surgery or trauma. Objective: The aim was to compare the maternal and fetal prognosis of emergency C-sections of bi-scar uteruses to those of uteruses with at least 3 scars at the Nianankoro Fomba Hospital in Segou. Materials and Methods: It was a descriptive and analytical cross-sectional study with prospective data collection over a 24-month period from March 20, 2018, to March 20, 2020. Results: In 2 years, we collected 103 emergency C-sections for multi-scar uterus out of 1198 C-sections with a frequency of 8.6%. The age group of 20 to 35 years was the most represented with 86.4%. The bi-scar uteruses were the most frequent with 77.7%. In 71.8% of cases, the C-section was performed during the latent phase of labor. The C-section was performed under loco-regional anesthesia in 89.3% of cases. Difficulties in hemostasis and bladder injury were the most frequent intraoperative accidents. Surgical site infection was the main postoperative complication. No maternal deaths were recorded. The perinatal prognosis was marked by 4.3% fresh stillbirths in bi-scar uterus against 3.7% in three or more scar uteruses and including 2 fresh stillbirths and 1 macerated. We did not record any early neonatal deaths after C-section. Conclusion: The frequency of emergency C-sections in patients with a multi-scar uterus remains very high in our hospital. A better awareness of the patients, their spouses and all the actors involved in the management of pregnancies and childbirth, can contribute to curb this trend.

Ovarian Pregnancy: A Case Report

Background: Ovarian pregnancy is a rare entity of ectopic pregnancy, with a prevalence in the literature estimated between 1/2500 to 1/5000 births. The majority of ovarian pregnancies are diagnosed in the 1st trimester due to the noisy symptomatology. However, in small proportions, they may continue into the 2nd or 3rd trimester, making their diagnosis more difficult. Aim: We report a case of ovarian pregnancy in a 26-year-old patient, discovered intraoperatively as a large unruptured ovarian mass. Case report: A 26-year-old woman referred to the maternity ward for management of fetal death in utero at 31 weeks of amenorrhea associated with overlying placenta previa. Ultrasound performed in the department, was in favor of an abdominal pregnancy stopped at 31 SA with a placenta that seemed to adhere to the posterior wall of the uterus, which was empty. A Laparotomy was performed, on exploration, a large right ovarian mass was found, the site of the pregnancy. A right adnexectomy, after adhesiolysis, was performed. The incision of the operative part revealed a macerated female fetus. The clinical evolution was favorable. Conclusion: We report on a case of unruptured ovarian pregnancy, discovered in the 3rd trimester of pregnancy. The ultrasound diagnosis of an ovarian pregnancy beyond the 2nd trimester remains a challenge, the management remains surgical.