Maternal Hospital Mortality in Cotonou: Incidence, Care-Associated Adverse Events and Causes

Introduction: Despite the many efforts made to combat preventable maternal deaths, these still remain high in Benin. It was therefore important to revisit the causes but especially the adverse events associated with care (EIS) in maternity. Objective: Determine the incidence, adverse events associated with care and causes of intra hospital maternal mortality in cotonou. Methods: This was a cross-sectional maternal mortality review study with retrospective data collection. It covered all cases of maternal death recorded between 2017 and 2021 in two (2) reference university maternities in Cotonou. Adverse events associated with care and the patient were analyzed using the maternal death audit grid validated for Benin. SPSS.26 software was used for data analysis. Results: The in-hospital maternal mortality ratio in Cotonou was 2028 maternal deaths per 100,000 live births in 2021. Only 7.2% (n = 36) of deaths were audited. The deceased mothers were 29.8 ± 7.4 years old, with no fixed monthly income in 82.7% (n = 420). Serious adverse events associated with care were: delay in decision to refer in 37% (n = 188), non-medical referral in 85.8% (n = 436) of cases, inadequate pre-referral treatment in 25.7% of cases. In receiving maternities, delay in diagnosis and inappropriate treatment at the receiving maternity were noted respectively in 22.9% and 28.6% of cases of maternal death. The direct causes of maternal death were dominated by serious obstetric hemorrhage in 43.9% (n = 223). As for the indirect causes, they were dominated by anemia excluding obstetric hemorrhages in 21.5% (n = 109). Conclusion: The in-hospital maternal mortality ratio was very high in Cotonou. The main cause was severe obstetric hemorrhage. There were several serious healthcare-associated adverse events whose correct management would significantly reduce the incidence of maternal deaths.

Epidemiology and Clinical Signs of Gynecological Cancers in an African Country South of the Sahara: Case of the Republic of Benin in 2022

Introduction: Gynaecological cancers are the deadliest of the women’s cancers in the Republic of Benin. Late diagnosis is the most common reason. Objective: This paper aims to describe the epidemiological characteristics, and clinical and pathological signs of gynaecological cancers treated in the Republic of Benin between 2018 and 2022. Patients and Methods: This was a cross-sectional, descriptive, retrospectively collected study of patient data treated between 2018 and 2022 in two university gynaecology departments in Cotonou. All gynaecological cancers that have histological evidence were included. The epidemiological, clinical and pathological characteristics of the cancers were assessed. Results: Cervical, endometrial and ovarian cancers were the most common in the proportions of 62.0%, 24.1%, 12.0% and 1.8% respectively. The mean age at diagnosis was 54 years. The victims were uneducated and had low economic power in 81% and 85% of cases, respectively. The consultation was late in 82.1% of cases. Metrorrhagia, postmenopausal metrorrhagia and pelvic cluster headache were the common reasons for consultation for cervical, endometrial and ovarian cancer, respectively. Diagnosis was late in 66.7% (n = 71). The most common histological types were squamous cell carcinoma, endometrioid adenocarcinoma, and serous cystadenocarcinoma for cervical, endometrial, and ovarian cancers, respectively. Conclusion: Gynaecological cancers were common and their consultation time was delayed. The diagnosis was made at the advanced stage and there were several reasons for this.

Vaginal Touch versus Transvaginal Ultrasound in the Management of Threatened Preterm Labour at the University Hospital Center of Porto-Novo (Benin)

Objective: To evaluate the risk of preterm delivery with vaginal touch in opposition with transvaginal ultrasound in pregnant women who present signs and symptoms of threatened preterm labour. Methods: A prospective study was conducted with descriptive and comparative aims at the University Hospital of Porto-Novo, Benin Republic between 1 March and 31 August 2016. Every pregnant woman admitted to the emergencies of the maternity between 28 and 34 of WA (weeks of amenorrhoea) and attended for preterm delivery risk with intact membranes was included. The risk of preterm delivery was evaluated using vaginal touch and ultrasound examination of cervical length. Results: The risk of preterm delivery was obvious and identical with the cervical dilatation ≥2 cm when the vaginal touch was applied [RR 2.34 IC 95% (1.71 - 3.20)] and ultrasound examination of cervical length - 4.16)]. The cervix obliteration was not statistically linked to preterm delivery. The ultrasound examination of cervical length had a better sensitivity (87.76%) and a negative predictive value (81.54%) against 59.18% and 74.68% respectively for cervical dilatation at vaginal touch. Bishop score also had a better specificity with the one of the ultrasound examination of cervical length (79.11% vs. 33.54%) whereas both of them had almost identical negative predictive value (81.17% vs. 81.54%). Conclusion: Vaginal touch was also as relevant as transvaginal ultrasound while evaluating the risk of preterm delivery. For the lack of ultrasound in emergency rooms, a good physical examination would be sufficient by its own to decide of an adequate management when there is a threat of preterm delivery.

Thyroid Function in Pregnant Women from a West-African Population

Thyroid dysfunction is frequent in pregnant women and is often associated with an increased risk of adverse maternal and fetal outcome. In the present work, thyroid function of pregnant women from Benin republic was studied. Two hundred forty (240) pregnant women, without thyroid disease history, have been included in the study. A blood sample was drawn for measurement of TSH, free T3 and free T4 serum levels. From the first to the third trimester, plasma levels of free T3 and free T4 decreased when plasma levels of TSH increased. Using recommendations of the 2011 American Thyroid Association (ATA) guidelines, thyroid dysfunction was observed in 24.17% of subjects. Hypothyroidism was present in 22.50% of subjects with 19.17% of subclinical hypothyroidism, 0.83% of overt hypothyroidism and 2.50% of hypothyroxinemia and hyperthyroidism was observed in 1.67% of subjects. An increase from 15.52% to 28.07% was observed in the frequency of hypothyroidism from the first to the third trimester of pregnancy. When an upper cut-off value of 4 mU/L was used for TSH, as recommended in the 2017 ATA guidelines, prevalence of thyroid disorders was 14.58% with 12.91% of hypothyroidism but no hypothyroidism was observed in women in the first trimester of pregnancy. A rise in hypothyroidism frequency was observed when pregnant women age increased. Hypothyroidism was very common in pregnant women in Benin. To allow accurate assessment of thyroid status in pregnant women in Benin, pregnancy specific range for plasma level of TSH and thyroid hormones should be established.