Cesarean Sections according to the Robson’s Classification in Two University Hospitals of Yaoundé: Indications and Maternofetal Outcome

Introduction: Cesarean section is a surgical intervention which consists in the extraction of a fetus from the uterus after its incision. The rate of cesarean section varies depending on the country and the health facility. For this reason, in 2015, the World Health Organization (WHO) recommended the use of Robson’s classification to evaluate the practice of cesarean sections in order to identify the groups of women who had abnormally high rates. The objective of our study was to evaluate cesarean sections using the Robson’s classification in CHRACERH and in the Yaoundé Central Hospital (YCH). Methodology: We carried out a retrospective cross sectional and descriptive study in two (02) university hospitals in Yaoundé which took place from December 2017 to May 2018. We included in our study all women who gave birth over a period of two (02) years from January 2016 to December 2017 in these two health facilities. Our sampling was exhaustive over the study period. The parturients’ information was collected using an anonymous and pretested questionnaire. The Robson’s group of every parturient was determined. Descriptive parameters like mean and proportions were calculated. We compared the rates and indications of cesarean sections between the both hospitals using Chi2 test. Results: Out of 330 deliveries realized in CHRACERH, we had 90 cesarean sections;hence, a rate of 27.2%. Out of 1863 deliveries carried out at the YCH, 462 were by cesarean section, hence a rate of 24.8%. The women who belonged to groups 1, 3 and 5 contributed to the highest rates of cesarean sections in both hospitals: in CHRACERH, group 5 (31.1%), group 3 (20%) and group 1 (15.6%), at YCH: group 3 (22.5%), group 1 (21.6%) and group 5 (17.3%). The indications of the cesarean sections varied depending on the Robson’s group and the hospital, the principal indication in group 1 was acute fetal distress (28.6%) in CHRACERH and cephalopelvic disproportion (36.7%) at YCH. Cephalopelvic disproportion was the predominant indication in groups 3 of CHRACERH (44.4%) and YCH (39.2%). In groups 5, CHRACERH and of YCH, a scarred uterus was the principal indication for the cesarean section at 82.4% and 78.4% respectively. At CHRACERH, the maternofetal complications were more frequent in groups 1 and 2 at the YCH, this was the case mostly in groups 1 and 3. Conclusion: The Robson’s classification is an adequate tool for the evaluation and comparison of the rates of cesarean sections. The rates of cesarean section in CHRACERH (27.2%) and at YCH (24.8%) were higher than the rates recommended by WHO. Robson’s groups 1, 3 and 5 were identified as the groups most at risk for cesarean sections in the both hospitals.

Caesarean Section in African Setting: Current Situation, Problematic and Qualitative Approaches at Laquintinie Hospital (Douala, Cameroon)

Background: Quality control of care aims to reduce or eliminate unnecessary care and to improve the quality of those who are useful both in their indication and in their implementation. Objective: We conducted this study to assess the rate of caesarean section, the rate of irrelevant indications, materno-foetal morbidity and mortality, biases in the management in order to suggest corrective approaches. Methods: It was a cross-sectional study conducted in the gynaeco-obstetrics department of the Laquintinie Hospital of Douala over a period of 4 months from January 1 to April 30, 2017. We included all pregnant women who had a caesarean section and who gave consent to our study as well as new-borns from these caesareans. We excluded caesarean deliveries from other health structures and referred to Laquintinie Hospital due to morbid operative follow-up. The variables collected were grouped under 3 main headings: socio-demographic data, clinical data and post-operative follow-up. Results: A total of 281 caesarean sections were performed out of a total of 967 deliveries;a caesarean section rate of 29.06% in 4 months. After data mining, 250 caesarean sections were included in the study because 31 cases of caesarean deliveries were unusable. Referred pregnancies accounted for 46.8% of the total population and the most common reason for referral was stationary labour (23% of cases). All caesareans were performed by the gynaeco-obstetricians. Women who had caesarean deliveries were informed by the operator of the surgical procedure in 28.4% of cases and 27.6% were notified of the indication for surgery. The operative kit was present in 98% of cases. The operating room was available in 93% of cases. Caesareans were performed mostly in an emergency context (91.2%) with a median turnaround time of 214 minutes (3 h 56 mins). Mechanical dystocia was the major indication in our series (21.2%) and 29 indications were irrelevant (11.6%). Intraoperative complications occurred in 3.2% of cases. Overall maternal mortality (per- and post-operative) was 0.8% (2 cases). We recorded 15 neonatal deaths out of which 8 were still births. Regarding the postoperative period, 78% of the operated patients did not have a good immediate postoperative monitoring. The post-operative protocol was not respected in 17% of cases. Postoperative complications occurred in 21.6% of patients with first cause being infections (10.8% with 5.6% being parietal suppurations). Conclusion: The frequency of Caesarean sections at Laquintinie Hospital is above the World Health Organization’s recommendations of 5% - 15%. There is a very big delay in the execution time of emergency caesareans, far above the international standards despite the quasi-availability of operating kits and the operating theatre. The state of the premises reveals a sub-workforce creating work overload and therefore a demotivation of the staff leading to insufficient communication between the operator and operated, a lack of postoperative follow-up and significant neonatal morbidity and mortality. Hence the need to initiate a staff satisfaction survey.

The Use of Visual Tests in the Screening Strategy of Cervical Dysplasies and Cervical Cancer at the Laquintinie Hospital Douala, Cameroon: A Cross-Sectional Study

Introduction: The prevalence of cervical cancer in Cameroon is 80.73/100,000 women, with an estimated incidence of 40/100,000 women-years. It is a real public health problem. There is no systematic and effective screening program for cervical cancer in our country, despite the advent of visual tests that are simple to use, low cost, and adapted to the modest income of our social groups. Objectives: We aimed at determining the usefulness and place of visual tests in screening for cervical dysplasia and cervical cancer for its implementation at the Laquintinie Hospital Douala, Cameroon. Methods: We conducted a prospective analytic cross-sectional study of cervical dysplasia and cervical cancer screening by visual testing at the Laquintinie Hospital Douala from December 1, 2016 to March 31, 2017. Data collection was by consecutive non-probabilistic method and consenting sexually active women older than 21 years were enrolled for study. Data analysis was with Epi InfoTM version 7. Associations were done with the Chi square, student t-test and Fischer’s exact test where appropriate. Bivariate and multivariate analysis was done and reported as odd ratios, adjusted odd ratios and 95% confidence intervals. Statistical significance was set at P 0.05. Results: We received 1590 women, of whom 1506 (94.7%) screened for dysplastic lesions and cervical cancer during the study period. The results obtained were: 1417 (94.1%) had a normal result;64 (4.2%) had a positive visual test (TV+);and 25 (1.7%) visual tests were inconclusive (TV-nC). Of the 64 women whose visual tests were positive, 15 (23.5%) were HIV+. We performed 80 colposcopies and biopsies, including 61 women with positive visual tests and 19 non-conclusive visual tests. Among women with TV+, we found 06 cancers (squamous cell carcinoma: 05, adenocarcinoma: 01) and 05 dysplasias (CIN1: 04, CIN3: 01). Histological examination in women with TV-nC revealed 02 dysplasias (CIN1: 02). Half of the women with cervical cancer were HIV+. In our series, the prevalence of cervical dysplasia and cervical cancer was respectively 05 per 1000 women and 04 per 1000 women. The early onsets of sexual intercourse and co-infection with HIV were the main factors associated. Visual tests were very sensitive (84.62%), but with a relatively low specificity (25.37%). Conclusion: Visual tests prove to be a useful tool for mass screening of precancerous and cancerous lesions of the cervix in view of its sensitivity, cost and performance.