Management of Ectopic Pregnancy at the Brazzaville Hospital and University Centre

Objective: To evaluate the current management of ectopic pregnancies (EPG) at the University Hospital Centre (UHC) in Brazzaville because the practice was usually limited to total salpingectomy by laparotomy. Patients and methods: This was a descriptive study, with retrospective data collection, conducted from July 30, 2015 to January 30, 2016. It included patient records admitted to the Obstetrical Gynecology Department of the Brazzaville University Hospital for an EP, a diagnosis made before visualization on ultrasound of an active embryo outside the uterine cavity or per laparoscopy, but often by exploratory laparotomy. Sociodemographic and clinical data, as well as the therapeutic modalities of the patients, were analyzed. Cases of women operated for EP in other health facilities and referred to the UHC for complication management and cases that were unusable were excluded. Results: We noted 39 EPs out of 4490 deliveries, representing a frequency of 0.86%. The average age of the patients was 28.9 years (extreme 18 - 46 years). The transfusion of labile blood products concerned 84.6% of patients. There was no therapeutic abstention;medical treatment was performed in 3 patients (7.7% of cases). Diagnostic and therapeutic laparoscopy was performed in 9 patients (23.1%) and laparotomy was used in 26 patients (66.7% of cases) in which 35 Salpingectomies (89.7% of cases) were performed. The immediate postoperative period was marked by anaemia (32 cases or 82.1%), surgical site infection (1 case or 2.6%) and parietal suppuration (1 case or 2.6%). Conclusion: The dissemination of therapeutic advances in the management of EP is also possible in African settings.

The Fate of Newborns Delivered through Cesarian Section at Brazzaville University Hospital

Objectives: To assess the fate of newborns born by emergency Cesarean section during the early neonatal period at the University Hospital Centre (UHC) in Brazzaville, with a view to improving neonatal prognosis. Patients and methods: This was a descriptive and cross-sectional analytical study of exposed and unexposed type, which took place from 24 March 2018 to 24 May 2018. All cases of newborns born by Cesarean section were included. Children born by extreme emergency and urgent Cesarean section were considered as exposed, and the others not exposed. The variables studied were the epidemiological characteristics of the mothers, the history of pregnancy and its management, anthropometric data on the newborn, the state of the child at birth and monitoring up to the seventh day. The test for comparing the proportions of target groups related to the child’s condition was used. Results: The mothers were aged 20 to 29 years (extreme 16 to 44 years);32 of them (22.5%) had a scarred uterus;29 pregnant women (20.4%) had a pathology associated with pregnancy. The distance travelled to consult was between 5 and 10 Km (63 cases or 44.3%). Emergency Caesarean sections were performed in 110 patients (77.5%) and scheduled Caesarean sections in 32 pregnant women (22.5%). Localoregional anaesthesia by spinal anaesthesia predominated (78.9%), by the association Bipivancaine + Fentanyl (69 cases or 48.6%) whose practitioner was often the nurse anaesthetist (131 cases or 92.3%). No accidents have occurred intraoperatively. At birth we noticed: 4.2% stillbirth, 19.7% bad, requiring resuscitation of at least 5 minutes for 16 newborns (57.1%). 26 newborns (18.3%) required care in the Neonatology Department. Early neonatal morbidity was dominated by respiratory distress (10 cases or 38.5%), early neonatal infection (5 cases or 19.1%) and a lethality rate of 19.2%. Conclusion: The future of the newborn, born by emergency Cesarean section is mixed;emergency control can improve the situation.