Polymyomectomy during Cesarean Section at the University Hospital Center of Brazzaville (Congo): About a Case and Review of the Literature

Introduction: Myomectomy during cesarean section has long been a controversial subject. The increased risk of intraoperative hemorrhage and potential hysterectomy has led many teams to contraindicate it, postponing it three to six months after delivery, thus giving more time for uterine involution, myoma shrinkage and reducing operative time and blood loss. Clinical Observation: We report the case of a polymyomectomy after use of a segmental tourniquet and bilateral ligation of the hypogastric arteries during a cesarean section for hemorrhagic placenta previa at the end of a spontaneous pregnancy of 28 weeks of amenorrhea in a 42-year-old nulliparous primigravida patient. Conclusion: Polymyomectomy during cesarean section is possible and requires knowledge of preventive hemostasis techniques and surgical experience.

Knowledge, Attitudes and Practices of Mothers Regarding Breastfeeding in the University Hospital Center of Brazzaville (Republic of Congo)

Objective: To analyze the knowledge, attitudes and practices of mothers about breastfeeding at the Brazzaville University Hospital Center. Population and Methods: Analytical KAP study, conducted from February 1 to May 31, 2019, including exclusively manner mothers who have started breastfeeding for at least 4 months and at most 24 months in accordance with the recommendations of the World Health Organization. The study variables were related to socio-demographic characteristics, knowledge, attitudes and practices. Results: One hundred and forty mothers were questioned. They were of a median age of 30, multiparous (61.5%), in a couple (78.6%), with gainful activity (47.9%). They had enough knowledge (87.1%) but harmful in 26.5% of cases, adapted attitudes (95%) with answers of different certainties, and bad practices (60%). Knowledge did not influence attitudes (p > 0.2). Knowledge and attitudes influenced practices (p Conclusion: An educational strategy on mothers’ knowledge and attitudes towards breastfeeding would help improve their breastfeeding practices.

Acute Genital Peritonitis in Brazzaville, Congo

Genital peritonitis is rare in daily surgical practice in Congo-Brazzaville. Clandestine abortions are incriminated. The purpose of the study is to analyze the epidemiological, etiological, diagnostic and therapeutic aspects of genital peritonitis. A retrospective and case series study was realized in departments of Digestive Surgery and Gynecology-Obstetrics of the University Hospital of Brazzaville. The inclusion criteria for the diagnosis of peritonitis were abdominal pain, fever, transit disturbances and signs of peritoneal irritation. The parameters studied were: age, etiological circumstances, anatomical lesions, type of surgical treatment and evolution. During the study period (July 1, 2015-December 31, 2017), 306 patients were admitted to both departments for acute generalized peritonitis. Among them, a genital cause was incriminated in 18 (5.9%) patients. The mean age was 27.6 ± 3.1 years. At the parity and gestational level, 93% of patients had at least two pregnancies, but not more than the second trimester. In addition, 50% of the patients had an induced miscarriage, due to uterine and intestinal lesions. Induced miscarriages accounted for half of etiological circumstances. Physical examination of the abdomen revealed abdominal contracture in 61.1% of cases. Main visceral lesions were uterine perforation (55.5%) followed by rupture of tubo-ovarian abscess (38.9%). The operative follow-up was simple in 83.33% of cases. In conclusion, genital peritonitis remains unfrequented. Median laparotomy has been the main therapeutic approach in our context where emergency laparoscopic surgery is not yet common.