Epidemiologic Profile of Maternal Deaths in Two Referral Hospitals in Cameroon

Introduction: Our objective was to compare the epidemiologic profile of maternal mortality in two structures serving as referral levels of care in Cameroon. Methodology: This cross-sectional, comparative study took place at the maternities of the Yaoundé Central Hospital (YCH) and the Bamenda Regional Hospital (BRH) from December 1st 2014 to May 31st 2015, a 6 months’ period. The medical records of deceased women over 5 years, from January 2010 to December 2014, were collected. We calculated the MMR (Maternal mortality rate) and studied the causes and risk factors associated with maternal death. The Epi info software 3.5.4 was used to analyze data with a significance level of P < 0.05. Results: The maternal mortality ratio (MMR) was 964 and 247 per 100,000 live births for YCH and BRH, respectively. More deaths occurred within the aged group range 20 to 34 years, 76.8% at YCH and 64.7% at BRH. At YCH, 70.7% of these patients were referrals versus 32.4% at BRH. Complication from abortion was often implicated at BRH (P = 0.007;OR = 0.31;CI = 0.13 - 0.74). Others causes were hemorrhage (YCH = 43.4%;BRH = 35.5%), hypertensive diseases (YCH = 17.2%;BRH = 14.7%) and infections (YCH = 8.1%;BRH = 17.6%). At YCH time elapsed from admission to death was <3 h (P = 0.005;OR = 6.63;CI = 1.49 - 29.5). Conclusion: Both hospitals have similar causes of maternal deaths, differing only in the context within which the deaths occurred. Improving access to good quality health care, satisfying unmet needs for family planning, availability of blood products and the establishment of health insurance could decrease the maternal mortality rate.

Risk Factors for Breast Cancer: A Case-Control Study of 315 Women Followed in the Gynecology and Oncology Departments of Two University Teaching Hospitals in Yaounde, Cameroon

Introduction: Breast cancer is the most common cancer and the first cause of cancer-related deaths among women in Cameroon. The aim of the study was to investigate its risk factors for breast cancer at two University Teaching Hospitals in Yaoundé. Methodology: A case-control study was conducted for 5 months, from February 25th to July 25th 2015, at the Gynecology unit of the Yaoundé Gyneco-Obstetric and Pediatric Hospital (YGOPH) and the Medical Oncology unit of the Yaoundé General Hospital (YGH). One hundred and five patients with breast cancer (cases) were compared to 210 women who did not have breast cancer (controls). SPSS Version 18.0.0 software was used to analyze the data with a statistical significance considered at P-value 50 years (P three times per week (P = 0.002;OR = 2.14;CI = [1.33 - 3.45]), palm oil consumption > two times per week (P = 0.001;OR = 2.38;CI = [1.4 - 4.1]). After multivariate analysis, age > 50 years (aOR = 41.48;CI = [2.46 - 69.9]) and consumption of red meat > three times per week [aOR = 7.33;(1.49 - 36)] were the risk factors considered significant for breast cancer. Conclusion: Age > 50 years and red meat consumption are independent risk factors for breast cancer at the Yaoundé General Hospital and at the Yaoundé Gyneco-Obstetric and Pediatric Hospital.

Risk factors of intrapartal fetal death in a low-resource setting

Objective: To identify the risk factors of intrapartal fetal death in a tertiary hospital in Yaoundé. Methods: It was a case-control study comparing 53 women who delivered with intrapartal fetal death to 106 women who delivered without intrapartal fetal death, carried out at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon. Results: The risk factors of intrapartal fetal death identified at bivariate analysis were: maternal age <20 years (OR = 3.1;CI = 1.1 - 8.3), absence of regular income (OR = 2.4;CI = 1.2 - 4.7), single motherhood (OR = 2.9;CI = 1.5 - 5.7), illiteracy and primary level of education (OR = 4.7;CI = 1.9 - 11.5), referral (OR = 5.0;CI = 2.5 - 9.9), parity 0 and 1 (OR = 2.3;CI = 1.1 - 4.5), no antenatal care (OR = 9.2;CI = 2.4 - 35.6), number of antenatal visits <4 (OR = 4.2;CI = 2.1 - 8.6), antenatal care in a health center (OR = 3.8;CI = 1.9 - 7.5), antenatal care by a midwife (OR = 2.5;CI = 1.3 - 4.9) or a nurse (OR = 5.2;CI = 1.4 - 18.7), absence of malaria prophylaxis (OR = 10.6;CI = 2.9 - 39.5), absence of obstetrical ultrasound (OR = 4.7;CI = 1.9 - 10.9), prematurity (OR = 3.4;CI = 1.5 - 7.3), abnormal presentation (OR = 2.6;CI = 1.1 - 5.9), ruptured membranes at admission (OR = 2.7;CI = 1.3 - 5.4), ruptured membranes >12 hours at admission (OR = 5.1;CI = 2.5 - 10.3), stained amniotic fluid (OR = 4.8;CI = 2.4 - 9.7), labor lasting more than 12 hours (OR = 18.1;CI = 8.0 - 41.0), presence of maternal complications (OR = 4.7;CI = 2.2 - 10.3), and presence of fetal complications (OR = 48.6;CI = 18.3 - 129), particularly acute fetal distress (OR = 52.3;CI = (14.6 - 186), cord prolapse (OR = 12.1;CI = 3.3 - 43.4), and birth weight <2500 g (OR = 2.8;CI = 1.2 - 6.6). Conclusion: Close attention should be offered to pregnant women, so as to identify these risk factors and promptly provide an appropriate management.

Outcome of cesarean delivery in women with excessive weight gain during pregnancy

The objective of this study was to assess the effects of excessive weight gain during pregnancy on the outcome of cesarean delivery. It was a cohort study comparing the outcome of cesarean delivery between 56 pregnant women with excessive weight gain during pregnancy and 75 pregnant women with no excessive weight gain during pregnancy, consecutively recruited at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon. In women delivered by cesarean section, excessive weight gain during pregnancy was found to predispose to: time interval from parietal incision to fetal extraction of more than five minutes, duration of cesarean section more than 60 minutes, blood loss more than 1000 ml during surgery, post-operative maternal complications, especially sepsis, fetal weight >3.5 kg and macrosomia. A systematic screening of excessive weight gain should be offered to all pregnant women, so as to prevent the adverse effects of excessive gestational weight gain on cesarean outcome.

Risk factors of clinical birth asphyxia and subsequent newborn death following nuchal cord in a low-resource setting

Introduction: Our aim was to identify the risk factors of clinical birth asphyxia and subsequent newborn death in the presence of nuchal cord in a sub-Saharan Africa setting. Methodology: It was a six-months’ case-control study involving 117 parturients whose babies presented with a nuchal cord at delivery. The study was carried out at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon, from January 1st to June 30th 2013. Results: The risk factors of clinical birth asphyxia identified were: first delivery, absence of obstetrical ultrasound during pregnancy, nuchal cord with more than one loop, duration of second stage of labor more than 30 minutes during vaginal delivery. The risk factors for newborn death from clinical birth asphyxia in the presence of nuchal cord were: maternal age Conclusion: We recommend a systematic obstetrical ultrasound before labor, so as to detect the presence of a nuchal cord, its tightness and the number of loops. Also, cesarean section should be considered when a nuchal cord is associated with first delivery, tightness or multiple looping.

Per-Partum Anaemia and Missed Post-Partum Haemorrhage in Low Resources Settings

Background: Post-partum haemorrhage is the leading cause of maternal death throughout the world, and anaemia is one of its indirect causes. Anaemia during labour increases the risk of PPH and may lead to maternal mortality even after moderate PPH. Undiagnosed PPH and post-partum anaemia increases the risk of late maternal death in the community. The aim of this study was to assess the prevalence of anaemia on admission for labour, the occult early post-partum haemorrhage and the magnitude of post-partum anaemia in a low resource setting. Methods: This was a longitudinal study. We included pregnant women in labour. Haemoglobin concentration was measured on admission (H0), then 24 hours (H24) and 48 (H48) hours later. The post-partum blood loss was estimated by delta haemoglobin, using the criteria of M. Driessen et al. Results: We recruited 245 pregnant women. The mean age was 27.0 ± 6.0 years. The mean hemoglobin concentration was 11.7 ± 1.9 g/dl, the frequency of anaemia was 30.6% and was related to ethnicity (P = 0.042) gestational age (p < 0.001) marital status (p = 0.014) and the inter pregnancy time space (p = 0.001). Twenty-two-point two percent had post-partum haemorrhage among which 40% were undiagnosed. The mean blood loss was 375 ml and post-partum anaemia rate was 44.5%. Conclusion: Anaemia on admission was related to socio-demographic characteristics. The frequencies of anaemia during labour, missed PPH and undiagnosed post-partum anaemia were high. Haemoglobin concentration on admission for labour and after delivery, reliable method to assess PPH should be mandatory, to better identify per and post-partum anemia, and the management of PPH, in low income environments.