Predictive Factors of Complications of Vaginal Delivery on Scarred Uterus at the YaoundéGynaeco-Obstetric and Paediatric Hospital

Objective: This study was aimed at identifying predictive factors of complications during vaginal delivery on scarred uterus. Methodology: During 9 months, from October 1st, 2015 to June 30th, 2016, a case control study was carried out at the Yaoundé Gynaeco-Obstetric and Pediatric Hospital. Eighty nine women each with a single scarred uterus who presented with complications during delivery (cases) were compared to eighty nine others who had a successfully trial of scar (control) during the study period. Data were analyzed using the CSPro version 6.0 and SPSS version 20.0 softwares with statistical significance set at P Results: We recruited 2 groups of 89 women, aged 17 to 40 years, with an average age of 29.05 years. The majority of women with complications were married (50.6%) and unemployed (42.8%). Following univariate analysis, predictive factors of complications were: prematurity (OR = 7.4), post-term (OR = 13.7), no history of vaginal delivery on scarred uterus (OR = 4.3), inter-pregnancy spacing period greater than 60 months (five years) (OR = 2.9), History of caesarian delivery indicated for cephalo-pelvic disproportion (OR = 6.6), less than four ante-natal consultations (OR = 3.6), antenatal consultations done in a Health Centre (OR = 2.7), ante-natal follow up conducted by a nurse (OR = 2.4;IC = [1.2 - 4.7]), referral from a different health unit (OR = 4.4, IC = 2.0 - 9.4), a Bishop score less than 7 on admission (OR = 12.4, IC = 5.6 - 27.4), a meconium stained amniotic fluid (OR = 9.9;CI = [3.6 - 26.8]). After logistic regression, the retained factors associated with complications were post-term (aOR = 34.5), absence of vaginal birth after caesarian delivery, (aOR = 11.7), previous caesarean section indicated for cephalo-pelvic disproportion (aOR = 6.1), a bishop score less than 7 (aOR = 12.0), meconium stained amniotic fluid (aOR = 13.6). Conclusion: Predictive factors of complications can help anticipate negative obstetric outcomes.

Birth Injuries in Neonates at a University Teaching Hospital in Cameroon: Epidemiological, Clinical and Therapeutic Aspects

Background: Statistics on birth injuries in Cameroon are scarce, despite its frequency in postnatal consultations;we sort to find its prevalence and contributing factors, the different clinical presentations and treatment methods. Methodology: This was a retrospective, descriptive study. Data on maternal characteristics, neonatal factors, the place of birth and qualification of birth attendant, age at diagnosis, clinical presentation and management were considered. Results: Among the 14,284 newborns that were consulted from January 2003 to February 2014, 263 (1.84%) had birth injuries. The average age at diagnosis was 12 days. The contributing factors were: advanced maternal age, macrosomia, vaginal and instrumental delivery. Birth attendants were mostly nurses and the health center was the place of birth for 57.4% of patients. The main clinical presentations were: obstetric brachial plexus palsy (70.6%), fracture of the clavicle (22.5%) and fracture of the humerus (4.80%). Physiotherapy and orthopedic treatment were methods used with favorable outcome. Conclusion: The frequency of birth injury is relatively high in our context. The diagnosis is late, birth attendants need to be trained and systematic examination of all newborns in delivery room encouraged.