Materno-Fetal Outcomes of COVID-19 Infected Pregnant Women Managed at the Douala Gyneco-Obstetric and Pediatric Hospital—Cameroon

Introduction: The first case of the novel coronavirus (COVID-19) pandemic in Cameroon was confirmed on March 6, 2020. Though widely considered that pregnant women are more susceptible to respiratory tract infections, the available body of literature on the effect of COVID-19 on pregnancy outcomes is shy from being conclusive. In Cameroon, the Douala Gyneco-Obstetric and Pediatric Hospital (DGOPH) was one of the main frontline tertiary health facilities for the management of severe forms of the disease. After four months of managing COVID-19 cases in the general population and especially in pregnant women at the DGOPH, we decided to take a stop, analyze our findings from the patients managed in order to drive future policies and clinical practices via informed decisions. Overall objective: To describe and understand the clinical burden of patients managed for COVID-19 in pregnancy or post-partum at the DGOPH. Methodology: Cross-sectional and descriptive study covering four months—March 24th to July 24th 2020 at DGOPH. Using a pretested questionnaire, we systematically enrolled all patients who fulfilled the inclusion criteria, with analysis done using proportions from an excel spreadsheet. Results: A total of 18 on the 301 pregnant women consulted at the DGOPH, tested positive for COVID-19 giving a prevalence of 6%, and representing 2.3% of all the 800 COVID-19 cases. Of the 44 pregnant women admitted at the DGOPH, 13 of them were due to COVID-19, giving a general admission proportion of 29.5% and a COVID-19 case admission rate of 72.2%. Two-thirds (66.7%) of the patients were aged 30 - 39 years and over 61.1% (n = 11) of the total cases were referred from other health facilities for better management. The most common presenting symptoms were: fever (27.4%), cough (21.5%) and dyspnea (15.7%). Over 72.2% of cases were in their third trimester, and only three had comorbidities. Nasal throat swab PCR was mainstay for confirmatory diagnosis (83.3%). Chest CT scan was realized in 50% (n = 9) of the patients and ground glass opacification (GGO) was observed in all of them. All 18 patients received the standard national recommended regimen therapy for COVID-19. While five of the cases are ongoing gestations, 8 of them were delivered by cesarean section (61.5%), mostly indicated for maternal distress. The neonatal mortality rate was 46%. Four of the 18 patients died giving a case fatality rate of 22.2%. Conclusion: The profile of COVID-19 pregnant women in Douala-Cameroon tends to be similar to what is observed around the world. However, the high ICU admission rate and high case fatality rates recorded differ from what is observed worldwide.

Improving Post Abortion Care (PAC) Delivery in Sub-Saharan Africa: A Literature Review

Saharan Africa (SSA) contributes 29% of the global unsafe abortions with 62% of abortion-related deaths. This is due to restrictive abortion laws, low quality post abortion care (PAC) and inadequate access to effective modern contraception. The overall objective was to review current literature on PAC in SSA and make recommendations for improvement especially in Cameroon. A literature review was conducted on PAC in SSA published during 2000-2018. The following databases were searched: MEDLINE, POPLINE, COCHRANE Library, African Index Medicus and GOOGLE Scholar. Thirty articles were reviewed from 16 countries ranging from observational studies to systematic reviews with meta-analysis. Major outcomes: 1) Manual vacuum aspiration (MVA) and misoprostol are equally safe and effective. 2) There is comparable effectiveness between physicians and trained mid-level cadres in PAC management. 3) PAC contraception uptake was increased when offered immediately before patient leaves the facility. 4) Gaps to PAC service use include inadequate access, low quality care and less adolescent-friendly environment. Task shifting of PAC to trained mid-level staff, decentralization of medical PAC using misoprostol, offering post abortion counselling and contraception to clients before leaving the health facility, encouraging linkage and provider-community partnership in PAC and reinforcement of advocacy for less restrictive abortion laws in Cameroon are recommended.

Comparison of Chest Computed Tomography Findings between Pregnant and Non-Pregnant Women with COVID-19 Infection in Douala Gyneco-Obstetric and Pediatric Hospital, Cameroon

Introduction: Pregnancy is a physiologic state associated with decreased immunity, and the use of medical imaging modalities with ionizing radiation must be justified as potential benefits must outweigh the risk of any harm. However, in the wake of SARS-CoV-2 virus pandemic, chest computed tomography (CT) is necessary to assess the severity of the disease. The objective of this study was to compare the chest CT findings of pregnant and non-pregnant women with SARS-CoV-2 viral pneumonia at a tertiary hospital setting. Materials and Methods: This was a cross-sectional, retrospective, descriptive study of admission records of pregnant and non-pregnant patients aged 15 - 49 years during a three (3) months period (April-July 2020) in DGOPH. Logistic regression was used to search for predictors of lung involvement during COVID-19. Results: A total of 31 patient files were studied of which 9 (29%) were those of pregnant women. The pregnant women mostly had a combination of lung ground-glass opacities and consolidation on CT compared to the non-pregnant women (7 out of 9 cases, 77.8%, vs. 6 out of 22 cases, 22.7%;p = 0.01). The group of pregnant women had more than 3 affected lobes (50.0% vs. 22.7%, p = 0.04) with a middle lobe predilection (77.8% vs. 31.8%, p = 0.02). CT predictors of COVID-19 pneumonia in the group of pregnant women after the multivariable logistic regression analysis were the presence of nodules (aOR = 13.9;95% CI: 1.25 - 134.2;p = 0.032) and linear bands of interlobular septal thickening (aOR = 17.8;95% CI: 1.46 - 217.6;p = 0.024). Conclusion: In this study, the chest CT of pregnant women with COVID-19 pneumonia revealed mostly a combination of findings compared to non-pregnant women, with more affected lobes. These findings suggest the likelihood of a greater CT severity of COVID-19 pneumonia among pregnant women and therefore the need for timely and appropriate management.