Contribution of Simulation to the Skills Laboratory for the Learning of Obstetrical Examination in an African Setting with Limited Resources

Objective: To evaluate the interest of the simulation in the learning of the obstetric examination of parturient by medical students. Materials and methods: It was an analytical cross-sectional study that took place from 1 to 28 February 2020 at the Yalgado Ouedraogo Teaching Hospital in Ouagadougou, Burkina Faso. The study population was made up of medical students at the Doctorate II level. The previous experience of the students in the obstetric examination of the parturient, the contribution of the simulation on their feelings and on their skills towards this examination were studied. The Mc Nemar Chi2 test was used to compare percentages on paired samples. Results: The level of difficulty in performing the obstetrical examination in the parturient evolved downwards after the practice of the simulation. The stress level to perform the obstetric exam has been significantly reduced. On the other hand, confidence has increased. The students’ ability to appreciate each of the elements of the obstetric examination studied had improved after the practice of simulation. Conclusion: The simulation in the skills laboratory was a great contribution and the acquisition of models of better fidelity would help to improve the contribution to the confidence building and the acquisition of skills by learners.

External Hemorrhoidal Thrombosis in Recent Births at the Maternity Ward of Saint Camille Hospital in Ouagadougou

Introduction: External hemorrhoidal thrombosis is a clinical is the most common postpartum proctologic accident. The aim of this work was to study hemorrhoidal thrombosis in recent mothers, in order to help improve its management. Patients and Methods: This was a descriptive and analytical cross-sectional study that was carried out at Saint Camille Hospital in Ouagadougou, Burkina Faso. Data collection was prospective and took place over a period of three months from September 1 to November 30, 2019. The study population consisted of recent births. The interview with the patients and their physical examination enabled the collection of data. Results: During the study period, 384 women were examined and 56 (14.6%) of whom presented with external hemorrhoidal thrombosis. The average age of patients who presented with external hemorrhoidal thrombosis was 29 years ± 5.2. The external hemorrhoidal thrombosis appeared in the form of a painful swelling at the level of the anal margin. In multivariate analysis, dyschezia and personal history of hemorrhoidal disease were risk factors for external hemorrhoidal thrombosis in the postpartum period (OR = 37.4 [6.8 - 205.7];OR = 23.9 [3.3 - 174.2]. Consumption of fruit and foods rich in dietary fiber were protective factors against the occurrence of this risk (OR = 0.02 [0.002 - 0.3]). Conclusion: External hemorrhoidal thrombosis remains a complication to be taken into account during the monitoring of postpartum women. It is important to encourage pregnant women to consume foods and fruits rich in fiber seem to reduce the risk of its occurrence.

Vaginal Bleeding in the Nonpregnant Patient Received in Emergency at Yalgado Ouedraogo University Hospital of Ouagadougou, Burkina Faso

Objective: To describe the epidemiological, clinical and therapeutic aspects of cases of vaginal bleeding in the nonpregnant patient received in emergency at Yalgado OUEDRAOGO University Hospital. Materials and Methods: It was a retrospective and descriptive study that involved the clinical records of 326 patients collected from January 01, 2009 to December 31, 2013. Results: The average age of women was 47 years old with extremes at 12 and 82 years old. Women of childbearing age accounted for 61.6% and postmenopausal women 18.7%. 70.7% of women were pauciparous or nulliparous. Menorrhagia and pelvic pain were the main signs associated. This symptomatology required hospitalization in 85.2% of cases. The main aetiologies were uterine myomas 49.69%, cervical cancer 23% and functional metrorrhagia 11.04%. Progestin was the most used drug in 67.1% of cases. Total abdominal hysterectomy and abdominal myomectomy were the most commonly used surgical methods with 22.3%, 44.4% of cases. Eleven death cases were observed. Conclusion: Gynecological metrorrhagia is more common in women of childbearing age than in menopausal women. The main causes are fibroma, cervical cancer and functional metrorrhagia.

Maternal Mortality in the Obstetrics and Gynecology Service of Regional Hospital Center of Ouahigouya: Epidemiological, Etiological Aspects and Contributing Factors—About 151 Cases Collected in Three Years from 1st January 2013 to 31 December 2015

The objective of our study was to study the epidemiological, etiological and contributory factors of maternal deaths in the obstetrics and gynecology department of the regional hospital center (RHC) of Ouahigouya from 2013 to 2015. We carried out a descriptive and analytical study on maternal deaths in maternity of the RHC of Ouahigouya, including all patients who died in the obstetrics and gynecology department of the RHC of Ouahigouya from 1 January 2013 to 31 December 2015, which meets WHO’s definition of maternal death. We recorded 151 maternal deaths and 5481 live births, a maternal mortality ratio of 2755 per 100,000 live births. The most affected women were women aged 20 - 24 years (27.8%), multiparous (25.5%), married women (88.7%) and those without income-generating activities (85.4%). The main causes of death from direct obstetrical complications were hemorrhage (38.3%), infections (21.5%), abortions (16.8%) and complications of hypertension disorders (15.8%) and for indirect obstetrical complications, malaria (36.6%), anemia (29.5%), and HIV/AIDS (9.1%). Contributing factors to maternal deaths prior to admission were delay in referral (33.3%) and delay in transfer (31.5%) and delay in admission (32.8%) and delay in diagnosis (23.4). From our study, it appears elsewhere as well as that most maternal deaths are preventable, hence the need for coordinated actions to effectively fight against maternal mortality.

Emergency Cesarean Section for Teenagers at Yalgado Ouedraogo Teaching Hospital (YOTH), Ouagadougou, Burkina Faso: Frequency, Indications, Maternal and Perinatal Prognosis

Objective: To study emergency cesarean section in teenagers with the goal of reducing morbidity and maternal-fetal mortality. Methods: This was a descriptive cross-sectional study with prospective collection of data on 248 cases collected from July 1st to December 31st, 2016. Results: The incidence of cesarean section in teenagers was 56.4%. The average age was 18 ± 0.4 years old. The vast majority were primiparous (92.7%). The main indications for emergency Caesarean section were: pre-eclampsia and its complications (20.2%), acute fetal distress (18.5), pre-rupture syndrome (14.1%) and bone dystocia (11.7%). The maternal mortality rate was 1.6% and perinatal mortality was 134 per 1000 live births. Conclusion: The rate of caesarean section is high at Yalgado OUéDRAOGO Teaching Hospital of Ouagadougou. Postoperative complications are sometimes serious and compromise the maternal and fetal outcome. There is a need for increased surveillance of all pregnant and recently delivered women to reduce maternal and perinatal mortality in teenagers.

Bilateral Tubal Molar and Embryonic Pregnancy

Aim: To report a case of bilateral tubal molar and embryonic pregnancy diagnosed and treated at the Yalgado Ouedraogo Teaching Hospital in Ouagadougou, Burkina Faso. Observation: It was an 18-year-old patient, G2P0 with no known pathological history. She was received in obstetric emergencies for suspicion of ectopic pregnancy in a two-month amenorrhea context. At the admission, the physical examination had found a sensitivity of the hypogastric region with a cry of the umbilicus and the bleeding. At pelvic ultrasound, the uterus was empty with a medium-abundance pelvic effusion and a left extra uterine mass. The initial rate of beta HCG was 5700 ml IU per ml. A framed laparotomy was carried out. The operative exploration has revealed a right tubal pregnancy cracked and a left unbroken tubal pregnancy. The diagnosis of a bilateral ectopic pregnancy was retained. A right salpingectomy and a left tubal caesarean section were carried out. Histological analysis confirmed the diagnosis of a left embryonic ectopic pregnancy associated with a right molar ectopic pregnancy. Conclusion: The systematic use of histological analysis for any extra uterine pregnancy treatment is required to not ignore an associated molar pregnancy.

Placental Abruption in the Obstetrics and Gynecology Service of Regional Hospital Center of Ouahigouya: Epidemiological, Clinical Ant and Therapeutic Aspects about 89 Cases Collected from 1^stJanuary 2013 to 31^stDecember 2015

Objective: To study epidemiological, clinical ant therapeutic aspects of placental abruption in the service of obstetrics and gynecology of regional hospital center of Ouahigouya. Methods: We conducted a cross-sectional study scheduled for 3 years, from 1st January 2013 to 31st December 2015. Data were collected from patients’ folder, theater register and maternity delivery register. Results: We recorded 5791 deliveries, out of which 89 were placental abruption cases giving a rate of 1.54% of deliveries. The women most affected were whose with age ranging 25 - 30 years (30.33%), the nulliparous women (32.58%), the married women (83.52%) and whose with bad antenatal clinic attendance (54.6%). The clinical aspect was most often complete: nil fetal heart rate (82.00%), hypertony uterine (79.90%) and vaginal bleeding (74.20%) were the most signs found. Spontaneous vaginal delivery has been made in 64.04%. Maternal prognosis was dominated by a morbidity linked by an anemia in 53.90%. Maternal lethality was 2.20%. Fetal newborn-death was 88.80%. Conclusion: Placental abruption represents an obstetrical and medical emergency by its start of brutal installation, its unforeseeable character and its materno-fetal consequences. Only a tacking of risk populations, precocious of diagnosis and a speed management in surgical and medical unit allow improving the prognosis of this disease.