The Obstetric and Perinatal Outcomes of Adolescent Pregnancies in a Developed Cosmopolitan Middle Eastern Country: A Retrospective Pearl-Peristat Registry

Background: Early marriage is prevalent in Middle Eastern culture. The objective of this study was to investigate the pregnancy outcomes of married pregnant adolescents in a prosperous and highly developed Middle Eastern society, when they receive sufficient prenatal care and social assistance. Methods: A retrospective analysis was performed on the Peristat-based Maternal-Newborn registry utilizing hospital data acquired from four main governmental hospitals in Qatar. The study analyzed the pregnancy outcomes of young adults [ages 20 - 24) who experienced their first pregnancy and compared them to the pregnancy outcomes of adolescents aged 15 to 19 years old. Results: The study comprised a cohort of 3152 pregnant married women. This cohort included 2674 women between the ages of 20 and 24, as well as 478 adolescents aged 15 to 19 years old. In comparison to the young adult group, the non-Qatari population in the adolescent group was significantly higher (78.6% (376/478) vs. 71.5% (1914/2674), p-value = 0.003). Other Arab nationalities accounted for more than half of the adolescent population. All the mothers were married, did not use alcohol, and were nonsmokers. There were no documented mothers under the age of 15. Attending antenatal clinics was significantly higher in the adolescent group (p < 0.001). There was no significant difference in the mean gestational age at birth between adolescents and young adults (38.5 ± 2.3 weeks vs. 38.7 ± 2.1 weeks, p = 0.06). Furthermore, adolescent mothers had a higher rate of low birth weight (13.6% vs. 10.4%, p < 0.001) than young mothers. There was a non-statistically significant rise in pre-eclampsia incidence. Other unfavorable pregnancy outcomes were less common among them, such as diabetes, operative vaginal delivery, caesarean section, stillbirth, NICU hospitalization, and an Apgar score of less than 7 at five minutes. There were no maternal deaths;however, there was a comparable rate of neonatal in-hospital mortality. Conclusion: Pregnancy during adolescence may not relate to significant problems in a well-tolerant culture that ensures dedicated antenatal and social support.

Obstetric Anesthesia Practice Significantly Evolved: A Field for Cesarean Delivery Parturient for the Provision of Safe Anesthesia in Urgent Circumstances

General anesthesia and Obstetric Anesthesia is the gold standard for a cesarean section but there are some cases where general anesthesia is unavoidable. The use of general anesthesia for cesarean delivery has decreased in recent years due to the widespread use of neuraxial techniques. The choice of anesthesia techniques for cesarean delivery depends on several factors, including the patient’s psychology and the attending physician’s experience. It is chosen because of its safety profile and its benefits to the mother and fetus. It may be indicated due to emergency, maternal refusal of regional techniques, or regional contraindications. Major complications include failed intubation, gastric content aspiration, and increased bleeding risk. This study aims to evaluate the impact of a newly launched team on obstetric anesthesia practice.

Obstetric References in Disadvantaged Environments: Case of References to the University Hospital Center of Kara, in Northern Togo

Introduction: References are frequent and most often carried out in emergency situations. The objective of this study was to describe the epidemiological and clinical profile of obstetric referrals to the CHU-Kara. Methodology: This was a retrospective cross-sectional descriptive study conducted from September 1, 2022, to February 28, 2023, at CHU-Kara, focusing on obstetric referrals to the Gynecology-Obstetrics department. Result: 828 patients were referred for obstetric reasons out of 1295 admissions, representing a frequency of 63.9%. The average age was 25.04 years. They were primigravida (38.3%), unemployed (62.7%). Motorcycles were the main means of transportation, accounting for 53.1% of cases. The average distance to reach the referral center was 31.6 km, covered in an average of 71 minutes. In 40.7% of cases, patients had less than 4 prenatal consultations and were referred in peripartum (56.6%) for pre-eclampsia (14%), post-term pregnancy (11.8%), dystocia (10.5%). Eighty-six point nine percent (86.9%) of the referred patients were able to deliver during their stay in the department, of which 61.7% had vaginal deliveries. The maternal and perinatal mortality rates were 0.7% and 14.9%, respectively. Conclusion: Obstetric referrals to Kara University Hospital are frequent during the perpartum period and are often carried out by motorbike.

Pattern of Referral of Obstetric Patients at a Tertiary Care Hospital in Southern Nigeria

Background: Health challenges that are difficult to manage at primary health centres should be referred to secondary health facilities, and if untreated, to the tertiary hospitals. A good referral should include the patient’s biography, such as age, gender, tribe, religion, occupation, medical history, the reason for the referral, treatments received, and clinical diagnosis. Objectives: To evaluate the referral patterns, indications for referrals, and feto-maternal outcomes for obstetric patients who were referred to the University of Port Harcourt Teaching Hospital. Materials and Methods: A prospective study of patients admitted to the Obstetric unit from January 1, 2021, to December 31, 2022. Data was collected from patients while on admission or clinic visits and recorded in an excel spread sheet. Data was analyzed with the Statistical Package for Social Sciences (SPSS) version 25. Results: Of the 3469 patients were admitted to the obstetric unit, 1476 and 1993 were admitted in 2021 and 2022, respectively. Most (70.35%) of the patients were in the 20-34 years age group, parity 1-4 was the most frequent (66.49%), while 85.39% of patients were booked. 10.46% of the booked patients were referred from other facilities, whereas 89.54% of patients were booked at our facility from the onset. Most common indications of referrals were previous caesarean section (CS) at term (40.09%) and hypertensive disorders of pregnancy (17.59%). The outcome for 2021 indicated 17 maternal deaths, 132 fetal deaths and 1010 live births, giving maternal mortality ratio (MMR) as 1810.44 per 100,000 live births and perinatal mortality ratio (PMR) of 130.7 per 1000 births respectively. In 2022, there were 17 maternal deaths, 130 fetal deaths and 1297 deliveries, giving a MMR of 1399 per 100,000 live births and a PMR of 100.2 per 1000 births. Conclusion: The pattern of referral among obstetric patients in this study shows that a lot of the patients do not get adequate care at the lower cadre of the referral system, hence adequate facilities should be made available in primary and secondary health centres to tackle obstetric emergencies.

Risk Stratification in Obstetrics: An Integrated Approach to Maternal Health

Introduction: Prenatal care is crucial for maternal and fetal health, highlighting the importance of obstetric risk stratification. This enables personalized care, avoiding unnecessary interventions and reducing costs. Conditions such as first trimester bleeding, spontaneous abortion, gestational trophoblastic disease, and ectopic pregnancy require specific approaches. Early identification of these complications is vital, especially in urgent and emergency obstetric cases, which demand immediate hospital attention. Objective: Comprehensive review of first trimester pathologies and gestational hypertension, focusing on obstetric risks and personalized prenatal management. Methods: Literature review on bleeding and gestational hypertension. Results: The study provides a detailed analysis of pathologies associated with first trimester uterine bleeding and hypertensive disorders, focusing on obstetric risk stratification. The main causes of maternal and fetal mortality are hypertensive disorders, hemorrhages, infections, childbirth complications, and abortion. Spontaneous abortion is common, with different classifications, ranging from threatened to missed abortion. Infected abortion is a severe complication. Brazil has restrictive abortion laws, but many unsafe abortions occur, resulting in high public health costs. Pharmacological treatment with misoprostol is a safe option. Other pathologies include gestational trophoblastic disease, ectopic pregnancy, and placenta previa. Preeclampsia and eclampsia are severe conditions requiring immediate treatment to avoid complications. Conclusion: Early identification and management of obstetric risk factors, such as uterine bleeding, are essential for positive maternal and fetal outcomes. A multidisciplinary approach is fundamental.

Polycystic Ovarian Syndrome (PCOS): Exploring Its Impact on Obstetrical Outcomes

Polycystic ovarian syndrome (PCOS) disrupts ovulation leading to both infertility and miscarriage;yet, its impact on obstetrical outcomes remains largely uncertain due to conflicting findings. We analyzed data from the CDC Pregnancy Risk Assessment of Monitoring System, specifically Standard Core and Phase 8 responses, with 9549 respondents across the United States through SPSS 28 software in this cross-sectional study. Two variables assessed PCOS status in respondents: history of PCOS and PCOS during pregnancy. With a history of PCOS, there were significantly increased odds of diabetic (OR 1.665, p < 0.001), hypertensive disorders (OR 1.589, p < 0.001) during pregnancy, neonatal mortality (OR 1.550, p < 0.001), cesarean section (C/S) (OR 1.489, p < 0.001), and preterm prelabor rupture of membranes (PPROM) (OR 2.081, p < 0.001). With PCOS diagnosed during pregnancy, there were significantly greater odds of diabetes (OR 3.278, p < 0.001), hypertensive disorders (OR 2.935, p < 0.001) during pregnancy, and significantly decreased risk for small for gestational age (2 standard deviations) (OR 0.337, p = 0.024). PCOS is a significant risk factor that contributes to maternal morbidity. Our results support the hypothesis that PCOS’ impact extends well into a woman’s obstetrical journey, with varying degrees of associated adverse maternal and fetal risks. Preliminary pathophysiologic explanations associated with PCOS gestational diabetes include pre-existing insulin resistance. Meanwhile, altered placentation and endovascular changes associated with PCOS secondary to a baseline deranged metabolic environment predispose patients to developing hypertensive disorders, PPROM, and preterm delivery. Associations between neonatal mortality and C/S can be attributed to elevated maternal body mass index. The pathophysiologic link between PCOS and the above obstetrical outcomes still remains unknown, necessitating further investigation;however, this study identifies the outcomes that require the most attention at this time.

Disparities across the CREOG Districts —Variations of Wellness and Inclusivity Efforts in Obstetrics & Gynecology Residency Websites between Two Consecutive Years

Background: Few studies have focused on the geographic and chronologic assessment of inclusivity and wellness in Obstetrics and Gynecology residency websites across the US. Objective: To identify variations in wellness and inclusivity website depictions across CREOG districts over the past two years. Methods: This is a cross-sectional analysis of the websites of ACGME-accredited OB/GYN residency programs across the United States between April 2022 and April 2023. The assessment was based on a compilation of 22 attributes devised and piloted by 49 medical students. A racially, geographically, and gender-diverse cohort of 11 students performed data collection. Results: A total of 560 websites were analyzed over two years. Wellness efforts remained unchanged in both years (website content, dedicated support personnel, and group activities). In 2023, a reduction in referencing of wellness (22%) and inclusivity (30%) occurred in leadership messaging. However, a 7% increase in the use of inclusive pronouns was noted. A reduction in gender diversity was identified (9% in faculty, 5% in residents), with programs favoring female-only teams. Similarly, a 7% reduction in the number of underrepresented in medicine faculty and residents was noted. A 15% reduction was noted in curricula referencing inclusivity in their mission statement and inclusivity focused research. Conclusions: This study suggests the variations across websites relative to inclusivity and wellness over the past two years. Updated websites may provide an accurate reflection of the offerings of programs and their investment in wellness and inclusivity across the nation.

Emergency Obstetric Hysterectomy in a Low Resources Country: An Eight-Year Retrospective Cohort Study from a Secondary Care Hospital in Niger

Introduction: Emergency obstetric hysterectomy (EOH) is a lifesaving procedure that is performed as a last resort in cases of severe postpartum haemorrhage. Objective: The objective of this study was to determine the incidence, socio-demographic profile of patients, indications, management and maternal-fetal outcomes of EOH in a maternity hospital with limited resources in Niger. Methodology: This was an eight-year retrospective cohort study involving the analysis of medical records from patients who underwent emergency obstetric hysterectomies between 1 January 2015 and 31 December 2022 at the Mother and Child Health Centre (MCHC) in Maradi, Niger. The epidemiological data, indications, and outcomes of EOH were collated and subjected to analysis using the statistical software package SPSS 21.0. Comparisons were made using the Chi-squared test. A p-value of less than 0.05 was considered statistically significant. Results: During the study period, 239 cases of emergency obstetric hysterectomy were recorded out of 269,710 deliveries, representing a frequency of 0.89%. The mean age of the patients was 32.41 years (range: 17 - 50 years). The patients were identified as married (239 cases, 100%), unemployed (228 cases, 95.4%), and not attending school (215 cases, 90%). The largest number of cases were observed in large multiparous women (i.e., those with more than five children), representing 58.6% of the total number of cases (140 patients). The average parity among this group was 6.15 children. The majority of patients (229 patients, 95.82%) had undergone in utero transfer, with 169 patients (70.71%), originating from peripheral maternity units in the Maradi region. Upon admission, 116 patients (48.53%) exhibited active genital haemorrhage, while 58 patients (24.26%) were in shock. The primary indications for hysterectomy were uterine rupture (153 patients, 64%), uterine atony (77 patients, 32.2%), and placental accreta (six patients, 2.5%). Hysterectomy was performed by an obstetric gynaecologist (230 patients, 96.2%), an obstetric gynaecology resident (six patients, 2.5%), or a general practitioner with district surgical expertise (three patients, 1.3%). In the majority of cases (180 patients, 75.3%), total hysterectomy was performed. The incidence of maternal mortality (26 patients, 10.9%), and perinatal mortality (223 newborns, 93.4%) was notably elevated in our series. Conclusion: Our findings are in close alignment with those previously documented in the literature. The practice of emergency obstetric hysterectomy is a common occurrence in our region. It is considered a last resort when conservative procedures have failed or are not an option. Improved obstetric management would result in a reduction in the number of cases of haemostatic hysterectomy. The availability of blood products is expected to improve maternal prognosis.

Obstetric Emergencies at the Kara University Hospital Maternity Ward: Sociodemographic, Etiological and Prognostic Aspects

Introduction: Obstetric emergencies are common throughout the world and more particularly in developing countries where they are responsible for high maternal-fetal mortality and morbidity. Objective: Study obstetric emergencies in the maternity ward of Kara University Hospital. Method: Retrospective and descriptive study from April 1, 2022 to March 30, 2023, carried out in the Obstetrics and Gynecology Department of Kara University Hospital. Results: Eight hundred and thirty-five (835) obstetric emergencies were recorded out of 2215 admissions, i.e. a frequency of 37.7%. The average age of the patients was 26.7 with a range of 14 and 45 years. They were primigravidas (36.7%) and nulliparous (38.7%), referred (84.7%) and came from rural areas (72%). Emergencies occurred in the 3rd trimester in 74.1% and in parturients (54.1%). Preeclampsia (27%), cessation of progression of labor due to feto-pelvic disproportion (12.4%), postpartum hemorrhage (7.5%) constituted the main obstetric emergencies. In 44.8%, the delivery was carried out vaginally. Magnesium sulfate was the most used drug, i.e. 30.1%;followed by antihypertensive medications in 28.1%. Blood transfusion was performed in 24.3%. The evolution was simple in 90.9%. The maternal fatality rate was 1.6%. The perinatal case fatality rate was 12.3%. Conclusion: Obstetric emergencies are common, dominated by preeclampsia, stopping progress of labor and postpartum hemorrhages. They are responsible for high morbidity and mortality.

Knowledge and Attitudes of Nursing Staff towards Obstetric Fistula at the Abeche University Hospital, Chad

Introduction: Prevention of obstetric fistula (OF) remains a challenge in Chad where its incidence is 464 cases/year. The present study aims to determine the knowledge and attitudes of nursing staff towards obstetric fistula. Patients and Method: This was a cross-sectional, descriptive and analytical study including nursing staff at the Abéché University Hospital. The survey took place from March to May 2023 and the sampling was exhaustive. Data collection was done using a form including a questionnaire on sociodemographic parameters, knowledge and attitudes. Participation in the study was voluntary and individual. Results: Participation in the study was 76.11%. Emergency department staff were the most represented, followed by gynecology-obstetrics staff with 34.4% and 20.91% of cases respectively. Nurses represented 53.17% of participants followed by doctors (23.52%). An exact definition of obstetric fistula was reported by 7.84% of participants and it was partial in 80.39%. The level of knowledge of risk factors was considered good in 12.41%. Exact knowledge of clinical signs was reported by 74.5% of cases. Among the participants, 1.96% reported that the treatment of obstetric fistula is traditional. Knowledge about means of prevention was considered good by 13.72% (n = 21), and attitudes by 26.79%? Obstetric fistula knowledge was influenced by profession (doctor, p = 0.011) and attitudes by service (p = 0.004) and profession (doctor, p = 0.001). Conclusion: Obstetric fistula is a curable disease whose prevention remains possible and requires good knowledge of the disease and the promotion of safe motherhood. This study should serve as a basis for the establishment of the obstetric fistula module in the curriculum of healthcare personnel and the promotion of continuing training for its eradication.

Obstetric Fistula: Epidemiological, Social and Therapeutic Aspects: Prospective Study of 196 Patients Admitted to the ZINDER Mother and Child Health Centre (CSME)

Introduction: Obstetric fistula (OF) is an abnormal communication between the genital and urinary tracts and/or associated with a recto-vaginal communication resulting from prolonged dystocic delivery. It is a frequent pathology in underdeveloped countries. In Zinder no study has been carried out on obstetric fistula. The aim of this study was to evaluate the epidemiological, social impact and therapeutic aspects of obstetric fistula at the CSME of Zinder. Patient and Method: This was a descriptive cross-sectional study of obstetric fistula care at CSME during the period of (January 2018 to June 2020). Results: A total of 196 cases were collected over 30 months. This represents an annual incidence of 78.4 fistulas. The median age of the patients was 18.63 years, and more than 65% were over 20 years old. One hundred and ninety-one patients (97.45%) did not attend school, and 56.12% (n = 110) lived in polygamous households. One hundred and fifty-one women (n = 151), 77.04% had full assistance from their husband during the first four (4) months of the pathology. Twenty-four (12.24%) had been notified of repudiation. Obstetrical risk of dystocia was found in 39.79% (n = 78) of the patients, of whom 24.49% (n = 48) had a focused antenatal consultation (CPNR). The labour lasted more than 24 hours in 100%. The majority of women are multiparous and 60% had at least 2 pregnancies. vesicovaginal fistula is the main pathological type with 86.23%. Fistulas were closed in 83.16% and 68.87% exited without urine loss. Conclusion: Obstetric fistula is a devastating disease affecting girls and young women in Niger, as in other countries in Africa and Asia. It is a major concern worldwide and is a social tragedy because it is disabling and depressing.

Evaluation of The Effectiveness of Abdominal and Vaginal B-Ultrasound in The Diagnosis of Acute Abdomen in Obstetrics and Gynecology

Objective: To explore the clinical effect of the combined application of abdominal and vaginal B-ultrasound in the diagnosis of acute abdomen in obstetrics and gynecology. Methods: Eighty patients admitted to our hospital from March 2023 to March 2024 were selected, all of whom were acute abdomen patients admitted to the Department of Obstetrics and Gynecology. In this study, the patients were divided into two groups. One group of 40 patients was given a simple abdominal B-ultrasound diagnosis (control group). The other group of 40 patients was given both abdominal and vaginal B-ultrasound examinations (experimental group). The diagnostic accuracy between the two groups was compared. Results: Patients in the experimental group had higher consistency rates with pathological diagnosis results in ectopic pregnancy rupture, embryonic arrest, acute pelvic inflammation, corpus luteum rupture, and intrauterine adhesions as compared to the control group. At the same time, the inspection accuracy rate of the experimental group (92.50%) was higher than that of the control group (70.00%) (P < 0.05). Conclusion: The combined application of abdominal and vaginal B-ultrasound in the diagnosis of acute abdomen was of great significance in improving the accuracy of clinical diagnosis and guiding doctors to provide effective treatment.

Obstetrical Emergencies in Ouahigouya Regional Teaching Hospital (Burkina Faso) in the Context of Insecurity Linked to Armed Groups: A Comparative Study between Patients from Precarious Security Zones and Those from Safe Areas

Introduction: Insecurity can be an obstacle to access to emergency obstetric and newborn care, that is why we proposed to study obstetrical emergencies in Ouahigouya Regional Teaching Hospital, a referral hospital in a region plagued by insecurity linked to armed groups. Method: This was an analytical cross-sectional study with prospective data collection over a 4-month period, from June 10 to October 10, 2020. Patients from precarious security areas were compared to those from safer areas. The Chi squared and Fisher tests were used for comparison of variables. Results: Obstetric emergencies accounted for 38.62% of admissions, from which 25.59% came from precarious security zones. Age was similar in both comparison groups. However, patients from unsafe areas were more likely to reside in rural areas (p 0.001) and more likely to be in unpaid occupations (p 0.001). Prenatal visits were less frequent (p 0.01) and women were more often multigravidae (p 0.01) in the precarious security group of patients. Apart from the more frequent uterine rupture (p = 0.02) in the group from precarious security zones, diagnosed complications and maternal mortality were similar in the 2 groups, while perinatal mortality was higher in the group of patients from precarious security zones (p 0.01). Conclusion: The precarious security situation has negative consequences on maternal and perinatal morbidity and mortality. Further studies are needed for better understanding of these consequences, and improvement of health system resilience strategies, to reduce related maternal and fetal morbidity and mortality.

The Place of Blood Transfusion in the Management of Obstetric Emergencies in the Gynaecology and Obstetrics Department of the Reference Health Center of Fana (Mali)

This is a prospective and descriptive study carried out at the gynecology and obstetrics department of the reference health center of Fana from 01 May 2019 to 30 November or 7 months. The main objective was to study the role of blood transfusion in the management of obstetric emergencies. During the study period we recorded 434 cases of obstetric emergencies of which 116 cases required an emergency blood transfusion or 26.73%. The most frequently found indications for blood transfusion are hemorrhages of the immediate postpartum 46.6% followed by severe malaria on pregnancy 27.6%. Blood remains the most prescribed and available Labile blood product in the department. Maternal prognosis was improved in 92.2%.

The Extent of Partograph Use and Associated Factors among Obstetric Care Providers in Government Hospitals in Southern Ethiopia: A Cross-Sectional Study

Background: Prolonged labor is a significant contributor to maternal morbidity and mortality. The World Health Organization encourages using the partograph to keep track and solve this issue. The extent of partograph use in Ethiopia, however, is hardly understood. This study aimed to ascertain the level of partograph use and related variables among obstetric care providers in government hospitals in southern Ethiopia. Methods: A cross-sectional institutional study was conducted among obstetric care providers in government hospitals in southern Ethiopia, from March to December 2015. The data were collected using a pre-tested questionnaire and format. To establish a statistical relationship, an odds ratio with a 95% confidence interval was utilized. Results: A total of 212 (55.1%) obstetric providers reported routine use of partograph to monitor labor. Midwives [AOR: 3.4, 95% CI: (1.2, 9.4)], clinical nurses [AOR: 3.0, 95% CI: (1.1, 7.6)], knowledge of partographs [AOR: 2.0, 95% CI: (1.2, 3.5)], positive attitudes toward partograph use [AOR: 3.7, 95% CI: (1.7, 7.7)], service of 2 - 5 years [AOR: 3.4, 95% CI: (2.8, 4.4)] and service of more than five years [AOR: 2.3, 95% CI: (2.0, 3.3)] were associated with partograph use. Conclusion: This study has shown that the use of partographs to monitor labor among obstetricians is consistent with other studies from developing countries. However, this does not mean that obstetric care does not need to be strengthened, as a significant proportion of obstetricians still do not use the partograph for labor monitoring. Therefore, it is recommended that midwives and nurses be given preference in the delivery of obstetric services, the knowledge and attitudes of providers be improved, and mechanisms be developed that can help keep senior care providers.

Assessing Strategies of Obstetric Fistula Management by Nurses/Midwives of Yaoundé Central Hospital and University Teaching Hospital

Every minute, a woman dies in pregnancy, and for every woman who dies 20 - 30 others will survive with morbidity, one of which is obstetrical fistula. Women who suffer from obstetric fistula experience continuous incontinence of urine and/or stool, stigma, social isolation and associated health problems. The World Health Organization estimates that there are currently more than 2 million women living with untreated obstetric fistula mostly in sub-Saharan Africa and South-East Asia, as well as in various other parts of the world. Caring for fistula patients and nursing them back to full physical and mental health can be one of the most challenging and also rewarding tasks undertaken by nurses. The surgery cannot succeed without proper pre-, peri- and post-operative care. The patients undoubtedly recover better with high-quality care—meaning the truly holistic, generous, and selfless care of a nurse who has the skills, understanding and determination to help these very vulnerable patients. Objective: This research seeks to assess the strategies of obstetric fistula management by nurses/midwives of Yaoundé central hospital and CHU by exploring the care they offer to clients pre-operatively, post-operatively, and when they are discharged from the hospital. Achieving Millennium Development Goal (MDG) 3 still remains a challenge to the developing countries although maternal mortality reduction is a priority agenda of each country. Methodology: This retrospective cross-sectional descriptive study design employed a sample of 100 nurses/midwives on active service, and who have at least managed a case of obstetric fistula. A quantitative questionnaire was used to collect data, which was analyzed using SPSS version 23. Results: The study proved a highly significant difference between management and qualification, with a p-value of 0.002. Also, it showed that there was a statistically significant difference between longevity of service and management with a p-value of 0.001. A majority of respondents were nurse assistants (52%), and up to 43% of respondents had 11 - 20 years of work experience. Up to 53% did not offer standard care with respect to their qualification, and up to 52% did not offer standard care with respect to their longevity in service. Conclusion: VVF is the most common type of obstetric fistula with a frequency of 6 to 10 cases, there is an overall poor management of obstetric fistula by nurses and midwives in YCH and CHU. There is an urgent need to train and retrain these health workers on the management strategies of obstetric fistula and to remind them of their personal commitment as care givers.

Epidemiological and Therapeutic Aspects of Obstetric Fistula in 2021: A Review of 97 Cases at the Departmental University Hospital Centre of Borgou and Alibori in Benin

Background: Obstetric Fistula (OF) is a breach of the birth canal due to obstructed labor. It is a major public health problem in developing countries. Objective: Study the epidemiology and treatment of obstetric fistulas at the Departmental University Hospital Centre of Borgou and Alibori (CHUD-B/A) in Parakou, Benin. Study Method: This was a descriptive and analytical cross-sectional study with prospective data collection on women treated during OF care missions from February 2020 to April 2021 in CHUD-B/A in Parakou, Benin. The data concerned their socio-demographic characteristics, obstetric history, the clinic and therapeutic characteristics of their obstetric fistulas. Results: In total 97 patients with OF were treated during the 14-month period. The average age of the patients was 36.42 ± 11.75 years old. The patients were married (51.54%), without professional occupation (54.64%) and had no formal education (73.20%). The vesico-vaginal variety was predominating (54.64%). The fistulas were of Type I (46.39%), Type II (20.62%) and Type III (32.99%) according to the classification of Waaldjik Kees. The patients were operated on under spinal anesthesia (94.79%), and vaginally (55.67%) according to the principle of Chassar Moir (68, 60%). The associated procedures were lengthening urethroplasty (17.53%), and interposition of the Martius flap (1.03%). The overall success rate without Stress Urinary Incontinence was 71.13%. The factors associated with the failure of the fistula repair were: the nutritional status of the patients (p = 0.004), the previous repair failure (p = 0.001), the high size of the fistula (p = 0.007), the fistula severity (p and a urethral reconstruction (p Conclusion: OF is a relatively frequent pathology in Benin. Vesico-vaginal fistula is the most common form. The success rate of the surgical treatment is satisfactory, but depends on some factors.

Obstetric Emergencies: Frequency, Socio-Demographic Aspects and Risk Factors at the Labe Regional Hospital Maternity Unit (Guinea)

Introduction: Obstetric emergencies are clinical situations of a serious nature, often dangerous, which develop unexpectedly, threatening the vital prognosis of the mother and/or foetus in the short term. The aim of this study was to contribute to a review of obstetric emergencies at the Labé Regional Hospital maternity unit. Methods: This was a prospective descriptive and analytical study conducted over a period of 6 months in the maternity unit of the Labé Regional Hospital. It concerned all patients admitted to the department for obstetric emergencies. Results: Obstetric emergencies accounted for 20% of obstetric admissions. The mean age of the patients was 25.12 ± 7.15 years, with extremes of 14 and 45 years. The patients were housewives (42.52%), 42.86% did not attend school and 77.41% were from urban areas. The poor were the most numerous (43.52%). The ambulance was the means of transport in only 9% of cases. Acute foetal distress, pre-eclampsia, bony dystocia and post-partum haemorrhage were the most common types of emergency in our series, with frequencies of 27.57%, 22.59%, 17.94% and 10.63% respectively. The risk factors identified were age, origin, gestational age and the state of the maternal pelvis. Conclusion: Obstetric emergencies are frequent in our study site and represent a major concern for patients, providers and the community alike. In order to reduce the frequency of obstetric emergencies, young girls should be enrolled in school, the legal age for marriage should be respected, quality antenatal care should be provided in basic health facilities, and proper planning and spacing of pregnancies should be implemented.

Factors Determining the Postponement of Schedule Gyneaco-Obstetric Surgery at CHUMEFJE in Libreville (Gabon)

The study aimed to identify factors causing delays in scheduled gynaeco-obstetric surgeries at CHUMEFJE in Libreville from January 2019 to July 2020. Through a 16-month observational survey, it was found that out of 346 scheduled procedures, 128 (36.4%) were postponed. Organizational issues in the operating theatre were responsible for 80.3% of these delays, with 95.3% being preventable. To enhance efficiency, improvements in operating theatre organization are recommended.

Practice of Obstetrical Hysterectomy at the Sylvanus Olympio University Hospital Center: Indications and Maternal Prognosis

Obstetric hysterectomy is a surgical procedure most often performed in a context of extreme emergency in an obstetric environment. The incidence of obstetric hysterectomy is differently expressed around the world. In the CHU-SO maternity ward, hemorrhagic obstetric emergencies are common. The extreme urgency in which patients are admitted, the insufficiency of the technical platform, associated with the challenge of the availability of blood products, often leads to performing an obstetric hysterectomy for hemostasis. It is responsible for high maternal morbidity and mortality. Since 2000 no study has been carried out on this practice in the service. Objective was to describe the practice of obstetric hysterectomy at the CHU-SO and specifically to determine the prevalence, the prognostic factors to be able to act to reduce maternal mortality. Method: A descriptive, cross-sectional, and analytical study was carried out at the Gynecology-Obstetrics clinic of the CHU-SO;from January 1, 2021, to June 30, 2022. All hysterectomies performed in an obstetric emergency context (during pregnancy, perpartum or postpartum) in the department were included in our study. We did not include cases of obstetric hysterectomies outside the SO hospital or planned non-obstetric hysterectomies. Results: We recorded 75 cases of obstetric hysterectomy and 15,625 deliveries (0.48%). The average age was 32.89 ± 5.93. The age group between 30 and 35 years old was the most affected with a rate of 37.33%. Labor and third trimester hemorrhage were the main reasons for admission, patients were referred in 80% of cases. The average parity was 3.25 ± 1.92 with utmost of 0 and 11. The pauciparous (41.67%) and multiparous (32%) were the most affected. The indications frequently found were uterine atony (44%);uterine rupture (33.33%). Subtotal inter adnexal hysterectomy was performed in 94.67%. General anesthesia practiced in 69%. They were all polytransfuses. Three poor prognostic factors were observed during our study, namely: uterine atony;the state of hemodynamic shock before the operation;lack of blood transfusion. The maternal death rate was 21.33%. Conclusion: Obstetric hysterectomy is a very mutilating and complicated surgical procedure and is still common practice in Africa. The maternal prognosis is still reserved with a very high mortality rate in Togo.