Bilateral Gravidic Gigantomastia at the Gynecological and Obstetrical Clinic of Dantec: A Case Report

The consequence of a monstrous and diffuse evolution of the usual epithelial hyperplasia of pregnancy, gravidic gigantomastia is a disabling pathology. Rarely, it poses a problem for management and its etiology is still undetermined. In spite of a benign condition, it is nonetheless a serious one because of the complications associated with excessive growth, the weight of the mammary gland and the compromise of breastfeeding function (through destruction of the nipple-areolar plate and surgery). We report a case of bilateral gravidic gigantomastia in a 31-year-old woman to discuss the diagnostic and therapeutic aspects.

The Multi-Center Comparative Clinical Trial of the Second Generation of Indomethacin VCu and TCu380A

Objective To study the effectiveness and side effects of the modified new indomethacin VCu IUD Material & methods It is a randomized multi-center clinical trial. Indomethacin VCu and TCu380A were inserted in 2 000 healthy women in 6 clinical units including urban and rural area from May 1997 to Feb 1998, with 1 000 cases in each group. Follow up time were 6, 12, and 24 month after insertion. Results The clinical characteristics of subjects in two groups were similar. Follow up was completed in 98.25% of cases. The net cumulative continuous rate at 6 month was 95.5% in TCu380A group and 97.5% in Indomethacin VCu group (P<0.05); at 12 month it was 93.79% and 94.78% respectively; at 24 month it was 88.23% and 89.77% respectively. The expulsion rate was higher in T group than in V group during 24 months. Termination due to pregnancy and bleeding or pain was similar in two groups. The occurrence of menorrahgia, prolonged bleeding and abdominal pain was also higher in T group than that in V group during 24 months after insertion. Spotting was more often in T group in 12 month. On the other hand, more subjects complained hypomenorrhea in V group. The total B/S period, average B/S period and the longest B/S period were all longer in T group during 4～6 month after IUD insertion (P< 0.01). The amount of hemoglobin was similar in two groups before IUD insertion. At the end of study, the amount of hemoglobin in T group decreased compared with baseline (P<0.001), and was lower than V group at the same time (P<0.001), while no change was observed in V group. Conclusion Compared with TCu380A, the second generation of indomethacin VCu possess the same contraceptive effect and cumulative continuous rate and lower side effects such as bleeding and abdominal pain. VCu is more beneficial to reproductive health of women, therefore, is worth of clinical application.

F&#339;tal Death in Utero: Maternal Epidemiological and Prognostic Aspects at Sylvanus Olympio Teaching Hospital in Lomé

The fetal death In Uterus is relatively a common problem in developing countries. In Africa, the rate of deaths varies from one hospital to another. We wanted to evaluate the prevalence, to describe the epidemiological aspects, etiologies and maternal prognosis associated with fetal deaths in Uterus in 2017 at Sylvanus Olympio Teaching Hospital in Lomé. Patients and methods: This was a retrospective descriptive study conducted from January 1st to December 31st, 2017. We have included all pregnant cases received and treated on the spot for in uterus deaths as defined by the World Health Organization. Medical termination of pregnancy records, intrapartum deaths, less than 22 amenorrhea weeks’ pregnancies and complications of abortion were not included. Results: The fetal death rate in uterus was 3.64%. The multigravida and multiparous were respectively 49% and 41%;the referees were 51%, 28% evacuated;21% came on their own. The gestational age of 28 - 37 weeks was 39% and 17% had no prenatal consultation. The analysis has revealed that high blood pressure, preeclampsia, and retroplacental hematomas were the main etiologies associated with fetal deaths in uterus. Conclusion: In uterus fetal deaths remain common in our country. The main causes were hypertension disorders of pregnancy. There were also some unknown causes which could be related to economic or cultural reasons. For instance, autopsies of in uterus deaths and placental anatomopathology examination are not performed because of culture.

Management and Maternal-Fetal Prognosis of Placental Abruption: A Retrospective Study of 130 Cases

Objective: To describe the epidemiological, clinical and prognostic factors and assess treatment of placental abruption in the obstetrics gynecology department of the Dakar Principal Hospital. Patients and Method: We carried out a retrospective observational study of 130 successive cases of placental abruption, which occurred from January 2015 to December 2017 at the Level 3 Maternity Unit of the Dakar Principal Hospital. Data were collected from non-computerized obstetric records and analyzed using Excel and Epi info software. Results: There were 130 cases of placental abruption, that is a prevalence of 1.5%. The average age of onset of placental abruption was 30 years. The history of hypertension concerned 32.3% of patients, the average gestational age of 32.5 weeks at the time of diagnosis, grade 3 of Sher was found in 48.5% of cases. The outcome of the pregnancy was a caesarean section in 79.2% of cases, the average weight of newborns was 2058 g. The management of the complications required a blood transfusion and intensive care. A haemostasis hysterectomy was performed in 6.2% of cases. Stillbirth rate was 53.7% and maternal mortality was zero. Discussion and Conclusion: Placental abruption, a severe complication of pregnancy, is associated with high perinatal morbidity and mortality linked to the severity of the clinical picture, despite an improved maternal prognosis.

Ovarian Pregnancy: A Case Report

Background: Ovarian pregnancy is a rare entity of ectopic pregnancy, with a prevalence in the literature estimated between 1/2500 to 1/5000 births. The majority of ovarian pregnancies are diagnosed in the 1st trimester due to the noisy symptomatology. However, in small proportions, they may continue into the 2nd or 3rd trimester, making their diagnosis more difficult. Aim: We report a case of ovarian pregnancy in a 26-year-old patient, discovered intraoperatively as a large unruptured ovarian mass. Case report: A 26-year-old woman referred to the maternity ward for management of fetal death in utero at 31 weeks of amenorrhea associated with overlying placenta previa. Ultrasound performed in the department, was in favor of an abdominal pregnancy stopped at 31 SA with a placenta that seemed to adhere to the posterior wall of the uterus, which was empty. A Laparotomy was performed, on exploration, a large right ovarian mass was found, the site of the pregnancy. A right adnexectomy, after adhesiolysis, was performed. The incision of the operative part revealed a macerated female fetus. The clinical evolution was favorable. Conclusion: We report on a case of unruptured ovarian pregnancy, discovered in the 3rd trimester of pregnancy. The ultrasound diagnosis of an ovarian pregnancy beyond the 2nd trimester remains a challenge, the management remains surgical.