Endometrial Cancer: Epidemiological, Histological and Therapeutic Aspects in the Gynecology-Obstetrics Department of the Donka National Hospital, CHU of Conakry

Objective: To study the epidemiological, histological and therapeutic characteristics of endometrial cancer in the Gynecology-Obstetrics department of the Donka National Hospital, CHU of Conakry. Methods: We conducted a retrospective descriptive study of 86 patients with endometrial cancer treated in the Gynecology-Obstetrics department of the Donka National Hospital from January 1, 2011, to December 31, 2021, based on their medical records. We analysed the epidemiological, histological and therapeutic aspects of the disease. Results: Endometrial cancer accounted for 3.1% of the 2793 gynecological pathology cases registered in the department during the study period, ranking third. The mean age of the patients was 63 ± 5 years. Most of them were uneducated (59.3%), postmenopausal (91.9%), nulliparous (30.2%), obese (65.1%) and hypertensive (77.1%). More than half of the patients (53.4%) were diagnosed at stage I. Endometrioid adenocarcinoma was the predominant histological type (68.6%). Surgery was performed in 96.6% of the patients, and chemotherapy in 14.0%. After a mean follow-up of 15 months, 84.5% of the patients were alive. Conclusion: Endometrial cancer is a common gynecological malignancy in our department. Endometrioid adenocarcinoma is the most frequent histological subtype. Surgery is the main treatment modality.

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.

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.

Surgical Treatment of Urological Complications of Gynecological and Obstetric Surgeries at the University Hospital of Conakry Guinea

Objective: To analyze the management of urological complications of gynecologic and obstetric surgeries. Material and Methods: We retrospectively studied 39 patients hospitalized in the Department of Urology of the Conakry Teaching Hospital for urological complications of gynecological surgery, during 9 years. The epidemiological, diagnostic, surgical and outcome parameters have been analyzed. Results: The urological complications of gynecologic surgery represent 0.29% of admissions in the Department of Urology. The mean age was 31 years with extremes of 18 and 47 years. Etiological factors were dominated by caesarean section with 74.36% of cases. The main lesions observed were vesico-vaginal and uretero-vaginal fistulas respectively 43.6% and 41.2% of cases. The mean delay of diagnosis was 5 months (extreme: 7 days to 3 years). Urine leakage from the vagina was the main symptom. The surgical treatment consisted in 17 surgeries for vesico-vaginal fistulas, 16 surgeries for uretero-vesical reimplantation, 2 surgeries for termino terminal ureterorraphia, 2 surgeries for vesico-uterine fistulas and 1 surgery for hysterectomy. Healing was obtained in all ureteral injuries and we noted two cases of failure in vesico-vaginal fistula. Conclusion: urological complications of gynecologic surgery remain frequent. They are dominated by the vesico-vaginal and uretero-vaginal fistulas and the main etiology is caesarean section. The treatment is surgical in our context.

Respiratory Complications of Measles in the Pediatric Ward of the Regional Hospital of Kindia/Guinea

Introduction: Measles is a highly contagious infectious disease caused by the measles virus belonging to the morbillivirus genus, the measles morbillivirus species and the Paramyxoviridae families. The aim was to study respiratory complications due to measles in children aged 1 to 15 in the pediatric ward of the Kindia regional hospital. Materials and Methods: A transversal descriptive study was carried out in the pediatrics department of the Kindia Regional Hospital from October 1, 2019, to March 31, 2020, on children aged 1 to 15 years hospitalized for measles with respiratory complications. Results: 53 cases of measles were recorded, i.e. 11.71% of hospital pathologies including 32 cases of respiratory complications, i.e. 60.38% with an M/F sex ratio of 1.66, male predominance of 62.5%, and a mean age of 4.10 ± 2.8 years. The outcome was favorable in 90.62% of our patients. The mortality was 9.38% with an average hospital stay of 6.8 ± 3.04 days. Conclusion: The respiratory complication of measles is a serious pathology due to the risk of mortality that it can cause, a consultation followed by rapid treatment can contribute to a reduction in complications and a faster cure.

肥胖不会影响接受体外受精及胚胎移植患者的疗效

Objective: To examine the outcome of in vitro fertilization according to the body mass index of infertile patients. Study design: Between September 2003 and May 2005, 573 patients underwent 789 in vitro fertilization cycles or ICSI because of male factor, tubal factor, and unexplained infertility were retrospectively included from our IVF database. The patients were classified in four groups: BMI< 20 kg/m2(264 cycles), 20 ≤BMI< 25(394 cycles), 25 ≤BMI< 30(83 cycles), and BMI ≥30(48 cycles). All patients had a long protocol for IVF with a combination of the GnRH agonist and recombinant FSH. Results: All parameters of ovarian response were comparable except the total required r-FSH dose. This dose was statistically higher in the group of BMI ≥30 compared to the other groups (p=0.0003). All parameters of IVF outcome were comparable, including the cancellation rate, the implantation rate, and pregnancy rates. Conclusion: Obese patients require a higher r-FSH dose to achieve follicular maturation than normal weight patients. Obesity does not affect negatively results of in vitro fertilization.

Treatment of Precancerous Lesions of the Cervix of the Uterus by Leep: Experience of the Principal Clinic of the Togolese Association of Family Well-Being Planning Center (ATBEF)

Objectives: Describe the socio-demographic characteristics, describe the main indications for LEEP and present the main complications. Methodology: This was a cross-sectional and descriptive study with consecutive recruitment of the study population through cervical cancer screening campaigns throughout the country during the period July 1, 2017 to April 30, 2019. Included were all patients eligible for LEEP and having benefited from this therapeutic method during our study period. Data were collected from a registry and recorded on a questionnaire developed for this study. These data were analyzed using Epi info 3.5.1 software. The following parameters were studied: patient age, indication for LEEP, intraoperative and postoperative complications, histological examination of the specimens, and postoperative surveillance and screening follow-up one year after LEEP. Results: During the study period, 12,595 women were screened for precancerous cervical lesions. A total of 474 women had precancerous lesions. Of these women, 227 had undergone loop resection, a rate of 47.9%. The main indications for LEEP were extensive lesions (68.7%), lesions penetrating the internal cervical os (12.8%). Incidents occurred in 7.5% of patients during the procedure. Post-operative complications occurred in 14.7% of cases. Conclusion: LEEP is a better way to treat precancerous lesions but is not well known by medical staff. The equipment of health facilities and the training of medical staff will make it possible to popularize the practice throughout the country. This extension will contribute to the fight against cervical cancer.

子宫栓塞治疗黏膜下纤维瘤:一种不好的替代外科手术的治疗方法?(法)

A case of septic expulsion of a leiomyoma is reported 18 weeks after uterine artery embolisation (UAE). The patient underwent UAE for a symptomatic sub- mucous leiomyoma (type 2) of 5 cm. She was feverish and presented pelvic pain and purulent vaginal discharges. Vaginal examination revealed a necrotic mass prolapsed through the cervix that was carefully twisted out. Histopathologic examination showed extensive necrosis of the myomatous tissue. Microbiologic cultures showed heavy growth of Escherichia coli. Such findings challenge the interest and the safety of UAE for submucous fibroids. Our case report stresses that uterine artery embolisation for submucous fibroids does not constitute, because of its risks, an alternative to conventional surgical treatment represented mainly by hysteroscopic resection.

枕后位的临床和超声诊断:350例分娩的前瞻性研究(法)

Objective:To evaluate clinical reliability compared to intrapartum ultrasound as a tool to diagnose occiput posterior position and to investigate the proportion of rotations occurring during labour. Patients and methods:350 women in labor with a singleton fetus in a vertex position were prospectively studied using ultrasound and obstetrical examination. Outcome of labor was also monitored. Results:Reliability of clinical examination is 85,7%,initial occiput posterior position represented 40,2%and most rotated in an anterior position (84,8%) while only 0,6%of initial anterior positions delivered in occiput posterior position. Logistic regression did not allow to find significant predictor of occiput posterior position rotation. Discussion and conclusion:Clinical examination is relatively reliable for posterior position diagnosis and in most cases,initially occipitoposterior positions rotate anteriorly.

The Caesarean Section in Dakar: Indications and Analysis Prognosis

The objective of this study was to analyze the indications of cesarean sections performed in a Level II clinic and to evaluate early maternal and neonatal outcome in the context of decentralization of obstetric and emergency newborn care. Material and Method: This was a retrospective descriptive and analytical study conducted at the maternity CSNC over a period of 12 months from 1 July 2010 to 30 June 2011. It included all women in childbirth by caesarean section and excluded patients admitted for management of complications of cesarean section performed in another structure. Results: During the study period, 595 caesarean sections were performed on a total of 4410 births, a rate of 13.5%. The average age of patients was 27 years. The mean parity was 2. The patients came from them even 55%. They were admitted with a single uterine scar in 28.40% of cases and bi-scar in 25.4% of cases. A pathology was associated with pregnancy in 31.6% of cases. These pathologies were dominated by vascular and renal syndromes (75.5%), anemia (13.8%) and the obstacles previa (10.1%). Caesarean sections were performed in 517 patients in emergency. The technique of Misgav Ladach was the most common 75.1%. The average hospital stay was 4.2 days with extremes of 0 and 15 days. Postoperative maternal mortality was 0.34%. Operative follow-up was simple in 98.3% of patients. Two patients (0.34%) died after surgery. In 92.4% of the cases, the newborns were alive. The Apgar score in the first minute was favorable (greater than or equal to 7/10) in 503 newborns (95.1%) and unfavorable (less than 7/10) in 47 cases (8.55%). At the fifth minute, he was favorable in 98.5% of the cases. Overall stillbirth was 72.26‰ with a total of 43 stillbirths including 3 macerated stillbirths. Conclusion: Cesarean section is by far the most accomplished action in gynecology and obstetrics. Its ease of implementation and low cost, and of course his results in terms of reduction of maternal-fetal morbidity and mortality make a key intervention and allowed its extension.

Endoscopic Hemostatic Treatment of Gastric Varices during Pregnancy by Injection of Histoacryl

The occurrence of pregnancy is relatively rare in patients with portal hypertension, and has been reported as clinical cases. However, few studies have evaluated the effectiveness of injecting histoacryl during pregnancy. The choice of treatment for varicose bleeding during pregnancy has been described in the literature based on the elastic ligature. We report the second case, to our knowledge, of treatment of bleeding gastric varices by injection of histoacryl with good maternal and fetal development.

Congenital Cytomegalovirus Infection and Maternal Varicella during Pregnancy.Is There a Coincidence?A Case Report

Background: Co-infections may represent substantial diagnostic and treatment challenges. Aim: To the better of our knowledge, we describe the first case in the literature of congenital Cytomegalovirus (CMV) infection following maternal CMV non primary infection contemporary to varicella during pregnancy. Case Presentation: A pregnant woman had a varicella during her pregnancy. Congenital CMV infection was fortuitously discovered in the neonate owing to a universal CMV screening. Retrospective analysis of maternal serums during pregnancy showed CMV reactivation. We aim to highlight that CMV reactivation could be due to varicella and discuss if it could facilitate the transplacental transmission of CMV. Conclusion: This case report emphasizes neonatal CMV screening, and warns against dual maternal infection especially because this may be at particular risk of transmission to the fetus.

Routine Screening for Cervical Cancer

Objective: To describe the screening for uterine cancer by visual methods. Method: We conducted a prospective and descriptive study over a period of 12 months from January to December 2020. Direct observation of providers and interview of patients were performed for data collection. Results: Out of 3400 patients, 1024 were enrolled for the study, or 30.11%. The average age of the patients was 41 years with the extremes of 17 to 87 years. Women aged 40 to 45 were the most represented with 58.78%, (n = 602). Housewives 85.83% (n = 879), they had a primary education level in 71.09% of cases (n = 728), the vast majority were married 92.28% (n = 945). Multiparous represented 58.78% (n = 602) of the sample, nulliparous 18.26% (n = 187), women living in rural areas 30.17% (n = 309), in urban areas 69.82% (n = 715). The test was positive in 43 patients (4.19%) but squamocylindrical junction was not visible in 17% of cases. The preparation of acetic acid and lugol: good preparation in 100% of cases; the conditions of use are not respected in 27% for acetic acid and 38% for lugol. Conclusion: Routine screening for cervical cancer (SCC) by visual methods is essential to decrease the incidence of invasive cervical cancer.

皮质类固醇与阿司匹林联合应用预防不明病因的复发性绒毛膜炎及胎盘绒毛间炎症(法)

We report the cases of two patients who had a favorable outcome with aspirin and corticosteroid therapy during pregnancy for chronic villitis of unknown etiology complicated by labor asphyxia and further intrauterine fetal demise in one gravida 3 patient and for chronic intervillositis of unknown etiology diagnosed after three perinatal deaths in another patient(gravida 4). Chronic villitis of unknown etiology(CVUE) is detected in 7 to 33%of placentas, mainly after intrauterine growth retardation(IUGR), unexplained prematurity, preeclampsia, perinatal asphyxia and intrauterine fetal death(IUFD). The less frequent chronic intervillositis of unknown etiology(CIUE)(0.6 to 0.9/1.000) has been implicated in recurrent severe pregnancy complications, such as spontaneous abortions, IUGR and IUFD. Histopathology and immunohistology are in favor of an immune response against the foreign fetal allograft. The favorable results obtained with corticosteroids and aspirin remain to be confirmed by larger series.

1例子宫内膜异位症合并腹水和胸腔积液的病例报道(法国)

Massive ascites associated with pelvic endometriosis is an uncommon combination. Pleural effusion may rarely occur. Fourteen cases are reported in the literature. We report the case of a black nulligravida woman followed for a primary infertility. Endometriosis was suspected in presence of increasing dysmenorrhea, cystic adnexal masse, umbilical nodes and ascites. The diagnosis was confirmed at exploratory laparoscopy. The patient had been followed for assisted procreation for six years and had undergone a conservative laparoscopic surgery never described. After several ascites recurrences, the pathology was resolved by Gonadotropin-releasing hormone agonist therapy. But a right pleural effusion with ascites occurred following a bad therapeutic observance. This complication reveals an early pregnancy never reported for this exceptional pathology. A conservative management allowed this unique case of well outcoming pregnancy. The possible pathogenesis of ascites and pleural effusion are explored and recommendations for diagnosis and treatment options are discussed.

1例子宫内膜异位症伴大量血性腹水的病例报道与文献回顾(法国)

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. It generally involves the peritoneum, ovaries and rectovaginal septum. Its characteristic symptoms include dysmenorrhea, pelvic pain, deep dyspareunia and infertility. It may also involve the gastrointestinal tract, urinary tract or extra abdominal sites, giving rise to a wide variety of clinical symptoms such as bloody stools, renal haemorrhage, hemoptysis and pleural effusion during menstruation. Recurrent hemorrhagic ascites secondary to endometriosis is an unusual occurrence, 41 cases have been reported since 1954. Here we report an additional case, in order to draw attention to this condition. A 28 years-old black nulligravida woman was seen for the first time in april 2000 with a chief complaint of infertility. Her past medical history was unremarkable. She had regular menses but associated with severe dysmenorrhea. She also recalled abdominal and pelvic pain for several years. She underwent an ovulation induction with gonadotrophin, which resulted in a progressive increase of pelvic pain. A first laparoscopy was performed, revealing voluminous ascites (10 I). Two years later the ascites recurred spontaneously. Ultrasound examination revealed suspect "para uterine masses". A second exploratory laparoscopy showed a voluminous bloody ascites (7I), and extensive adhesions. On histologic examination all specimens (peritoneal biopsies) were compatible with endometriosis and ruled out malignancy. Treatment with GnRH analog was performed and full remission was obtained after 6 months. One year later, the, ascites recurred again spontaneously, leading to a third laparoscopy in an other medical institution. Histologic examination showed endometrial stromal tissue and fibrous proliferation. Later she became pregnant after in vitro fertilization. In the first trimester of pregnancy, the pelvic ultrasound showed only a small effusion in the pouch of Douglas. Still, the ascites did not progress during pregnancy. The patient was hospitalized from 27 to 33 weeks of gestational age for threatened labor, but she finally had a normal vaginal delivery at 36 weeks of gestational age. Four months later, she had no complaint, but the pelvic ultrasound showed the recurrence of the ascites. She will have a drainage. The future treatement will consists of GnRH analog for about six months, which will be relayed by a long term progestative therapy. A diagnosis of endometriosis should always be considered in middle-age women who presents with bloody ascites. Long follow-up is advisable for patients who undergo conservative treatment because of the high risk of recurrence.

控释地诺前列酮普贝生用于引产的评价(法)

Objective:To evaluate the efficacy of cervix ripening with vaginal controlled-release Propess. Patients and methods:A retrospective study of all women who underwent cervical ripening with Propess during the study period from 1st January 2002 to 31st December 2004 was carried out. A total of 130 patients who experienced Propess was compared with the next following patient who delivered spontaneously matched on gestational age. Modes of delivery,failure of labor,maternal morbidity were recorded. Results:Indications for induction of labor were:post-term pregnancies in 18.5%,pre-eclampsia in 20.8%,oligohydroamnios in 18.5%,post-term pregnancy and oligohydramnios in 10.8%,intra-uterine fetal growth in 6.9%,premature rupture of membranes in 6.9%,diminution of fetal mobility in 6.1%and miscellaneous in 11.5%. Failure of cervical ripening was 21.2%. Patients in the Propess group had a 3.5 fold higher risk of Cesarean section 95%CI:1.5-8.3; P < 0.04 . There was no case of maternal or fetal death. There was no difference in incidence of maternal complications,and post-partum haemorrhage. Discussion and conclusion:Use of vaginal pessary Propess does not induce adverse maternal or fetal morbidity. However,it was associated with a higher incidence of Cesarean delivery.

76例感染性肠道疾病和妊娠病例报道及文献回顾(法)

Objective. Obstetrical prognosis for women suffering from Crohn’s disease and from ulcerative colitis, and consequences of pregnancy on inflammatory bowel diseases (IBD). Patients and methods. Retrospective study, of 76 pregnancies, after the diagnosis of IBD among 77 women (33 ulcerative colitis, 44 Crohn’s disease). Results. Pregnancy did not modify the evolutive profile of IBD. No particular gravity of IBD revealed during pregnancy or post-partum was noticed. The outcome of the 54 pregnancies associated with quiescent IBD was the same as in the general population. Five of ten pregnancies started during an active period of Crohn’s disease or ulcerative colitis ended in fetal loss (3 spontaneous abortions, 2 medical terminations). In women with a first acute episode or IBD reactivation during pregnancy (n=12), one-third of the newborns were low weight for gestational age, one-third were born preterm and only one-third were term babies with normal weight. Vaginal delivery did not trigger development or exacerbation of perianal Crohn’s disease (n=20). Cesarean section was performed in 2 with an ileal pouch-anal anastomosis (n=4) and 1 patient with an ileo-rectal anastomosis (n=3) to avoid injury to the anal sphincter. Ileostomy (n=2) did not contraindicate delivery. Conclusion. Control of IBD is the main obstetrical factor for prognosis. Starting pregnancy can be advised if the disease is quiescent, with rapid and efficient management of possible flare-ups. Delivery route must be determined on a case-by-case basis, each considering pregestational anal continence and the clinical presentation of the perineum.

Chiladiti综合征造成剖宫产后小肠梗阻坏死:首例病例报道(法)

Chiladiti’s syndrome is the association of a radiological and clinical semiology of the interposition of large colon or small intestine between the lower side of diaphragm and liver. We report the case of a 32-year-old woman,primigravida,who undergone a caesarean section at 39 weeks of amenorrhoea,for a clinical picture of persistent abdominal pain and a beginning hepatic cytolysis. The patient presented one day after the ceasarean section an occlusive syndrome of the small intestine. The etiology of the occlusion of the small intestine in post-partum was a Chiladiti’s syndrome with inter hepatodiaphragmatic incarceration of the small intestine discovered at the computed tomography. An exploratory laparotomy confirmed and permitted to treat Chiladiti’s syndrome complicated by an occlusion.

HIV感染妇女的分娩模式:对2000—2004年同所医院358例患者的回顾性研究(法)

Objective: Evaluate the mode of delivery of HIV-infected women and the risk of mother-to-child transmission. Patients and methods: A retrospective study conducted on HIV-infected women who delivered at the maternity ward of Bichat Hospital in Paris between 1st January 2000 and 31st December 2004. Pregnancy care, antiretroviral therapy, decision of the mode of delivery and neonate treatment were conformable to the French recommendations. Results: The analysis was performed on 332 cases out of 358 pregnancies followed during this period. 75%received a Highly Active Anti Retroviral Therapy(HAART), 24%an AZT monotherapy and 1%did not receive any antiretroviral treatment. Plasmatic HIV viral load was under the level of detectability(50 copies/ml) for 64,6%of women under HAART and 28,7%of women under AZT monotherapy. Only 31,7%of women under HAART delivered vaginally. 44,7%of women under HAART with undetectable viral load at the moment of delivery delivered vaginally. 59,5%of women who were allowed to deliver vaginally had finally a vaginal delivery. 332 women gave birth to 341 babies with 9 twin pregnancies and one still-birth at 22 WA. Out of these 340 babies, 3 babies whose mother received HAART were HIV infected(2 in utero and 1 per-partum). Discussion and conclusion: The reasons why only one third of HIV-infected women could deliver vaginally in this study are primarily the persistence of a detectable HIV viral load under HAART. Women’s choice of the mode of delivery comes next, which depends on the quality of the counselling about the benefits and risks of the cesarean section in the context of HIV infection. The third reason is obstetrical contra indications to vaginal delivery in the context of HIV infection. In the future, it is possible to reduce the incidence of cesarean section in HIV-infected women by elevating the level of HIV plasmatic viral load which allowed vaginal delivery(1000 copies/ml), by improving the observance to antiretroviral treatment, by adaptating antiretroviral medications posology using determination of serum protease inhibitors concentration and by modifying obstetrical management with less restrictive contra indications to vaginal delivery. However the impact of prophylactic cesarean section when plasmatic HIV viral load is undetectable must still be evaluated.