Objectives: The aim of our study was to investigate the relation of some sociodemographic factors and delays presentation in breast cancer. Patients and method: This was an observational study in Breast Unit of Aristide Le Dantec Teaching Hospital in Dakar. Were included in the study all patients followed for breast cancer from January 2008 to December 2014. The following variables were selected and stratified: age, place of living, educational attainment, menopausal status, socioeconomic status and family history of breast cancer. For each variable, an association with the stage and presentation delay was assessed. Results: Two hundred and fifty nine (259) patients met the inclusion criteria. No correlation was found between the studied socio-demographic factors and delay. Negative history of family breast cancer was associated with presentation delay. The only factor associated with locally advanced breast cancer after adjusting confounding factors was low level of income. Conclusion: A significant percentage of women with breast cancer in Senegal are experiencing presentation delay. Coordinated efforts with public health department are needed to educate the focused groups and mitigate the barriers.
INTRODUCTIONBreast cancer is the most common cancer diagnosed in women worldwide with over 1.3 million new cases per year. There is a wide variation in the geographical burden of the disease with the highest incidences seen in the developed regions of the world and the lowest incidences observed in the least developed regions. ABSTRACTBackground: Breast cancer is the most common cancer diagnosed in women worldwide with over 1.3 million new cases per year. There is a wide variation in the geographical burden of the disease with the highest incidences seen in the developed regions of the world and the lowest incidences observed in the least developed regions. The objective of this study was to understand further the risks for breast cancer in Senegalese population which can then inform public health strategies to try and reduce the burden of breast cancer.Methods: This matched case control study was conducted in 2015 in Aristide Le Dantec Teaching Hospital in Dakar. All women with pathologically confirmed primary breast cancer were considered as cases. For each case, 2 agematched women were recruited. We collected and compared demographic factors, family history of breast cancer, socioeconomic variables, reproductive variables (age at menarche, age at first pregnancy and first live birth, parity, menopausal status, duration of breastfeeding), and exogenous hormone use up to 6 months. Odds ratios from univariate logistic regression were used to estimate the relative risk of breast cancer associated with the various factors, and their predictive effects. Results: In all, 212 women with breast cancer who were diagnosed as having breast cancer and 424 control women were involved in the study. The mean±SD age of cases and controls was 43.37±11.94 years (range 18-83 years) and 42.04±11.08 years (range 18-84 years), respectively. There were no significant differences between cases and controls with regards to marital status, parity, age at menarche, past oral contraceptive use, age at first last full-term pregnancy and history of breastfeeding. Breast cancer risk was significantly greater in women with a family history of the disease (OR 2.12, 95% confidence interval [CI] 1.35-3.31). A significant increase in breast cancer was observed among illiterate women compared to educated women (OR 1.27, CI 1.02-1.58), in premenopausal women and those without occupation. Conclusions: In this study, reproductive factors as early menarche or menopausal status were not associative to the risk of breast cancer and the early age at diagnosis and the positive history of breast cancer suggest a genetic pattern of this disease in Senegalese woman. But this fact is difficult to confirm for financial reasons.
Background: This study aims to clarify the epidemiological profile of patients and describe the diagnostic, therapeutic and prognostic aspects of uterine ruptures at Nabil Choucair Health Center, in the suburbs of Dakar.Methods: This was a retrospective and prospective, descriptive and analytical study conducted over a period of 112 months, from July 31, 2005 and March 31, 2015; it concerned all diagnosed cases with uterine rupture, managed at Nabil Health Center Choucair Dakar. Data were collected from antenatal notebooks, delivery records, surgical reports and anesthetic records. The following parameters were studied: socio-demographic characteristics (frequency, chracteristics of patient), the course of pregnancy, diagnostic, prognostic, and therapeutic aspects. Data analysis was performed using SPSS software (version 11.0).Results: During the study period, we recorded 26 uterine ruptures from a total of 34,097 deliveries, that is a frequency of 8 out of 10,000 births. The epidemiological profile of the patients was that of a 30-year old woman, on average, few previous deliveries with an average parity of 3, who received on average 3 antenatal and evacuated in 50% of cases. Uterine rupture occurred in 17 patients on a new uterus (65, 4%) and in 9 patients on a scarred uterus (34.6%). Two patients (7%) were in hemorrhagic shock. A laparotomy aimed at specifying the place of rupture and making the treatment was performed in all patients. It was 18 uterine segmento-corporeal ruptures (69.2%), 5 segmental ruptures (19.2%) and 2 corporeal ruptures (7.6%). We recorded 9 uterine ruptures with living fetus (38.5%). Twenty-three patients (88.5%) underwent conservative suture against only 3 hemostasis hysterectomy (11.5%). The postoperative courses were uneventful in 57.7% of cases. Eleven patients (42.3%) had anemia and we recorded maternal deaths, which is a maternal mortality of 3.84%.Conclusions: Uterine rupture is a serious complication that is still responsible for significant maternal and fetal mortality. Prevention is based on careful monitoring of pregnancy and delivery.
"Locked twins" is a rare event occurring in about 1 in every 1000 twin births. A 21-year-old primigravida with a 31-week twin pregnancy was admitted for delivery. The head of the first twin was locked to the chin of the second twin at the top of the symphysis pubis. Caesarean section was performed allowing the delivery of both dead twins. Twins gestations with first twin in the breech presentation raise index of suspicion of potential locked twin. However, management of such situation is controversial with most authors and colleges recommending caesarean section to avoid interlocking heads. We report another rare case of interlocking heads and bring up the topic about management of breech-first twin deliveries.
Objectives: To assess the quality of the obstetric evacuation system at the Youssou Mbargane Diop Hospital in Dakar. Methods: Our study was conducted at the Hospital of Youssou Mbargane DIOP in Rufisque, a district about 26 km from downtown Dakar. This was a qualitative and evaluative descriptive study in the form of operational research aimed at improving the quality of obstetrical evacuations and resolving problems through a dynamic and team approach. It was carried out within the framework of the AQUASOU project (Improvement of Quality and Access to Emergency Obstetric Care in French). A liaison sheet was completed at the arrival of each evacuated patient, prospectively during the period from December 24 2006 to July 10 2008. The epidemiological characteristics were, origin of the evacuated, the evacuation conditions, evacuation patterns and therapeutic data. The data were collected through an Excel database developed for this purpose. The analysis was done using the Epi-Info version 6.0 software. Results: The frequency of evacuations was 23.2%. The average age of our patients was 25.3 years with extremes of 14 years and 48 years. More than half of the evacuees (59%) came from the Sanitary District of Rufisque. The majority of evacuations were made in a taxi (76.5%). An ambulance was used in 190 cases (20.6%). Seated transport was performed in 78% of cases. The transfer was medicalized in almost one-third of cases (29.3%). A liaison sheet was established during the transfer of patients in 77% of the cases. Evacuations were related to hemorrhage in 23.3%, dystocia in 22.2%, and fetal-adnexal anomaly in 17.3% of cases. No treatment was instituted before evacuation in 56% of evacuees. 48.5% of the evacuees had received treatment beyond. Conclusion: The poor quality of obstetric evacuations seems to be a brake on the decline in maternal and neonatal mortality in Senegal. Training and retraining of health personnel would improve maternal-fetal and neonatal morbidity and mortality.
Wharton's jelly is a mucoid, avascular and connective tissue which plays the role of umbilical vessels protection. Its absence exposes to poor neonatal outcomes or fetal death. We report a rare case of Absence of Wharton’s Jelly, diagnosed by examination of the placenta the examination with a live fetus.
Background: For a lot of women, childbirth is still a feared moment. Despite considerable progress in the management of childbirth and its complications, maternal and neonatal morbidity and mortality are still a major problem even in developed countries. To evaluate the influence of day of delivery on obstetrical and perinatal outcome.Methods: Retrospective cohort study conducted at the Philippe Maguilen SENGHOR health center maternity ward from January 1, 2011 to June 30, 2019, on patients with a pregnancy of more than 22 weeks of amenorrhea who were received for delivery management. The deliveries periods were divided according to whether they occurred on a working day (deliveries from Monday to Friday, excluding public holidays) or on weekends and public holidays (deliveries on Saturdays, Sundays and days declared as public holidays according to the Gregorian and Senegalese event calendars). The data were extracted from our E-perinatal database and analysed in the Statistical Package for Social Science (SPSS 24, Mac version).Results: Over 102 months, we recorded 42 870 deliveries. The average age of the patients was 27 years with extremes of 13 and 50 years. Nearly one in three deliveries took place on a holiday or weekend (n=13566-31.6%). The rate of caesarean delivery on weekends/holidays (18.8%) was lower than that on weekdays (21%). The odds ratio of having/benefiting from a weekend/holiday caesarean section was 0.87 (CI 0.83-0.92, p<0.0001). Our results suggest that patients who deliver on weekdays are more likely to receive a caesarean section than those who deliver on weekends or holidays. Perineal injury, World Health Organization obstetric complications, and neonatal outcome showed no significant difference by day of delivery.Conclusions: Our results contradict the idea that deliveries on weekends and holidays are more risky for patients and their children.
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