The prevalence of post-caesarean scar uterus, the most important risk factor of uterine rupture is increasing globally. Grand multiparity can also increase the risk of uterine rupture. The issue of grand multiparous with single post caesarean scar is poorly investigated.
Objectives
The purpose of this study was to assess the factors associated with the mode of delivery of grand multiparous with post caesarean single uterine scar in low resources settings.
Patients and Method
It was a retrospective cohort study conducted from the 1
st
January to the 31
st
of May 2016, in three university teaching hospitals of the university of Yaoundé I in Cameroon. Grand multiparous (GMP) defined as parity ≥5 with single post-caesarean lower segment uterine scar admitted at a gestational age of 37 completed weeks and above were compared to grand multiparous without scar uterus at term. GMP with unknown scar were excluded. The mode of delivery and materno-fetal and neonatal outcome were investigated.
Results
We included 33 GMP with single lower segment uterine scar and 120 GMP without uterine scar. Induction of labor and acute fetal distress were not related to having a scar or not in grand GMP, but augmentation of labor was less likely to be conducted in case of GMP with scar uterus(p = 0.08). The frequency of vaginal delivery was 75.8 and 87.5% in grand multiparous with and without uterine scar respectively (OR 0.17–1.16; P = 0.085), with one case of instrumental delivery in scarless group. However, single scar multiparity status increased by 2.42 folds the risk of delivery by caesarian section (P = 0.066). Cephalo-pelvic disproportion increased the indication of caesarian section by 12-fold in the GMP with scar group (p = 0.031), but mechanical dystocia related indications (CPD, macrosomia,) were present in only 4 cases out of 8 caesarian sections in the exposed group. The Apgar score at the fifth minute was better in the GMP with scar group. (p = 0.037).
Conclusion
Grand multiparous with single post-cesarean uterine scar should be given a chance of vaginal delivery in the absence added feto-maternal morbidity.
Background: Polycystic ovary syndrome (PCOS) is a heterogeneous syndrome posing diagnostic problems in current practice, because of the cumbersomeness associated with the application of the criteria that define it; giving rise to over or under diagnosis of it. Anti-Müllerian hormone (AMH) is an effective alternative in this case, being a stable, reproducible and non-operator dependent marker to diagnose PCOS due to the link that binds it to the multiple pre-antral follicles in the ovaries of PCOS patients. The aim of this study was to determine the threshold value of AMH required to define PCOS in our African population, by revealing the correlation with antral follicles count (AFC) on endovaginal ultrasound.Methods: We carried out a comparative cross-sectional study, with retrospective data collection in 23 infertile patients diagnosed with PCOS according to the Rotterdam 2003 criteria, and 23 non-PCOS infertile controls having performed the AMH test using the Immunotech technique at CHRACERH. Endovaginal ultrasound (U/S) was performed using a 7.5 mega Hertz (MHz) transvaginal transducer by different qualified operators (radiologists, gynecologists). The comparison of the two independent groups (PCOS and non-PCOS) was performed by the Student t-test; correlations between AMH, age, AFC and ovarian volume obtained by the Pearson test; and the diagnostic power of AMH test in PCOS was evaluated by receiver operating characteristic curves (ROC).Results: AMH was approximately twice as high in PCOS compared to controls (6.09 versus 3.80, P <0.001) and was inversely correlated with age (r = -0.301; P ˂0.05); significantly correlated antral follicle count (R = 0.85, P <0.0001) and ovarian volume (r = 0.625, P <0.0001). ROC analysis revealed that the AMH test was very informative for the diagnosis of PCOS with an area under the curve (AUC) at 0.90 (0.81-0.99; 95% CI); and the threshold value given by the farthest point of the diagonal representing the nil contribution test was 4.40 ng/L, and predicted PCOS with a sensitivity of 96% and a specificity of 70%.Conclusions: AMH is a predictive marker for PCOS. It is highly correlated with AFC and ovarian volume and appears to decrease with age. It offers good diagnostic performance in PCOS, with a threshold value of 4.40 ng/L for a sensitivity of 96% and specificity of 70%.
Introduction: Abnormal uterine bleeding (AUB) is one of the most commonly encountered symptoms in gynecological consultations. The prognosis is rarely endangered but the impact on the quality of life is sometimes important. Objective: Our objective was to assess the epidemiological profiles of patients consulting for AUB at the Yaounde Gyneco-Obstetrics and Pediatrics Hospital. Methodology: We carried out a descriptive cross-sectional study at the Yaounde Gyneco-Obstetrics and Pediatrics Hospital. We included all women with acute or chronic per vaginal bleeding and we excluded all cases of bleeding in pregnancy, bleeding due to infection, pre pubertal bleeding and the incomplete files. Data were collected from January to May 2019, using a questionnaire, and analyzed using Epi Info version 3.5.4 and SPSS version 7. softwares. Results: A total of 163 patient files were exploited and analyzed. The frequency of AUB in outpatient gynaecology clinics was 3.7%. AUB patients had a mean age of 36 ± 12.27 years and the most represented age group was 30 to 35 years, with 17.1% cases. Sixty-seven representing 41.1% patients were married, 23.9% were civil servants, 23.1% were tertiary employees, and 40.3% had secondary level of education. Almost 44.1% were nulliparous and 53.9% had unknown HIV status an 83.4% have never used contraception. Conclusion: The frequency of AUB during gynecological consultations is 3.7%. Those women have an average age of 36 years, most of them are nulliparous and have never use contraception.
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