The novel coronavirus (SARS-Cov-2) that appeared in December 2019 in China quickly spread to all countries around the world leading the World Health Organization (WHO) to declare a pandemic on 11 March 2020. This pandemic is particularly serious in that it severely undermines health care systems in all affected countries, including developing and resource-constrained countries, forcing them to adapt quickly. Current data on COVID-19 and pregnancy are limited. The first published Chinese data seem to show that the symptoms in pregnant women are substantially the same as those in the general population. Through the first 2 cases of COVID-19 observed during pregnancy at Angré University Hospital, the authors wanted to share their experience, under the conditions of a low-resources country
The novel coronavirus (SARS-Cov-2) that appeared in December 2019 in China quickly spread to all countries around the world leading the World Health Organization (WHO) to declare a pandemic on 11 March 2020. This pandemic is particularly serious in that it severely undermines health care systems in all affected countries, including developing and resource-constrained countries, forcing them to adapt quickly. Current data on COVID-19 and pregnancy are limited. The first published Chinese data seem to show that the symptoms in pregnant women are substantially the same as those in the general population. Through the first 2 cases of COVID-19 observed during pregnancy at Angré University Hospital, the authors wanted to share their experience, under the conditions of a low-resources country.
Uterine myomas are observed in about 3-12% of pregnant women. These uterine fibroids can affect the outcome of pregnancy. There is an increased risk of spontaneous abortion, irregular fetal presentation, aseptic necrosis, placenta previa, premature birth, caesarean section, peripartum hemorrhage and also compression of nearby organs. Although myomectomy during pregnancy is not recommended, some emergency situations lead to retain this surgical indication. The authors report 2 cases of voluminous uterine myomas (FIGO type VI) that caused mechanical compression of the urinary tract with ureterohydronephrosis during the second trimenon of pregnancy. In our first clinical observation, the presence of fibroid was associated with severe bilateral ureterohydronephrosis, myomectomy was essential before the evolutionary risk towards renal failure. In our reported second case, there was no pain but acute retention of urine that required bladder catheterization. This retention was associated with sub-occlusive symptoms with stopping the materials for two weeks without gas. They benefited from a laparotomic myomectomy before term, with a favourable outcome for the mother and the child. The myomectomy during pregnancy remains exceptional and the evolutionary modalities are unpredictable with an increased risk of haemorrhage which can darken the obstetric prognosis, or even the vital one of the mother-child couple. Close prenatal monitoring is still necessary after the myomectomy.
Spontaneous uterine rupture following a history of surgical treatment of an interstitial tubal ectopic pregnancy (EP) is a rare clinical form. This uterine rupture occurring after a wedge resection of the uterine horn, is a serious obstetric complication involving maternal and fetal vital prognosis and obstetric fate of patients in the absence of immediate management. Our observation concerned a 32-year-old gestant, G3P1 (without living children), with a history of interstitial EP dating back to 3 years during which a uterine wedge resection was performed. For this patient, a prophylactic caesarean was recommended between 36 and 37 weeks of amenorrhea. The patient presented during her prenatal follow-up at 37 weeks and 6 days, a complete uterine rupture involving the right uterine horn with the death of a fetus weighing 2900g. The rupture extended throughout the uterine horn, with the right uterine pedicle intact and the right fallopian tube absent. A conservative treatment of the uterus was decided since the patient had no living children. The purpose of our observation is to recall the risk of uterine rupture after cornual uterine excision hence the importance of performing during a EP if possible, a salpingectomy at the level of the uterine horn and if necessary coagulate the intramural portion of the tube. And also in case of uterine wedge resection, to hasten the prophylactic caesarean section as soon as sufficient maturity of the fetus to reduce the incidence of this pregnancy complication.
Objective: To evaluate the surgical management of myomas at the Teaching Hospital of Angré according to the FIGO (International Federation of Gynecology and Obstetrics) classification. Patients and methods: This was a cross-sectional study at the Teaching Hospital of Angre from January 1, 2020, to December 31, 2022. Patients whose operative indication was clearly identified were included in the study. Incomplete files were not included. The variables studied were anthropometric parameters, clinical characteristics of myomas, and surgery. Due to the large size and multifocal location of uterine myomas, the therapeutic option remained surgery by laparotomy. Results: Most patients were over 35 years old (71.5%) and nulliparous (52.8%). The first indication for surgery was menometrorrhagia (88.6%), followed by the desire for motherhood (37.8%) and dysmenorrhoea (20.2%) for myomas most often FIGO type 4 (p = 0.0031). Myomectomy under cervical-isthmic tourniquet was the most common procedure for FIGO type 4 myomas (66.1%; p = 0.0543). Hysterectomy was most frequently performed for FIGO type 7 myomas (43.9%; p = 0.0543). For myomectomy, the first complication was anaemia (3.5%) followed by uterine suture haemorrhage (1.7%) (p = 0.5139). Conclusion: Our surgical practice at the Teaching Hospital of Angre is in accordance with FIGO recommendations. However, an effort should be made to promote the minimally invasive surgical approach (laparoscopic, hysteroscopic, transvaginal ablation) for small fibroids (≤ 5 cm) or FIGO type 0 to 3, which is not very frequent in our current practice.
As part of the optimization of care, ultrasound scans are routine during pregnancy. The result is the more frequent finding of a benign-looking tumor associated with pregnancy. These are most often mature teratomas of the ovary also called dermoid cyst. We report a case of mature ovarian teratoma larger than 60 mm, diagnosed in early pregnancy. The objective of this clinical case is to discuss the pathophysiological mechanisms, prognosis and management in countries under medical care. This case occurred in a primigest, nulliparous 28-year-old woman who did not have a specific medical history. The pregnancy was brought to term without major complications. The mode of delivery was a cesarean section, which gave us the opportunity to perform the cystectomy. In view of this case, we propose that, in the absence of a laparoscopy or a laparotomy for an ovarian cyst associated with pregnancy and when the maternal-fetal condition allows it, therapeutic abstention may be considered. In this case, special prenatal monitoring must be carried out by a multidisciplinary team of obstetrician, sonographer, intensive care anesthesiologist and neonatologist. Apart from complications directly related to the cyst during pregnancy, we recommend a full term caesarean section. This represents an opportunity to perform the cystectomy at the same time of operation.
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