BackgroundCongenital uterine anomalies like bicornis or bicornuate uterus are relatively rare in sub-Saharan Africa. They are associated with an increased rate of spontaneous abortion, preterm delivery, and infertility. The occurrence of bicornis bicollis uterus with unilateral cervical atresia is exceptional and its management is controversial. We hereby report a rare cause of chronic pelvic pain in a Cameroonian teenager due to unilateral obstructive hematometra and hematosalpinx in the non-communicating horn of a bicornis bicollis uterus.Case presentationA 13-year-old premenarchal non-virgin female presented with chronic and severe cyclical crampy pelvic pain. On clinical examination, she had a perforated hymen, a single vagina, and one uterine cervix. A two-dimensional pelvic ultrasonography revealed hematometra but missed out the underlying anomaly. Failure to drain the hematometra by serial cervical dilatations prompted an exploratory laparotomy which revealed: bicornis bicollis uterus with a right rudimentary uterine horn communicating with the vagina and a left non-communicating uterine horn distended by hematometra due to a homolateral cervical atresia. She underwent utero-vaginal canalization and a left hemi-hysterotomy with drainage of the hematometra. The postoperative period was uneventful. Regular cyclic menses occurred thereafter beginning at the first postoperative month. She had complete resolution of symptoms without recurrence after six months.ConclusionDue to the risk of compromised fertility from bicornis uterus and the diagnostic challenges akin to resource-limited settings, we highlight the need for a high index of suspicion by healthcare providers when faced with chronic pelvic pain in premenarchal adolescents.

BackgroundUterine fibroids are the most common uterine tumours in females of reproductive age. During pregnancy, uterine fibroids may be complicated by aseptic necrobiosis. We herein report an ambiguous clinical presentation of uterine fibroids in pregnancy and discuss the diagnostic challenges encountered in our resource-constraint setting.Case presentationA term pregnant Cameroonian woman was admitted to our maternity unit with clinical findings suggestive of a strangulated umbilical hernia. She underwent an emergency caesarean section which fortuitously revealed aseptic necrobiosis of a uterine fibroid, managed within the same surgical intervention by myomectomy. Her post-operative course was uneventful.ConclusionThe authors highlight the need for a high index of suspicion by healthcare providers, as well as the need for a multidisciplinary approach for a favourable maternal and foetal outcome.

BackgroundVisible congenital malformations (VCMs) are one of the principal causes of disability in the world. Prenatal diagnosis is a paramount mandatory integral part of the follow up of pregnancies with VCM of the foetus in high-income setting. We aimed to determine the incidence of prenatal diagnosis of VCMs in a low-resource setting with no policy on antenatal diagnosis of VCMs.MethodsWe carried out a prospective cohort multicenter study from July 2015 to June 2016 in 10 randomly selected maternity units of Yaoundé, Cameroon. We enrolled all newborns with one or more detectable VCMs at birth. Variables studied were findings of the 1st, 2nd and 3rd trimesters’ obstetrical ultrasound scans, in order to establish a concordance between the clinical and sonographic diagnoses of the VCMs and determine the frequency of antenatal diagnosis as well as the rate of medical abortion.ResultsThe incidence of VCMs was 9 per 1000 births. The main VCMs were malformations of the skeletal (4.3%), neurological (2.2%), and gastrointestinal (2.1%) systems. The sex ratio was 1.1. Among the malformed newborns, 37% were premature and in 18.5% the diagnosis of a VCM was confirmed after a therapeutic termination of pregnancy (following suggestive findings of a malformation on antenatal ultrasound scan). The prevalence of sonographic antenatal diagnosis of VCMs was 21%. Hydrocephalus was the most diagnosed VCM antenatally. The mean gestational age at which antenatal clinics were initiated was 15 ± 5 weeks. The mean number of obstetrical ultrasound scans performed was two.ConclusionThe incidence of VCMs in our resource-limited setting is high and antenatal diagnosis rates are very low. Overall, our study emphasizes on the importance antenatal diagnosis of VCMs, often overlooked in our setting. The goal being to reduce maternal and foetal morbidity in a setting already burdened by a high maternal and neonatal mortality.

Background: Quite a tricky day-to-day clinical condition which may present as the first alarming sign of a life-threatening pathology, neonatal respiratory distress (NRD) remains an emergency until its etiology is diagnosed and appropriate treated delivered to the neonate. While the prevalence, risk factors, etiologies, diagnosis and management of this potentially fatal neonatal condition has not been examined extensively, the objective of this scoping review is to synthesise contemporary studies on the prevalence, risk factors, etiologies, diagnosis and management of NRD. Methods: We searched MEDLINE and Google Scholar up to November 13, 2020 for observational and experimental studies and systematic reviews addressing NRD without language restriction. Eight investigators working in four pairs independently selected and extracted relevant data. The methodological quality of all included studies was assessed.Results: We included 81 studies eligible with a total of 511,158 neonates from 21 countries across the world. The risk of bias was low in 61 (75%), moderate in 14 (17%), and high in six (8%) studies. The prevalence of NRD ranged from 0.21 to 84.8% and the highest prevalence rates were observed in Saudi Arabia (78.5%) and Iraq (84.8%). Its highest reported case fatality rates were in Sudan (36%) and India (47.1%). Predisposing factors included prematurity, male gender, low and high birth weights, low socio-economic status, smoking, infectious anamneses, diabetes mellitus, antepartum haemorrhage, cesarean delivery, fetal distress, anesthetic drugs and meconium stained amniotic fluid. Attending four or more antenatal care visits conveyed protection against NRD. Its diagnosis was mainly clinical using the Silverman-Anderson score. Its leading etiology was neonatal infection followed by transient tachypnoea of the newborn and hyaline membrane disease. With regards to its management, it is widely recommended to start with resuscitation followed by specific management of the etiology of NRD by medical or surgical measures or both. Conclusion: The prevalence and mortality rates of NRD are alarming, particularly in low- and middle-income countries. Most of its risk factors are preventable. Neonatal infections is the leading cause of NRD. Overall, we have presented an updated overview of NRD which should serve to ameliorate its healthcare.

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