An estimated 2 million women living in countries with limited resources currently have vesico-vaginal, recto-vaginal, or mixed types of fistulae because of the necrosis that occurs with obstructed labor. We evaluated factors readily assessed by the examining practitioner in a consecutive case series of surgical repairs of obstetrical fistulae, for the ability of those factors to stand as a prognostic guide, in a clinical score. Objectives: To identify the predictors of surgical repair outcomes and establish a Score combining these different determinants to facilitate the care of obstetric fistula. Methods: We conducted a multicentric prospective study between 2011 and 2014 in Democratic Republic of the Congo (DRC). Outcomes: We measured 3 months post-surgery in a series of 483 patients with obstetrical fistula repaired by the same surgeon included closure and failure appreciated by dye test. Multivariable generalized estimating equation models were used to generate adjusted odd ratios (OR) and 95% confidence intervals (CIs). The scores ranging from 3 to 14 were established from the outcomes determinants identified. Results: In total, 483 women were enrolled, and 390 cases were at their first surgery and were included in the obstetric fistula (OF) prognosis score and classification. Their mean age was 35 years at the time of the surgery and 25 years at the onset of OF. In 28.6%, the fistula patient was primigravida. Mean duration between onset of the fistula and surgical treatment was 8 years. In 24%, the fistula patients lived separated from their partners. Overall closure rate of the fistulas was 85.7%. Severe vaginal fibrosis (p < 0.01), big fistula size (<0.01), small distance from fistula to external urethral meatus (<0.01) and prior surgery (p < 0.48) predicted failed fistula closure. A clinical score ranging from 3 to 14 points is a prognostic score with a range of 1 to 4 for the distance between the fistula and the external meatus and the size, and a scale of 1 to 6 for fibrosis. 768Conclusions: This study demonstrated that the marked vaginal scarring; large fistula size and distance to urethral meatus are predictors for unsuccessful fistula repair. Due to the lack of a standard classification that is never unanimous among the different surgeons, this prognostic score allows the combination of the different determinants assessing the chances of success and can help the practitioners to orient the patients towards the determined skill scale to take care of the patients.

Objective: To identify the epidemiologic profile of the teenage mother; determine the frequency of teenage deliveries at CHME/Monkole; identify the most common obstetric complications during childbirth in adolescents; and evaluate the maternal and fetal prognosis of teenage birth in our environment. Methods: We conducted a descriptive study with a retrospective approach using records of teenage births admitted to the CHME/Monkole maternity between January 1, 2016 and December 31, 2017. Results: The overall rate of teenage delivery was 3.9%. 2016 saw a high rate of 55.2%. The average age was 18.2 years old, and the age group 17 -19 was the most affected. The commune of Mont-Ngafula had registered more cases than the other communes with 56.7%. The majority of teenage girls who gave birth were primigravida (91%). Urogenital infection was the most common pathology observed during antenatal care (ANC) visits in teenage pregnancies (25.4%). Fetal-pelvic disproportion and water loss were the most common reasons for transfer, 15% each. Most pregnancies were completed (73.1%). The delivery was eutocic in 55.2% of cases. The tearing of the soft tissues was the most encountered complication (7.5%). Most newborns (83.6%) had not received neonatal resuscitation in the delivery room. One case of maternal death was registered (1.5%), and two cases of neonatal deaths were noted (3%). Conclusion: Teenage pregnancy is a risk factor for childbirth. The most important risk is presented by a caesarean section following a bony pelvic dystocia and the tearing of the soft tissues during eutocic delivery. Educating young people about family planning remains important to prevent early pregnancies and thus promote girls' schooling.

Background: Pregnant women in the Democratic Republic of Congo (DRC) are at increased risk for developing obstetric fistulas (OFs) as a result of obstructed labor, in conditions similar to many other African countries. No case-control study of biological and social risk factors for OF has been reported from the DRC. This study aimed to identify factors that would aid in prevention and early identification of women who are at risk of developing OF. Methods: Participants were enrolled in a case-control study at four obstetric clinics in the central DRC. Cases of OF were evaluated as they presented, then a control participant was enrolled among women presenting subsequently to the same clinic, seeking to match parity at the time of the fistula and tribe of the case. A questionnaire was administered to elicit physical, obstetric, demographic, socioeconomic, religion, geographic, and delivery attributes of the participants. Case-control comparisons sought to identify independent risk factors for OF in the total case-control pairs and in subgroups of the participants. Logistic regression was utilized to identify independent risk factors for OF in the total case-control study group and in selected subgroups of the participants, and linear regression was utilized to estimate the variation explained between case and control outcomes from the variables independently significant in the logistic regression models. Results: A total of 177 case-control pairs were enrolled. Among all pairs, shorter height of the case (odds ratio = 1.06, 95% Confidence Limits 1.02-1.12); more kilometers travelled to the delivery site (1.02, 1.01-1.02); her village, not town, residence (OR = 5.52, 2.72-11.2), and her lower professional status (2.95, 1.53-5.72) were statistically independent factors associated with OF development.

Objective: To identify the epidemiologic profile of the woman having practiced the clandestine abortion, to determine the frequency and the complications of the clandestine abortion and to evaluate the prognosis of the clandestine abortion in our area. Method: The present study is descriptive and retrospective covering the period from January 2017 to December 2017, the one year period. On 118 patients received in the service for clandestine abortion, 60 were retained for the study. The 58 other files were excluded because of not containing sufficient information for this study. The descriptive statistical analyses were applied for the data analysis. Results: The frequency of the allowed patients for complication of clandestine abortion caused at the Saint Joseph hospital of Kinshasa was 6.03%. The most concerned population with this practice was less than 15 years and more than 45 years; they were unmarried (41.6%) and nulliparous (41.6%) in most cases. Ancillary medical staff (especially nurses) was accused the most in this practice of the illegal abortion caused by the dilatation and curettage with 50%. The genital haemorrhage constitutes the principal complication and reason for consultation and accounted for 78.3%. The assumption of responsibility is primarily medical and surgical. The vital prognosis is satisfactory for the immediate one, because no death is noted. Conclusion: The clandestine abortion remains public health problem in our communities. The results found in our study call for certain reflections so that to reduce its frequency and to avoid its complications.

Over 90 percent of illness and death attributable to malaria occurs in Sub-Saharan Africa, frequently among pregnant women and young children. Infection with P. falciparum results in high parasitemia percentages and it is the most frequent cause of malaria that results in illness and death in Africa. In areas with holoendemic transmission, such as in most of the Democratic Republic of the Congo (DRC), adults are exposed to malaria every few days or weeks throughout life and, if surviving, have relatively mild bouts of illness because of acquired immunity.