The Donka Hospital is a publicly owned hospital in Conakry, Guinea. It has inadequate facilities to handle demand, and many Guineans cannot afford its services. More than once in recent years the hospital has had to deal with a major influx of patients wounded in civil disturbances.
Abdominal pregnancy is a rare form of ectopic pregnancy, in which the fertilized egg implants and develops in the abdominal cavity. Diagnosis and management are difficult. We report the case of a 31 year-old female accountant referred from a local clinic for abdominal pregnancy in the context of 10 years of primary infertility. Despite the presence of suggestive signs and the number of ultrasounds performed, it was not until the 29th and 31st weeks that the diagnosis of abdominal pregnancy was made. We performed a laparotomy at 37 weeks and extracted a healthy live infant. Fetal extraction led to placental intrusion, the after-effects of which were enamelled with haemorrhagic complications originating from the placenta. These led to a right adnexectomy removing the placenta after an unsuccessful attempt to stop the abundant haemorrhage originating from the placenta. The immediate post-operative course was straightforward, with the patient discharged on the third post-operative day and the newborn well. The importance of this case is to underline the delay in making the diagnosis of abdominal pregnancy in our environment, despite the more frequent use of ultrasound and the possibility of full-term delivery of a healthy child. Conclusion: Abdominal pregnancy is a rare event. It is difficult to diagnose, and a conservative attitude to pregnancy is possible.
Objective: To evaluate the effectiveness of antibiotic prophylaxis during cesarean section in the Gynecology-Obstetrics department of the Donka national hospital in Conakry. Methodology: This was a prospective case-control analytical study lasting 3 months involving 250 patients undergoing cesarean section. The short protocol included 125 patients who received a single dose of 2g of antibiotics intraoperatively after cord clamping while the other 125 patients (long protocol) received antibiotic therapy for 48 hours after the procedure. Results: The sociodemographic profile of the patients was the same in both arms. The mean age of the patients was 24 years with extremes of 14 and 42 years; the 20-24 age group was the most represented (31.2% vs 32.8%). Our series was dominated by primiparas (40% vs 42%). The main mode of admission was evacuation (78.4% vs 64%). The main early postoperative complication encountered was fever (8.2% vs 13.2%) followed by surgical site infection (4% vs 12%). Bivariate analysis shows a statistically significant association between the occurrence of postoperative fever and the long antibiotic protocol (p = 0.028) and this protocol is a protective factor against surgical site infection (p = 0.013). And is more frequently used in the context of emergency cesarean section (p = 0.011). Conclusion: Antibiotic prophylaxis is as effective as antibiotic therapy and thus represents a significant health saving for our countries.
Introduction: Surgical interventions are essential in certain situations requiring the pregnant woman to be spared the complications of pregnancy or dystocic delivery. The aim of this work was to identify factors associated with post-cesarean maternal complications. Methodology: This was a 6-month prospective analytical study, from June 1 to December 31, 2022, carried out in the gynecology-obstetrics department of the Ignace Deen National Hospital of the Conakry University Hospital, involving pregnant and parturient women undergoing cesarean section in the department during the data collection period who had or had not had postoperative complications and agreed to participate in the study. Results: The frequency of post-cesarean complications was 8.31%. The mean age of the patients was 26.7±5.93 years. The 25-34 age group was the most represented (49.4%). They were mainly housewives (41.3%), married (95.7%), not in school (43.0%) and evacuated (41.8%). Emergency cesarean section was the most commonly performed (69.0%). Anemia (53.5%), surgical site infection (26.8%) and postpartum hemorrhage (16.9%) were the most frequently recorded complications with a case fatality rate of 0.7%. Factors likely to be associated with the occurrence of post-cesarean complications were obstetric evacuation (OR=2.151; CI: 1.312-3.527), multiparity (OR=3.544; CI: 2.009-6.252), absence of PNC (OR=21.702; CI: 11.012-42.769), prenatal follow-up in health centers (OR=3.027; CI: 1.597-5.737), emergency cesarean (OR=2.619; CI: 1.353-5.067), qualification of the prenatal follow-up agent (OR=7.317; CI: 2.698-19.842) and prolonged labor (OR=2.057; CI: 1.261-3.353). Conclusion: The elements likely to influence the occurrence of postoperative complications were obstetric evacuation, multiparity, absence of prenatal consultation, prenatal monitoring in health centers, emergency cesarean section, qualification of the prenatal monitoring agent (health technical agent) and prolonged labor. Raising awareness of the importance of prenatal monitoring, performing prophylactic cesareans in the event of any absolute indication for cesarean section, limiting births, and good monitoring of the immediate postpartum period could reduce the risk of post-cesarean complications.
Le syndrome de Marfan est une affection génétique autosomique dominante du tissu conjonctif (fibrillinopathie) rare, due à un défaut de synthèse de la fibrilline de type I. Il est caractérisé par un polymorphisme clinique avec des atteintes ostéo articulaires plus spécifiques (arachnodactylie, pectus carinatum, dolichosténomelie) et moins spécifiques (laxité ligamentaires, cyphose, pieds plats) ; des manifestations ophtalmologiques, cardio-vasculaires, pleuro pulmonaires. Son pronostic vital dépend de l’atteinte cardio-vasculaire. L'atteinte ostéoarticulaire, bien que classique, décrite comme seule circonstance de révélation clinique du SM est rare et source potentielle d'un important retard diagnostique. Nous rapportons ce cas pour alerter la communauté rhumatologique sur cette présentation atypique et souligner la nécessité d'un dépistage cardiologique systématique et urgent pour le pronostic vital. Marfan syndrome is a rare autosomal dominant genetic disorder of connective tissue (fibrillinopathy), due to a defect in the synthesis of type I fibrillin. It is characterized by a clinical polymorphism with more specific osteoarticular involvement (arachnodactyly, pectus carinatum, dolichostenomelia) and less specific osteoarticular involvement (ligamentary laxity, kyphosis, flat feet); ophthalmological, cardiovascular, and pleuropulmonary manifestations. Its vital prognosis depends on the cardiovascular involvement. Osteoarticular involvement, although classic, described as the only circumstance of clinical revelation of MS, is rare and a potential source of significant diagnostic delay. We report this case to alert the rheumatology community to this atypical presentation and to emphasize the need for systematic and urgent cardiological screening for vital prognosis.
