Objective: This study was undertaken to report on the prevalence and management of late complications in twin-to-twin transfusion syndrome (TTTS) treated by laser therapy when both twins are alive 1 week after surgery...Objective: This study was undertaken to report on the prevalence and management of late complications in twin-to-twin transfusion syndrome (TTTS) treated by laser therapy when both twins are alive 1 week after surgery. Study design: A total of 151 consecutive TTTS cases were treated by selective fetoscopic laser therapy. Cases in which both twins were alive 1 week after surgery were followed up with ultrasound and Doppler examination, including middle-cerebral artery peak systolic velocity measurement (MCA-PSV). Results: In the 151 cases treated with laser, both twins were still alive 7 days after the procedure in 101 cases. Intrauterine death of 1 and both twins occurred in 7 and 1 cases, respectively. Recurrence of TTTS with the polyhydramnios-oligohydramnios sequence occurred in 14 (14% ) cases. In another 13 (13% ) cases,amniotic fluid remained normal in both sacs, but MCA- PSV increased above 1.5 MoM in 1 twin and decreased concomitantly below 0.8 MoM in the co-twin. This was related to anemia and polycythemia, respectively, and resulted from unidirectional feto-fetal blood transfusion, mainly from former recipients into former donors. Late complications were managed accordingly by repeat laser, amnioreduction, cord coagulation, intrauterine blood transfusion, or elective delivery. Conclusion: MCA-PSV Doppler measurements are useful in the follow-up of double survivors to detect and manage late complications after selective laser therapy.展开更多
Objective: To analyze maternal deaths, identify causes and dysfunctions leading to these deaths in order to contribute to the implementation of strategies to reduce maternal mortality at CHU Kara. Method: Cross-sectio...Objective: To analyze maternal deaths, identify causes and dysfunctions leading to these deaths in order to contribute to the implementation of strategies to reduce maternal mortality at CHU Kara. Method: Cross-sectional descriptive study involving 65 cases of maternal deaths recorded at CHU-Kara from January 1, 2018 to June 30, 2021. Results: Our study focused on 65 cases of maternal deaths recorded at the maternity ward of CHU-Kara. The average age was 30 years, with a range of 15 to 45 years. They were mostly housewives (52.3%), uneducated (38.5%), multiparous (41.5%), and referred (86.2%). The causes were mainly direct obstetric causes (81.54%), with preeclampsia and its complications (28.30%) and immediate postpartum hemorrhage (20.75%) being the most common. However, uterine rupture (20.5%) and post-abortion sepsis (16.4%) were the most lethal etiologies. Delayed evacuation (46.43%), inadequate transportation (91%), and insufficient prenatal care (72.31%) were the dysfunctions before referral. Within the CHU Kara, delays in management (58.46%), unavailability of blood and labile products (18%), and insufficient monitoring were the dysfunctions identified. Ninety-five point four percent (95.4%) of the deaths were preventable. Conclusion: The magnitude of intrahospital maternal deaths, the various dysfunctions observed in the occurrence of maternal deaths before referral/evacuation and within the hospital highlight the importance of effectively implementing recommendations from audits in the fight against maternal mortality. The majority of the deaths were preventable (95.38%).展开更多
Objective: The role of anesthesia in maternal mortality is unknown in the Democratic Republic of Congo (DRC). This study was conducted with the objective of analyzing the determinants of morbidity and maternal mortali...Objective: The role of anesthesia in maternal mortality is unknown in the Democratic Republic of Congo (DRC). This study was conducted with the objective of analyzing the determinants of morbidity and maternal mortality linked to anesthesia in course of cesarean section. Methods: This is a prospective, analytical and mono-centric study carried out on women who underwent cesarean section at the Centre Hospitalier Mère-Enfant Monkole from January 1st, 2011 to December 31st, 2018. The variables analyzed were socio-demographic, clinical, biological and anesthetic as well as the maternal issues. Data analysis was performed with SPSS 21.0 software. The determinants of mortality were sought by logistic regression with p Results: During this period, 1954 cesarean sections were performed. The mean age of the women was 31 years (range 14 to 47), 1549 women (79.3%) had completed prenatal consultation in Monkole and 405 (20.7%) elsewhere. The emergency was extreme in 192 cases (9.82%), absolute in 445 (22.77%) and relative in 1317 (67.4%). Locoregional anesthesia (LRA) was performed in 1811 cases (92.68%). The main complications were marked by arterial hypotension (22.9%) due to spinal anesthesia, and mortality was 0.56%. In multivariate analysis, only extreme emergency (aOR 7.62 95% CI: 2.80 - 71.23 p = 0.007), coma on admission (aOR 10.44 95% CI: 1.81 - 60.13 p = 0.009), general anesthesia (aOR 15.41 95% CI: 2.11 - 40.21 p = 0.007) and intraoperative transfusion due to anemia/hemorrhage (aOR 8.63 95% CI: 1.07 - 69.55 p = 0.043) persisted as determinants of maternal death. Conclusion: Maternal mortality (0.56%) in this series was relatively low for a low-income country and no death was directly related to anesthesia. General anesthesia, extreme urgency, intraoperative transfusion due to anemia/bleeding, and coma on admission were the major determinants of mortality.展开更多
Objective. To determine risk factors of failed labor in case of fetal macrosomia. Materials and methods. Medical charts of two hundred and forty six women who delivered macrosomic infants ( > 4,000g) between Januar...Objective. To determine risk factors of failed labor in case of fetal macrosomia. Materials and methods. Medical charts of two hundred and forty six women who delivered macrosomic infants ( > 4,000g) between January 2004 and May 2005 were reviewed. Maternal and obstetrical data were analyzed by mode of delivery. Univariate and multivariate (logistic regression analysis) were performed to identify risk factors of failed labor. Results. Rate of cesarean delivery was 18.3% . Indications for cesarean were: failure to progress in 55.6% , arrest in fetal descent in 22.2% , fetal distress in 6.7% , and other in 8.9% . There was a higher risk of failed labor in nulliparous women (p < 0.001), in case of a symphysio-fundal measurements > 34cm (p = 0.004), in nulliparity associated with symphysio-fundal measurements > 34cm (p < 0.001), in case of previous cesarean delivery (p = 0.004), in cases of maternal height < 1.65m (p = 0.02), and with ocytocin use (p = 0.05). In multivariate analysis, nulliparity associated with symphysio-fundal measurements > 34cm (OR = 5.2; CI 1.5- 18.4), previous cesarean section (OR = 3.7; CI 1.1- 12.4) and maternal height < 1.65m (OR = 2.6; CI 1.2- 5.5) were independent factors of failed labor. Conclusion. Failure of labor in case of macrosomia can be predicted in the event of previous cesarean section, shorter maternal height, and association of nulliparity and symphysio- fundal measurements > 34cm.展开更多
Recall the clinical signs and personal and family medical history suggestive of Elhers-Danlos syndrome, mainly type IV. Review of literature and presentation of a clinical case observed in a female patient with Elhers...Recall the clinical signs and personal and family medical history suggestive of Elhers-Danlos syndrome, mainly type IV. Review of literature and presentation of a clinical case observed in a female patient with Elhers-Danlos disease type IV who developed dissection of a renal artery during pregnancy. The prevalence of the syndrome is increasing, reaching, according to the latest publications 1/5000 births. It is important to determine the type of syndrome to assess prognosis. In the classic type and in the hyper mobile type, pregnancy is generally well tolerated although certain complications linked to connective tissue dysfunction such as pelvic instability, premature delivery, bleeding postpartum and perineal lacerations, may develop. Ehlers-Danlos syndrome can be associated with serious and even fatal complications for these patients: vascular dissection or uterine rupture. It is important for obstetricians to be aware of the clinical signs and symptoms suggestive of Elhers-Danlos syndrome in a pregnant patient and to know the diagnostic possibilities and potential risks. If a type IV syndrome is diagnosed, it is very important to inform the patient about the potential implications for pregnancy and maternal health, as well as the risk of transmission to the child and the possibility of antenatal diagnosis.展开更多
The aim of our work is the study of nutrition diabetic women, and the study of the health status of their newborns in West of Algeria. Our study was performed on 165 diabetic mothers aged 20 to 45 years and 161 newbor...The aim of our work is the study of nutrition diabetic women, and the study of the health status of their newborns in West of Algeria. Our study was performed on 165 diabetic mothers aged 20 to 45 years and 161 newborns admitted to the hospital specialized in obstetrics and gynecology of Sidi Bel Abbes. A food survey and anthropometric study were achieved in our population, clinical and socioeconomic data were recorded in an identification card. Our results show that the average age of women with diabetes is 33.26 ± 5.15 ans. The socio-economic survey shows that 47.32% of women have an average monthly income;their education level is low with only 8.06% having a higher level. Anthropometric parameters show that 48.08% of elderly diabetic women aged 30 to 40 years are overweight BMI > 25. Dietary survey indicates that women experienced iron, calcium and vitamin B9 deficiency. The results of clinical data have shown the existence of gestational diabetes with a rate of 50.90%;macrosomia is dominant in their newborns with a rate of 22.26%. We noted the presence of hypoglycemia in 18.01% and inutero death in 12.42%.展开更多
Objective. The aim of the study was to evaluate feasibility and results of ambulatory transurethral injections of Macroplastiqueusing the system MISunder local anaesthesia, for treatment of female stress urinary incon...Objective. The aim of the study was to evaluate feasibility and results of ambulatory transurethral injections of Macroplastiqueusing the system MISunder local anaesthesia, for treatment of female stress urinary incontinence. Material and methods. We have performed a prospective multicentre study which has enrolled 20 patients between January 2003 and May 2004. Mean age was 72.8 ans (range 40 to 91)- . Preoperative inclusion criterias were positive stress test, 24 hours PAD test more than 10 g and post-void residual less than 100 ml. Urethral hypermobility was present in 8 patients (42.1% ), and 3 patients was diagnosed as intrinsic sphincter deficiency (16.7% ) on urodynamics examination. Pre and postoperative evaluation of urinary symptoms and quality of life were performed with the MHU score (Mesure du Handicap Urinaire), the Ditrovie score and the Contilifescale. The Macroplastique implant (Uroplasty) contains silicone and a bioabsorbable gel. Injections were perfomed under the midurethral mucosa (2.5 ml at 6 hours and 1.25 ml at 2 and 10 hours) using the system MIS(Uroplasty). No cystoscopy was required and the mean operative time was 15 minutes. Results. The procedure was feasible under pure local anaesthesia in all cases. No intra-operative complications occurred. Postoperative complications had included 2/19 local pain (10.5% ), 3/19 minimal urethrorrhagia (15.8% ) and 6/19 urinary retentions (31.6% ), which were treated by heterologous intermittent catheterization during 3 to 20 days. Eight patients returned home the same day (42.1% ). The mean hospital stay was 2.3 days. Mean postoperative followup was 8.3 months (range 2.7 to 19.1). No patient required a second injection. Results had shown a 36.9% success rate (7/19), 52.6% improvement (10/19) and 10.5% failure (2/19).At follow- up, stress test was negative in 66.7% of patients (12/18) and PAD test was<10 g in 66.7% (10/15). Modifications on maximal flow rate were non significant after injections. Postoperatively, all urinary symptoms were improved exc展开更多
We report two cases of maternal diaphragmatic hernia during pregnancy. Diaphragmatic hernia is an unusual and severe disease. Maternal and fetal prognosis are threatened. Diagnosis is uncertain when confronted to resp...We report two cases of maternal diaphragmatic hernia during pregnancy. Diaphragmatic hernia is an unusual and severe disease. Maternal and fetal prognosis are threatened. Diagnosis is uncertain when confronted to respiratory and digestive symptoms without any specificity. The chest X ray is the first exam to perform. The objective of this work is to discuss the management of such a pathology in terms of ways of delivery and surgical cure of hernia.展开更多
Objectives.- The GRECO study has collected data on pregnancies, regardless of their outcome, that occurred in women taking an oral contraceptive. Patients and methods.-The analysis concerned 551 women prospectively re...Objectives.- The GRECO study has collected data on pregnancies, regardless of their outcome, that occurred in women taking an oral contraceptive. Patients and methods.-The analysis concerned 551 women prospectively recruited in services of gynaecology or obstetrics, termination of pregnancy centres, family planning centres or consultations of gynaecology in France throughout 2002 and who were 12 weeks pregnant or less. Results.-Contraception used during the cycle of conception was an estroprogestative combination in 88% of cases, a microprogestative in 8.7% , a macroprogestative in 0.9% or another type of pill in 2.4% . Progestatives were levonorgestrel 59.0% , gestoden 17.2% , desogestrel 4.7% , norethisterone acetate 2.9% , norgestimate 1.8% , cyproterone acetate 2.0% , norgestrel 1.6% . When asked about the potential cause of the oral contraceptive failure, 76.9% of women reported events such as missed pills which were the most frequent cause of failure (60.8% of failures and 80.1% of events, 2.7 ± 2.7 missed pills), followed by vomiting and diarrhoea. 81.5% of women chose to terminate their pregnancy. Discussion and conclusion.-The GRECO study, despite its limitations (retrospective collection of missed pills data, declaratory data)-showed that missed pills, even once, were the most common reason for oral contraceptive failure. The most frequent decision was the termination of pregnancy.展开更多
The genital self- mutilation is not rare in women. Risk factors found in these cases are: mood disorders, food behavior anomalies and antecedents of sexual aggression. However, surgical repair is not done in emergency...The genital self- mutilation is not rare in women. Risk factors found in these cases are: mood disorders, food behavior anomalies and antecedents of sexual aggression. However, surgical repair is not done in emergency: we find no similar report to our clinical case describing an added up bilateral reduction nymphoplasty carried out in emergency after hemorrhagic genital self-mutilation. We discuss psychological risk factors, psychiatric diagnosis and optimal treatment, studied from medico-ethical point of view, for this surgical emergency.展开更多
To describe the frequency of maternal and neonatal complications resulting from the use of Thierry’s spatulas. Materials and methods. This retrospective study included 166 patients treated during a 17- month period. ...To describe the frequency of maternal and neonatal complications resulting from the use of Thierry’s spatulas. Materials and methods. This retrospective study included 166 patients treated during a 17- month period. Results. For 100% of the patients, the use of the spatulas allowed the extraction of the new born, in 68 cases (41% ) the new born was engaged between one and two centimeters below the spines. A mediolateral episiotomy was performed in 159 patients (96% ). A serious perineal tear (Type 3) occurred for 6 of these patients (3.6% ). A simple perineal tear (Type 1) or vaginal tear occurred in 24 (18% ). Episiotomy was performed in 18 patients and was significantly protective. No case of serious neonatal complication were related to the use of the spatulas. Conclusion. We found that perineal tear rate is similar to that observed with other instruments used for fetal extraction. No case of fetal trauma could be related to the use of the spatulas; this was the goal of Thierry who creation the instrument. The use of Thierry’s spatulas as a reference instrument is warranted, particularly for cases of prematurity, as these spatulas fulfil the modern obstetrics requirements of fetal protection, without maternal risk.展开更多
Progressive familial intrahepatic cholestasis type 3 (PFIC3) is a rare cholestatic liver disease. Such liver disease can get worse by female hormone disorder. Albumin dialysis or Molecular Adsorbent Recirculating Syst...Progressive familial intrahepatic cholestasis type 3 (PFIC3) is a rare cholestatic liver disease. Such liver disease can get worse by female hormone disorder. Albumin dialysis or Molecular Adsorbent Recirculating System (MARS) has been reported to reverse severe cholestasis-linked pruritus. Here, we report the first use of MARS during a spontaneous pregnancy and its successful outcome in a patient with PFIC3 and intractable pruritus. Albumin dialysis could be considered as a pregnancy-saving procedure in pregnant women with severe cholestasis and refractory pruritus.展开更多
Introduction: References are frequent and most often carried out in emergency situations. The objective of this study was to describe the epidemiological and clinical profile of obstetric referrals to the CHU-Kara. Me...Introduction: References are frequent and most often carried out in emergency situations. The objective of this study was to describe the epidemiological and clinical profile of obstetric referrals to the CHU-Kara. Methodology: This was a retrospective cross-sectional descriptive study conducted from September 1, 2022, to February 28, 2023, at CHU-Kara, focusing on obstetric referrals to the Gynecology-Obstetrics department. Result: 828 patients were referred for obstetric reasons out of 1295 admissions, representing a frequency of 63.9%. The average age was 25.04 years. They were primigravida (38.3%), unemployed (62.7%). Motorcycles were the main means of transportation, accounting for 53.1% of cases. The average distance to reach the referral center was 31.6 km, covered in an average of 71 minutes. In 40.7% of cases, patients had less than 4 prenatal consultations and were referred in peripartum (56.6%) for pre-eclampsia (14%), post-term pregnancy (11.8%), dystocia (10.5%). Eighty-six point nine percent (86.9%) of the referred patients were able to deliver during their stay in the department, of which 61.7% had vaginal deliveries. The maternal and perinatal mortality rates were 0.7% and 14.9%, respectively. Conclusion: Obstetric referrals to Kara University Hospital are frequent during the perpartum period and are often carried out by motorbike.展开更多
Introduction: Obstetric emergencies are common throughout the world and more particularly in developing countries where they are responsible for high maternal-fetal mortality and morbidity. Objective: Study obstetric ...Introduction: Obstetric emergencies are common throughout the world and more particularly in developing countries where they are responsible for high maternal-fetal mortality and morbidity. Objective: Study obstetric emergencies in the maternity ward of Kara University Hospital. Method: Retrospective and descriptive study from April 1, 2022 to March 30, 2023, carried out in the Obstetrics and Gynecology Department of Kara University Hospital. Results: Eight hundred and thirty-five (835) obstetric emergencies were recorded out of 2215 admissions, i.e. a frequency of 37.7%. The average age of the patients was 26.7 with a range of 14 and 45 years. They were primigravidas (36.7%) and nulliparous (38.7%), referred (84.7%) and came from rural areas (72%). Emergencies occurred in the 3<sup>rd</sup> trimester in 74.1% and in parturients (54.1%). Preeclampsia (27%), cessation of progression of labor due to feto-pelvic disproportion (12.4%), postpartum hemorrhage (7.5%) constituted the main obstetric emergencies. In 44.8%, the delivery was carried out vaginally. Magnesium sulfate was the most used drug, i.e. 30.1%;followed by antihypertensive medications in 28.1%. Blood transfusion was performed in 24.3%. The evolution was simple in 90.9%. The maternal fatality rate was 1.6%. The perinatal case fatality rate was 12.3%. Conclusion: Obstetric emergencies are common, dominated by preeclampsia, stopping progress of labor and postpartum hemorrhages. They are responsible for high morbidity and mortality.展开更多
Obstetric hysterectomy is a surgical procedure most often performed in a context of extreme emergency in an obstetric environment. The incidence of obstetric hysterectomy is differently expressed around the world. In ...Obstetric hysterectomy is a surgical procedure most often performed in a context of extreme emergency in an obstetric environment. The incidence of obstetric hysterectomy is differently expressed around the world. In the CHU-SO maternity ward, hemorrhagic obstetric emergencies are common. The extreme urgency in which patients are admitted, the insufficiency of the technical platform, associated with the challenge of the availability of blood products, often leads to performing an obstetric hysterectomy for hemostasis. It is responsible for high maternal morbidity and mortality. Since 2000 no study has been carried out on this practice in the service. Objective was to describe the practice of obstetric hysterectomy at the CHU-SO and specifically to determine the prevalence, the prognostic factors to be able to act to reduce maternal mortality. Method: A descriptive, cross-sectional, and analytical study was carried out at the Gynecology-Obstetrics clinic of the CHU-SO;from January 1, 2021, to June 30, 2022. All hysterectomies performed in an obstetric emergency context (during pregnancy, perpartum or postpartum) in the department were included in our study. We did not include cases of obstetric hysterectomies outside the SO hospital or planned non-obstetric hysterectomies. Results: We recorded 75 cases of obstetric hysterectomy and 15,625 deliveries (0.48%). The average age was 32.89 ± 5.93. The age group between 30 and 35 years old was the most affected with a rate of 37.33%. Labor and third trimester hemorrhage were the main reasons for admission, patients were referred in 80% of cases. The average parity was 3.25 ± 1.92 with utmost of 0 and 11. The pauciparous (41.67%) and multiparous (32%) were the most affected. The indications frequently found were uterine atony (44%);uterine rupture (33.33%). Subtotal inter adnexal hysterectomy was performed in 94.67%. General anesthesia practiced in 69%. They were all polytransfuses. Three poor prognostic factors were observed during our study, namely: uterine atony;the 展开更多
Objective: To study the epidemiological, histological and therapeutic characteristics of endometrial cancer in the Gynecology-Obstetrics department of the Donka National Hospital, CHU of Conakry. Methods: We conducted...Objective: To study the epidemiological, histological and therapeutic characteristics of endometrial cancer in the Gynecology-Obstetrics department of the Donka National Hospital, CHU of Conakry. Methods: We conducted a retrospective descriptive study of 86 patients with endometrial cancer treated in the Gynecology-Obstetrics department of the Donka National Hospital from January 1, 2011, to December 31, 2021, based on their medical records. We analysed the epidemiological, histological and therapeutic aspects of the disease. Results: Endometrial cancer accounted for 3.1% of the 2793 gynecological pathology cases registered in the department during the study period, ranking third. The mean age of the patients was 63 ± 5 years. Most of them were uneducated (59.3%), postmenopausal (91.9%), nulliparous (30.2%), obese (65.1%) and hypertensive (77.1%). More than half of the patients (53.4%) were diagnosed at stage I. Endometrioid adenocarcinoma was the predominant histological type (68.6%). Surgery was performed in 96.6% of the patients, and chemotherapy in 14.0%. After a mean follow-up of 15 months, 84.5% of the patients were alive. Conclusion: Endometrial cancer is a common gynecological malignancy in our department. Endometrioid adenocarcinoma is the most frequent histological subtype. Surgery is the main treatment modality.展开更多
Background: Intra uterine device (IUD) is commonly used as contraceptive procedure. A mislocation is possible and may reduce quality of life. Aim: This paper aims to present a rare case report and emphasize on the dif...Background: Intra uterine device (IUD) is commonly used as contraceptive procedure. A mislocation is possible and may reduce quality of life. Aim: This paper aims to present a rare case report and emphasize on the difficulty of diagnosis. Case Presentation: A 40-year-old woman had a history of IUD implantation after her last delivery. Six years later, she visited a doctor for a pelvic pain going on for a long period. The diagnosis of mislocated intra uterine device (IUD) was made using imaging techniques. Conclusion: A pelvic pain in a woman, going on for a long period, should evoke a migrated IUD. Thorough exploration and management are required.展开更多
Introduction: According to the World Health Organization, globally one in six people experience infertility in their lifetime. Infertility is considered as a major and global public health issue. In most cases, women ...Introduction: According to the World Health Organization, globally one in six people experience infertility in their lifetime. Infertility is considered as a major and global public health issue. In most cases, women bear the burden of infertility to protect the male ego. Although men and women are equally likely to have fertility problems. The aim of this study was to identify the causes of infertility of couples residing in Libreville. Patients and Methods: This was a retrospective descriptive study performed over 2 years, from 1<sup>st</sup> January 2021 to 31<sup>st</sup> December 2022. Data was obtained from 162 couples attending the assisted reproduction department of the mother and child hospitals in Libreville. Statistical analysis was done using IBM SPSS Statistics version 22.0 software. Results: During the study period, 28.5% of couples could afford IVF treatment. The average for woman age was 39.1 ± 4.06 while the average age for male patients was 41.53 ± 7.08 years with minimum and maximum age of 34 et 66 years. More than half (58.6%) of female partners were employed in the public sector. Half of the male partners (50%) were employed in the private sector. The median duration of infertility was 6 years. Approximately 49.4% of couples were diagnosed with primary infertility. The most common causes of infertility in female patients were Fallopian tubes obstruction (53.2%), uterine factors (24.2%) and hormonal problems (19.6%). With regards to male factors infertility, testicular causes were predominant (53.6%). Oligoasthenoteratozoospermia were the major semen abnormalities (55.7%) found after semen evaluation. Both male and female partners were sub-fertile in 47.5% of cases. Unexplained infertility was found in 11% of couples. Conclusion: This study showed that the diagnostic of infertility faced by couples residing in Libreville should involve both male and female partner.展开更多
Female contraception uses both hormonal and non-hormonal methods. The aim of the study is to determine the impact of female contraception on uterine vascularisation and the endometrium. Method: It was a descriptive co...Female contraception uses both hormonal and non-hormonal methods. The aim of the study is to determine the impact of female contraception on uterine vascularisation and the endometrium. Method: It was a descriptive comparative study with an analytical aim. It took place at the University Clinic of Obstetrics Gynaecology and the Radiology and Medical imaging Department of Sylvanus Olympio University Hospital in Lomé over a two-month period from May 15, 2023 to July 15, 2023. Group 1 included women using a modern contraceptive method and group 2 women not using a modern contraceptive method. Epidata 3.1 and R 4.0.4 software were used to process the data. Results: Each group included 50 women. There were no significant differences in uterine and endometrial biometrics. All women on contraception had their zone 1 vascularized, without vascularisation of zone 2, without significant difference with women without contraception The pulsatility index was greater than 3 in 51% (n = 51) of women, including 62.7% (n = 32) of women without contraception and 37.3% (n = 19) of women on contraception, with a statistically significant difference (p = 0.009). Conclusion: Contraceptive methods do not influence the biometry of the uterus. However, uterine artery Doppler indices can predict abnormal uterine bleeding.展开更多
Preeclampsia remains a major obstetrical problem, affecting 3-5% of pregnancies and can be up to 18% in some African countries. Epidemiological studies based on the immune theory showed the relationship between exposi...Preeclampsia remains a major obstetrical problem, affecting 3-5% of pregnancies and can be up to 18% in some African countries. Epidemiological studies based on the immune theory showed the relationship between exposition to sperm and preeclampsia. Repeated exposition to seminal liquid would therefore be a protection against preeclampsia, as observed in women having frequent unprotected sex, or having had a previous normal pregnancy with the same partner. Other publications showed an increased risk of preeclampsia in patients who received sperm during an intrauterine insemination (IUI) or during an in vitro fertilization (IVF). We report a case of reoccurrence of severe preeclampsia in a mixed afro-caucasian couple having had a child delivered normally at term in the past. The couple later went for a sperm donation as a result of a chemotherapeutic treatment for Hodgkin Lymphoma which the man suffered from. The fact that the sperm was gotten from the same donor did not stop the reoccurrence. The first pregnancy gotten from sperm donation ended up into a medical termination of pregnancy (MTP) at 23 weeks 2 days of amenorrhea, and the second pregnancy issued from the same donor ended into a cesarean delivery at 28 weeks of a child with intrauterine growth retardation (IUGR).展开更多
文摘Objective: This study was undertaken to report on the prevalence and management of late complications in twin-to-twin transfusion syndrome (TTTS) treated by laser therapy when both twins are alive 1 week after surgery. Study design: A total of 151 consecutive TTTS cases were treated by selective fetoscopic laser therapy. Cases in which both twins were alive 1 week after surgery were followed up with ultrasound and Doppler examination, including middle-cerebral artery peak systolic velocity measurement (MCA-PSV). Results: In the 151 cases treated with laser, both twins were still alive 7 days after the procedure in 101 cases. Intrauterine death of 1 and both twins occurred in 7 and 1 cases, respectively. Recurrence of TTTS with the polyhydramnios-oligohydramnios sequence occurred in 14 (14% ) cases. In another 13 (13% ) cases,amniotic fluid remained normal in both sacs, but MCA- PSV increased above 1.5 MoM in 1 twin and decreased concomitantly below 0.8 MoM in the co-twin. This was related to anemia and polycythemia, respectively, and resulted from unidirectional feto-fetal blood transfusion, mainly from former recipients into former donors. Late complications were managed accordingly by repeat laser, amnioreduction, cord coagulation, intrauterine blood transfusion, or elective delivery. Conclusion: MCA-PSV Doppler measurements are useful in the follow-up of double survivors to detect and manage late complications after selective laser therapy.
文摘Objective: To analyze maternal deaths, identify causes and dysfunctions leading to these deaths in order to contribute to the implementation of strategies to reduce maternal mortality at CHU Kara. Method: Cross-sectional descriptive study involving 65 cases of maternal deaths recorded at CHU-Kara from January 1, 2018 to June 30, 2021. Results: Our study focused on 65 cases of maternal deaths recorded at the maternity ward of CHU-Kara. The average age was 30 years, with a range of 15 to 45 years. They were mostly housewives (52.3%), uneducated (38.5%), multiparous (41.5%), and referred (86.2%). The causes were mainly direct obstetric causes (81.54%), with preeclampsia and its complications (28.30%) and immediate postpartum hemorrhage (20.75%) being the most common. However, uterine rupture (20.5%) and post-abortion sepsis (16.4%) were the most lethal etiologies. Delayed evacuation (46.43%), inadequate transportation (91%), and insufficient prenatal care (72.31%) were the dysfunctions before referral. Within the CHU Kara, delays in management (58.46%), unavailability of blood and labile products (18%), and insufficient monitoring were the dysfunctions identified. Ninety-five point four percent (95.4%) of the deaths were preventable. Conclusion: The magnitude of intrahospital maternal deaths, the various dysfunctions observed in the occurrence of maternal deaths before referral/evacuation and within the hospital highlight the importance of effectively implementing recommendations from audits in the fight against maternal mortality. The majority of the deaths were preventable (95.38%).
文摘Objective: The role of anesthesia in maternal mortality is unknown in the Democratic Republic of Congo (DRC). This study was conducted with the objective of analyzing the determinants of morbidity and maternal mortality linked to anesthesia in course of cesarean section. Methods: This is a prospective, analytical and mono-centric study carried out on women who underwent cesarean section at the Centre Hospitalier Mère-Enfant Monkole from January 1st, 2011 to December 31st, 2018. The variables analyzed were socio-demographic, clinical, biological and anesthetic as well as the maternal issues. Data analysis was performed with SPSS 21.0 software. The determinants of mortality were sought by logistic regression with p Results: During this period, 1954 cesarean sections were performed. The mean age of the women was 31 years (range 14 to 47), 1549 women (79.3%) had completed prenatal consultation in Monkole and 405 (20.7%) elsewhere. The emergency was extreme in 192 cases (9.82%), absolute in 445 (22.77%) and relative in 1317 (67.4%). Locoregional anesthesia (LRA) was performed in 1811 cases (92.68%). The main complications were marked by arterial hypotension (22.9%) due to spinal anesthesia, and mortality was 0.56%. In multivariate analysis, only extreme emergency (aOR 7.62 95% CI: 2.80 - 71.23 p = 0.007), coma on admission (aOR 10.44 95% CI: 1.81 - 60.13 p = 0.009), general anesthesia (aOR 15.41 95% CI: 2.11 - 40.21 p = 0.007) and intraoperative transfusion due to anemia/hemorrhage (aOR 8.63 95% CI: 1.07 - 69.55 p = 0.043) persisted as determinants of maternal death. Conclusion: Maternal mortality (0.56%) in this series was relatively low for a low-income country and no death was directly related to anesthesia. General anesthesia, extreme urgency, intraoperative transfusion due to anemia/bleeding, and coma on admission were the major determinants of mortality.
文摘Objective. To determine risk factors of failed labor in case of fetal macrosomia. Materials and methods. Medical charts of two hundred and forty six women who delivered macrosomic infants ( > 4,000g) between January 2004 and May 2005 were reviewed. Maternal and obstetrical data were analyzed by mode of delivery. Univariate and multivariate (logistic regression analysis) were performed to identify risk factors of failed labor. Results. Rate of cesarean delivery was 18.3% . Indications for cesarean were: failure to progress in 55.6% , arrest in fetal descent in 22.2% , fetal distress in 6.7% , and other in 8.9% . There was a higher risk of failed labor in nulliparous women (p < 0.001), in case of a symphysio-fundal measurements > 34cm (p = 0.004), in nulliparity associated with symphysio-fundal measurements > 34cm (p < 0.001), in case of previous cesarean delivery (p = 0.004), in cases of maternal height < 1.65m (p = 0.02), and with ocytocin use (p = 0.05). In multivariate analysis, nulliparity associated with symphysio-fundal measurements > 34cm (OR = 5.2; CI 1.5- 18.4), previous cesarean section (OR = 3.7; CI 1.1- 12.4) and maternal height < 1.65m (OR = 2.6; CI 1.2- 5.5) were independent factors of failed labor. Conclusion. Failure of labor in case of macrosomia can be predicted in the event of previous cesarean section, shorter maternal height, and association of nulliparity and symphysio- fundal measurements > 34cm.
文摘Recall the clinical signs and personal and family medical history suggestive of Elhers-Danlos syndrome, mainly type IV. Review of literature and presentation of a clinical case observed in a female patient with Elhers-Danlos disease type IV who developed dissection of a renal artery during pregnancy. The prevalence of the syndrome is increasing, reaching, according to the latest publications 1/5000 births. It is important to determine the type of syndrome to assess prognosis. In the classic type and in the hyper mobile type, pregnancy is generally well tolerated although certain complications linked to connective tissue dysfunction such as pelvic instability, premature delivery, bleeding postpartum and perineal lacerations, may develop. Ehlers-Danlos syndrome can be associated with serious and even fatal complications for these patients: vascular dissection or uterine rupture. It is important for obstetricians to be aware of the clinical signs and symptoms suggestive of Elhers-Danlos syndrome in a pregnant patient and to know the diagnostic possibilities and potential risks. If a type IV syndrome is diagnosed, it is very important to inform the patient about the potential implications for pregnancy and maternal health, as well as the risk of transmission to the child and the possibility of antenatal diagnosis.
文摘The aim of our work is the study of nutrition diabetic women, and the study of the health status of their newborns in West of Algeria. Our study was performed on 165 diabetic mothers aged 20 to 45 years and 161 newborns admitted to the hospital specialized in obstetrics and gynecology of Sidi Bel Abbes. A food survey and anthropometric study were achieved in our population, clinical and socioeconomic data were recorded in an identification card. Our results show that the average age of women with diabetes is 33.26 ± 5.15 ans. The socio-economic survey shows that 47.32% of women have an average monthly income;their education level is low with only 8.06% having a higher level. Anthropometric parameters show that 48.08% of elderly diabetic women aged 30 to 40 years are overweight BMI > 25. Dietary survey indicates that women experienced iron, calcium and vitamin B9 deficiency. The results of clinical data have shown the existence of gestational diabetes with a rate of 50.90%;macrosomia is dominant in their newborns with a rate of 22.26%. We noted the presence of hypoglycemia in 18.01% and inutero death in 12.42%.
文摘Objective. The aim of the study was to evaluate feasibility and results of ambulatory transurethral injections of Macroplastiqueusing the system MISunder local anaesthesia, for treatment of female stress urinary incontinence. Material and methods. We have performed a prospective multicentre study which has enrolled 20 patients between January 2003 and May 2004. Mean age was 72.8 ans (range 40 to 91)- . Preoperative inclusion criterias were positive stress test, 24 hours PAD test more than 10 g and post-void residual less than 100 ml. Urethral hypermobility was present in 8 patients (42.1% ), and 3 patients was diagnosed as intrinsic sphincter deficiency (16.7% ) on urodynamics examination. Pre and postoperative evaluation of urinary symptoms and quality of life were performed with the MHU score (Mesure du Handicap Urinaire), the Ditrovie score and the Contilifescale. The Macroplastique implant (Uroplasty) contains silicone and a bioabsorbable gel. Injections were perfomed under the midurethral mucosa (2.5 ml at 6 hours and 1.25 ml at 2 and 10 hours) using the system MIS(Uroplasty). No cystoscopy was required and the mean operative time was 15 minutes. Results. The procedure was feasible under pure local anaesthesia in all cases. No intra-operative complications occurred. Postoperative complications had included 2/19 local pain (10.5% ), 3/19 minimal urethrorrhagia (15.8% ) and 6/19 urinary retentions (31.6% ), which were treated by heterologous intermittent catheterization during 3 to 20 days. Eight patients returned home the same day (42.1% ). The mean hospital stay was 2.3 days. Mean postoperative followup was 8.3 months (range 2.7 to 19.1). No patient required a second injection. Results had shown a 36.9% success rate (7/19), 52.6% improvement (10/19) and 10.5% failure (2/19).At follow- up, stress test was negative in 66.7% of patients (12/18) and PAD test was<10 g in 66.7% (10/15). Modifications on maximal flow rate were non significant after injections. Postoperatively, all urinary symptoms were improved exc
文摘We report two cases of maternal diaphragmatic hernia during pregnancy. Diaphragmatic hernia is an unusual and severe disease. Maternal and fetal prognosis are threatened. Diagnosis is uncertain when confronted to respiratory and digestive symptoms without any specificity. The chest X ray is the first exam to perform. The objective of this work is to discuss the management of such a pathology in terms of ways of delivery and surgical cure of hernia.
文摘Objectives.- The GRECO study has collected data on pregnancies, regardless of their outcome, that occurred in women taking an oral contraceptive. Patients and methods.-The analysis concerned 551 women prospectively recruited in services of gynaecology or obstetrics, termination of pregnancy centres, family planning centres or consultations of gynaecology in France throughout 2002 and who were 12 weeks pregnant or less. Results.-Contraception used during the cycle of conception was an estroprogestative combination in 88% of cases, a microprogestative in 8.7% , a macroprogestative in 0.9% or another type of pill in 2.4% . Progestatives were levonorgestrel 59.0% , gestoden 17.2% , desogestrel 4.7% , norethisterone acetate 2.9% , norgestimate 1.8% , cyproterone acetate 2.0% , norgestrel 1.6% . When asked about the potential cause of the oral contraceptive failure, 76.9% of women reported events such as missed pills which were the most frequent cause of failure (60.8% of failures and 80.1% of events, 2.7 ± 2.7 missed pills), followed by vomiting and diarrhoea. 81.5% of women chose to terminate their pregnancy. Discussion and conclusion.-The GRECO study, despite its limitations (retrospective collection of missed pills data, declaratory data)-showed that missed pills, even once, were the most common reason for oral contraceptive failure. The most frequent decision was the termination of pregnancy.
文摘The genital self- mutilation is not rare in women. Risk factors found in these cases are: mood disorders, food behavior anomalies and antecedents of sexual aggression. However, surgical repair is not done in emergency: we find no similar report to our clinical case describing an added up bilateral reduction nymphoplasty carried out in emergency after hemorrhagic genital self-mutilation. We discuss psychological risk factors, psychiatric diagnosis and optimal treatment, studied from medico-ethical point of view, for this surgical emergency.
文摘To describe the frequency of maternal and neonatal complications resulting from the use of Thierry’s spatulas. Materials and methods. This retrospective study included 166 patients treated during a 17- month period. Results. For 100% of the patients, the use of the spatulas allowed the extraction of the new born, in 68 cases (41% ) the new born was engaged between one and two centimeters below the spines. A mediolateral episiotomy was performed in 159 patients (96% ). A serious perineal tear (Type 3) occurred for 6 of these patients (3.6% ). A simple perineal tear (Type 1) or vaginal tear occurred in 24 (18% ). Episiotomy was performed in 18 patients and was significantly protective. No case of serious neonatal complication were related to the use of the spatulas. Conclusion. We found that perineal tear rate is similar to that observed with other instruments used for fetal extraction. No case of fetal trauma could be related to the use of the spatulas; this was the goal of Thierry who creation the instrument. The use of Thierry’s spatulas as a reference instrument is warranted, particularly for cases of prematurity, as these spatulas fulfil the modern obstetrics requirements of fetal protection, without maternal risk.
文摘Progressive familial intrahepatic cholestasis type 3 (PFIC3) is a rare cholestatic liver disease. Such liver disease can get worse by female hormone disorder. Albumin dialysis or Molecular Adsorbent Recirculating System (MARS) has been reported to reverse severe cholestasis-linked pruritus. Here, we report the first use of MARS during a spontaneous pregnancy and its successful outcome in a patient with PFIC3 and intractable pruritus. Albumin dialysis could be considered as a pregnancy-saving procedure in pregnant women with severe cholestasis and refractory pruritus.
文摘Introduction: References are frequent and most often carried out in emergency situations. The objective of this study was to describe the epidemiological and clinical profile of obstetric referrals to the CHU-Kara. Methodology: This was a retrospective cross-sectional descriptive study conducted from September 1, 2022, to February 28, 2023, at CHU-Kara, focusing on obstetric referrals to the Gynecology-Obstetrics department. Result: 828 patients were referred for obstetric reasons out of 1295 admissions, representing a frequency of 63.9%. The average age was 25.04 years. They were primigravida (38.3%), unemployed (62.7%). Motorcycles were the main means of transportation, accounting for 53.1% of cases. The average distance to reach the referral center was 31.6 km, covered in an average of 71 minutes. In 40.7% of cases, patients had less than 4 prenatal consultations and were referred in peripartum (56.6%) for pre-eclampsia (14%), post-term pregnancy (11.8%), dystocia (10.5%). Eighty-six point nine percent (86.9%) of the referred patients were able to deliver during their stay in the department, of which 61.7% had vaginal deliveries. The maternal and perinatal mortality rates were 0.7% and 14.9%, respectively. Conclusion: Obstetric referrals to Kara University Hospital are frequent during the perpartum period and are often carried out by motorbike.
文摘Introduction: Obstetric emergencies are common throughout the world and more particularly in developing countries where they are responsible for high maternal-fetal mortality and morbidity. Objective: Study obstetric emergencies in the maternity ward of Kara University Hospital. Method: Retrospective and descriptive study from April 1, 2022 to March 30, 2023, carried out in the Obstetrics and Gynecology Department of Kara University Hospital. Results: Eight hundred and thirty-five (835) obstetric emergencies were recorded out of 2215 admissions, i.e. a frequency of 37.7%. The average age of the patients was 26.7 with a range of 14 and 45 years. They were primigravidas (36.7%) and nulliparous (38.7%), referred (84.7%) and came from rural areas (72%). Emergencies occurred in the 3<sup>rd</sup> trimester in 74.1% and in parturients (54.1%). Preeclampsia (27%), cessation of progression of labor due to feto-pelvic disproportion (12.4%), postpartum hemorrhage (7.5%) constituted the main obstetric emergencies. In 44.8%, the delivery was carried out vaginally. Magnesium sulfate was the most used drug, i.e. 30.1%;followed by antihypertensive medications in 28.1%. Blood transfusion was performed in 24.3%. The evolution was simple in 90.9%. The maternal fatality rate was 1.6%. The perinatal case fatality rate was 12.3%. Conclusion: Obstetric emergencies are common, dominated by preeclampsia, stopping progress of labor and postpartum hemorrhages. They are responsible for high morbidity and mortality.
文摘Obstetric hysterectomy is a surgical procedure most often performed in a context of extreme emergency in an obstetric environment. The incidence of obstetric hysterectomy is differently expressed around the world. In the CHU-SO maternity ward, hemorrhagic obstetric emergencies are common. The extreme urgency in which patients are admitted, the insufficiency of the technical platform, associated with the challenge of the availability of blood products, often leads to performing an obstetric hysterectomy for hemostasis. It is responsible for high maternal morbidity and mortality. Since 2000 no study has been carried out on this practice in the service. Objective was to describe the practice of obstetric hysterectomy at the CHU-SO and specifically to determine the prevalence, the prognostic factors to be able to act to reduce maternal mortality. Method: A descriptive, cross-sectional, and analytical study was carried out at the Gynecology-Obstetrics clinic of the CHU-SO;from January 1, 2021, to June 30, 2022. All hysterectomies performed in an obstetric emergency context (during pregnancy, perpartum or postpartum) in the department were included in our study. We did not include cases of obstetric hysterectomies outside the SO hospital or planned non-obstetric hysterectomies. Results: We recorded 75 cases of obstetric hysterectomy and 15,625 deliveries (0.48%). The average age was 32.89 ± 5.93. The age group between 30 and 35 years old was the most affected with a rate of 37.33%. Labor and third trimester hemorrhage were the main reasons for admission, patients were referred in 80% of cases. The average parity was 3.25 ± 1.92 with utmost of 0 and 11. The pauciparous (41.67%) and multiparous (32%) were the most affected. The indications frequently found were uterine atony (44%);uterine rupture (33.33%). Subtotal inter adnexal hysterectomy was performed in 94.67%. General anesthesia practiced in 69%. They were all polytransfuses. Three poor prognostic factors were observed during our study, namely: uterine atony;the
文摘Objective: To study the epidemiological, histological and therapeutic characteristics of endometrial cancer in the Gynecology-Obstetrics department of the Donka National Hospital, CHU of Conakry. Methods: We conducted a retrospective descriptive study of 86 patients with endometrial cancer treated in the Gynecology-Obstetrics department of the Donka National Hospital from January 1, 2011, to December 31, 2021, based on their medical records. We analysed the epidemiological, histological and therapeutic aspects of the disease. Results: Endometrial cancer accounted for 3.1% of the 2793 gynecological pathology cases registered in the department during the study period, ranking third. The mean age of the patients was 63 ± 5 years. Most of them were uneducated (59.3%), postmenopausal (91.9%), nulliparous (30.2%), obese (65.1%) and hypertensive (77.1%). More than half of the patients (53.4%) were diagnosed at stage I. Endometrioid adenocarcinoma was the predominant histological type (68.6%). Surgery was performed in 96.6% of the patients, and chemotherapy in 14.0%. After a mean follow-up of 15 months, 84.5% of the patients were alive. Conclusion: Endometrial cancer is a common gynecological malignancy in our department. Endometrioid adenocarcinoma is the most frequent histological subtype. Surgery is the main treatment modality.
文摘Background: Intra uterine device (IUD) is commonly used as contraceptive procedure. A mislocation is possible and may reduce quality of life. Aim: This paper aims to present a rare case report and emphasize on the difficulty of diagnosis. Case Presentation: A 40-year-old woman had a history of IUD implantation after her last delivery. Six years later, she visited a doctor for a pelvic pain going on for a long period. The diagnosis of mislocated intra uterine device (IUD) was made using imaging techniques. Conclusion: A pelvic pain in a woman, going on for a long period, should evoke a migrated IUD. Thorough exploration and management are required.
文摘Introduction: According to the World Health Organization, globally one in six people experience infertility in their lifetime. Infertility is considered as a major and global public health issue. In most cases, women bear the burden of infertility to protect the male ego. Although men and women are equally likely to have fertility problems. The aim of this study was to identify the causes of infertility of couples residing in Libreville. Patients and Methods: This was a retrospective descriptive study performed over 2 years, from 1<sup>st</sup> January 2021 to 31<sup>st</sup> December 2022. Data was obtained from 162 couples attending the assisted reproduction department of the mother and child hospitals in Libreville. Statistical analysis was done using IBM SPSS Statistics version 22.0 software. Results: During the study period, 28.5% of couples could afford IVF treatment. The average for woman age was 39.1 ± 4.06 while the average age for male patients was 41.53 ± 7.08 years with minimum and maximum age of 34 et 66 years. More than half (58.6%) of female partners were employed in the public sector. Half of the male partners (50%) were employed in the private sector. The median duration of infertility was 6 years. Approximately 49.4% of couples were diagnosed with primary infertility. The most common causes of infertility in female patients were Fallopian tubes obstruction (53.2%), uterine factors (24.2%) and hormonal problems (19.6%). With regards to male factors infertility, testicular causes were predominant (53.6%). Oligoasthenoteratozoospermia were the major semen abnormalities (55.7%) found after semen evaluation. Both male and female partners were sub-fertile in 47.5% of cases. Unexplained infertility was found in 11% of couples. Conclusion: This study showed that the diagnostic of infertility faced by couples residing in Libreville should involve both male and female partner.
文摘Female contraception uses both hormonal and non-hormonal methods. The aim of the study is to determine the impact of female contraception on uterine vascularisation and the endometrium. Method: It was a descriptive comparative study with an analytical aim. It took place at the University Clinic of Obstetrics Gynaecology and the Radiology and Medical imaging Department of Sylvanus Olympio University Hospital in Lomé over a two-month period from May 15, 2023 to July 15, 2023. Group 1 included women using a modern contraceptive method and group 2 women not using a modern contraceptive method. Epidata 3.1 and R 4.0.4 software were used to process the data. Results: Each group included 50 women. There were no significant differences in uterine and endometrial biometrics. All women on contraception had their zone 1 vascularized, without vascularisation of zone 2, without significant difference with women without contraception The pulsatility index was greater than 3 in 51% (n = 51) of women, including 62.7% (n = 32) of women without contraception and 37.3% (n = 19) of women on contraception, with a statistically significant difference (p = 0.009). Conclusion: Contraceptive methods do not influence the biometry of the uterus. However, uterine artery Doppler indices can predict abnormal uterine bleeding.
文摘Preeclampsia remains a major obstetrical problem, affecting 3-5% of pregnancies and can be up to 18% in some African countries. Epidemiological studies based on the immune theory showed the relationship between exposition to sperm and preeclampsia. Repeated exposition to seminal liquid would therefore be a protection against preeclampsia, as observed in women having frequent unprotected sex, or having had a previous normal pregnancy with the same partner. Other publications showed an increased risk of preeclampsia in patients who received sperm during an intrauterine insemination (IUI) or during an in vitro fertilization (IVF). We report a case of reoccurrence of severe preeclampsia in a mixed afro-caucasian couple having had a child delivered normally at term in the past. The couple later went for a sperm donation as a result of a chemotherapeutic treatment for Hodgkin Lymphoma which the man suffered from. The fact that the sperm was gotten from the same donor did not stop the reoccurrence. The first pregnancy gotten from sperm donation ended up into a medical termination of pregnancy (MTP) at 23 weeks 2 days of amenorrhea, and the second pregnancy issued from the same donor ended into a cesarean delivery at 28 weeks of a child with intrauterine growth retardation (IUGR).
