Iris Publishers_World Journal of Gynecology & Womens Health (WJGWH)

Practice of Manual Intrauterine Aspiration for Post- Abortion Care (PAC): Prospective Study of 137 Cases at Owendo’s CHU Maternity Hospital

Abstract

Objective: Describe and analyze the practice of MIA in our environment with a view of contributing to the reduction of morbidity and maternal mortality.
Methodology: Descriptive and analytical cross-sectional study, conducted at the motherhood of Owendo’s CHU for 24 months, from 1 January 2017 to 31 December 2018. All women who consulted for incomplete abortions with gestational terms below 12 SA were enrolled. The management consisted of uterine evacuation by MIA. For each patient we studied socio-demographic and pregnancy variables, MIA practice, morbidity and maternal mortality.
Results: One hundred and thirty-seven patients were eligible, representing a frequency of 5.5%. The average age of patients was 26.58±1.68 years, with predominance for 16-24 years old. The mean gestational age was 8.13±1.57 SA, 76 cases (55.47%) were aborted and 69 cases (90.79%) were clandestine. The treatment consisted of uterine evacuation. In 89 cases (64.96%). This was done with the electric vacuum cleaner (EMIA) versus 48 cases (35.04) for SMIA. The use of general anesthesia was necessary for 12 cases (8.75%), medical resuscitation 9 cases (6.57%) and resuscitation 1 case (0.73%) with p-value equal to 0.001 and 0.01 respectively for induced abortions. The average length of hospital stay was 1.8±2.08 hours. No maternal deaths were observed.
Keywords: Abortion care after abortion; MIA-Maternal death

Introduction

According to the WHO, induced abortion today is one of the frequent complications of the first trimester of pregnancy and one of the pillars responsible for maternal deaths in low-income countries [1,2]. Worldwide, 20 million at-risk abortions and 80000 deaths per year are recorded or 1/8 deaths. Africa has 3.7 million and 23 miles of deaths as a result of these complications [3]. Abortion is a public health problem that affects women of all ages, but especially young women who are less financially well off and less informed about family planning services. Moreover, these are most often advanced clinical forms and their management is often delayed [1]. This delay is multifactorial. In 2009, a series produced by Mayi-Tsonga and al. At the Libreville University Hospital showed that women died from unsafe abortions. These deaths were related to long delays in receiving emergency obstetric care (EOC) [4]. The authorities then supported the recommendations of the Hospital Committee on Maternal Mortality, which called for shortening delays and also improving the care of women suffering from abortion complications. This explains why the Gabonese Society of Obstetric Gynecology and Reproduction (GSOGR) have agreed to participate in the FIGO initiative for the prevention of unsafe abortions and their consequences [5]. For example, hospitals have introduced manual intra-uterine aspiration training (MIA) into health care provider. It is a method of uterine evacuation that mobilizes few means, accessible by all health formations and preserves fertility by avoiding immediate complications. It can be made using syringe (SMIA) or electric vacuum cleaner (EMIA). Since then, MIA has been widely used in all health units in Libreville.
The purpose of our study was to describe and analyze the practice of MIA in motherhood of Owendo’s Teaching hospital with a view to contribute to the reduction of maternal morbidity and mortality.

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Iris Publishers_World Journal of Gynecology & Womens Health (WJGWH)

Death from Acute Hyponatremia Following Uneventful Abdominal Hysterectomy: Lessons from a Case Report

Abstract

A 38-year-old woman underwent a routine/uneventful abdominal hysterectomy for abnormal uterine bleeding (AUB) and uterine fibroids. Approximately 24 hours later, she developed severe hyponatremia (Na = 118 mEq/L), brain edema and coma, and she died 3 days later. The mechanism of hyponatremia was, likely, due to excessive and/or inappropriate fluid infusion of 2/3:1/3 solution. The inability to regulate her fluids and electrolytes (Na and K), was, likely, related to addback estrogen therapy given for 3 months preoperatively in conjunction with a GnRH agonist to optimize the patient’s hemoglobin and shrink the uterus/fibroids. It has been known that postmenopausal women and men can regulate excessive hyponatremic fluid absorption and electrolytes better than premenopausal women implicating an estrogen role. Estrogen has been found to inhibit the Na/K-ATPase pump in a variety of tissues/organs including the brain. This woman’s pathology of the endometrium was reported as proliferative indicating that enough estrogen may have been available to inhibit her Na/K-ATPase pump resulting in inability to regulate her fluids and electrolytes leading to her death.
Keywords: Hysterectomy; Hyponatremia; Death; GnRH agonist; Addback therapy

Introduction

Hysterectomy is the most frequently performed gynecologic procedure worldwide with a lifetime risk for hysterectomy in the US of 45% [1]. Uterine fibroids, abnormal uterine bleeding (AUB) and chronic pelvic pain with or without endometriosis are the three major indications for hysterectomy and together, they account for 55% - 85% of all hysterectomies [2].
However, in spite of its common practice and advancements in techniques and technologies, hysterectomy is still associated with considerable risks and complications resulting in significant morbidity (15%-30%) and mortality (0.03%-0.04%) [3]. In 2018, a population-based, retrospective cohort study of 93 059 adult women who underwent abdominal hysterectomy from April 1, 2003, to October 1, 2014, in Ontario, Canada, reported a 30-day mortality of 59 (0.06%) [4].
Although the cause of death was not specified in any of the above studies, the most frequent associated morbidities listed were wound complications, venous thromboembolism (VTE), urinary tract infection (UTI), sepsis and blood transfusion. Herein we present a unique case of uneventful abdominal hysterectomy for AUB and uterine fibroins who died from acute dilutional hyponatremia.

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Iris Publishers_World Journal of Gynecology & Womens Health

Importance of Sonographic Endometrial Morphology in Detecting Hyperplasia and Carcinoma

In 2008, the American College of Obstetricians and Gynecologists (ACOG) put together a special committee to produce recommendations on the role of transvaginal sonography to evaluate endometrium in postmenopausal women [1]. Transvaginal ultrasonography usually is sufficient for an initial evaluation of postmenopausal bleeding if the ultrasound images reveal a thin endometrial echo (less than or equal to 4 mm), given that an endometrial thickness of 4mm or less has a greater than 99% negative predictive value for endometrial value for endometrial cancer [1].

However, certain types of endometrial carcinoma e.g., type II can present with endometrial thickness of less than 4 mm [1]. The International Endometrial Tumor Analysis (IETA) group was formed in Chicago at the World Congress of Ultrasound in Obstetrics and Gynecology in 2008 with the aim of agreeing on terms and definitions to describe ultrasound findings in the uterine cavity.
We present retrospective analysis of 1,842 patients in whom we compare endometrial thickness and appearance (morphology) with the results of clinically indicated endometrial biopsy results.

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Iris Publishers_World Journal of Gynecology & Womens Health

Updates in Management of Hypertensive Disorders of Pregnancy

Hypertensive disorders of pregnancy (HDP) were discovered a long time ago but our knowledge about their etiopathogenesis are still limited. These disorders can affect many pregnant women all over the world putting them, their families and their countries under significant health burden. The main goal of all research efforts regarding treatment of HDP is how to prevent highly morbid complications and mortality of HDP that may affect both mother and fetus. Delivery is the main line of treatment for severe cases, but we have to put in our mind risk of prematurity as a possible outcome in case of termination besides the possibility of incidence of complications like eclampsia and hypertensive emergency postnatally. Researchers believed that studies working on prevention would result in major improvement of overall women care worldwide, and screening will definitely allow prompt starting therapy for those patients and prevent further sequences. Recently many guidelines support and recommend Aspirin 81mg for the prevention of preeclampsia in high-risk patients using evidence-based data about the time and indications of its intake. Great efforts have been contributed to developing evidence-based guidelines to enhance our strategies to deal with these disorders. Reviewing, pooling and comparing these guidelines would help us to refine our questions that may need to be answered by further studies. Trials confirmed that application of standardized strategies for treating HDP significantly improves both maternal and fetal outcomes. In this article, we are going to review recent updates and guidelines about the treatment of HDP and provide references for your further readings.

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