1
|
Huyghe S, Telo S, Danwesse E, Ali E, van den Boogaard W, Lagrou D, Caluwaerts S, Ngbalé RN. Mise à jour thérapeutique et pronostique de la rupture utérine dans une maternité à Bangui, CAR. Public Health Action 2023; 13:13-18. [PMID: 37529553 PMCID: PMC10380413 DOI: 10.5588/pha.23.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/12/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Maternal mortality rates remain high (882/100,000 births) in the Central African Republic (CAR), primarily due to frequent obstetric complications. Médecins Sans Frontières supports a referral maternity ward in the capital, Bangui. OBJECTIVES To describe the prevalence, associated factors and fatality of one of the most severe complications, uterine rupture, as well as the effect of a history of uterine surgery. METHODS This is a cross-sectional study based on retrospectively collected data between January 2018 and December 2021 for women who delivered new-borns weighing over 1,000 g. RESULTS Of 38,782 deliveries, 229 (0.6%) cases of uterine rupture were recorded. Factors associated with uterine rupture were parity ⩾5 (adjusted odds ratio [aOR] 7.5, 95% confidence interval [CI] 4.6-12.2), non-occipital foetal presentation (aOR 2.8, 95% CI 2.1-3.7) and macrosomia (OR 4, 95% CI 2.6-6.4). The fatality rate was 4.4%, and the stillbirth rate was 64%. Uterine rupture occurred in non-scarred uterus in 150 (66.1%) women. Adverse outcomes were more common in cases of uterine rupture on non-scarred uterus compared to scarred uterus, with higher maternal mortality (6% vs. 0%, P = 0.023) and lower Apgar scores (<2) for new-borns (69.1% vs. 45.8%, P < 0.001). CONCLUSION Uterine rupture remains a major issue for maternal and perinatal health in the CAR, and efforts are needed to early detect risk factors and increase coverage of the comprehensive emergency obstetric and neonatal care.
Collapse
Affiliation(s)
- S Huyghe
- Médecins Sans Frontières Centre Opérationnel de Bruxelles, Mission en République Centrafricaine, Bangui, République Centrafricaine
| | - S Telo
- Médecins Sans Frontières Centre Opérationnel de Bruxelles, Mission en République Centrafricaine, Bangui, République Centrafricaine
| | - E Danwesse
- Médecins Sans Frontières Centre Opérationnel de Bruxelles, Mission en République Centrafricaine, Bangui, République Centrafricaine
| | - E Ali
- Ministère de la Santé, Direction de la Santé, Luxembourg, Luxembourg
| | - W van den Boogaard
- Médecins Sans Frontières Centre Opérationnel de Bruxelles, Luxembourg Operational Research Unit (LuxOR), Luxembourg, Luxembourg
| | - D Lagrou
- Médecins Sans Frontières Centre Opérationnel de Bruxelles, Département Médical, Bruxelles, Belgique
| | - S Caluwaerts
- Médecins Sans Frontières Centre Opérationnel de Bruxelles, Département Médical, Bruxelles, Belgique
| | - R N Ngbalé
- Centre Hospitalier Universitaire Communautaire, Bangui, République Centrafricaine
| |
Collapse
|
2
|
Pasquier E, Owolabi OO, Fetters T, Ngbale RN, Adame Gbanzi MC, Williams T, Chen H, Fotheringham C, Lagrou D, Schulte-Hillen C, Powell B, Baudin E, Filippi V, Benova L. High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study). BMC Pregnancy Childbirth 2023; 23:143. [PMID: 36871004 PMCID: PMC9985077 DOI: 10.1186/s12884-023-05427-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 02/03/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR). METHODS We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records' reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity. RESULTS We analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%). CONCLUSION Our data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings.
Collapse
Affiliation(s)
- Estelle Pasquier
- Epicentre - Médecins Sans Frontières, 34, avenue Jean Jaurès, 75019, Paris, France. .,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. .,Department of Public Health - Institute of Tropical Medicine, Antwerp, Belgium.
| | - Onikepe O Owolabi
- Guttmacher Institute, New York, USA.,Vital Strategies, New York, USA
| | | | - Richard Norbert Ngbale
- Ministère de la santé et de la Population de la République Centrafricaine, Bangui, Central African Republic
| | | | | | - Huiwu Chen
- Epicentre - Médecins Sans Frontières, 34, avenue Jean Jaurès, 75019, Paris, France
| | | | | | | | | | - Elisabeth Baudin
- Epicentre - Médecins Sans Frontières, 34, avenue Jean Jaurès, 75019, Paris, France
| | - Veronique Filippi
- Faculty of Epidemiology and Population Health - London School of Hygiene and Tropical Medicine, London, UK
| | - Lenka Benova
- Department of Public Health - Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
3
|
Lagrou D, Zachariah R, Bissell K, Van Overloop C, Nasim M, Wagma HN, Kakar S, Caluwaerts S, De Plecker E, Fricke R, Van den Bergh R. Provision of emergency obstetric care at secondary level in a conflict setting in a rural area of Afghanistan - is the hospital fulfilling its role? Confl Health 2018; 12:2. [PMID: 29387145 PMCID: PMC5776770 DOI: 10.1186/s13031-018-0137-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 01/12/2018] [Indexed: 11/28/2022] Open
Abstract
Background Provision of Emergency Obstetric and Neonatal Care (EmONC) reduces maternal mortality and should include three components: Basic Emergency Obstetric and Neonatal Care (BEmONC) offered at primary care level, Comprehensive EmONC (CEmONC) at secondary level and a good referral system in-between. In a conflict-affected province of Afghanistan (Khost), we assessed the performance of an Médecins Sans Frontières (MSF) run CEmONC hospital without a primary care and referral system. Performance was assessed in terms of hospital utilisation for obstetric emergencies and quality of obstetric care. Methods A cross-sectional study using routine programme data (2013–2014). Results Of 29,876 admissions, 99% were self-referred, 0.4% referred by traditional birth attendants and 0.3% by health facilities. Geographic origins involved clustering around the hospital vicinity and the provincial road axis. While there was a steady increase in hospital caseload, the number and proportion of women with Direct Obstetric Complications (DOC) progressively dropped from 21% to 8% over 2 years. Admissions for normal deliveries continuously increased. In-hospital maternal deaths were 0.03%, neonatal deaths 1% and DOC case-fatality rate 0.2% (all within acceptable limits). Conclusions Despite a high and ever increasing caseload, good quality Comprehensive EmONC could be offered in a conflict-affected setting in rural Afghanistan. However, the primary emergency role of the hospital is challenged by diversion of resources to normal deliveries that should happen at primary level. Strengthening Basic EmONC facilities and establishing an efficient referral system are essential to improve access for emergency cases and increase the potential impact on maternal mortality.
Collapse
Affiliation(s)
- Daphne Lagrou
- 1Medical department, Mother and Child Health Unit, Brussels Operational Centre, Médecins Sans Frontières, Rue de l'Arbre Bénit 46, 1050 Brussels, Belgium
| | - Rony Zachariah
- 2Medical department (Operational Research), Operational Centre Brussels, Médecins Sans Frontières, Luxembourg City, Luxembourg
| | - Karen Bissell
- 3International Union against Tuberculosis and Lung Disease, Paris, France
| | - Catherine Van Overloop
- 4Operational department, Brussels Operational Centre, Médecins Sans Frontières, Brussels, Belgium
| | | | | | | | - Séverine Caluwaerts
- 1Medical department, Mother and Child Health Unit, Brussels Operational Centre, Médecins Sans Frontières, Rue de l'Arbre Bénit 46, 1050 Brussels, Belgium
| | - Eva De Plecker
- 1Medical department, Mother and Child Health Unit, Brussels Operational Centre, Médecins Sans Frontières, Rue de l'Arbre Bénit 46, 1050 Brussels, Belgium
| | - Renzo Fricke
- 4Operational department, Brussels Operational Centre, Médecins Sans Frontières, Brussels, Belgium
| | - Rafael Van den Bergh
- 2Medical department (Operational Research), Operational Centre Brussels, Médecins Sans Frontières, Luxembourg City, Luxembourg
| |
Collapse
|
4
|
Caluwaerts S, Fautsch T, Lagrou D, Moreau M, Modet Camara A, Günther S, Di Caro A, Borremans B, Raymond Koundouno F, Akoi Bore J, Logue CH, Richter M, Wölfel R, Kuisma E, Kurth A, Thomas S, Burkhardt G, Erland E, Lionetto F, Lledo Weber P, de la Rosa O, Macpherson H, Van Herp M. Dilemmas in Managing Pregnant Women With Ebola: 2 Case Reports. Clin Infect Dis 2015; 62:903-905. [PMID: 26679622 PMCID: PMC4787604 DOI: 10.1093/cid/civ1024] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 12/09/2015] [Indexed: 11/20/2022] Open
Abstract
We report 2 cases of Ebola viral disease (EVD) in pregnant women who survived, initially with intact pregnancies. Respectively 31–32 days after negativation of the maternal blood EVD-polymerase chain reaction (PCR) both patients delivered a stillborn fetus with persistent EVD-PCR amniotic fluid positivity.
Collapse
Affiliation(s)
- Séverine Caluwaerts
- Médecins Sans Frontières, Operational Centre Brussels.,Institute of Tropical Medicine, Antwerp
| | - Tessy Fautsch
- Médecins Sans Frontières, Operational Centre Brussels
| | - Daphne Lagrou
- Médecins Sans Frontières, Operational Centre Brussels
| | - Michel Moreau
- Department of Emergency Medicine, Centre Hospitalier Chrétien, Liège, Belgium
| | | | - Stephan Günther
- The European Mobile Laboratory Consortium.,Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Centre for Arboviruses and Hemorrhagic Fever Reference and Research, Hamburg, Germany
| | - Antonino Di Caro
- The European Mobile Laboratory Consortium.,National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Benny Borremans
- The European Mobile Laboratory Consortium.,Evolutionary Ecology Group, University of Antwerp, Belgium
| | - Fara Raymond Koundouno
- The European Mobile Laboratory Consortium.,Laboratoire des Fièvres Hémorragiques en Guinée, Université Gamal Abdel Nasser de Conakry.,Institut National de Santé Publique, Conakry, Guinea
| | - Joseph Akoi Bore
- The European Mobile Laboratory Consortium.,Laboratoire des Fièvres Hémorragiques en Guinée, Université Gamal Abdel Nasser de Conakry.,Institut National de Santé Publique, Conakry, Guinea
| | - Christopher H Logue
- The European Mobile Laboratory Consortium.,Public Health England, Porton Down, United Kingdom
| | - Martin Richter
- The European Mobile Laboratory Consortium.,Robert Koch Institute, Berlin
| | - Roman Wölfel
- The European Mobile Laboratory Consortium.,Bundeswehr Institute of Microbiology, Munich, Germany
| | - Eeva Kuisma
- The European Mobile Laboratory Consortium.,Public Health England, Porton Down, United Kingdom
| | - Andreas Kurth
- The European Mobile Laboratory Consortium.,Robert Koch Institute, Berlin
| | - Stephen Thomas
- The European Mobile Laboratory Consortium.,Public Health England, Porton Down, United Kingdom
| | | | - Elin Erland
- Médecins Sans Frontières, Operational Centre Barcelona, Spain
| | | | | | | | | | | |
Collapse
|
5
|
Abstract
AbstractPorosity of reservoir rocks is an important petrophysical characteristic, used as a basic parameter in simulation studies for predicting reservoir quality. An extensive debate continues about the techniques that are available for porosity measurements and visualization. One aspect is the fact that petrophysical measurements are performed on volumetric samples, whereas classical geological petrography using a petrographical microscope is restricted to 2D analysis. This leads to a discrepancy between petrographical and petrophysical studies. This paper aims to evaluate microfocus X-ray computed tomography (μCT) as a technique that can link petrography and petrophysics. A short overview of the μCT technique is given, together with a discussion of its limitations, mainly due to artefacts. Optimization of image quality and procedures for quantification are outlined. μCT results for porosity measurements of a limestone and a sandstone are compared with results obtained by other techniques.
Collapse
Affiliation(s)
- M. Van Geet
- Katholieke Universiteit Leuven, Fysico-chemische Geologie
Celestijnenlaan 200C, B-3001 Heverlee, Belgium
- SCK-CEM, Waste and Disposal Department
Boeretang 200, B-2400 Mol, Belgium
| | - D. Lagrou
- Vito, Energy Technology
Boeretan 200, B-2400 Mol, Belgium
| | - R. Swennen
- Katholieke Universiteit Leuven, Fysico-chemische Geologie
Celestijnenlaan 200C, B-3001 Heverlee, Belgium
| |
Collapse
|