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Background: Maternal mortality was insufficiently reduced in Cameroon in 2015 despite the adoption of Millennium development goals. To tackle the situation and meet the sustainable Millennium goals target of 140/100,000 live births by 2030, the Government adopted the strategies of building reference hospitals where high quality obstetric care, timely and optimal management of obstetric emergencies will be offered. The objective of this study was to describe the patterns of obstetric emergencies in Douala Gynaeco-obstetric and Paediatric Hospital, evaluate the outcomes of their management and the contribution to maternal mortality. Patients and Methods: 418 patients with obstetric emergencies were included in a two-phase cross-sectional study. Data were retrieved from patients’ case notes during the retrospective phase and a questionnaire filled for each case received during the prospective phase. Patterns of obstetric emergencies were determined and for each, the following were analysed: patient managed in this hospital or referred from other hospitals, management according to hospital guidelines, timing of care, result of management (recovery with no admission in ICU (intensive care unit), admission in ICU, death). Factors associated with each case of death were analysed. Results: The patterns of obstetric emergencies (OE) were dominated by HDP (hypertensive diseases in pregnancy) (20.57%), abortions (14.83%), Ectopic pregnancies (13.87%), Acute foetal distress (13.15%) and Obstructed labour (9.56%). PPH (post partum haemorrhage) represented 7.65% and Sikcle cell crisis (SCA) 0.91%. 40% of cases were referred from other hospitals. Six cases of deaths were recorded with a global case fatality of 1.43%. The causes of death were PPH, HDP, and Sickle cell anaemia 33.33% each. The case fatality of SCA was 50%, disclosing our worst performance. Conclusion: Management of OE following standardized hospital guidelines, reinforcement of referral systems, upgrading obstetrical services with ICU will result in least adverse maternal outcomes and especially reduced maternal mortality.

Saharan Africa (SSA) contributes 29% of the global unsafe abortions with 62% of abortion-related deaths. This is due to restrictive abortion laws, low quality post abortion care (PAC) and inadequate access to effective modern contraception. The overall objective was to review current literature on PAC in SSA and make recommendations for improvement especially in Cameroon. A literature review was conducted on PAC in SSA published during 2000-2018. The following databases were searched: MEDLINE, POPLINE, COCHRANE Library, African Index Medicus and GOOGLE Scholar. Thirty articles were reviewed from 16 countries ranging from observational studies to systematic reviews with meta-analysis. Major outcomes: 1) Manual vacuum aspiration (MVA) and misoprostol are equally safe and effective. 2) There is comparable effectiveness between physicians and trained mid-level cadres in PAC management. 3) PAC contraception uptake was increased when offered immediately before patient leaves the facility. 4) Gaps to PAC service use include inadequate access, low quality care and less adolescent-friendly environment. Task shifting of PAC to trained mid-level staff, decentralization of medical PAC using misoprostol, offering post abortion counselling and contraception to clients before leaving the health facility, encouraging linkage and provider-community partnership in PAC and reinforcement of advocacy for less restrictive abortion laws in Cameroon are recommended.

Background: A novel viral respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for a worldwide pandemic. The effects of this new disease in pregnant women and newborns are actually not well known. Methods: We investigated the clinical features and outcomes of four neonates born to mothers with a severe form of COVID-19 and a positive RT-PCR for SARS Co-V2 in Douala Gynaeco-Obstetric and Pediatric Hospital (Cameroon) from April 20 to June 5, 2020. Results: All four mothers were symptomatic and had a positive RT-PCR for SARS CoV-2 from nasopharyngeal swab on admission. All of them delivered prematurely through cesarean section because of severe respiratory distress and one died shortly after delivery. The four premature male infants were born between 30 weeks and 35 weeks 2 days of gestation and had birth weights ranging from 1090 g to 2950 g. All infants had 1-minute Apgar scores that ranged from 7 to 8 and 5-minute Apgar scores varying between 8 and 9. They were isolated from their mothers immediately after birth and received formula feeding. Three of the four infants were tested using nasopharyngeal swab specimens for RT-PCR 24 to 48 hours after birth and were negative for COVID-19. All the infants were treated in a dedicated area at the neonatal care unit and presented with mild respiratory distress on admission with a Silverman score that varied between 2 and 4/10. During their hospitalization, all the infants also presented with jaundice and underwent phototherapy. Three of them had anemia with hemoglobin levels ranging from 105 to 123 g/L requiring for blood transfusion. The hospital stay varied between 3 and 48 days. Three infants were discharged healthy and one died. Conclusion: This case series suggests the possibility of poor maternal and neonatal outcomes in case of severe COVID-19 in mothers. It also suggests that severe COVID-19 in pregnant women may be a risk factor for prematurity for the newborns. It is crucial to screen pregnant women, to implement infection prevention, control measures and to provide close monitoring of neonates born to mothers with a severe form of COVID-19.

Introduction: The first case of the novel coronavirus (COVID-19) pandemic in Cameroon was confirmed on March 6, 2020. Though widely considered that pregnant women are more susceptible to respiratory tract infections, the available body of literature on the effect of COVID-19 on pregnancy outcomes is shy from being conclusive. In Cameroon, the Douala Gyneco-Obstetric and Pediatric Hospital (DGOPH) was one of the main frontline tertiary health facilities for the management of severe forms of the disease. After four months of managing COVID-19 cases in the general population and especially in pregnant women at the DGOPH, we decided to take a stop, analyze our findings from the patients managed in order to drive future policies and clinical practices via informed decisions. Overall objective: To describe and understand the clinical burden of patients managed for COVID-19 in pregnancy or post-partum at the DGOPH. Methodology: Cross-sectional and descriptive study covering four months—March 24th to July 24th 2020 at DGOPH. Using a pretested questionnaire, we systematically enrolled all patients who fulfilled the inclusion criteria, with analysis done using proportions from an excel spreadsheet. Results: A total of 18 on the 301 pregnant women consulted at the DGOPH, tested positive for COVID-19 giving a prevalence of 6%, and representing 2.3% of all the 800 COVID-19 cases. Of the 44 pregnant women admitted at the DGOPH, 13 of them were due to COVID-19, giving a general admission proportion of 29.5% and a COVID-19 case admission rate of 72.2%. Two-thirds (66.7%) of the patients were aged 30 - 39 years and over 61.1% (n = 11) of the total cases were referred from other health facilities for better management. The most common presenting symptoms were: fever (27.4%), cough (21.5%) and dyspnea (15.7%). Over 72.2% of cases were in their third trimester, and only three had comorbidities. Nasal throat swab PCR was mainstay for confirmatory diagnosis (83.3%). Chest CT scan was realized in 50% (n = 9) of the patients and ground glass opacification (GGO) was observed in all of them. All 18 patients received the standard national recommended regimen therapy for COVID-19. While five of the cases are ongoing gestations, 8 of them were delivered by cesarean section (61.5%), mostly indicated for maternal distress. The neonatal mortality rate was 46%. Four of the 18 patients died giving a case fatality rate of 22.2%. Conclusion: The profile of COVID-19 pregnant women in Douala-Cameroon tends to be similar to what is observed around the world. However, the high ICU admission rate and high case fatality rates recorded differ from what is observed worldwide.

Recto vaginal fistula can be secondary to various and multiple causes. However, intercourse is an exceptional cause. The objective of this work is to expose its clinical, therapeutic and prognostic particularities. We report the case of rectovaginal fistula in a 29-year-old patient, following consensual sex. She underwent posterior colpoperineorraphy under spinal anesthesia, with a favorable outcome. Post-coital recto vaginal fistula is a stigmatizing pathology responsible for polymorphic complications. Prompt care can improve quality of life and the obstetrical prognosis of the patient.