SummaryBackgroundPost-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage.MethodsIn this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283.FindingsBetween March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus ...

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Induction of labor has been in practice for several decades but the decision to induce labor in multifetal gestations has not been accepted by many practitioners in contemporary obstetrics. The aim of this study was to compare maternal and fetal outcomes among women with uncomplicated twin gestations who were induced at term and those who were not. It was a cross-sectional analytic study that lasted ten years, (1 st January 2000 to 31 st December 2009 inclusive) at the maternity of the central hospital, Yaounde, Cameroon. 158 women were enrolled, 79 were induced and 79 went into labor spontaneously. Maternal and fetal outcomes, duration of labor, the prevalence of caesarean section were compared in the two groups. The average age of the women in the groups was 26, 75 ± 3.65 years (range 15 -41 years). For those who were induced, indication was premature rupture of membranes in 44 (56%) of cases. The characteristics of induced and none induced women were similar, except for the number of antenatal consultations (P ≤ 0.001). There was a significant difference in the duration of labor in the two groups (6 hrs versus 9, 75 hrs; P ≤ 0.001). The overall rate of vaginal delivery in the two groups was 87, 97% (n = 139), 88.87% in the group that was induced versus 86.07% in the group that labor was spontaneous (OR 1, 22; 95% IC 0, 51-2, 92; P ≤ 0.90). With respect to primary outcomes, there were no statistically significant differences between the group that labor was induced and that which labor was spontaneous. The prevalence of caesarean delivery was similar in the two groups (10%, 12% vs 13%, 92%; OR 0%, 7%; 95% IC 0, 27-1, 85; P ≤ 0.50). The main indications for caesarean section were acute fetal distress and failed induction. The first and fifth minute APGAR scores less than 7 in the first twins delivered in the two groups were similar. The 312 children delivered in both arms did not show any complications at birth. However, there were 3 neonatal deaths (1 vs 2). There were no cases of uterine rupture or maternal deaths among the 156 women. Induction of labor may be proposed to women with uncomplicated term twin gestations with specific indications. Induction in these highly selected cases does not impute any additional risks but close monitoring of labor is very necessary.

Nevertheless, in low-income countries and particularly in SubSaharan Africa, health systems have not been able to popularized AU to benefit from it numerous advantages in materno-foetal and neonatal care. 7 Despite the numerous constraints to the expansion of AU in SubSaharan Africa, it has been demonstrated that an easy access to that technology would reduce the very high morbi-mortality rate. [8][9][10][11][12][13] The goal of our study was to assess the evolution of practice of AU in Cameroon (central Africa) over the past 3 decades. MethodsWe searched for articles in Medline (pubmed) and Google scholar. Only pertinent articles were included in our analysis. Extraction of studies and assessment of their appropriateness were done by the same investigator. Search in Google scholarArticles were retrieved on June 21, 2018 and languages were English and French. The period under srutiny ranged from January 1, 1990 to May 31st 2018. Only studies carried out in Cameroon with AU as primary or secondary theme were selected. Three combination of search terms were used : a. « Ultrasonographie -anténatale -Cameroun »: 10 articles selected out of the 576 found.b. « Echographie -Anténatale -Cameroun »: 11 articles selected out of the 479 found.