EMC - Gynécologie-Obstétrique最新文献

Assisted delivery allows birth for some second stage foetal distress or when maternal pushing is insufficient. Vacuum extractor is one of the different techniques used for instrumental delivery. This technique is still rarely used in France despite almost easy handling, and its use results in fewer perineal tears than forceps. Correct utilization and efficiency are based on labour mechanisms, and strict respect of its indications decreases foetal risks.

Discovering myomas in a woman who wants to become pregnant or in a pregnant woman is likely to raise questions and worries. The role played by these myomas on spontaneous fertility or their impact in case of Assisted Reproductive Technology (ART), depends on their size, their localisation and their number. Any doctor who have to cope with this situation has to choose and suggest either an expectative or an interventionist behaviour. Consequences must be clearly explained to the patient whatever the position chosen. Pregnancy after embolisation for myomas is still a fairly rare case and what may come of it will have to be considered on the long run. The management of uterine myomas in a pregnant woman should be as little invasive as possible even if these myomas generate abdominal pain, premature ripping of membranes, delivery haemorrhage, and fœtal misposition. An uterus with myomas is compatible with pregnancy, and it is essential to avoid producing iatrogenicity.

Main characteristics of foetal hypotrophy or small-for-gestational-age infants, intrauterine growth retardation, and chronic foetal distress are addressed in this chapter. Causative factors and patho-physiology are discussed. Current concepts on diagnosis, follow-up and prognosis are synthesized.

Dysmenorrhoea, the most burdensome chronic pain syndrome in women, results in frequent absences from school or work, which translate into major social and economic costs. Primary essential dysmenorrhoea requires neither a physical examination nor other investigations. Secondary dysmenorrhoea is often caused by endometriosis. The mechanism underlying dysmenorrhoea is tissue hypoxia secondary to myometrial hypercontractility and to myometrial arteriolar constriction in response to endometrial overproduction of prostaglandins. Monthly pain should no longer be considered inevitable, as effective treatment is now available. The main drug classes used to treat dysmenorrhoea are nonsteroidal antiinflammatory drugs and oral contraceptives, both of which inhibit prostaglandin production.

Fourteen years ago, the first preimplantation genetic diagnosis was described in the literature. The aim of the preimplantation genetic diagnosis is to analyse genes or chromosomes of embryos just before their transfer into the uterus. This technique avoids, for an identified pathology, the birth of children suffering from this pathology or repetitive medical abortions after prenatal diagnosis. The preimplantation genetic diagnosis needs to be performed by a multidisciplinary team working in well defined legal conditions. The preimplantation genetic diagnosis procedure includes an in vitro fertilization and intracytoplasmic sperm injection, a biopsy of one embryo cell and the genetic analysis of this cell. However, only a restricted number of genetic pathologies can benefit from such management. Preimplantation genetic diagnosis is a promising procedure for numerous patients. However, the evolution of its indications highlights the importance of informing both the couples and the society.

A conservative approach of axillary lymph nodes is now possible in women with small breast cancer since a sentinel lymph node technique has been developed. The concept of this technique is to examine only one particular lymph node, called “sentinel node”, which reflects accurately the nodal status of the axillary region of the arm. To be detected, this node has to be specifically marked using a lymphophilic tracer (blue dye and/or isotopes). The main objective is to decrease upper extremity morbidity related to traditional axillary dissection. Long-term effects of this multidisciplinary technique that involves surgeons, nuclear medicine physicians, and pathologists, remain insufficiently evaluated. However, this promising procedure should significantly improve patients management, allowing a treatment specifically adapted to each case.

Alcoolism leads to severe structural anomalies, called as the fœtal alcohol syndrome. A moderate alcohol intake leads to neurobehavioral impairment of the fœtus. Screening for alcohol consumption, appropriate information of the youngs about harmfull effects of alcohol during pregnancy is a great task for workers in the field of public health.