Revue francaise de gynecologie et d'obstetrique最新文献

Aim: In order to assess their undertook a retrospective study in their department over a 4 year period: from January 1991 to December 1994.

Method: the study concerned 129 patients who were treated by cerclage. This procedure was performed prophylactically in the great majority of them (97), while it was carried out as an emergency in 32 (25%).

Results: the authors drew a distinction between two groups (prophylactic and emergency suture) when analyzing the various results: complications due to suture, mean age of pregnancy at delivery, threatened premature labor, mean length of prolongation obtained. These personal data formed the basis of a review of the literature, in order to specify the indications for suture adopted by various authors at the present time.

Conclusion: the authors found themselves to be in agreement with data from the literature, considering a history of at least two obstetric accidents (late abortions) and/or the existence of a severe uterine malformation to be the principal indication for prophylactic suture. "Emergency" suture should be performed whenever there is a serious threat of early premature labor in the presence of cervical changes such that suture offers the only chance of prolonging the pregnancy.

A series of hysterectomies performed during labor or shortly after delivery, all as emergencies is reported. The study covered the ten years 1982-1991, during which 65,488 deliveries resulted in infants with a birth weight of 500 g or more. There were no hysterectomies among the 21,998 primipara, the incidence in multipara being 1 per 3,954 deliveries. Five operations were performed for rupture of the uterus and six for cataclysmic bleeding. Seven of the 11 patients had history of caesarean section. In multipara, the existence of a caesarean scar multiplied the risk of emergency hysterectomy by a factor of 18. There were no maternal deaths but all patients required transfusion with more than 6 units of packed cells. These results emphasize the fact that a history of caesarean is the principal etiologic factor in patients experiencing complications of pregnancy which require emergency peri-partum hysterectomy.

The authors report the hormonologic characteristics of 20 obese and hirsute women meeting the criteria for adrenaltype hyperandrogenism, suppressible by dexamethasone, without hyperprolactinemia and without any late developing partial enzyme block appearance. The laboratory profile of these women differed from that of a group of women with type 1 polycystic ovaries syndrome. In this same group obese women in whom LH/FSH ratio was below 1, there was evidence under baseline conditions of a moderate increase in testosterone and delta 4-androstenedione in relation to increased plasma levels of DHA and SDHA, plasma delta 4 and delta 5-androgen levels falling precipitalely during the dexamethasone suppression test. The ACTH stimulation test revealed greater reactivity for 17 hydroxy-pregnenolone (p < 0.001) and less for 21-deoxycortisol than in the control group of normal women (p < 0.01). The essentially adrenal origin of plasma hyperandrogenism in certain cases of obesity is discussed. Insulin could increase adrenal sensitivity to ACTH and its possible action in vivo on the activity of adrenal enzymes requires clarification. The accumulation of certain androgens in the adrenal cortex could also be responsible for dysregulation of 3 beta ol-dehydrogenase and 11-hydroxylase.

The authors report 5 cases of breast angiosarcoma collected in the Salah Azaiz Institute of Tunis, the only oncology center in this country, between 1969 and 1990. They enumerated 4,000 malignant breast tumors during this period; i.e. an incidence of 1.25%, higher than that in the world literature (0.4%). The mean age of patients was 44. Three were post-menopausal, and two were of childbearing age, one of whom was pregnant. This rare tumor is virtually limited to women. Affection is scarce, it affect's almost exclusively women. It generally present as a painless, ill-defined mass, without regional lymphadenopathy. The diagnosis of angiosarcoma is difficult since the histologic appearance is sometimes identical to that of a hemangioma. Hence the value of very thorough histologic examination of the entire operative specimen. Treatment is based upon mastectomy. The usefulness of adjuvant chemotherapy and/or radiotherapy is uncertain. The prognosis remains gloomy despite early diagnosis and treatment. The authors attempt in this study to identify the various features of this serious and uncommon condition, based upon the rare published cases in the world literature.

Two defined management approaches, temporization limited to 48 hours and immediate induction of labor, for premature rupture of the membranes at term were compared in a prospective study between January 1 1991 and November 30 1993 in the Maternity Unit of Yaoundé University Hospital. During this period, 268 cases of premature rupture of the membranes were seen among 3252 deliveries, i.e. an incidence of 8.2%. In the temporization group (153 cases), spontaneous onset of labor was effective in 95 patients (62.1%) within 12 hours and in 137 patients (89.5%) within 24 hours after premature rupture of the membranes. Spontaneous deliveries in this temporization group accounted for 129 cases (92.8%). In the induction of labor group, spontaneous delivery occurred in 119 cases (93.2%). There were ten cesareans in the temporization group and eight cesareans and two vacuum cup extractions in the induction group. Short term (24 hours) prophylactic antibiotics were given to 34 patients, i.e. 16 cases in which the duration of rupture of the membranes was more than 24 hours and 18 cases of cesarean section. Maternal infections concerned 18 cases (6.7%) including 12 cases (4.4%) of malaria. Microbiology of vaginal swabs revealed 6 cases of pseudomonas, 4 cases of staphylococcus aureus and 3 of candida albicans. Neonatal infections confirmed by blood culture and assay of C-reactive-protein involved 24 cases (20.3%). There were three fetal deaths, i.e. perinatal mortality of 1.1%. Risk factors, in these three fetal deaths, included postmaturity (1 case).(ABSTRACT TRUNCATED AT 250 WORDS)

We report a clinical case of a large sacro-coccygeal teratoma diagnosed antenatally by ultra-sound at 35 weeks gestation. A review of the literature shows that their outcome depends upon the size of the tumor, its degree of maturity, whether its location is pelvic or not, the presence of any associated malformations, prematurity, atraumatic delivery and upon prompt and complete removal of the tumor.

Three recent cases of cervical pregnancy form the basis of a review of its principal clinical and ultrasonographic characteristics and their resultant management consequences. Ultrasonography enables better diagnosis and management, leading to the preservation of subsequent fertility.

Severe obstetric bleeding is the primary cause of maternal morbidity and mortality. While classical causes such as uterine inertia or retained placenta are well known, inversion of the uterus is a rare cause which should not be missed. Only very rapid diagnosis and management can avoid serious and irreversible consequences. A case of inversion of the uterus is reported. The circumstances of onset and treatment possibilities are also discussed.