Revue francaise de gynecologie et d'obstetrique最新文献

The authors report 6 cases of carcinoma of the ovary presenting during pregnancy in the Department of Gynecology and Obstetrics of La Grave University Hospital, Toulouse, between 1972 and 1994. Analysis of this series is followed by a review of the literature which reveals that carcinoma of the ovary fortunately remains a rare event during pregnancy. All reported series conclude that the diagnosis is made at an early stage. Management depends in great part on the age of the pregnancy and stage of malignancy. During the first 6 months, immediate surgery is essential, with sacrifice of the pregnancy, except at stage IA1. During the final 3 months, surgery is delayed until fetal maturity. This classical attitude is currently being questioned. This classical attitude is currently being questioned. Some teams feel that conservative treatment followed by chemotherapy is possible, thereby preserving the pregnancy. The choice of the couple must always be taken into account when making these management decisions.

Unlabelled: The aim of this study was to determine the optimal solution to the dilemma of "wait-and-see" or "evacuation of uterine contents" and to identify objective criteria in support of one or other of these management choices, in particular in 26-34 week pregnancies with PRM, which is the most difficult situation. On the basis of a clinical study of 54 cases, week pregnancies with PRM did not enable temporization for any considerable time because of the onset of amniotic infection, and a large number of premature newborn with a gestational age of 31-32 weeks, below 1500-1700 g respectively, died a short time after birth.

Conclusions: In 26-34 week pregnancies with PRM, a "wait-and-see" attitude with its sometimes very considerable septic risks is justified by a high chance of fetal survival score (CFSS)--a concept suggested by the authors--, i.e. with a gestational age between 30-34 weeks and respective fetal weights (determined by ultrasonography) between 1400-2100 g, absence of intrauterine fetal pathology, favorable fetal vitality parameters, good prognosis foe vaginal delivery, low C-reactive protein levels, low-grade pathogenicity of cervicovaginal flora, etc. In their preliminary study, the authors suggest determination of a chance of fetal survival score (CFSS) which is of prognostic value and can be useful in determining optimal management in the dilemma raised by PRM in 26-34 week pregnancies.

This study is a review of the literature on Zarate's partial subcutaneous symphysiotomy. Unfortunately, this operation is now forgotten since many obstetricians in western countries and even those of developing countries feel that symphysiotomy is an obsolete obstetric procedure. Partial subcutaneous symphysiotomy is an operation intended to widen the maternal pelvis in order to enable vaginal delivery in the presence of moderate feto-pelvic disproportion. The procedure, which requires only a urinary catheter, a scalpel and local anesthesia, consists of division of the anterior ligament of the public symphysis and part of the inferior ligament (arcuate ligament of the pelvis), while leaving intact the superior ligament or "anatomo-surgical restraint" of Zarate, ensuring limitation of pelvic spread. Symphysiotomy has currently been abandoned by all or almost all teams because of its alleged maternal and fetal morbidity and mortality. We feel, however, that in certain rural areas of third world countries, often ill-equipped and with poor medical services, this procedure can still be very useful in certain exceptional situations in dystocia by moderate feto-pelvic disproportion, in circumstances in which cesarean section is impossible. The experience of the rare teams still using symphysiotomy shows that a degree of disdain is legitimate in face of the ominous reservations expressed as to the possible complications of this procedure.

Local, so-called incurable, recurrences of breast or genital cancers were as therapeutic challenge in the past. The authors undertook a pilot trial of laser treatment in 45 patients, as a palliative measure, in view of the serious psychological and physical problems experienced by these women constantly confronted by the presence of painful, visible and often ulcerated tumor lesions. CO2 and Nd:YAG lasers were used for tumor vaporisation and coagulation, the combined use of these two wavelengths providing the new study concept which emerged from this pilot trial.

The authors report a case of simultaneous intra-uterine and ectopic pregnancy in the presence of a Lippes loop (inert intra-uterine device) which appeared to have been well tolerated for four years. Predisposing factors appeared to be infection, evidenced by the peri-adnexal adhesions found at surgery for the ectopic pregnancy, together with spontaneous multiple ovulation. The intra-uterine pregnancy culminated in a spontaneous abortion. Although apparently very rare, the association of intra-uterine pregnancy and ectopic pregnancy in the presence of an intra-uterine device should be born in mind whenever intrauterine contraception fails.

The authors report a case of post-partum unilateral vulval hematoma. The highly unusual complication of a thrombosed vulval varicosity.

The problem of the treatment of premature labor has not yet been resolved. The positive effect of using sympathomimetics is not as significant as was initially thought and they are not free of side-effects. A review of the literature forms the basis of a comparison of sympathomimetics with nifedipine and indomethacin. The latter sometimes offer a better alternative but must be used with care. The potential benefits of oxytocin antagonists are still being evaluated.

Critical review of eating disorders in girls, based upon five cases:four of anorexia nervosa and one of boulimia, such problems neing accompanied from a gynecologic standpoint by amenorrhea. Interpretation of colpocytologic findings, differing between cases. Suggestion of the central nervous origin of these disorders.

Contraception during breast feeding must take two points into account: the first physiological contraception due to anovulation which disappears at around the 9th week of lactation); the second pharmacological: any substance ingested by the mother during breast feeding is excreted in milk, chiefly by passive diffusion. All pharmacokinetic studies have shown that the transfer of progesterone or of estrogen when taking a contraceptive pill is extremely slight, being of the same order as that of natural hormones. When it is decided to use hormonal contraception, this should be started after the 6th week of lactation, when lipid profile has returned to normal and thromboembolic risk is identical to that of the population in general. As with all prescription during lactation, the drug should be taken as far as possible from the next feed. Barrier techniques (combining condoms and spermicides) are an elegant alternative to drug methods.