Revue francaise de gynecologie et d'obstetrique最新文献

A retrospective study enabled us to evaluate the "wait-and-see" attitude adopted in our department in case of premature rupture of the membranes at term. The series included 88 patients (9.74%) who delivered spontaneously or after induction. The following maternal parameters were studied:time between rupture and delivery, pyrexia and chorioamnionitis number of vaginal digital examinations, histology and placental bacteriology. Neonatal criteria were based upon an infection assessment. Our results showed that approximately 80% of patients were in labor within 24 hours following rupture. Cesarean section rate remained stable (13%) in comparison with the overall rate for the department. Neonatal infectious morbidity (5.7%) showed no increase. The incidence of chorioamniotitis did not vary (7 cases) but appeared to be related to the number of vaginal examinations before labor. In conclusion, our attitude of temporization did not result in any increase in the number of cesarean sections nor of neonatal infections in comparison with the general population in the department. Prostaglandins might be useful in unfavorable obstetric situations.

In order to evaluate the advantages and possible disadvantages of early oral realimentation following cesarean section, the authors undertook a randomized prospective study involving 100 patients divided into 2 groups: A, in which oral feeding remained forbidden until the spontaneous restoration of intestinal function; and B, in which oral feeding was restarted as early as 6 hours postoperatively. The results of the study indicate the usefulness of early realimentation after cesarean section which, in particular, enabled a 4 hour decrease in the time before which flatus was passed and a 5-fold decrease in gastrointestinal problems.

Bone response to hormone replacement therapy (HRT) was assessed in a retrospective longitudinal study. 115 women started on HRT for the first time and 252 controls underwent initial densitometric evaluation (spine and femur) and a second evaluation on average 29 months later. Patients were classified as post-menopausal or perimenopausal according to whether they had had more or less than 6 months amenorrhea. Oral or non-oral 17-beta estradiol was used at the dose generally accepted to be skeletally protective. In the post-menopausal group, prescription of HRT was followed by spinal and femoral bone gain (+ 2.85% and + 1.06% per year respectively). There was no bone gain with HRT in the peri-menopausal women, but the stability seen contrasted greatly with the very marked bone loss found in controls (spine - 3.09% per year and femur - 1.78% per year). Lumbar densitometric variations were correlated, at least in the post-menopausal group, with those in the femur, but the amplitude of femoral variations was half that of the spine. Body mass index (BMI) was not found to be a predictive factor of bone response to HRT in this group, but the time since the menopause and initial densitometric results were. For the spine, the % of subjects losing their bone mass in response to the start of HRT, nil in the post-menopausal group, was 16% in peri-menopausal women. The % of good responders increased from 8% peri-menopausally to more than 59% 2 years after the menopause. The response in the femur appeared to be very different, with 20% good responders and a % of stable subjects similar to that of the control group. Femoral variations and the existence regarding the spine of a group showing no or only a poor response to HRT would be in favor of densitometric monitoring when initial bone mass is low.

There are still some precise and traditional indications for the use of spa-treatment in gynecology, even though they have been reduced or limited by the extraordinary progress made in exploratory techniques and different medico-surgical treatments. It also appears that the most recent and varied of these indications, especially concerning the multiple problems linked to menopause, can be usefully treated by spa-therapy. It is the role of practitioners, well informed of the multiple treatments available in the centers of hydrotherapy, to make the right choice, at the right moment, and concerning the right spa-center.

Vascular abnormalities may create difficulties during exposure of the lateral surface of the ureter during radical lymphadeno-hystero-colpectomy for uterine carcinoma. The aim is to avoid peroperative bleeding due to damage to abnormal vessels (in particular abnormal anastomotic uterine vein) crossing the lateral surface of the ureter. The authors have encountered such vascular abnormalities three times during radical lymphadeno-hystero-colpectomy. Recognition of the abnormal vessel crossing the lateral surface of the ureter and its division between two separate sutures prevented accidental peroperative bleeding as well as possible damage to the terminal (juxta-vesical) part of the ureter.

On the basis of a series of 600 deliveries between January 1 and May 1 1993, the authors analyze cases of unrecognized delivery-related hemorrhage. Hemorrhage of this type, defined retrospectively on the basis of a difference of at least 3g/100 ml in hemoglobin levels at the time of admission to the labor ward and on the 2nd day post-partum, were found in 3.83% of deliveries and were responsible for 51.11% of falls in hemoglobin of 3g/100 ml or more. Primiparity, induced labor (oxytocics), episiotomy, forceps extractions and cesarean section are their etiologic factors. Particular care should be taken in the presence of any of these factors and induced labor may be useful in the prophylaxis of these unrecognized hemorrhages.

The authors report a new case of Bartholin's gland carcinoma and its link with human papillomavirus. Should women with HPV have Pap smears the accessory glands of the vulva in addition to cervical smears?

Pre-therapeutic evaluation of menopausal hormone replacement therapy (HRT) requires certain measures in addition to a standard gynecological assessment. It is important to identify any possible breast or endometrial disorder which might require specific treatment or an adjustment of standard HRT. Skeletal status is assessed by history and, if necessary, by double-photon absorptiometry. Following such evaluation, absolute contra-indications are few in number, by virtue of the use of natural estradiol and non-androgenic progestogens. They essentially concern breast cancer and a thrombo-embolic history. The first follow-up visit, at three months, enables confirmation of the acceptability and efficacy of treatment and its adjustment if required. A monitoring calendar is then suggested.

The author reports 50 cases of rupture of the uterus among 11,060 labors i.e. one rupture per 220 labors. This study shows that rupture of the uterus occurs in women in poor socio-economic circumstances. Uterine scarring seems to be a more important factor than age and multiparity. Traumatic rupture is also common, resulting from obstetric procedures but above all from abdominal expression, most often performed outside hospital. Rupture of the uterus may present in many different ways. It was diagnosed in 32 cases before delivery while in 18 cases it was discovered during cesarean section or extraction of retained placenta. The lower segment was the elective site of rupture. With regard to treatment, suture was possible in 42 cases while hysterectomy proved necessary in the other 8 cases in view of the poor local tissue state. The prognosis remains gloomy, with a high risk of maternal death and, above all, a 58% fetal death rate.