Revue francaise de gynecologie et d'obstetrique最新文献

This study involves 106 cases of the uterus seen at the Rabta Maternity and Neonatology Center (Tunis) over a period of 6 years. The incidence was 1.51% of labors and 75.4% of cases involved rupture of a scarred uterus. Rupture of a healthy uterus accounted for 24.6% of cases. The clinical picture was asymptomatic in 66.25% of cases involving a scarred uterus. Treatment of rupture of the uterus was essentially conservative by suture of the tear (73.6%). Maternal mortality was 2.8%. Perinatal mortality was high at 37.7%.

Per- and postoperative mortality remain high in black Africa, with rates of the order of 30 to 40% according to teams. Three essential causes are generally reported: infection, hemorrhage and anesthetic complications. There can be no doubt as to the advantages of celiosurgery over open surgery: low postoperative morbidity, less than 1% serious complications, real savings in treatment costs by shortening of average hospital stay and time off work. Celio-surgery is technology-dependent and operator-dependent. The cost of equipment remains prohibitive and its maintenance delicate and expensive, potentially hampering the implantation and spread of this new technique in Africa, which also lacks specifically trained staff as well as an appropriate technical infrastructure. Nevertheless, the experience of teams in Cameroon and Gabon are encouraging with 110 and 220 patients respectively treated by celio-surgery without complications. A veritable journeyman-apprentice approach is necessary for the learning of these new techniques by teams in developing countries, in several possible ways (locally or abroad), in order that the population as a whole can enjoy the benefits of the reproducible therapeutic and diagnostic advances of new techniques (celio-surgery, MAP, antenatal diagnosis, medical imaging).

A case was seen of partial hydatidiform mole coexisting with a viable twin pregnancy. Apart from prematurity which created early problems in caring for these girls twins, born with a good Apgar score and birth weights of 1400 g and 1350 g, the outcome was satisfactory for both the mother and daughters, who thrived marvelously. The incidence of this clinical form of trophoblastic disease which is 1/10,000 deliveries in our series confirms it rarity as reported by many authors.

Pelvic congestion syndrome is encountered in three pathological situations: premenstrual syndrome, intermenstrual syndrome, chronic pelvic congestion syndrome. The first two syndromes, with a range of physical and/or psychological symptoms, are cyclical. Their pathogenesis is multifactorial. Hormonal and circulatory factors are essentially blamed. Treatment is most often based upon combinations of progestogens and venotonics. The third syndrome, that of chronic pelvic congestion, is characterised by long term pelvic pain and raises etiopathogenic problems which remain only partially solved and in which a vascular role may sometimes be recognised. Endovaginal ultrasonography with colour-coded Doppler and celioscopy sometimes reveal pelvic varicose veins and indicate their responsibility for such pain, after having eliminated specific pelvic pathology (post-infectious or post-operative inflammatory sequelae of pelvic tissue, rupture of the broad ligaments, endometriosis, etc.). Treatment is above all medical, based upon hormone therapy acting upon venous receptors, venotonics which decrease the consequences of stasis, intermittent courses of anti-inflammatory agents and antibiotics when there is inflammation secondary to local infection. These various types of treatment may be combined. Surgical treatment should be restricted to certain carefully assessed cases only.

The authors report two cases of tuberculosis of the uterine cervix. They point out the exceptional nature of this form of genital tuberculosis, and its epidemiological aspects. They stress that its macroscopic appearance is highly suggestive of a carcinomatous lesion. Doubt can be eliminated only by cervical biopsy and appropriate treatment for tuberculosis can then be started. Surgery is only very rarely required.

In the context of organic pelvic pain, alongside post-infectious pain or pain related to endometriosis, ruptured ligaments of the pelvic fascia are an important cause of the pelvic congestion syndrome well known to classical authors. Surgical treatment combines two procedures: suture of the tear and exclusion of the pouch of Douglas.

Pelvic adhesions may be responsible for pelvic pain, at least partially, in the following conditions: sequelae of past infection, chronic active inflammatory state, endometriosis, post-operative adhesions. The problem in the presence of adhesions is to determine whether pain is mechanical, inflammatory and/or linked to associated ovarian dystrophy, and what is the psychological component. The postulate "adhesion = pain" is far from constant and there is no systematic relationship between clinical picture and anatomical findings. After careful clinical and laboratory evaluation, celioscopy is the key diagnostic procedure. It should include thorough examination of all pelvic organs, of the abdomen in general and the peri-hepatic region in particular. A diagnosis of psychosomatic pain can be made only in the absence of any macroscopic, histological and bacteriological lesion, though bearing in mind that this term certainly covers failure to recognise other causes.

Endometriosis is defined by the presence outside the uterine cavity of tissue histologically and functionally similar to the endometrium. Endometriosis consists of glands and an underlying cytogenic stroma. This ectopic tissue can react to hormonal stimulation: estrogens and progesterone (growth, decidualisation, withdrawal bleeding). Pain is correlated with the depth of implantation of endometriosis lesions. Deeply infiltrating endometriosis exceeds 6 mm in depth, with an incidence of between 6 and 20% of women complaining of pelvic pain. The authors review the various types of treatment and mention the special role of celio-surgery and prolonged hormone therapy.