Revue francaise de gynecologie et d'obstetrique最新文献

Vaginal ultrasonography of the uterus using a high frequency endocavitary probe was performed in 300 postmenopausal women: 150 receiving no replacement nor suppressive hormone therapy and 150 receiving adjuvant anti-estrogen treatment in the form of tamoxifen because of breast cancer. Evidence was found of hydrometra in 84 cases (28%): 10 in the group taking no hormone therapy (6.6%) as compared with 74 in the group exposed to tamoxifen (49.3%). The difference was statistically significant (p < 0.01). In addition, mean thickness of the endometrium was estimated at 6 mm (range: 2-40) in the first group versus 12 mm (range: 3-60) in the second (p < 0.001). It emerged from this comparative ultrasound study that the incidence of postmenopausal hydrometra was influenced by taking tamoxifen. Fluid secretion appearances seen one out of two in treated patients reflect the paradoxical proestrogenic type action of tamoxifen on the uterine mucosa.

Objective: Reevaluation of the usefulness of routine uterine curettage with every cervical cone biopsy.

Material: Retrospective analysis of 250 cervical cone biopsies over an 18 year period.

Results: 240 analysable cases were included. 90 patients had undergone cone biopsy only and 150 cone biopsy accompanied by uterine curettage. Curettage material was histologically normal 115 times (76.6%), negative or invalid 26 times (17.3%) and pathological 10 times (6.6%). Pathology consisted of 7 cases of hyperplasia and 3 of endometritis.

Conclusion: Routine uterine curettage whenever cone biopsy is performed is of no value other than in certain special circumstances concerning clinical status and ultrasound findings.

Analysis of 150 cases of women with uterine scarring seen in our unit showed that vaginal delivery was possible in 49.7% of them provided that a number of rules, which the authors particularly stress, are applied. An attempt has been made to define factors likely to weaken the uterus and predispose to uterine rupture. Our maternal mortality rate of 0.6%, often due to infection and bleeding, agrees with that of the literature. The 0.4% uterine rupture rate was related to lack of health education of pregnant women. Fetal status at birth was usually good after vaginal delivery. The authors feel that knowledge of the circumstances of the first cesarean section and the subsequent course is essential, while hysterosalpingography has a major role to play in the choice of the most appropriate type of delivery.

The authors report a prenatal diagnosis of osteogenesis imperfecta or Porak and Durante disease, in which the child survived. The diagnosis was made by ultrasonography which revealed major abnormalities of osteogenesis more particularly affecting the lower limbs, which were short and deformed. Other essential features of this syndrome are osteoporosis, hyperrelaxation of ligaments and blue sclerae. This rare and genetic condition is due to type I collagen abnormalities. It is often governed by dominant transmission but manifestation of the gene is variable within a given family. Molecular biology and genetic studies offer new possibilities of prenatal diagnosis, but ultrasonography remains the investigation of choice, possibly helped by X-ray of the uterine contents.

The authors report the principal abdominal surgical emergencies which may occur during pregnancy. Missed diagnosis of these acute abdomens forms the basis of their gravity in terms of both maternal and fetal prognosis.

Metromenorrhagia is common around the time of the menopause. Following a careful history and full gynecological examination, vaginal ultrasonography and hysteroscopy combined with biopsies enable the investigation of such genital bleeding. Vaginal ultrasonography can be used to visualise the uterine cavity and measure the thickness of the endometrium. The term atrophy is used if the latter is less than 5 mm. If, on the contrary, the endometrium is thick or if there is a more notable intracavitary lesion, hysteroscopy and the collection of biopsy material guided by it will provide the diagnosis.

Acute pelvic pain is a common syndrome in women and is an emergency. Management requires rapid diagnostic evaluation to enable immediate treatment. Blood tests (beta-HCG assay, etc.), bacteriological studies and pelvic ultrasonography may be required. Gynecological problems are the commonest etiology: ectopic pregnancy, miscarriage, PID. The possibility nevertheless remains of appendicitis, sigmoid diverticulitis, UTI or renal colic, all of which are medical or surgical emergencies.

Bleeding during the final three months is a serious event. Mortality is very slight in developed countries but morbidity remains considerable. Fetal mortality and morbidity are notable, linked to resultant pathology or prematurity. Their existence requires hospitalisation in a department of gynecology/obstetrics, with a team including an obstetrician, anesthetist/intensive care specialist, and pediatrician. Bleeding is due to placental separation involving the inter-villous chamber (basal decidual hematoma) or the marginal region (marginal decidual hematoma). Precise diagnosis of refractory bleeding is essential and must be obtained simultaneously with treatment. Maternal and fetal prognosis can only be improved by early and appropriate management. The treatment of serious cases is based upon intensive therapy including the replacement of losses, the correction of possible hemostasis problems and fetal extraction. Delivery is a critical phase, with the risk of extremely heavy bleeding and decompensation. This stage of labour requires careful monitoring and intensive therapy without delay.