[Delivery in breech presentation: what way should we choose?]

The breech delivery is considered dangerous because of the higher rates of perinatal mortality and morbidity which become attached to it, consequences of obstetric traumas bound to the obstetric operations. What way of delivery is it necessary to privilege? What are the arguments which we have to support our choice? To assess the maternal and fetal outcome according to the way of delivery. In this retrospective study, 194 women with a singleton pregnancy in a breech presentation delivered at term in our maternity unit in Ariana's Hospital from January 2007 to December 2009. Breech presentation was noticed in 2, 59%. The main factors favoring this presentation are: the primipara, the uterine deformations, the pathological ponds, the abnormalities of the amniotic liquid, the fetal weight and the fetal deformations. Vaginal delivery was accepted in 57,7% of women and 75% from them delivered in natural way. The rate of caesarians was 56,7 %. Among these patients, 74, 5 % were indications in a cold caesarian [scar womb, pathological pond, RPM > 12 hours, estimated [esteemed] fetal weight > 3800g]. The Apgar's score was superior to seven in 97.6% of cases. There was no significant difference in fetal morbidity, Apgar's score or in the need of transfer in intensive care unit. When the acceptance conditions of the vaginal delivery are combined and when the surveillance of the labour is rigorous, it seems that there is no excess of neonatal risk by the natural ways

[Cervical incompetence: diagnosis ; indications and strapping outcome]

Cervical incompetence, a major cause of late abortions and preterm delivery is a diagnosis increasingly easy to establish.Strapping is deemed effective to prevent recurrence of such accidents midwifery. To evaluate the relevance of the diagnosis of cervical incompetence, check the main indications of banding and study the outcome of rimmed pregnancies. A retrospective study about 103 rimmed pregnancies collected in the service of Motherhood Hospital Mahmoud El Matri Ariana to the period of January 2001 until December 2008. The diagnosis of cervical incompetence is suspected in a body of evidence linking ATCD of late abortions or premature births found in respectively 46.2% and 31.1% of our patients in our series, 16.98% are carriers of known uterine defects. 8.49% are classified as high risk front of 3-ATCD of late abortions or preterm delivery and were circled systematically. 2.83% are rimmed after confirmation the incompetent cervix by calibration of the cervix and 55.99% because of clinically short cervix. The strapping has reduced the rate of late abortion which decreased from 46.6% before strapping to 7.6% after. As for preterm delivery, it is reduced from 31.1% before strapping to 18.5% after. This difference is statistically significant. The average term of confinement in our series is 36SA six days. 68 cases were delivered at term. Among patients in whom we have accepted the vaginal delivery, 74.2% had spontaneous labor. One case of rupture of the anterior lip of the cervix was noted. The indication of a cervical strapping needs a well established diagnosis involving data from history, clinical examination and possibly endo-vaginal ultrasound to confirm the high-risk of cervical incompetence. The strapping participates significantly to prolong the duration of pregnancy, to lower rates of early major premature and to improve the chance of viability and prognosis of fetuses without serious repercussions on the workflow

[Exploration of infertility: Correlation hysterography hysteroscopy]

In literature, a uterine lesion in found in half of the infertile womenTo compare the results of the hysteroscopy and the hysterosalpingography in the study of the uterine cavity as exploration of feminine infertility. Retrospective study, over a period of four years from 1 January 2005 to 31 December 2008however, on 140 cases of infertile patients explored in the gynecology obstetrics department in Mahmoud El Matri hospital. Compared with hysteroscopy, hysterography had an overall sensitivity of 76.56%, a specificity of 77.63%, a PPV of 74.24%, an NPV of 79.72% and a very strong correlation with coefficient of 0.83. Best correlations between the two examinations were found with polyps, fibroids and synechia. Hysterosalpingography remains the first line examination in the exploration of feminine infertility. However, hysteroscopy must be realized as a second examination in case of lesions found at the hysterography or at once in certain cases