[How to predict spontaneous resolution of early pregnancies?]

Assessment of early pregnancy is indicated in women with suspected abnormalities. It is based on biochemical assessment and on trans vaginal sonography. To identify clinical, biological and ultrasonographic parameters that are predictive of spontaneous pregnancy resolution. A prospective observational study was performed interesting women with a positive pregnancy test without visualization of the pregnancy on the initial scan. All parameters measured during the initial visit were tested by univariate and multivariate analysis to identify parameters predicting spontaneous resolution of pregnancy. A total of 2675 women were included in the study. In 94 cases [4%] the location of pregnancy was unknown. Univariate and multivariate analysis showed that four parameters contributed significantly to the predictive power of the logistic model: Absence of pain [p =0,036], endometrial thickness < … 12 mm [p =0,021], initial serum beta hCG level < 1000 UI/l [p =0,015] and progesterone level < 29 nmol/l [p <0,001]. Women with a high probability of spontaneous resolution of their pregnancies can benefit from a spaced monitoring until the rate of beta -hCG will be negative

[Prospective study of the contribution of hydrosonography in the exploration of the uterine cavity]

Recent developments in ultrasound have led to a new exploration technique: hydrosonography. To evaluate diagnostic performance of hysterosonography in the assessment of the uterine cavity, by comparing it with standard transvaginal ultrasound and particularly with diagnostic hysteroscopy. This is a prospective study over a period of nine months from 1st January to 30 September 2009. Transvaginal ultrasound was performed for all patients followed by hydrosonography then by diagnostic hysteroscopy. Sixty-two patients underwent three examinations. The mean age of our patients was 42.2 years. Bleeding disorders of the menstrual cycle were the most common reasons for seeking. Referring to the pathological examination, hysteroscopy is the most accurate technique in the diagnosis of endometrial hyperplasia and intracavitary masses, followed by hydrosonography then by transvaginal ultrasound. The concordance between hydrosonography and hysteroscopy in the diagnosis of submucosal fibroids and hyperplasia of the endometrium is very good [K> 0.8]. The hysterosonography seems a relevant exam, allowing a complete assessment of the uterine cavity

[Hysteroscopic myomectomy]

Hysteroscopic resection of submucous myomas is a safe alternative to conventional surgery. To evaluate the anatomical and functional results of endoscopic resection of submucous myomas and to present the principle complications of this technique. This is a retrospective study performed in the department "B" of gynecology and obstetrics in maternity center of Tunis "La Rabta". It analyzes a series of 105 hysteroscopic resections of intracavitary fibroids during a period of 8 years from January 2003 to December 2010. The mean age of our patients was 41 years and 5 months. The most frequently reason for consultation was the disorder of the menstrual cycle type of menometrorrhagia [47.6%], menorrhagia [22.8%] and postmenopausal bleeding [11.4%]. Preoperative assessment of the fibroid was based on transvaginal ultrasound in all cases associated with diagnostic hysteroscopy in 51.4% of cases and with hydrosonography in 28.6% cases. The mean size of the fibroid was 3.08 cm. Type 0 myomas represented 42.8% of cases. The most frequent emplacement of the myoma was the anterior surface of the uterus [44.7%]. After surgery, the resection was considered as complete in 88 patients [83.8%], partial in 17 patients [16.2%] requiring a second operation. The functional result was good with disappearance of bleeding symptoms in 90% of cases after a mean follow up of 17 months. Hysteroscopic resection of sub mucosal fibroids is a technique that respects the uterine cavity with satisfactory functional results and low morbidity

[Safety of magnesium sulfate in severe preeclampsia]

Several observational studies and randomized trials have described the use of various regimens of magnesium sulfate to prevent or reduce the rate of seizures and complications in women with severe preeclampsia. To assess the validity of a service protocol in the management of severe pre-eclampsia all specifying the benefits, complications and side effects of magnesium sulfate. We have performed a retrospective descriptive study over two years [2009-2010] concerning 150 patients affected with severe preeclampsia in the department "B" of gynecology and obstetrics of the "Rabta" at the Centre of Maternity and Neonatology of Tunis [third level maternity]. The protocol consisted in the administration of 3 grammes of magnesium sulfate followed by intravenous dose of 1 g/hour associated with an anti-hypertensive treatment. One hundred and forty patients [93%] had 2 or more criteria of severity associated. Seventy-eight [52%] patients with severe preeclampsia have profited an anti-hypertensive treatment based on nicardipine associated with magnesium sulfate without notable secondary effects. In two cases [1.3%] an eclampsia was noted with magnesium sulfate, 27.4% of severe preeclampsia was noted at a term within 34 week of amenorrhea. Only one case of surdosage was noted in post partum. The use of magnesium sulfate in practice does not appear to increase the risk of complications or major side effects in the mother and fetus

[Sigmoido-vesical fistula: a case report]

Background: Colovesical fistula is a rare complication of inflammatory and neoplasic pelvic diseases [0.2%]

Aim: To report a new case

Case: We report the case of a 74-year-old woman, with a charged previous medical history and had not had hysterectomy. She was admitted because of cystitis with haematuria associated to faecaluria and pneumaturia confirmed by an intravenous pyelogram. Water-soluble contrast medium show the sigmoidovesical fistula. A sigoid sticture is identified at colonoscopy and biopsy was realised. The patient had had sigmoidectomy with Hartmann's procedure. Histologic study confirm the diverticulatis with preidiverticular abcess and fistula

We suggest that early diagnosis and management of sigmoid diverticulatis is required to prevent complicatins like stricture and fistula

[Intrauterine insemination with conjoint semen. How to increase the success rate?]

Intrauterine insemination is usually proposed as the first line therapy for infertility related to cervical hostility, male factor, unexplained infertility or mild endometriosis. The overall success rate of IUI is about 10-20%clinial pregnncy per cycle. The Aim of this study is to evaluate factors that increase the succes rate of IUl. We restrospectively analysed 206 cycles of JUl with partner's semen in 138 infertile couples. The clinical and laboratory factors that may influence the pregnancy rates were analysed women's age, etiology of infertility, duration of infertility, ovarian stimulation, day of hGC and sperm parametres. The per-cycle clinical pregnancy rate was of 14.56%. Optimal pregnancy rates were observed in less than 38 years old women [18.29%vs 9.52%. p<0.05]. The succes rate was statistically depending of the number of IUI cycles until three [p<0.05], the day of hGC [p<0.05] and the sperm count after conventionally prepared semen [p<0.05]. Sperm parameters was of no value in predecting the pregnancy rates, and neither seam's to be the total dose of administrated Gonadotrophin or the etiology of infertility, but it seams that, when a cervical factor or PCO were involved, the succes rate is higher. Besides, getting three or more than three follicles may increase the succes rate but expose to a warrying risk of multiple pregnancy. According to this study, the only statitically significant factors that are associated with successful IUI were, women partner's age [<38 ans], number of IUl cycles [during the first three JUl cycles], day of hGC [>J13] and sperm count after conventional semen preparation [>1.10[6]/mL]

[Large placental chorioangioma]

The large placental chorioangioma is a non-trophoblastic vascular tumor of placenta which size is more than 4 cm. It's rare tumor, the incidence is between 1/3500 and 1/9000 birth. We analyze, on base of our case and from a literature review, the ultrasonic aspects of this tumor; we bring out also the physiological mechanisms of maternal and fetal complications and finally we detail the therapeutic possibilities. Chorioangioma appears in ultrasound scan like a thoroughly limited hypoechogene zone. The vascular origin of the tumor can be confirmed by color Doppler. A left-right shunt effect results from arterio-venous communications and causes backwardness growth and fetal death in-utero The fetus is exposed to anemia and microangiopathic thrombopenia The maternal complications are hydramnios, abruption placenta, premature ruptured membrane. Therapeutic possibilities are reduced: In several fetal anemia, an exsanguinous transfusion can be done. Some techniques for tumor devascularization are be tried by someone

[Sertoli-leydig cell tumor of the ovary]

Sertoli-Leidig cell tumor of the ovary is a rare tumor. It accounts for 0.5 - 1% of all ovarian tumors. Sertoli-Leidig cell tumors are commonly benign and they occur in young women who desire further childrearing. Although, the treatment must be as conservative as possible. For the malign Sertoli-Leidig cell tumor, radical treatment is required. The aim of this work is the analysis of clinical, para-clinical and therapeutic aspects of these tumors

[Abruptio planeentae]

Abruptio Placentae is one of the most typical obstetrical emergencies. We present a retrospective study about 45 cases of placental abruption. The diagnosis was confirmed in all cases by both clinical and anatomopathological findings. Study the epidemiological profile of the patient, the circumstances of diagnosis, the modes of delivery and the fetal morbidity. The prevalence of placental abruption was about 0.34%. Patients were primiparous in 40% of the cases. This problem occurred during the third trimester in 97.8% of the cases. Elevated blood pressure was found in 44.4% of the cases. The incomplete form represented 77.8% of cases. Blood clotting disorders were detected in 8 patients. Fetal death rate was 37.77%. This problem remains unpredictable and sudden. Both maternal morbidity and fetal mortality rates remain high

Association fibrome uterin et grossesse. A propos de 23 cas

The coexistence of leiomyoma and pregnancy may lead to complications with unequal gravity. Material and methods: The authors propose a retrospective study about 23 cases of association of fibromyoma and pregnancy collected over a period of seven years. Study of the effect of fibromyoma on pregnancy and vice-versa. Analysis mode of delivery. Aseptic necrobiosis: 21.7%. Urinary tract compression: 4.3%. Miscarriage: 13%. Threatened premature birth: 26%. Caesarean section: 47.8%. Premature birth: 8.6%. Neonatal death: nil. Maternal morbidity due to this association is important. It is essential that pregnant women be aware of the importance of prenatal consultation during the first trimester of pregnancy

[Maternal and neonatal metabolic complications in gestational diabetes]

We present a retrospective study of 140 cases of gestational diabetes. The objective of our study was to evaluate the frequency of infant and maternal metabolic complications associated with gestational diabetes. Maternal hypoglycaemia was the most frequent complication [11 %], while ketoacidosis was rare and occurred in only one case [0,9 %]. Neonatal metabolic complications were mostly hypoglycemia [19 %] and hypocalcemia [7%]. Pregnancy in diabetic women entail more risks than normal pregnancy. But these risks are actually limited

tumeur de Brenner maligne: Particularites et prise en charge

Brenner's tumour of the ovary is rare, mostly benign. It was described for the first time by mac naughton jones in 1898. von numers listed the first malign form in 1945 that represents 2% of tumours. On the basis of a personal report and of 160 cases listed in the literature, we propose to study anatomoclinical and epidemiological elements of this hurt and to study histological particularities and various therapeutic processes. Malignant brenner's tumour arises mostly in peri and postmenopausal period. Clinical signs are not specific. Histological exam puts the problem of the choice of the histological malignant criteria. Metastasis occurs in half of cases. They are mostly loco-regional. The treatment is essentially surgical. The efficiency of an additive treatment seems to be debatable

Chemoembolisation of hepatocellular carcinoma

Transcatheter oily chemoembolisation was done to 36 patients with hepatocellular carcinoma. 9 patients had underwent the procedure followed by injection of gel foam particles. Surgery was done to 7 patients following the procedure by one to two months. All patients were followed up by Alphaf feto-protein level after 7 - 10 days and by CT after one mouth of the procedure. Alpha feto-protein level dropped in 27 cases to less than 50% compared with the pre-chemoembolisation level and to a level between 50% to 75% of the previous level in 6 cases while no significant changes occured in 3 cases. C.T. showed marked decrease in the tumour size in 5 cases, slight decrease in the tumour size in 23 patients while no change in size occured in 8 cases