[Early diagnosis and management of cervical ectopic pregnancy]

Cervical pregnancy is the rarest of ectopic pregnancy. The classical treatment remains hysterectomy, in particular when diagnosis is made late. The possibilities of more and more premature diagnoses, sometimes before any clinical expression, let suspect the possibility of conservative treatments. We report two cases of medical treatment for early diagnosed cervical pregnancies. Through a review of the literature, we resume diagnostic criteria and various therapeutic possibilities. The two cases were diagnosed in the first trimester. The treatment consisted in intramuscular administration of methotrexate. The first patient had ultrasound-Guided feticide before the administration of methotrexate. Actually, vaginal ultrasound allows early diagnosis of cervical pregnancies, even before the beginning of vaginal bleeding. This advancement allowed conservative treatment. In this situation, current reference is the methotrexate to which can be associated an intracardiac potassium chloride injection in case of embryo positive heart activity

[Ovarian pregnancy. about three cases]

Ovarian pregnancy is a rare type of ectopic pregnancy. Its diagnosis and management are often difficult. To highlight specific diagnostic and therapeutic properties of ovarian pregnancy. Retrospective Study over a period of 4 years. We observed the patients presenting ovarian pregnancies. Diagnosis was evocated in time of surgery and confirmed by histological data. We observed three patients presenting ovarian pregnancies. All our patients had an abdominal ache. Diagnosis was made by ultrasound scan examination in one case. One patient had a laparotomy as a matter of urgency; the two others had a laparoscopy. All the patients were managed conservatively. The diagnosis of ovarian pregnancies was evocated in time of surgery and confirmed by the histological data. The ovary is a rare location for extra-uterine pregnancy. This type of ectopic pregnancy has some clinical properties. The diagnosis is intricate and based on per operatory observations. The management is in spite of medicines improvement, based on surgery

[First trimester ultrasound: an early screening tool for fetal structural and chromosomic abnormalities]

Prenatal diagnosis has been greatly expanded in recent years. Many biological and sonographic criteria participated in the development of fetal medicine. Analyze the contribution of first trimester ultrasound in prenatal diagnosis of aneuploidy and early fetal malformations, and its impact on the strategy of prevention of disability. A prospective longitudinal descriptive study including all women who did a first trimester ultrasound during their pregnancy. We evaluated the detection rate of malformations and chromosomal abnormalities of the morphological embryonary study and nuchal translucency. These tests were then confronted with the results of fetal samples and the outcome of pregnancy. 593 ultrasound examinations were performed. The average age of pregnant women was 32.7 years. The mini-morphological ultrasound study revealed 26 abnormalities [3 major lethal malformations, 5 cystic hygroma and 18 increased nuchal translucency]. Chromosomal abnormalities were found in six cases. The first trimester ultrasound has ensured the detection of 2/3 of total aneuploidies of the study. The first trimester ultrasound allows early detection of a large number of aneuploidies and fetal malformations

[Prenatal ultrasound aspects of arthrogryposis multiplex congenita]

To analyze the contribution of prenatal ultrasound in the diagnosis of arthrogryposis multiplex congenital according to its type and antenatal expression. Retrospective study led between January 1993 and November 2007. We studied the cases of arthrogryposis suspected or diagnosed by antenatal ultrasound while analyzing the circumstances of discovery, the profile of the pregnant women and the abnormal scan findings. 16 Observations have been collected. We recovered one multiple pterigium syndrome and five observations of severe fetal akinesia sequences diagnosed in the second trimester. The arthrogryposis was part of different syndromes in other cases. Four distal arthrogryposis had been diagnosed in the second trimester. All cases suspected during the third trimester were associated to an anomaly of the amniotic fluid, mainly to a polyhydramnios. The abnormal scan findings were less specific to this term. Arthrogryposis multiplex congenital is rare. It has several morphological aspects. Some ultrasound aspects are specific in the first and second trimesters. The diagnosis is more difficult at the third trimester

Place du sulprostone dans la prise en charge des inerties uterines. A propos de 60 cas

The serious haemorrhages of the delivery still one of the'first causes of maternal mortality. We report an analytical study over a period of 18 months and gathering 60 cases of haemorrhage of the delivery by uterine inertia having imposed the recourse to the sulprostone. The average age of the patients was 31 years, the average parity was L9, the rate of childbirth per Caesarean was 65%. The uterine surdistension was fhe principal etiology of the uterine inertia. The average time of administration of the sulprostone was 10 mn. No complication related to the product was noted. The effectiveness of the treatment was observed in 93.3% of the cases, with 4 cases of failure