[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

Prediction of ectopic pregnancy in early pregnancy of unknown location

Women having pregnancies of unknown location [PUL] can be defined as those having positive pregnancy test when no pregnancy is visualized on transvaginal ultrasound [TVS]. To identify diagnostic parameters which are predictive of ectopic pregnancies in women with early pregnancies of unknown location. We undertook a prospective observational study of pregnant women with suspected early pregnancy complications. Ninety-four patients were classified as having a pregnancy of unknown location [PUL] by transvaginal ultrasound; blood sample was taken on presentation to measure the serum human chorionic gonadotrophin [,-HCG] and progesterone levels. All collected data were tested by univariate analysis and then analyzed in a stepwise procedure to form a logistic model for predicting ectopic pregnancy. A total of 2675 women were referred for suspected early pregnancy was unknown. Three parameters were found to be statistically significant for predicting ectopic pregnancy: progesterone level, vaginal bleeding associated with pain and the presence of free fluid in the pouch of Douglas. The overall model described by these variables offer a sensitivity of 79 %and a specificity of 59% in the prediction of ectopic pregnancy. Logistic regression model can help in the clinical decision-making in women with pregnancy of unknown location

[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

[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

Primary leiomyosarcoma of the vagina. Case report and literature review

The vast majority of primary vaginal cancers are squamous cell carcinoma. The leiomyosarcoma of the vagina is extremely rare neoplasm. It comprising 2% to 3% of vaginal malignancies. Only 77 cases have been reported up to date in Anglo-Saxon literature. Report of a new case. We report a case of a patient 43 years old, single and presented a tumor of 7 cm to the detriment of the posterior wall of the vagina. The treatment consisted of a radical colpohysterectomy followed by postoperative radiotherapy. After 40 months, she is still alive without local or distant recurrence. This is a rare observation. The surgery is the basic treatment, the poor prognosis of these tumors remains linked especially to the histological grade

Primary leiomyosarcoma of broad ligament

Primary broad ligament leiomyosarcoma [LMS] is an extremely rare tumor with few well-documented cases. We are aware of 15 previously reported observations. Aim: Report of a new case. In this report we report a case of a right pelvic sidewall leiomyosarcoma with involvement of the appendix in a 49-year-old woman. A hysterectomy, bilateral salpingo-oophorectomy, omentectomy and appendicectomy were done, without complications. The patient died five months later. The case illustrates the difficulty of correct diagnosis before intervention. On this occasion, review of the literature confirms that this site remains unusual and the management is difficult