[Uterine synechias treated exclusively hysteroscopically - about 127 cases]

This retrospective study of 127 patients with uterine synechias treated exclusively hysteroscopically included 84 [66.25%] low fertility patients, 36[28.5%] with menstrual disorders and 7 [4%] with no other symptoms. About ninety three patients [73.8%] had a past history of trauma on a gravid uterus. Operative hysteroscopy was performed in all cases, including sections with scissors in 8 cases [13.3%] between 1995 and 1996, and electrosection between 1997 and 2003. A single endoscopic procedure was efficient in 70% of cases and second procedure were required in 6 cases [7.5% of the patients]. No complications due to infection, bleeding or metabolic disorders occurred, but perforations were seen in 2 patients [2.5%] both with complexe synechia. Good anatomic results were achieved after 1 hysteroscopic procedure [70%]. Clinical results were less satisfactory, particularly in cases with low fertility in which another pathology was often associated [31.42%]. We obtained good results in 78.57% of the patients with amenorrhea. However, 49 pregnancies were achieved including 12 normal deliveries

[Laparoscopic treatment of adnexal abscess - about 86 cases]

To Specify the epidemiological profile of the patients presenting an adnexal abscess the therapeutic modes and the ulterior fertility. Retrospective clinic survey about 86 cases of adnexal abscess collected in the Service A of the Center of Motherhood and Neonatology the Rabta Turns during a period of 7 years going from January 1996 to December 2002 A laparoscopic drainage has been achieved in all patients; 35 patients underwent a second laparoscopy 3 to 6 months later. The clinic symptomatology was dominated by the pelvic pain [97% and the fever in 65% of cases A latero - uterine adnexal mass has been discerned m 56% of patients. The echography practiced in all cases evoked the diagnosis in 49 cases. The exclusive laparoscopy permitted a conservative treatment in 52% of the cases. No new immediate operation was necessary in the first two months after the initial surgery. At the time of the control laparoscopy an adhesiolysis was made in any case necessary. A distal tuboplasty has been achieved in 17 patients and 6 patients were sent in IVF. Thereafter, 12 patients out of 19 that didn't use a contraceptive mean had a spontaneous intra-uterine pregnancy [63%]. Conclusion this survey confirms that the laparoscopic surgery is a sure and efficient technique for the treatment of the adnexal abscesses The anatomical results observed at the time of the control suggests that this second surgical phase is essential for the patients who want a future pregnancy

[Krukenberg's tumor- about 5 cases]

KRUKENBERG's tumor is an ovarian metastasis of a digestive neoplasm. It is a rare tumor. We realized a retrospective study over 5 years, in the service "A" of the CMNT. We listed 5 cases of KRUKENBERG's tumors. The average age of our patients was of 47 years. The main motive for consultation are pelvic pains. Clinical exam finds an abdominal mass in 4 cases. The treatment is surgical associated to the chemotherapy. The primitive tumor was found in 4 cases, it was gastric in three patients. KRUKENBERG's tumor is a rare tumor, it touches the young woman. The prognosis of this tumor remains dark. The surgical treatment and the chemotherapy improve little the survival

[Thrombocytopenia in pregnant women- about 148 cases]

Thrombocytopenia in pregnant women is a common finding. We report a retrospective study of 148 cases over a period of two years. The average age was 30 years. 17% had antecedents of haemorrhagic accidents. Pathologies associated to the thrombocytopenia were dominated by the anaemia and the preeclampsia. The average term of discovery was of 33 weeks of gestation and 4 days. 102 cases were diagnosed in the third trimester. Thrombocytopenia was light in more than half of cases. Only 14 patients [95%] had rates of plaques < 50 000 /mm[3]. Causes of thrombocytopenia were dominated by the gestational thrombocytopenia. It was the etiology in 89 patients [60%]. Preeclampsia and its complications were in second position. Gestational thrombocytopenia was followed in a regular way by platelet counts. Thrombocytopenia in complications of the preeclampsia [HELLP syndrome] impose an interruption of the pregnancy. The immune thrombocytopenia < 30 000 / mm[3] and the one that was symptomatic benefited from corticosteroids. Haemorrhagic complications were observed in 43 patients [31,5%]. 15 patients [10%] were transferred in a unity of intensive care. No case of maternal mortality was recorded. Delivery was by natural way in 69% of cases, instrumental in 7,4% of cases and by caesarean section in 23,6% of cases. General anesthesia was realized in 95% of cases. Percutaneous umbilical blood sampling was not realized at any patient. No neonatal haemorrhagic complication was observed. The association thrombocytopenia and pregnancy is of high risk. It can be at the origin of haemorrhagic complications involving maternal and fetal vital preview. The coverage requires a multidisciplinary cooperation between obstetrician, haematologist, pediatrician and anaesthesist

[Amelia - about two cases]

Amelia is a rare syndrome characterized by complete absence of one or all four limbs. We reported two cases of amelia observed in service A of the CMNT during 2002. The purpose of this article is to discuss the different etiologies of this malformation and to underline the contribution of the ultrasound done early [12 weeks of gestation]. Amelia is the result of toxic, mechanic or genetic causes. The antenatal diagnosis by ultrasonography is very useful

[Hysteroscopic myomectomy - about 90 cases]

We conducted a retrospective study of 90 cases of fibroma electroresections performed by hysteroscopy. Mean follow-up was 21 months. Clinical manifestations disappeared totally [80%] or nearly so in 93.5% of the patients. No predictive factor for functional success was observed. Seven of the 20 infertile patients became pregnant. Four gave birth at full term, in 74% of the cases the uterine cavity was found to be satisfactory at follow-up examination. The size and depth of the fibroma within the uterine wall were factors which predicted anatomical success

[Complications of the diagnostic and operational coelioscopies in gynaecology, about 5049 cases]

To present and compare with the literature, the complications which have occurred during 10 years of coelioscopic experiment. Material and processes: 5049 diagnostic and operational coelioscopies were practiced between January 1990 and December 2003 in the obstetric service of gynaecology "A" of the center of maternity and neonatology of Tunis. The major or advanced acts accounted for 28.5% of the practiced ccelioscopies. The rate of complications related to the phase of installation of the coelioscopy was 6.45%. 93.6% of our complications occurred at the time of major or advanced coelioscopies. 32 complications having imposed the immediate or differed laparoconversion. The most frequent complications were in connection with difficulties of hemostase accounting for 59.4%. The digestive, urinary, anaesthetic and infectious complications respectively accounted for 21.8%, 9.4%, 6.25%, and 3.1% of the accidents. The respect of against indications, the preoperative digestive preparation, the vesical survey as well as the rigour in the operational gestures should reduce the risk of complications related to this technique