[Comparison of two oxytocin administration protocols in elective cesarean section: 5 iu versus 10 iu]

Background: Although Oxytocin is used systematically during caesarean section, no recommendation precise optimal dose for this indication. The bolus administration of 10 IU intravenously after extraction of the newborn, is accompanied by side effects mainly hemodynamic

Objectives: To compare two Oxytocin protocols: 05 IU bolus Vs. 10 IU bolus during Cesarean section by studying their respective effectiveness [effects on uterine tone] and adverse effects

Methods: A prospective randomized double-blind study including 87 term parturients for undergoing a C-section under loco regional anesthesia. Parturients were randomized into two groups depending on the injected Oxytocine dose: - Group 1 [n = 43]: 10 IU + 25 IU IVD in 500 ml of serum / 3h - Group 2 [n = 44]: 5 IU IVD + 25 IU in 500 ml serum / 3h

Results: The variation of the heart rate and the incidence of low blood pressure were significantly greater for Group 1. No significant differences between the two groups regarding blood loss was noticed per or postoperatively. The type of digestive side effects were more common in the first group

Conclusion: Administration of 5 units of Oxytocin during the scheduled C-sections is effective for uterine tone without superimposed bleeding risk, guarantees better hemodynamic stability and less side effects than the 10 units dose

[Indication of metformin in the management of hormonal dysfunction secondary to polycystic ovarian syndrome: prospective comparative study about 63 cases]

Polycystic ovarian syndrome [PCOS] is the most common hormonal dysfunction in women. It's a cause of female infertility by oligoanovulation, clinical and biochemical hyperandrogenism and polycystic ovaries. Weight loss, firstly proposed in overweight or obese patient suffering from PCOS, aims to reduce hyperinsulinism and hyperandrogenism. Recently, Metformin, an insulin sensitizer, has been proposed as an alternative first line treatment for polycystic ovarian syndrome by improving hyperinsulinemia and hyperandrogenism in these women. The aim of our study, and through a literature review, is to demonstrate if Metformin should be used as a first-line drug for infertile women with this syndrome or as an adjunction to Clomifene Citrate, the longest established treatment already used in this syndrome. A prospective comparative study including 63 patients with PCOS has been done during 2 years. Women were randomly allocated to clomifene + Metformin [Metformin group, Metformin took during 8 weeks, 850 mg twice a day, plus Clomifene 100 mg per day during five days] or Clomifene only [100 mg per day during five days]. All patients underwent a two- month's diet. The middle age was about 30.63 years and the body mass index [BMI] was about 29.88 kg/ m[2]. We noticed a 6.2% weight loss in both groups [a non significant difference in p=0.04]. The median of infertility period was about 2.49 years. The ovulation rate in the Metformin group was 53.12% [significant difference for inducing ovulation p=0.02] and 32.25% in Clomifene group [non-significant difference 0.07]. There was also a significant difference for ongoing pregnancies [p=0.04]. In fact, 11 on 32 patients [34%] achieved a full-term pregnancy in Metformin group versus only 4 ones on 31 patients [12.9%] in Clomifene group. Our conclusion is that Metformin is an effective addition to Clomifene Citrate in term of reestablishment of ovulation and full-term pregnancies achievement, excluding ART cycles

[HELLP syndrome: about 17 cases and literature review]

HELLP syndrome is defined as an association of hemotytic anemia, raised liver enzymes and thrombocytopenia. It is a severe manifestation of pre-eclampsia. We tried to specify the epidemic factors and the best management of HELLP syndrome A retrospective study held during 6 years in the department of gynaecotogy and obstetrics in La Marsa hospital and according to a literature revue. The dominating symptoms included low abdominal pain and vomiting. The syndrome was discovered after 30.5 weeks of amenorrhea on average. Infant extraction was by cesarean section in 11 cases. Maternal morbidity was mainly marked by eclampsia and haemostatic disturbances while neonatal morbidity was attributable to the included prematurity. The main management consists essentially in a medical reanimation, in addition to a rapid foetal extraction

[Ovarian cyst: comparison between sonography, coelioscopy and patholy about 100 cases]

The ovarian cysts are a common pathology in gynecology. The aim of our study is to confront ultrasound and coelioscopic data in final anatomo pathological diagnosis of ovarian cysts and to assess the efficiency and the morbidity of coelioscopic treatment. We report a retrospective study of 100 ovarian cysts collected in CHU of Mongi Slim La Marsa from October 1st, 2003 to November 30th, 2007. The coelioscopic exploration coupled with the extemporany review has a sensitivity of 100%. The benefits of coelioscopy are: less esthetic desagrement, a decrease in morbidity per and post operatory and economic benefit. The risk of ignoring a malignant lesion is not zero with a risk of spread tumor .That's why it must respect strict rules and convert if malignancy is suspected. Coelioscopy has let a reliable diagnosis of malignancy with a low morbidity, it is an efficient and comfortable technic for patients

[Role of the hysteroscopy and laparoscopy in managementof the female infertility: about 200 cases]

Infertility is a common disease which affects nearly 10% of women at reproductive age. The hysteroscopy and laparoscopy are becoming very important in the management of this pathology. We tried to assess the current results of both hysteroscopy and laparoscopy, to study the prognosis factors as well as operating techniques and to clarify their contribution in comparison with other therapeutic techniques. This is a retrospective study about 200 cases of hysterolaparoscopy performed for female infertility in women admitted at the department of Gynaecology and Obstetrics in Mongi Slim's Hospital La Marsa. The hysteroscopy was abnormal in 75% of cases: the uterine synechias [23%], endometria hypertrophy [19%], endometrial polyps [10%], uterine fibroids [9%], atrophy [7.5%] and malformations [3.5%]. The operating hysteroscopy procedure was performed in 27.3% of cases with a rate of subsequent pregnancy in 34.9%. There is different data between the hysterosalpingography and hysteroscopy in 34.8%. The operating laparoscopy was performed in 70% of cases divided between adhesiolysis [27.2%], tubal surgery [37.8%], electrocoagulation or excision of endometriosis nodule [17.2%] and ovarian drilling for PCOS [17.8%]. The rate of pregnancy is 39.9% after laproscopic surgery [divided between intrauterine pregnancy 37.1% and ectopic pregnancy 2.8%]. The data of the hysterosalpingography and laparoscopy are different in 21.1%. Hysteroscopy and laparoscopy are diagnosing and treating both uterine and tubal infertility as well as some ovarian abnormalitis.They have, thus, the main role in diagnosis and treatment of female infertility.They permit to correct data from the HSG in more than a quarter of cases and to improve the rate of pregnancy in more than one third of cases

[Red-cell alloimmunization: epidemiology, prevention and management]

Although very rare, red-cell immunization is a main factor of hemolytic fetal anemia and severe neonatal jaundice. We emphasize on the prevention of immunization in different situations of feto maternal bleeding by early intravenous injection of 200 at 300 IU or more depending on the term of pregnancy, the circumstances and results of the Kleihauer's test. Prophylaxis conrresponds a systematic intramuscular injection of 300 IU immunoglobulin [Natead [R]] at 28 WA, is performed in many countries. This measure implies information and rigor from Perinatal's professional. If this systematic prophylaxis was conducted, it is not necessary to repeat the IAR until the birth. But if the patient has not received the injection of 28 WA, IAR of the 8[th] month must be maintained

Efficacy of patient controlled epidural analgesia during labor analgesia - a prospective randomized study using 0.1% bupivacaine with fentanyl 2 microg/ml

Epidural analgesia is the most effective for the control of pain during labor but irregularity of analgesia, toxicity of local anesthetics [LA] and driving block are the major limits of the modalities of maintenance. The purpose of this work was to assess efficiency and adverse effects of adaptations offered with Patient Controlled Epidural Analgesia [PCEA]. 40 monofoetal parturients were randomized in two groups: 0.1% bupivacaine continuous drip associated to fentanyl 2 Ig/mL [CP-group] or same products administrated in PCEA. Evaluation of analgesia, driving and sensory block allows adapting the outputs of drip. Consumption schedule in LA was of 7.5 +/- 2 mL/h in the CP-group and 3.5 +/- 1.5 mL/h in PCEA-group [p < 0.05]. Consumption accumulated by LA is reduced by 35% from the very beginning and 43% a 4-th hour [p < 0.05]. Incidence of the driving block was of 11 cases in CP-group against 4 in PCEA-group per first hour and of 13 cases against 3 per second hour [p < 0.001]. 50% of clinical obstetric interventions were brought together in the CP-group against 5% in the PCEA-group [p = 0.013]. Incidence of side effects is comparable. Besides the perfect analgesia, PCEA offers a psychic independence which explains comfort and maternal satisfaction. Accumulation of LA entails a driving block involved in the change of dynamics of the labor. Incidence of clinical obstetric interventions is the major observation of our study

[Transvaginal ultrasound of the cervix in the estimation of severity of premature labour]

Premature labour is a frequent situation,it complicates about 6% of births, with increasing perinatal morbidity and mortality.The purpose of this study is to analyse the place of the ultrasound of the cervix in the coverage of a premature labour and the evaluation of the severity of the premature labour being able to have therapeutic implications. It is about a prospective study 56 patients presenting a premature labour between 28 and 34 weeks realized in the service of maternity in Mongi Slim hospital of Marsa for a period of 12 months going from January 2006 till January 2007. In our study 56 patients presented an ultrasonographic cervical length

Hematocolpos with imperforate hemivagina and duplicated uterus: diagnosis and treatment

To document the means of diagnosis and treatment of the exceptional malformation hematocolpos with imperforate hemivagina and duplicated uterus. Cases of four patients treated at La Marsa University Hospital, in the Department of Obstetrics and Gynecology between 2000 and 2004, were reported. Mean age17.2 years [range: 15-22 years]. Three left hematocolpos and a right one are observed. All patients underwent vaginal conservative surgical treatment [excision of vaginal septum] +/- radical treatment: hemi-colpohysterectomy in case of failure of conservative treatment. The clinical presentation was a primary dysmenorrhea associated with a pelvic collection. An ipsilateral renal agenesis is present in all cases. Sonography is essential to assess the diagnosis of renal anomalies. Pelvic MRI is the most important examination. It occurately localises the different collections and identifies their content. Conservative surgical management was effective in three cases out of four

[ role of practitioner in the management of sexual aggression]

Sexual violences constitue a problem of public health whose frequency is alarming in all the contries. Any doctor, what ever his specialization must feel concerned by this medical problem. Thi report helps and guides doctors to find the best manner to expecting and reception of victims. The principal objectives of sexual violence victims managment are: 1].To ensure near the victim and the family a multidisciplinary,psycho-medicosocial managment to accomodate and inform the victim. The multidisciplinary team joins together psychological, doctors, welfare officers and other professionals of health. Organization of reception center specialized open 24 hours a day with structuring of regional network and training of professionals of health in order to ensure a follow-up of the victims and to evaluate the results of this managment. 2].To ensure a medical managment of optimal competence[examination with care] in order to avoid with the victims of sexual abuse the repetation of the genital examinations. Collection on a structured file of all the data elements as well as the medico-legal elements wich can contribute to establish the proof of the aggression[taking away for cytology and molecular biology]. 3].To prevent the infections risks, the pregnancy and psychological risks of after-effects. In conclusion, the managment of the supposed victim must be global, prolonged, and multidisciplinary.It will comprise medical care, a psychological follow-up to organize without imposing it and finally without forgetting medico-legal aspects

Maternal and neonatal metabolic complications in cases of gestational diabetes about 220 cases

We report a retrospective study of 220 cases of gestational diabetes collected during a 5 year period [2001-2006]. Hypoglycemia was the most frequent maternal metabolic complication [11%], whereas ketoacidosis was rare, seen in only two patients [0.8%]. Neonatal metabolic complications were mostly hypoglycemia [19%] and hypocalcaemia [7%]. Pregnancy in diabetic women involves more risks than pregnancy in non-diabetic women. However, these risks are now better controlled

[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

[Fetal cystic hygroma antenatal diagnosis, prognosis and management]

Fetal cystic hygroma is a rare congenital malformation. The incidence of this pathology is 1/700 pregnancies. This malformation can be seen at antenatal ultrasonography from the end of the first trimester of pregnancy. The prognosis depends on chromosome analysis, other ultrasound abnormality and the size of the fetal cystic hygroma. Starting from a case diagnosed in the prenatal follow up and from literature review, the authors discuses the ultrasound diagnosis, prognosis and management of this malformation

[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

Reflexion sur l'association de la maladie de Recklinghausen et grossesse. A propos de six cas

Recklinghausen's neurofibroimatosis is a phacomatosis with dominant autosomal transmission and variable expression. The authors propose an analysis of six cases of Recklinghausen's disease associated to the pregnancy. From these observations and review of the literature, they release the particularities of this association. The appearance of high blood pressure seems more frequent at the patients affected by Recklinghausen's disease than in the unhurt population. A disease prevention of hypertensive complications by the use of low dose of Aspirine can be proposed in the presence of gravity's criteria

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