[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

[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

[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

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

[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