[Postpartum depression: prevalence and risk factors prospective study concerning 302 Tunisian parturients]

Depression is a common condition especially in the postpartum. It exposes mothers, newborns and couples for psychosocial complications. They were to estimate the prevalence of the depression in postpartum in a population of 302 Tunisian parturients and to identify its associated factors. Our study was prospective, in two stages: at the first week [T1], then between sixth and tenth week of the postpartum [T2]. The study was conducted at CHU Hédi Chaker in Sfax, Tunisia. We used the Arabic version and validated the Edinburgh Postnatal Depression Scale [EPDS] for screening for postpartum depression. We used the scale MSSS. "Maternity Social Support Scale"to assess the social and family support and the Azrin scale to evaluate the satisfaction of the conjugal relationship. An epidemiologic questionnaire was used to collect the sociodemographic and clinical data. At T1, 302 women were examined. At T2, 139 were reexamined [46% of the initial population]. In the first stage, the prevalence of the intense postpartum blues, according to EPDS, was 19,2%. In the second stage, the prevalence of the postnatal depression was 12, 9%. Factors associated with postpartum blues intense were the low socioeconomic status [p =0, 01], a lower educational level [p = 0,017], the poor marital relationship [p =0, 04], an insufficient social support [p ‹0,001], the difficulty to accept pregnancy [p =0,001], the presence of psychiatric the presence of psychiatric history [p =0,001], the prematurity [p =0,001] and an ill newborn birth [p =0,001]. Factors associated with the post natal depression were the low socioeconomic status [p =0,01], the poor marital relationship [p =0,034], difficulty with pregnancy [p =0,001] and the presence of psychiatric history [p =0,001]. Postpartum depressions are common. It seems to be the result of the interaction of several biological, psychological and social factors. This suggests the importance of screening for women having such risk factors to prevent the installation of this depression. This detection should be done early in postpartum or else in the later postnatal consultations. This allows an adequate treatment for the mothers, for the relationship mother-new born and later, for the psychological equilibrium of the child

[Sexuality and contraception: a prospective study about 85 cases]

Contraception opposing procreation interferes with the primary purpose of sexuality. Few studies have yet been made on the actual interaction between contraception and sexuality. To study contraceptive practices is non medicalized contraception and oral contraception, study aspects of women's sexuality and to study the physiological impact and psychological contraception on women's sexuality. Prospective and analytical study conducted over a period spanning from October 2008 to February 2009. This study was based on a survey, carried out through an oral questionnaire to 85 women in reproductive age, married, with contraceptive-based pill or natural birth control for at least one cycle, having experienced during their personal background a sexuality contraception or at least one contraceptive method other than its current average. Comparison between the group of women using oral contraception and women not using contraception medicalized showed significant differences in outcomes relating to: the average frequency of intercourse / month [p = 0.01], sexual desire [p = 0.01], sexual pleasure [p = 0.03]. The comparison of the different parameters of sexuality among the group of women using intra uterine device and women using oral contraceptives showed no significant differences in the parameters of sexuality. The awareness of the big importance of the interaction between sexuality and contraception, in one way or another, could help us tailor our applications to contraceptive practices of each woman

Antepartum detection of macrosomic fetus: the effect of misdiagnosis

To determine the effect of misdiagnosis of macrosomia on maternal and perinatal outcomes. We conducted a retrospective study, between January 2007 and December 2008 of women [n = 464] who delivered singleton neonates with actual birth weight over 4000g and in whom fetal weight was estimated, by both methods :sonographic and clinical, up to 3 days before delivery. Statistical comparisons were made between patients in whom fetal macrosomia was predicted: "prediction " group [n=336]and those in whom it was not " non prediction "group [n=128] for outcome variables. The cesarean delivery was performed in 35.9% in " non predicted " group, and in 35.7% in the " predicted " group. The difference was not statistically significant. Failure to detect macrosomia was associated with higher rates of maternal and fetal complications in the group " non predicted " compared with the group " predicted " :perineal trauma, post partum hemorrhage, 5- minute Apgar scores less than 7, and shoulder dystocia, mostly related to the higher rate of surgical vaginal deliveries. The misdiagnosis of fetal macrosomia substantially did not modify the cesarean section rate but leads to increase the maternal and neonatal complications

[Prospective study about 45 cases of disseminated intravascular coagulation]

Disseminated intravascular coagulation [DIC] in obstetric disorders is a severe complication. To study the frequency and means of diagnosis of DIC and the therapeutic care and maternal morbidity induced. Monocentric, prospective and descriptive study about 45 cases of intravascular coagulation in an obstetrical service collected at the University Hospital of Obstetrics and Gynecology Hedi Chaker of Sfax over a period ranging from June 2007 to June 2010. All the pregnant patients who have given birth beyond 28 weeks and have presented a DIC were selected for this study. The mean age of patients was 31.4 years. The mean parity was 2.6. The main diseases during pregnancy were: severe preeclampsia [22.2%], diabetes [28.8%], intrauterine fetal death [17.7%], previa placenta [8.8%]. The main causes of DIC were: uterine atony [44.4%], abruptio placenta [22.2%], Hellp syndrome [11.1%] and uterine rupture [6, 6%]. The lowest rate of platelets was 21000/mm3. The fibrinogen level was <0.5 g in 40% of cases. Despite reanimation and transfusion with blood products, surgical treatment was necessary in 77.7% of cases. All the patients were transferred in intensive care unit with an average stay of about three days. No maternal death was reported. DIC is a frequent complication of many obstetrical diseases. The treatment is urgent. It requires first to the cause and the shock by massive transfusions of packed red blood cells, fresh frozen plasma, and platelets, associated with antifibrinolytic drugs, if necessary

[Female sexuality during pregnancy and postpartum: a study of 80 tunisian women]

To investigate the impact of pregnancy and the post partum period on the female sexuality and the coupledom, and to evaluate the quality of information and dialogue about this subject. A prospective descriptive and analytical study included patients from the department of obstetrics and gynecology in the university hospital Hédi Chaker during July and August 2010. We choose randomly 80 Tunisian women, whatever the reasons for consultation. Data were obtained via questionnaires containing 45 questions about sexual behavior during the last pregnancy and the postpartum period, the influence on coupledom, and the quality of information and dialogue about this subject. Statistical analysis was conducted using SPSS for Windows version 17. Statistical significance was defined as a p value 5% using the X2 test. The average age was 31.64 [+/- 6] years. Before pregnancy, sexuality was qualified as "satisfactory" by nearly the half of the sample [48, 5%] against 78.8% by their partners. 18% of women thought it was not possible to have intercourse during pregnancy. This idea doesn't correlate with the education [p=0.151] neither the geographic origin [p=0.064]. 54.5% of women mentioned a decrease on their sexual interest and activity during pregnancy. The three main causes of this decline were: the physical symptoms [83%], the fear to harm the fetus [66.7%] and the women hypoactive sexual desire [33.4%]. After delivery, sexual interest and activity tends to be reduced in 64% of women. The resumption of normal sexual activity was about 4 months around the delivery [with variations between 1 month and 2 years]. Sexuality was considered as taboo by 81, 8% of women. The information on sexuality by health professionals was deemed insufficient by 78.8% of women. Sexuality remains a taboo for the most of woman. Their belief in the impossibility of intercourse during pregnancy doesn't correlate with education neither with origin. The period of pregnancy and the postpartum changes the sexual behavior, interferes with the quality of life and disturbs the coupledom. However information and the support of women in this period are still insufficient

[Cervical ripening at term. a randomized and prospective study: Misoprotol versus dinoprostone]

To compare the efficacy and safety of cervical ripening at term by vaginal Misoprostol and Dinoprostone. We performed a prospective randomized study on cervical ripening with misoprostol and dinoprostone in the third trimester of pregnancy. 300 patients have been divided into two groups: one consisted by 150 patients who received Misoprostol [Cytotec registered] and the second consisted by 150 patients who received Dinoprostone [Pr‚pidil registered]. Analysis of our results allowed to reveal: a significant decrease in the time of entry into work for the Misoprostol group [9.08 hours versus 12.51 hours, p = 0.007], a significant reduction delivery time [14.48 hours versus 19.30 hours, p = 0.001]. Moreover, the birth rate in the first 24 hours after the first dose was significantly higher in the Misoprostol group [86.7% versus 72.7%, p = 0.003]. The use of oxytocin was significantly reduced with Misoprostol [44% versus 58.7%, p = 0.01]. The mode of delivery was not influenced by membership in one or other of the two groups. Misoprostol seems an interesting molecule for cervical ripening and labor induction

[Ligation of internal iliac arteries for sever hemorrhage in obstetric]

To assess the efficiency of arteries ligation in intractable obstetrical hemorrhage. Prospective study which concerned 53 patients who underwent internal iliac arteries ligation for persistent and severe obstetrical hemorrhage from January 2007 to June 2010. The average age of patients was 29.3 years. The mean parity was 2.2. Main etiology of hemorrhage were: uterine atony [62.2%], abruptio placentae [15.1%]. Coagulation disorders and hypovolemic shock were observed respectively in 20.7% and 37.7%. Blood transfusion was performed in all cases. Internal iliac arteries ligation allowed hemorrhage control in 90.5% of cases. In five cases a hysterectomy was necessary to control bleeding.. No peroperative complication were observed. Internal iliac arteries ligation is a prerequisite treatment of severe postpartum hemorrhage. It is a good alternative to arterial embolization

[Pregnancy in dermatomyositis and polymyositis]

To determine the incidence of pregnancies during the inflammatory myopathy [IM], its influence on this disease and the influence of IM on the pregnancy's outcome. From 1979 to 2007 we have collected retrospectively 67 cases of IM [53 women and 14 men] in the department of internal medicine CHU Hedi Chaker of Sfax [Tunisia]. Diagnosis criteria were those and Peter. We have included pregnancies occurring after diagnosis of DM or PM and cases of IM occurring during pregnancy or postpartum. Five women [4DM and PM], average age 30.6 years [range 26 - 41 years] concluded 10 pregnancies [9.4%]. The fertility rate is 2 pregnancies per patient. Nine pregnancies occurred after the diagnosis of myositis in 4 women. IM was inactive at conception in all this case. No flare-up in IM has been noted during these pregnancies. The DM was revealed to the 10th day post-partum in one patient. Therapeutic interruption of pregnancy was needed in 3 cases. 4 pregnancies were completed without incident and resulted in the birth of healthy newborns. Foetal complication were observed in the other two pregnancies occurring in one patient who also presents an APS associated with DM. it was a foetal death in utero and premature delivery of a newborn who died in 3rd day after birth. Pregnancy in the MI is rare. Its influence on the activity of the disease is variable, both during the pregnancy than post-partum. The foetal prognosis is good when the disease is in remission. However foetal complications are important in case of active IM

[Emergency peripartum hysterectomy: indications and prognosis]

Detect the risk factors, indications and maternel morbidity of haemostatic hysterectomy. A retrospective study of 46 women who had haemostatic hysterectomy between 2005 and 2009. The mean age was 33.3 years. The mean parity was 3.5. 35% of patients had a previous cesarean section. The mode of delivery was: vaginal delivery [47.8%], cesarean delivery [52.2%]. The hysterectomy was subtotal in 39 cases [85%]. The indications of haemostatic hysterectomy was: uterine inertia [44%], disseminated intravascular coagulation [26%], placenta accreta [8.7%], Placenta praevia [13%], uterine rupture [8.7%]. Three patients were dead. Five patients had a depression. Six patients had a dyspareunia. Five patients had a decrease of sexual desire. Haemostatic hysterectomy is a multilating surgery giving an irreversible infertility. The development of arterial embolization avoid the appeal to this surgery

[Genital prolapse in young women: a study of risk factors]

To determine the risk factors for genital prolapse in a group of 33 young women less than 45 years old. We studied 33 young women who had been operated for genital prolapse, whereas the control group consisted of women operated for benign gynaecologic disorders. In the study group the number of pregnancies and deliveries, the babies'weight, the positive family history of prolapse were heavier than in the control group. The women with prolapse had more often chronic pulmonary diseases, asthma, as well as operations for abdominal hernias. The mode of delivery, be it a cesarean section or the use of forceps, and the active second stage of labor had no effect whatever on the occurring of genital prolapse in young women. Our data support the suggestion that multiparity, babies weight and congenital factors are responsible for a higher rate of genital prolapse in young women

[Confrontation ultrasonography-cal25-histology in the managment of ovarian cysts: a prospective study about 77 cases]

To study the correlation between ultrasound, Doppler,measurement of CA 125 and histology in the preoperative diagnosis of ovarian cysts. Prospective and analytical study about 77 patients in whom we analyzed the contribution of ultrasound, the assay of CA125, the couple CA125 ultrasonography and laparoscopy in the diagnosis and management of cysts the ovary. The value of CA125 was considered pathological like the one adopted by our biochemistry laboratory of the CHU Habib Bourguiba, Sfax [> 35 UI / ml]. The mean age was 35.6 years. On the whole, ultrasound has a sensitivity of 71.41% and a specificity of 80%. The positive predictive value was 35.71% and negative predictive value was 96.55%. The sensitivity of CA125 to detect malignant lesions among ovarian cysts was 85.71% and a specificity of 85.93%. The PPV was low [42.85%]. The combination Ultrasound-CA125 had a sensitivity of 85.7%, a specificity of 82.8%, a PPV and NPV respectively 35.3% and 98.1%. The concordance between the macroscopic perlaparoscopic and histological diagnosis of different tumors was 83.3% for functional cysts, 77.7% for serous cysts, and 100% for dermoid cysts, endometriosis and bleeding. The contribution of Doppler ultrasound and tumor markers is essential in the diagnosis of ovarian cysts

[Obstetrical prognosis following ligation of hypogastric arteries]

Ligation of hypogastric arteries is a conservative surgical treatment in cases of postpartum hemorrhage. To study the fertility and pregnancies outcome in women who required hypogastric artery ligation for severe post-partum haemorrhage in our hospital. The fertility and pregnancy outcome parameters were retrieved from medical files and telephone interviews. 34 patients required hypogastric ligation on this period. 39 pregnancies were observed with 30 term deliveries, 1 ectopic pregnancies and 8 miscarriages. Two patients had infertility and pregnancy was obtained in less than 10 months most once desired.Pregnancy outcome was normal. 73, 3% of deliveries were by caesarean. Hypogastric artery ligation for post-partum haemorrhage is not responsible for secondary infertility. Following pregnancies do not suffer complications from the ligation

[Anatomic and functional results after surgical treatment of uro genital prolapse: prospedtive study about 93 cases]

Genital polapse is a frequent olisease several techniques were described. To evaluate the anatomical and functional results of surgery for genital prolapse by vaginal and abdominal approach. Prospective study on 93 patients operated for urogenital prolapse [50 by high and 43 vaginal approach] in the department of obstetrics and gynecology of Sfax. Anatomic results and postoperative patient satisfaction was assessed. Quality of life was assessed using the French versions of the questionnaires Pelvic Floor Distress Inventory [PFDI 20], Pelvic Floor Impact Questionnaire [PISQ 7]. The mean age of patients was 59 years. 85.9% of our population consisted of postmenopausal women. The results of the postoperative visit, after a mean of 28.7 months, showed about the anatomical level, a success rate for the treatment of prolapse by high 82% against 72.1% for vaginal delivery, but the difference is not significant [P = 0.45]. For prolapse of grades 1 and 2, surgical treatment by high and low has corrected all the elements of prolapse. For prolapse of grades 3 and 4, high surgery has resulted in a satisfactory anatomical result in 86%, while the lower channel yielded a significant result in 76.5%, and recurrence were interested mainly the anterior stage. The questionneer PFDI 20, showed an improvement in the quality of life after surgery significantly in both groups [p<0.003]. The improvement was more significant PFDI 20 after surgery by high versus vaginal surgery [p <0.002]. Regarding PFIQ 7, improved quality of life was observed after surgery without significant differences between the two groups. The treatment of urogenital prolapse is mainly based on surgical and reconstructive surgery to restore anatomical and functional surgery also in order to improve the quality of life of patients

[Cytologic study of 8827 PAP smear with cytosistologic confrontation]

Cervical cancer is the second female cancer. Currently, pap smears represent the most effective tool for screening of neoplastic cervical lesions and their precursors. The objective of this study is to deal with epidemiology, cytology and histology of all cervical lesions and to evaluate pap smears reliability in cervical cancer screening. Our study included 8827 pap smears collected during three years [2003-2005]. Results of pap smears were reported according to the 2001 Bethesda system. A comparative cytohistologic study was performed in 342 cases. For statistical analysis, we used Chi 2 test and considered differences as significant for a p value less than 0,05. The mean age of our patients was 41 years. Pap smears were normal in 269 cases [3,1%], inflammatory in 8070 cases [9]4%] and showed epithclial cell defects in 46 cases [0,5%]. A cytohistologic accord was found in 944%of cases. Pap smear was more sensitive in detecting high grade squamous lesions [50 to 100%] than those of low grade [33,3 to 66,6%]. Pap smear is the most useful tool for screening of preneoplastic cervical lesions which tend to be mole and more a pathology of young females. Its sensibility and specificity are better in detecting high grade intraepithelial lesions

[Nicardipine versus salbutamol in the treatment of premature labor: comparison of their efficacy and side effects]

The objective of this study is to compare the tocolytic action and the side effects of nicardipine to those of salbutamol in patients presenting premature labor in order to propose nicardipine as a promising alternative to salbutamol in the treatment of premature labor. Forty eight patients admitted for premature labor were included in this prospective randomized study comparing nicardipine and salbutamol, administered with intra venous drip. The nicardipine group included 25 patients and the salbutamol group included 23 patients. The epidemiologic characteristics of the 2 groups are similar. No significant difference between the 2 groups was noted in the average time of disappearance of the uterine contractions. In nicardipine group, the pregnancy was prolonged more than 48 hours in 87.5% of the cases against 85.8% in salbutamol group [P: NS]. Adverse effects linked to tocolysis were recorded. In nicardipine group, 8% of the patients presented an intolerance of the molecule, against 47% of salbutamol group, the difference is significant [P=0.02]. The term of delivery was similar in both groups. The neonatal status of the infants was identical in the two groups. In the group of new born hospitalized, we did not note biological disorders concerning the glycemia and the calcemy. Nicardipine is at least as effective as salbutamol in tocolysis; but it has less secondary effects. Thus, nicardipine is proposed as the tocolytic of first intention instead of the salbutamol which is considered as reference molecule

[Fibromyalgia prevalence in Tunisia]

To estimate fibromyalgia [FM] prevalence in Tunisia Data on a cross-section of 1000 individuals aged 15 years or older living in Sfax were collected by interviewers using the London Fibromyalgia Epidemiology Study - Screening Questionnaire [LFES- SQ]. The sampling was realized by empirical poll and respecting quota according to delegation, rural or urban environment, sex and age according to the demographic national data. The positive screened subjects were invited to be examined to confirm or exclude the FM by applying the 1999 ACR criteria. The questionnaire was administered to a second group of 252 volunteers, all were afterward examined. This allowed 10 study specificity and sensibility of the questionnaire and allowed to calculate the FM prevalence. 159 subjects were screened positive, only 141 were examined. The specialized exam allowed confirming the diagnosis of FM in 67 subjects. FM prevalence is different according to sex, age, study level and socio-economic level. Two hundred and fifty two volunteers answered the questionnaire then all examined. The questionnaire specificity was 90.8% and the sensibility 79;4%. FM prevalence in Tunisia, calculated by Bayes theorem, is estimated between 8.27% and 12.3%. FM prevalence in Tunisia is estimated at least at 8.27%

[Functional disability indexes: translation difficulties and cross cultural adaptation problems]

To summarize the difficulties involved in translating tests in Arabic and to describe the translation methods and to apply those to functional indexes. Four functional indexes were translated and then.subjected to the following test validation methods: back translation, pre-test, and review by an expert committee. Translation problems were underlined. These include in particular the different types of equivalence between the source language and the target language [semantics, idioms, conceptual. equivalences]. Problems related to comprehensive literal words were the most observed. The current method combining translation with back translation is not sufficient and must be used with, a pretest and a review committee