[Delivery in breech presentation: what way should we choose?]

The breech delivery is considered dangerous because of the higher rates of perinatal mortality and morbidity which become attached to it, consequences of obstetric traumas bound to the obstetric operations. What way of delivery is it necessary to privilege? What are the arguments which we have to support our choice? To assess the maternal and fetal outcome according to the way of delivery. In this retrospective study, 194 women with a singleton pregnancy in a breech presentation delivered at term in our maternity unit in Ariana's Hospital from January 2007 to December 2009. Breech presentation was noticed in 2, 59%. The main factors favoring this presentation are: the primipara, the uterine deformations, the pathological ponds, the abnormalities of the amniotic liquid, the fetal weight and the fetal deformations. Vaginal delivery was accepted in 57,7% of women and 75% from them delivered in natural way. The rate of caesarians was 56,7 %. Among these patients, 74, 5 % were indications in a cold caesarian [scar womb, pathological pond, RPM > 12 hours, estimated [esteemed] fetal weight > 3800g]. The Apgar's score was superior to seven in 97.6% of cases. There was no significant difference in fetal morbidity, Apgar's score or in the need of transfer in intensive care unit. When the acceptance conditions of the vaginal delivery are combined and when the surveillance of the labour is rigorous, it seems that there is no excess of neonatal risk by the natural ways

[Exploration of infertility: Correlation hysterography hysteroscopy]

In literature, a uterine lesion in found in half of the infertile womenTo compare the results of the hysteroscopy and the hysterosalpingography in the study of the uterine cavity as exploration of feminine infertility. Retrospective study, over a period of four years from 1 January 2005 to 31 December 2008however, on 140 cases of infertile patients explored in the gynecology obstetrics department in Mahmoud El Matri hospital. Compared with hysteroscopy, hysterography had an overall sensitivity of 76.56%, a specificity of 77.63%, a PPV of 74.24%, an NPV of 79.72% and a very strong correlation with coefficient of 0.83. Best correlations between the two examinations were found with polyps, fibroids and synechia. Hysterosalpingography remains the first line examination in the exploration of feminine infertility. However, hysteroscopy must be realized as a second examination in case of lesions found at the hysterography or at once in certain cases

[Cervical incompetence: diagnosis ; indications and strapping outcome]

Cervical incompetence, a major cause of late abortions and preterm delivery is a diagnosis increasingly easy to establish.Strapping is deemed effective to prevent recurrence of such accidents midwifery. To evaluate the relevance of the diagnosis of cervical incompetence, check the main indications of banding and study the outcome of rimmed pregnancies. A retrospective study about 103 rimmed pregnancies collected in the service of Motherhood Hospital Mahmoud El Matri Ariana to the period of January 2001 until December 2008. The diagnosis of cervical incompetence is suspected in a body of evidence linking ATCD of late abortions or premature births found in respectively 46.2% and 31.1% of our patients in our series, 16.98% are carriers of known uterine defects. 8.49% are classified as high risk front of 3-ATCD of late abortions or preterm delivery and were circled systematically. 2.83% are rimmed after confirmation the incompetent cervix by calibration of the cervix and 55.99% because of clinically short cervix. The strapping has reduced the rate of late abortion which decreased from 46.6% before strapping to 7.6% after. As for preterm delivery, it is reduced from 31.1% before strapping to 18.5% after. This difference is statistically significant. The average term of confinement in our series is 36SA six days. 68 cases were delivered at term. Among patients in whom we have accepted the vaginal delivery, 74.2% had spontaneous labor. One case of rupture of the anterior lip of the cervix was noted. The indication of a cervical strapping needs a well established diagnosis involving data from history, clinical examination and possibly endo-vaginal ultrasound to confirm the high-risk of cervical incompetence. The strapping participates significantly to prolong the duration of pregnancy, to lower rates of early major premature and to improve the chance of viability and prognosis of fetuses without serious repercussions on the workflow

Maternal and fetal outcomes of large fetus delivery: a comparative study

To review the deliveries of macrosomic babies, weighing over than 4000g and their obstetrical and neonatal outcomes. Retrospective study involving a total of 209 deliveries at term of macrosomic babies between Marsh 2006 and February 2007 in the Maternity Hospital of Mahmoud ELMATRI, Tunis. The study concerned risk factors, mode of delivery and the incidence of maternal and perinatal complications.We compared data in the study group to a control group of normal weight infants delivered at the same period. Macrosomia occurred in 9.2% of all deliveries. The main risk factors of macrosomia were maternal age over 30 years [p=0,017], multiparty [p<0.001], diabetes mellitus [p=0.012] and prolonged term of delivery [p=0.02]. These risk factors were statistically significant compared to control group. Caesarian delivery was achieved in 24.4% in macrosomy group and in 13.7% in control group [p=0,003] the major part occurred during labor. Among vaginal deliveries in macrosomia group, shoulder dystocia was noted in 1,9%, fetal respiratory failure and admission in intensive care unit was noted in 4,8% of the cases and hypoglycemia complicated 15,8% of deliveries. Maternal complications were dominated by post partum hemorrhage documented in 1.2% of the cases and perineal tears noted in 8,2% of vaginal deliveries.Vaginal delivery is the most frequent mode of delivery for a fetus weighing in excess of 4 kg and vaginal delivery should be attempted in the absence of contraindications and there is no need for elective systematic caesarian. However, shoulder dystocia remains the main complication of vaginal delivery for macrosomic fetuses and requires experienced obstetricians to manage these deliveriesbetter, other tests are requiring: magnetic resonance imaging and Tc-Squid biosusceptometers

[Unexpected diagnosis of a cystic pelvic mass: benign mesothelioma of the uterus: case report]

Benign mesothelioma is a rare tumour mostly found in the genital tract. We report the case of 30- years old woman presenting pelvic pain. The ultrasound scan revealed a cystic pelvic mass. Laparoscopic exploration showed a uterine posterior formation. The resection of the dome was performed. Histologic exam and immunochemistry concluded to a benign cystic mesothelioma. The benign mesothemioma of the uterus is usually discovered in histology, differential diagnosis of the uterus is usually discovered in histology, differential diagnosis for solid forms can be made with leiomyoma or adenomyoma, whereas the cystic forms can be discussed essentially with the ovarian cysts. The presence of mesothelial immunophenotype in immunochemistry improves diagnosis. Clinical outcome is always favourable without recurrence or malignant transformation

First trimester diagnosis of Pallister-Killian syndrome in a fetus with suggestive abnormalities

Pallister-Killian Syndrome is a rare, sporadic chromosomal disorder characterized by a tetrasomy 12p often in mosaic. It is only in 2000 that the first case of PKS was diagnosed in the first trimester further to an increased nuchal translucency. Report a new case. To our knowledge, we present the first case of early prenatal diagnosis of Pallister Killian Syndrome due to the presence of an increased nuchal translucency, a diaphragmatic hernia, a typical facial dysmorphism and a micromelia of a predominantly rhizomelic type. A chorionic cells biopsy showed a normal karyotype. The diagnosis was revealed on cytogenetic analysis of amniotic fluid sampling. The main ultrasound indicators of PKS seem to be: Hydramnios, congenital diaphragmatic hernia [CDH] and a micromelia of a rhizomelic type. The hydrops fetalis, hygroma coli or increased nuchal translucency [INT], fetal overgrowth, ventriculomegaly and presence of a sacral appendix are less common. The amniocentesis with the study of the karyotype on amniotic cells is considered to be the gold standard for the diagnosis of PKS. A good morphological study during the first trimester in search of ultrasound abnormalities highly suggestive of PKS is able to direct the cytogenetic study

[Immature t eratoma of the ovary and pregnancy]

Composing of less than 1%of all ovarian cancers, immature teratoma is a malignancy that mainly affects the young. Immature teratoma of the ovary together with pregnancy is rare. To nor knowledge, this association was reported only in twelve cases. We Report two cases of immature teratoma of the ovary diagnosed during pregnancy and their respective issue. Observation 1st case. A 28 years old woman gravida 1 with an immature teratoma of the ovary discovered during delivery by caesarean section. The treatment was conservative including salpingo-oophorectomy, omentectomy. aortic lymph node dissection and appendectomy. This patient had a second pregnancy with a good outcome. She delivered by cacsarean section in order to perform radical treatment: hysterectomy and oophorectomy of the remaining ovary. 2nd case. A 22 years old woman gravida I with adnexal mass diagnosed during an ultrasonography exam at 15 weeks gestation. A conservative treatment was indicated, including salpingo oophorectomy, omentectomy, aortic lymph node dissection, appendectomy and biopsy of the resnaining ovary. The patient bad a normal vaginal delivery. Immature teratoma is graded from 1 to 3. The management of this association is discussed, but it takes in consideration the surgical staging, the grade and the secretion of alpha FP. Conservative treatment without associating chemotherapy can be tempted in tumours with a stade Al and a low grade

[Obstetric Vesicovaginal fistulas, about 131 cases]

Vesicovaginal fistulas are the most frequent type of urogenital fistulas. Obstetrical cause remains the dominant etiology. They still represent a public health problem. to study epidemiological aspects of obstetric vesico-vaginal fistulas and their management. a retrospective multicentric study among 19 hospital departments from February 1982 to January 2007. 131 VVF [92% of urogenital fistulas]. The vaginal route for surgical repair was used in 2/3 cases. The mean diameter of the fistula was 11.35mm. In 122 cases [86.5%], the fistula was unique. IVU findings were normal in 83% cases. All patients had normal renal function apart one who had acute renal failure. 177 interventions were performed [1.37 intervention per patient]. Our findings suggest a regression in obstetrical VVF. However many efforts on institutional, socioeconomic and obstetrical levels have to be done in order to eradicate this pathology that is of major handicap for women regarding socioeconomic, functi6nal and psychological effects

[Prenatal diagnosis and management of fetal megacystis]

Prenatal diagnosis of fetal megacystis particularly in the first trimester requires assessement of pronostic and aetiotogycal criteria. Report anew case we report a case of severe megscystis in female fetus diagnosed at 23 weeks of gestation. There are no other associated ultrasound findings. Fetal karyotyping was normal [46XX]. Termination of pregnancy for medical indications was realised because of progressive enlargement of the fetal bladder. Post-mortem examination showis megacystismicrocolon-in testinal hypoperistalsis syndrome. Fetal megacystis is a severe condition when diagnosed early in pregnancy. Ultrasonography follow-up and fetal karyotyping are important to evaluate prognosis

[Polycystic ovary syndrome with infertility]

The definition of the polycystic ovary syndrome has been controversial for a long time. Rotterdam consensus established precise criteria since two among three set the definition as follow: anovulation, hyperandrogenism and polycystic ovaries. of this study is to stress on the particularity of ovarian dystrophy and the management of the resulting infertility that represents an important rate of medical counselling of women desiring pregnancy. Literature review. Management consists in two parts: treating hyperinsulinism and stimulating ovulation. The "step up low done" protocole is now taking the place of the classical "step down" protocole. Ovarian drilling have to be considered in case of resistance to Citarate of Clomifen. The hyperstimulation syndrome is the common complication to avoid by a regular following. The "coasting" represents an interesting alternative in case of an explosive response in order to obtain a controlled follicular failure. Clinical management of the PCOS have to be organized in regard to patient's age, history, desire of pregnancy and medical staff experience

[Prenatal diagnosis of omphalocele: a report of four cases]

Fetal omphalocele is a congenital midline defect of the ventral abdominal wall with herniation of abdominal contents into the base of umbilical cord. The prenatal diagnosis of omphalocele by real-time sonography is important for intrauterine and neonatal management and prognosis. The prognosis and mortality rate is determined rather by the presence of serious associated anomalies, such as cardiovascular and chromosomal defects, than by the omphalocele itself. MRI should be used to screen for other associated anomalies. In this report we describe four cases of fetal omphalocele diagnosed by sonography. In one case an MR examination was performed for suspected associated nervous anomalies. Prenatal literatures further reviewed to assess the clinical significance of this finding

Fistule vesico-uterine apres cesarienne

We report a vesico- uterine fistula occurring seven days after a cesarean section and closing after aspirated bladder drainage. It is a rare obstetrical complication that has two main clinics symptoms: urinary leakage and menouria. The diagnosis is confirmed by cystography and hysterography. The treatment is surgical, delayed if the fistula is occurring after cesarean section. In this case, the bladder drainage may result in the closure of fistula