[Epidemiological profile, etiological diagnosis and prognosis of uterine synechias: Report of 86 cases]

Uterine synechias may pose real problems for fertility prognosis. It depends mainly on its etiology. To study the epidemiological profile of patients, describe the circumstances of discovery of uterine synechias, specify the diagnostic procedures for pelvic ultrasound, hysterography and hysteroscopy and estimate the benefits on fertility. A retrospective study over a period of 10 years from 1 January 2000 to December 31, 2009 in the department of obstetrics gynecology B Charles Nicolle's Hospital in Tunis. We collected 86 patients. The age average was 35.42 years, gestit average of 1.36 with 37.2% of nulligeste and an average parity of 0.67. The uterine revision was the main etiology [55.8%]. The main circumstance of discovery was the exploration of infertility [60%]. Hysterosalpingography showed a luminal filling defect in 79% of patients mostly fundic location [37.3%]. Faced with data from the hysteroscopy sensitivity of HSG was 78% and positive predictive value was 100%. For the seat of the synechia its sensitivity is only 40%. The surgical procedure took place in one time in 74 cases. Our complication rate is 8.14%: 2 uterine perforations, 2 falseroads and 3 cases of hemorrhage stopping surgery. The main etiology is a history of uterus revision. The main circumstance of discovery is the exploration of infertility. Anatomic results were generally good as testified hysteroscopy control

[Pallister-Killian syndrome with additional manifestations of cleft palate and sacral appendage]

Report of a rare congenital abnormalities. We report a rare case of Pallister-Killian syndrome in a 33 weeks gestation infant. In addition to the characteristic phenotype, this patient had a cleft palate, diaphragmatic hernia and sacral appendage. These additional manifestations are not among the Pallister-Killian syndrome's features. The diagnosis was made in antenatal period by cytogenetic studies and showed mosaic 47, XY +I [12p]. Presence of diaphragmatic hernia makes this syndrome, prenatally letal, similar to the Fryns syndrome and then requires skin biopsy and fiboblast chromosome examination for cytogenetic diagnosis

[Neonatal respiratory morbidity after elective caesarean section at term]

Incidence of elective caesareans at term is increasing these last decades with an associated increase of neonatal respiratory morbidity. To analyse the influence of elective Caesarean delivery at term on the incidence of neonatal respiratory distress in order to propose an effective strategy of prevention. It is an analytical study compiling all births resulting from elective Caesarean at term [gestationnel age ranging between 37 and 41+6 GA], reported over two years period at the Charles Nicolle hospital [Tunis-Tunisia]. We compared 250 live births, without maternel risk factors, delivered by elective Caesarean to 250 births delivered by vaginal way. Frequency of the elective Caesarean at term was of 3.6% live births; it was mainly indicated in the presence of a cicatricial uterus. The incidence of respiratory morbidity was 6% [15/250] in the group exposed to the elective caesarean versus 1.6% [4/250cas] in the reference group, OR = 3.9; 95%CI: [1, 28-11, 99] p<0.01. Before the term of 39 GA, OR = 5.22; 95%CI: [1.14-23.87] p=0.01. After 39 GA, the risk of respiratory distress decreased: OR = 1.86 95%CI: [0.30, 11.35] NS. The principal etiology of respiratory distress in the exposed group was the transitory tachypnea of the newborn. Incidence of respiratory distress was higher at newborn babies born from elective Caesarean with a significant reduction in this incidence after the term of 39 GA

[Neonatal screening of congenital toxoplasmosis. Prospective study]

While toxoplasmosis infection in women is often benign, transmission of maternal infection to the fetus can lead to severe sequelae. Because the majority of patients with acute toxoplasmosis are asymptomayic, a systematic serologic screening program will needed with monthly serologic screening of all seronegative pregnant women until delivery. The aim of this study was to identify cases of congenital toxoplasmosis among all live births of women found to be seronegative in pregnancy once at least. During a prospective study period of 16 months [from 07/02/2003 to 30/06/2004] we conduct a neonatal screening of all live births of women found to be seronegative in pregnancy once at least. Peripheral samples were obtained from every couple mother/ infant. Serological methods performed for diagnosis of toxoplasma specific IgM and IgG antibodies were Hemaglutination and Enzyme-linked immunosorbent assay [ELISA]. Four cases of congenital toxoplasmosis were diagnosed after birth. All cases were asymptomatic and a specific treatment was started soon after diagnosis. The clinical and serologic evolution was normal in three cases. A serologic rebound at two years was reported in one case with a chorioretinitis in the examination of the ocular fundus. Neonatal as well maternal screening during pregnancy and at birth should be systematic to prevent, diagnose and treat early the affected neonates usually asymptomatic

[Neonatal prognosis of second twin]

Twin pregnancy is associated to high neonatal morbidity particularly for the second twin. To assess twin delivery practice in our department and prognosis of second twin. retrospective study of medical files of parturition women with twin pregnancy between January 2003 and December 2006. Were excluded women delivered before 28 weeks gestation, twin pregnancies with death or malformation of one of twins. Descriptive and comparative analyses were realised. one hundred forty six twin pregnancies were counted. Vaginal delivery was attempted with 90 parturition women with 85,5% of success. Caesarean section delivery rate was 47,2%. Overall there's no difference between twins considering neonatal complication. In case of vaginal delivery, the second twin's 5 minutes Apgar score was statistically under the one of the 1st twin if compared to the caesarean section delivery. This difference was no more significant if regarding the Apgar score under 7 at 5 minutes. Apgar score of the second twin was also under the one of the first twin in non cephalic presentation. vaginal delivery of twin pregnancy was not associated to high risk for twins. Obstetrical manoeuvres should be well controlled to reduce obstetrical trauma

[Prospective epidemiologic study of group B streptococcus vaginal colonization in pregnant woman]

Group B streptococcus is known to be the principal medium responsible of maternal and severe neonatal infection. Assessing the prevalence of group B streptococcus [GBS] in our population, emphasize risk factors of GBS vaginal colonization and main characteristics of isolated strains. Prospective study of GBS vaginal colonization at admission for delivery upper to 34 amenorrhea weeks. Two hundred and seven vaginal swabs were carried out. Prevalence of GBS was 13%. Primigravida represents a risk factor of GBS vaginal colonization regarded to multigravida. False negative rate was 1,6%, All isolated strains were susceptible to penicillin C and to ampicilin, 44,4%were resistant to erythromycin. Systematic screening of GBS must be introduced in our population. Per partum antibioprophylaxis must consider susceptibility of isolated strains to antibiotics

[ cord blood bank in Tunisia: usefulness and feasibility]

The cord blood is a souce of hematopoietic stem cells. This have encouraged the creation of many cord blood banks around the world. By this prospective study during 2 years, we tryed to show the advantages of such sources of progenitors, and to evaluate our techniques of collection, freezing, biological and microbiological survey. For this aim, we tested 100 specimens of cord blood before and after defrosting. Our selection criteria were a volume >/= 60 ml, a CD 34+ cells count >/= 2. 10[6], bacteriological and serological negativity. This 100 specimens have an average volume of 95,22 ml, an average nuclear cells count of 10,95.10[6] and an average CD 34+ cells count of 2,96. 10[6]. The average cells viability after defrosting is 96,69%, and the average efficiency rate of 92,11%. The specimens selected according to our selection criterias were of 39%. Our results confirm the feasibility of a cord blood bank in the "Centre National de Transfusion Sanguine" in Tunis

[Early-onset neonatal bacterial infections: a series of 144 cases]

Early-onset neonatal bacterial infections continue to be a major cause of morbidity and mortality in the newborn. The aim of this study was to determine the incidence, the risk factors and bacterial epidemiology of these infections. All cases of early-onset neonatal bacterial infections were identified for the years 2001-2003 using data from obstetric and neonatal reports at the neonatal unit of Charles Nicolle Hospital. 144 cases were identified over 11 201 live births, that is an incidence of 12.85%, of which 22 cases of sepsis infections. 22.9% of all newborns were premature and 18% had a low birth weight. Membrane rupture occurred more than 12 hours before delivery in 63.2% of cases and an intra-partum fever in 57.7% of cases. Half of newborns were symptomatic with a mean age of 7.5 hours at onset of symptomatology. The principal etiologic agents were Group B Streptococcus [GBS] and Escherichia coli [E.coli], responsible respectively of 50% and 29.1% of proved infections. GBS had been recognised as the most prevalent agent in term newborn [58.9%] and the E.coli in premature newborn [38.5%]. The neonatal mortality before discharge was 2.77% of all cases. Neonatal bacterial infections continue to be a major cause of morbidity in the newborn. The most common etiologic agents remain GBS and E.coli

[Diagnostic value of immunohistochemistry in ovarian sex cord-stromal tumors]

The ovarian tumors' diagnosis is bused on biological and radiologic tests but only the histological examination associated to an immunohistochemical study allow best diagnosis. The purposes of this study is to examine inhibin and other markers immunoreactivity to ovarian sex cord-stromal tumors and their histological mimics and to discuss its value in the differential diagnosis. We report a retrospective study of 31 cases of ovarian sex cord-stromal tumors and review the clinical, pathologic and immunohistochimical features of these tumors. The average age of our patients was 51.3 years with an average size of 8,4 cm. Immunostaining for inhibin was positive in 66% of granulosa cell tumor, in 50% of Sertoli-Leydig cell tumor and in 54% of thecoma-fibroma group. Inhibin immunoreactivity was more important than with cytokeratin and epithelial membrane antigen, but less marked than with CD99, vimentin, smooth muscle actin, desmin and 5-100 protein. The results of this study show that although it is not complete specificity, inhibin, contrarily to the other markers, can be used to help in the distinction between ovarian sex cord-stromal neoplasms and the other primary and metastatic tumors

[Conservative management of cervical pregnancy. Case-report]

Cervical pregnancy is one of the rarest ectopic locations. It can be responsible of spontaneous haemorrhage enquiring hysterectomy. Ultrasonography technical improvements allow early diagnosis and conservative treatment. This study aims to report a new case of cervical pregnancy treated conservatively. Patient with cervical pregnancy diagnosed on ultrasonography and treated by one dose systemic methotrexate requiring a second injection because of no decreasing of serum beta human chorionic gonadotrophin level leading to expulsion of the pregnancy one month later. Methotrexate is the standard treatment of early diagnosed cervical pregnancy. When haemorrhage occurs, many therapeutic methods allow conservative treatment in order to preserve fertility

Adenomyosis at hysterectomy

adenomyosis is a frequent gynecologic pathology which affects women particularly in the fifth decade. It is responsible of abnormal uterine bleeding and pelvic pain. The diagnosis can be difficult especially when it's associated to other gynaecologic pathologies. Contribution of transvaginal sonography and magnetic resonance imaging made preoperative diagnosis possible. The aim of this study is to report frequency, epidemiologic profile, clinical signs and diagnostic and therapeutic methods of adenomyosis. This is a retrospective study about 52 cases of adenomyosis diagnosed upon 336 hysterectomies for benign pathologies. Descriptive analysis of epidemiologic, clinical, diagnosis and therapeutic data was performed. prevalence of adenomyosis was 15% and multiparity observed for 90% of women was the main risk factor. women desirous of pregnancy and affected by adenomyosis can benefit from conservative treatment, but hysterectomy remains the reference treatment

[Management of pheochromocytoma during pregnancy: about three cases]

Background: Pheochromocytoma is a rare disease that can be diagnosed for the first time during pregnancy. Diagnosis is difficult because it can mimic common gravid hypertension. Maternal and fetal prognosis depends on early diagnosis and adequate multidisciplinary management

Aim: We report 3 cases of pregnant patients with pheochromocytoma

Cases: For the first patient, diagnosis was made before pregnancy and pheochromocytoma, was treated surgically at 20 weeks of pregnancy with good evolution. The second patient was hospitalized in a severe preeclampsia, acute pulmonary edema and fetal demise with fatal outcome. Pheochromocytoma was diagnosed during autopsy. The third patient had medical abortion of pregnancy because of tumor recurrence after surgical treatment

Rare association to pregnancy and clinical signs of pheochromoytoma as hypertension renders diagnosis difficult. A systematic etiology research to early hypertension during pregnancy can allow better screening of pheochromocytoma and improvement of foeto-maternal prognosis