[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

[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