RESUMEN
Assessment of early pregnancy is indicated in women with suspected abnormalities. It is based on biochemical assessment and on trans vaginal sonography. To identify clinical, biological and ultrasonographic parameters that are predictive of spontaneous pregnancy resolution. A prospective observational study was performed interesting women with a positive pregnancy test without visualization of the pregnancy on the initial scan. All parameters measured during the initial visit were tested by univariate and multivariate analysis to identify parameters predicting spontaneous resolution of pregnancy. A total of 2675 women were included in the study. In 94 cases [4%] the location of pregnancy was unknown. Univariate and multivariate analysis showed that four parameters contributed significantly to the predictive power of the logistic model: Absence of pain [p =0,036], endometrial thickness < 12 mm [p =0,021], initial serum beta hCG level < 1000 UI/l [p =0,015] and progesterone level < 29 nmol/l [p <0,001]. Women with a high probability of spontaneous resolution of their pregnancies can benefit from a spaced monitoring until the rate of beta -hCG will be negative
RESUMEN
Recent developments in ultrasound have led to a new exploration technique: hydrosonography. To evaluate diagnostic performance of hysterosonography in the assessment of the uterine cavity, by comparing it with standard transvaginal ultrasound and particularly with diagnostic hysteroscopy. This is a prospective study over a period of nine months from 1st January to 30 September 2009. Transvaginal ultrasound was performed for all patients followed by hydrosonography then by diagnostic hysteroscopy. Sixty-two patients underwent three examinations. The mean age of our patients was 42.2 years. Bleeding disorders of the menstrual cycle were the most common reasons for seeking. Referring to the pathological examination, hysteroscopy is the most accurate technique in the diagnosis of endometrial hyperplasia and intracavitary masses, followed by hydrosonography then by transvaginal ultrasound. The concordance between hydrosonography and hysteroscopy in the diagnosis of submucosal fibroids and hyperplasia of the endometrium is very good [K> 0.8]. The hysterosonography seems a relevant exam, allowing a complete assessment of the uterine cavity
RESUMEN
Hysteroscopic resection of submucous myomas is a safe alternative to conventional surgery. To evaluate the anatomical and functional results of endoscopic resection of submucous myomas and to present the principle complications of this technique. This is a retrospective study performed in the department "B" of gynecology and obstetrics in maternity center of Tunis "La Rabta". It analyzes a series of 105 hysteroscopic resections of intracavitary fibroids during a period of 8 years from January 2003 to December 2010. The mean age of our patients was 41 years and 5 months. The most frequently reason for consultation was the disorder of the menstrual cycle type of menometrorrhagia [47.6%], menorrhagia [22.8%] and postmenopausal bleeding [11.4%]. Preoperative assessment of the fibroid was based on transvaginal ultrasound in all cases associated with diagnostic hysteroscopy in 51.4% of cases and with hydrosonography in 28.6% cases. The mean size of the fibroid was 3.08 cm. Type 0 myomas represented 42.8% of cases. The most frequent emplacement of the myoma was the anterior surface of the uterus [44.7%]. After surgery, the resection was considered as complete in 88 patients [83.8%], partial in 17 patients [16.2%] requiring a second operation. The functional result was good with disappearance of bleeding symptoms in 90% of cases after a mean follow up of 17 months. Hysteroscopic resection of sub mucosal fibroids is a technique that respects the uterine cavity with satisfactory functional results and low morbidity