[Indicators for successful vaginal delivery after cesarean section: a proposal of a predictive score]

The purpose of this study is to determine predictive factors of successful vaginal delivery after cesarean section, and to estimate the risks of this trial of labor [TOL]. A retrospective study about 352 women undergoing a TOL after cesarean section was carried out. Different variables stratified by the termination of the TOL were analysed with statistic tests. TOL success rate was 76.1%. Parity >/= 3, prior vaginal delivery following cesarean section, body mass index < 30, fundal height < 34 cm, and low fetal head level at the beginning of labor increased significantly the probability of success. Uterine rupture rate is 1.1%. Failure of TOL was associated with a higher risk of uterine scar dehiscence and rupture, and higher fetal morbidity. A predictive score of successful vaginal delivery after cesarean section is proposed

[Placenta praevia percreta with bladder invasion a life-threatening complication of pregnancy]

Placenta percreta is characterized by the penetration of tro-phoblast through the myometrium and peritoneum. This inva-sion may also involve adjacent structures. This condition is the most serious of placental implantation anomalies. It is a rare but life-threatening complication of pregnancy. We present a case of placenta praevia percreta with involvement of the bladder, discuss the particularities of the diagnosis and management, and review the literature

[Prune belly syndrome: Early prenatal diagnosis and management]

Prune Belly syndrome in characterized by a combination of megacystis, anterior abdominal wall distension with deficiency of the abdominal wall musculature, and bilateral cryptorchidism. Diagnosis is easy after 15 weeks of gestation, but may be difficult at the end of the first term. Authors report 2 cases of Prune Belly syndrome diagnosis at 11 and 14 weeks of gestation respectively. Afterliterature review, diagnosis and prognosos particularities of this syndrome are discussed

[Tubo-ovarian actinomycosis. A report of two cases and literature review]

Actinomycosis is an infection due to an anaerobic Gram-positive bacillus bacteria: Actinomyces. Tubo-ovarian locallisation is rare. It more often appears clinically as a pseudo-tumoral and feverish syndrome, evoking wrongly a malignant tumoral pathology, and often leads to a mutilating surgical treatment. Intra-uterine device appears as the principal favorable factor of this pathology. Basing on two cases reported by the authors, and after literature review, physiopathology, clinical and paraclinical expression, and treatment of this affection are discussed. A set up is made

hemivagin borgne: Methode diagnostique et problemes therapeutiques

Blind hemivagina with duplex uterus and agenesis of the homolateral urinary tract is a rare malformation. For this reason, diagnosis may be not found. We report one case of duplex uterus with blind hemivagina in a fourteen-year-old adolescent girl. From this case, clinical signs, principal diagnosis criteria, complications and treatment are discussed, transvaginal resection of the hemivaginal septus is the best method of treatment but resulting hymeneal rupture may constitute a real problem of treatment in some social environments. So we propose to evaluate endoscopic septotomy

[Pemphigoid gestationis: a pregnancy- related pathology underestimated by obstetricians]

Pemphigoid gestations [herpes gestationis] is an autoimmune bullous dermotosis occurring during pregnancy or in the post-partum period. The interaction of this rare pathology with pregnancy is underestimated by obstetricians. Authors report one case of pemphigoid gestations diagnosed in a pregnant woman at term. After a literature review clinical aspects of this dermatosis and especially its interactions, with pregnancy are assessed

disjonction symphysaire du peripartum. A propos de trois cas et revue de la litterature

Peripartum pubic symphysis separation is a rare complication of delivery, but the incidence seems to be under-estimated. We report three cases of pubic syphysis separation identified in a two-year period. All case occurred following spontaneous non operative vaginal deliveries. The underlying etiology and pathophysiology has not been fully elucidated. Thus, prevention is difficult. Conservative therapy usually result in a complete recovery within many weeks

estimation echographique du poids foetal a terme: Proposition d'un score predictif d'un poids superieur a 4500 g.

Estimation of fetal weight at term is essential because of risks of macrosomic infant delivery. The purpose of this study is to assess sonographic prediction of macrosomia and especially in fetal weight °> 4500 g Material and method: in a retrospective study on one year period, we analyzed sonography of 214 pregnant women at term having delivered macrosomic infants. From sensitivity, specificity and VPP found for each fetal measurement [abdominal transverse diameter ATD, femur length: FL, and biparietal diameter BPD] we tried to determine the best thresholds values that permit to suspect fetal weight more than4500g. sensitivity of ATD °> 100 mm, FL °> 76mm and BPD°> 94 mm in prediction of macrosomia were: 70,5%, 56% and 58,9% respectively. The most reliable and predictive thresholds for macrosomia more than 4500g were 105 mm, 78mm and 98 mm respectively for ATD, FL and BPD. In an other study, we have Found that fundal height °> 37 cm is also predictive of such a macrosomia. So we have proposed a pre-diclive score of fetal weight more than 4500 g, based on the best thresholds found for fundal height, ATD, FL and BPD

accouchement du macrosome de 4500 g et plus. A propos de 61 cas

The objective of this study is to review the difficulties in prediction of great macrosomia, to assess trial of labor results, and to confirm the increased risk of perinatal complications. Material and method: in this retrospective study we analyzed 61 deliveries of infants with weights > 4500 g in one year period. This group was compared with a group of infants weighing between 4000 and 4500g [339 cases] born during the same period. Elective cesarean delivery was performed for 3 cases of the second group because of overestimation of fetal weight. 38 cases of the first group [62.3%] were delivered vaginally after underestimation of fetal weight. Incidence of shoulder dystocia in vaginal delivery was 13.5% in the first group and 5.32% in the second one, but difference was not statistically significant [p= 0.07]. difference between incidence of hypoglycemia in the first group [18.03%] and in the second one [2.06%] was highly significant [p=0.00006] there is no reliable method for prediction of fetal weight > than 4500 g. with literature review, we confirm the increased risk of shoulder dystocia, birth asphyxia and hypoglycemia for these infants. So we believe that cesarean delivery is justified in all cases of fetal weight estimation > 4500g

grossesse ovarienne: Le point en 2003. A propos de 4 cas et revue de la litterature

Ovarian pregnancy remains a rare form of extraciterine pregnancy. It's incidence is estimated all to 6% of ectopic pregnancies. We report 4 cases of ovarian pregnancies. diagnosed at the obstetric and gynecology department or NabeuI Hospital [Tunisia] during a 4 year period. An update on ovarian pregnancy based on these 4 cases and a literature review is provided. In contrast to tubal pregnancy, ovarian pregnancy occurs as a single event in an otherwise healthy woman. There is no specific clinical, laboratory test or ultra sonographic signs for differentiating ovarian from tubal pregnancy. At laparoscopy, it frequently suggest haemorrhage from the corpus luteum or a rupture of ovarian cyst. Histology is the only means of establishing the diagnoses. Ovarian pregnancy rupture is often.more dangerous than tubal pregnancy, but conservative treatment is often possible. Recurrency is exceptional and future fertility usually is unmodified

Kyste de l'ovaire ge'ant: Apropos de deux observations

Giant ovarian cyst is rare. During the last 25 years, 14 cases only are reported in the anglo-saxon literature. We present two new cases of giant benign ovarian Cyst. Diagnosis, methods and difficulties of exploration for positive and differential diagnosis were discussed. Treatment is based on the removal of the Cyst through a large midline laparotomy, possibly after a drainage of its contents. We report our experience concerning the laparoscopic treatment of this Cyst