[Breech presentation: Does the decision of vaginal delivery depend on parity?]

Background: The breech presentation delivery mode is still controversial. The cesarean section is becoming the current trend especially in case of primiparous

Aim: To compare the maternal and fetal prognosis of the breech presentation delivery according to the parity

Methods: We conducted a retrospective comparative study covering a two years period. Our data was collected from all patients accepted for vaginal delivery of breech presentation into the entree of the labor room. We compared the primiparous group [G1, n=45] to a second group with parity ? 2 [G2, n=56] in terms of maternal and fetal prognosis

Results:The two groups were comparable in term of epidemiological profile and labor evolution. The average age was of 28,2 years in the group G1 vs 30,9 years in the group G2. The average term was 37,4 weeks of amenorrhea, comparable between both groups. We did not note statistically significant difference between both groups regarding duration of work shifts. Indeed, the phase of latency had lasted 4,2 hours in the group G1 vs 3,8 hours in the group G2. The active phase had lasted 3,4 hours in the group G1 vs 2,3 hours in the group G2. 71% of the deliveries of the group primipare and 78% of multipare had taken place in Vermelin. The appeal to a caesarian during the work was necessary to 5 [11,1%] primipares against 3 [5,3%] in the group G2. This difference was not significant [p=0,5]. We objectified no statistically significant difference in term of foetal prognosis [Apgar 7 in 1 minute: G1 [n=2] vs G2 [n=2] with p=0.82 or of transfer in neonatal resuscitation: G1 [n=5] vs G2 [n 3] with p= 0.28 between both groups

Conclusion: We can conclude that the parity is not a significant variable in the vaginal delivery of the breech presentation

[Audit of sterilization practices in two Tunisian hospitals: current situation and perspectives]

In most Tunisian hospitals, medical devices [MD] are sterilized at surgical or medicine departments. To overview during one month the practice of sterilization. aterial Methods: An audit of practices through direct observation was carried out at the neonatology and gynaecology departments at the Maternity and Neonatology Center of Tunis and the surgical department at the Salah Azaïz Institute. An assessment grid has been defined and the non-compliance rates have been calculated. A score has been drawn for four evaluation categories of MD treatment. 123 criteria were assessed. The level of non-compliance ranges from 53% to 62% depending on the department. Scores interpretation underlines that the present situation is behind the required level of safety. Traceability stands at the most critical position. Staff and environment safety present scores of 26/54 and 28/62 respectively for the Maternity and Neonatology Center of Tunis and the Salah Azaïz Institute. The less critical situation is that of patient safety, even if it is far below the expected level. This audit has highlighted major malfunctions in the sterilization process. This is related to the absence of a strict regulation. A corrective action plan has been implemented for the short, medium and long terms

[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

Extralobar pulmonary sequestration revealed by prenatal hydrothorax

Pulmonary sequestration is a rare congenital pulmonary anomaly that can be diagnosed in utero. Report a New case: ln this case report of extralobar pulmonary sequestration, the authors report a case revealed by hydrothorax and describe this disease appearance in different imaging technique [Doppler ultrasonography, magnetic resonance imaging and postnatal multislice CT angiography]

[Early diagnosis and management of cervical ectopic pregnancy]

Cervical pregnancy is the rarest of ectopic pregnancy. The classical treatment remains hysterectomy, in particular when diagnosis is made late. The possibilities of more and more premature diagnoses, sometimes before any clinical expression, let suspect the possibility of conservative treatments. We report two cases of medical treatment for early diagnosed cervical pregnancies. Through a review of the literature, we resume diagnostic criteria and various therapeutic possibilities. The two cases were diagnosed in the first trimester. The treatment consisted in intramuscular administration of methotrexate. The first patient had ultrasound-Guided feticide before the administration of methotrexate. Actually, vaginal ultrasound allows early diagnosis of cervical pregnancies, even before the beginning of vaginal bleeding. This advancement allowed conservative treatment. In this situation, current reference is the methotrexate to which can be associated an intracardiac potassium chloride injection in case of embryo positive heart activity

[Ovarian pregnancy. about three cases]

Ovarian pregnancy is a rare type of ectopic pregnancy. Its diagnosis and management are often difficult. To highlight specific diagnostic and therapeutic properties of ovarian pregnancy. Retrospective Study over a period of 4 years. We observed the patients presenting ovarian pregnancies. Diagnosis was evocated in time of surgery and confirmed by histological data. We observed three patients presenting ovarian pregnancies. All our patients had an abdominal ache. Diagnosis was made by ultrasound scan examination in one case. One patient had a laparotomy as a matter of urgency; the two others had a laparoscopy. All the patients were managed conservatively. The diagnosis of ovarian pregnancies was evocated in time of surgery and confirmed by the histological data. The ovary is a rare location for extra-uterine pregnancy. This type of ectopic pregnancy has some clinical properties. The diagnosis is intricate and based on per operatory observations. The management is in spite of medicines improvement, based on surgery

[First trimester ultrasound: an early screening tool for fetal structural and chromosomic abnormalities]

Prenatal diagnosis has been greatly expanded in recent years. Many biological and sonographic criteria participated in the development of fetal medicine. Analyze the contribution of first trimester ultrasound in prenatal diagnosis of aneuploidy and early fetal malformations, and its impact on the strategy of prevention of disability. A prospective longitudinal descriptive study including all women who did a first trimester ultrasound during their pregnancy. We evaluated the detection rate of malformations and chromosomal abnormalities of the morphological embryonary study and nuchal translucency. These tests were then confronted with the results of fetal samples and the outcome of pregnancy. 593 ultrasound examinations were performed. The average age of pregnant women was 32.7 years. The mini-morphological ultrasound study revealed 26 abnormalities [3 major lethal malformations, 5 cystic hygroma and 18 increased nuchal translucency]. Chromosomal abnormalities were found in six cases. The first trimester ultrasound has ensured the detection of 2/3 of total aneuploidies of the study. The first trimester ultrasound allows early detection of a large number of aneuploidies and fetal malformations

[Prenatal ultrasound aspects of arthrogryposis multiplex congenita]

To analyze the contribution of prenatal ultrasound in the diagnosis of arthrogryposis multiplex congenital according to its type and antenatal expression. Retrospective study led between January 1993 and November 2007. We studied the cases of arthrogryposis suspected or diagnosed by antenatal ultrasound while analyzing the circumstances of discovery, the profile of the pregnant women and the abnormal scan findings. 16 Observations have been collected. We recovered one multiple pterigium syndrome and five observations of severe fetal akinesia sequences diagnosed in the second trimester. The arthrogryposis was part of different syndromes in other cases. Four distal arthrogryposis had been diagnosed in the second trimester. All cases suspected during the third trimester were associated to an anomaly of the amniotic fluid, mainly to a polyhydramnios. The abnormal scan findings were less specific to this term. Arthrogryposis multiplex congenital is rare. It has several morphological aspects. Some ultrasound aspects are specific in the first and second trimesters. The diagnosis is more difficult at the third trimester