[Prospective study of the relationship between heart rate fetal anomalies, pH umbilical cord at birth and Apgar]

The search for an acute fetal distress during labor remains one of the objectives of obstetrical surveillance. To find a relationship between different aspects of fetal heart rate [FHR] occurring during labor, Apgar score at first minute and the pH blood at birth. A prospective study which involved 170 single-fetal pregnancies to term. In our population, by comparing the APGAR score in the first minute and umbilical pH, it was found that only 25.7% of newborns with Apgar at 1st minute less than 7 had an umbilical arterial pH <7.15. Thus in our study, the Apgar score did not predict umbilical acidosis and the difference was significant [p = 0.02]. In the same population, by comparing the analysis of FCR and umbilical PH, we found that fetal bradycardia was associated with pH umbilical lowest with an average of 7008 and the difference was significant [p = 0.008]. Other types of ERCF were also significantly associated with neonatal acidosis. Recording fetal heart rate is a limited review to assess the exact condition of the fetus. It has a good negative predictive value but there is little specific consideration. Combination with other techniques to better assess the fetal state

[Metformin effects on clomifene-induced ovulation in the polycystic ovary syndrome]

Polycystic ovary syndrome [PCOS] is a common, complex endocrine disorder for women on reproductive age. A high incidence of ovulation failure is observed in PCO women and perhaps linked to insulin resistance related to metabolic features In the last few years some studies assessed hyperinsulinimea and insulin resistance attenuation effects, by insulin sensitizing agents such as metformin, in PCOS women suggesting potential scope for these drugs in CC ovulation induction quality improvement. Aim: Our prospective study aim is to compare the effectiveness of clomifene citrate plus metformin and clomifene citrate plus placebo in women with newly diagnosed polycystic ovary syndrome. From February 24 to September 29 [2007], PCOS was explored on women attending the Department of Obstetrics and Gynaecology sterility consultation unit [CHU Hedi Chaker-Sfax] according to the Rotterdam 2003 diagnostic criteria. PCOS patients were randomized to receive, in addition to clomifene citrate treatment, placebo or metformin 850 mg two times a day all ovulatory cycle for three trials maximum. Ovulation detection was done by the E2 serum measurements and ovarian transvaginal ultrasonography' evolution controlling on 7th, 11th and 13th day of the cycle. Within 7 months, 32 PCOS women were recruited in the study and equally allocated to the two groups. Baseline characteristics were similar in metformin group and placebo one. Ovulation was characterized by the presence of at least one mature follicle [> 16mm], a circulating estradiol concentration in the edge of 150-250pg and accessory an endometrial depth > 8mm. The ovulation rate in the metformin group was 62.5% compared with 37.5% in the placebo group, a non-statistically significant [small study population] but important difference [1.66 times]. Analyses show a higher mature follicle number and estradiol concentration in metformin group than in the placebo one. Metformin effect was, in our study, his only insulinosensitizer property consequence far away a 'making thinner' or Hyperandrogenism reducing ones. The ovulatory response to clomifene can be increased in polycystic ovary syndrome women by decreasing insulin secretion with metformin

Sirenomelia: report of two cases

Sirenomelia is a serious congenital deformity in which the legs are fused together, giving the appearance of a mermaid [of the Greek Mythology], Its prevalence has been estimated at about 1, 5 to 2 in 100 000 births. We report two cases of foetuses with Sirenomelia. The first case is that of a premature baby weighing 1050g. The second case is a premature baby resulting from a triple pregnancy and weighing 1450g. They presented a fused lower limb and absent kidneys, anus and external genitalia. They died rapidly. These two cases will allow us to debate the clinical signs, the aetiology and the prognosis of such congenital malformation as well as the difficulties of prenatal diagnosis

[Ovarian stimulation and granulosa cells tumors, about 5 cases]

Ovarian stimulation for the treatment of the infertility expose the patient and its ovaries to above physiological high concentrations of gonadotrophin. The major complications of the use of these therapeutic are the ovarian hyperstimulation and the multiple pregnancies. We describe 3 cases of granulosa cells tumors of the ovary after stimulation with the clomifene and / or gonadotrophin. A review of the literature does not allow to make the link between these therapeutic and tumoral pathology, however animal experimentation showed a relation between the exposition with gonadotrophin and the granulosa cells tumors. The most confirmed hypothesis being able to explain this association in human race is the increase of intra follicular gonadostimulins which is oncogen for the granulosa cells

[Transvaginal ultrasound of the cervix in the estimation of severity of premature labour]

Premature labour is a frequent situation it complicates about 6% of births, with increasing perinatal morbidity and mortality. The purpose of this study is to analyze the place of the ultrasound of the cervix in the coverage of a premature labour and the evaluation of the severity of the premature labour, being able to have therapeutic implications. It is about a prospective study on 48 patients presenting a premature labour between 28 and 35 weeks realized in the service of maternity in Hddi Chaker hospital of Sfax for a period of 7 months going from January till July, 2005. In our study 23 patients presented an ultrasonographic cervical length