[Laparoscopic double sacrocolpopexy: a failure for the posterior compartment?]

Aim: To evaluate the anatomical and functional outcomes of laparoscopic sacrocolpopexy using an anterior and a posterior prolen mesh, for the cure of genital prolapse. STUDY Methods: This is a consecutive five year prospective observational study in which 80 patients presented with at least a Stage 2 apical prolapsed [Baden and Walker], with an anterior or a posterior vaginal wall prolapse, who underwent a double sacrocolpopexy. Two prolen prosthesis [Pro-swing[registered sign] - Textile Hi-Tec[Trade Mark Sign], Fr] were used for this technique. Pre- and post-operative data referring to prolapse quantitation [Baden and Walker classification], scores of quality of life and sexuality [French equivalent of the Pelvic Floor Distress Inventory [PFDI], Pelvic Floor Impact Questionnaire [PFIQ] and Pelvic organ prolapse-urinary Incontinence-Sexual Questionnaire [PISQ-12] were compared. Peri and postoperative complications constituted the secondary outcome measures

Results: At 2 years after surgery, all patients were accessible for evaluation. For these patients, the anatomical success rates [Stage 0 or 1] on the apical, anterior or posterior compartments were respectively 100%, 97.5% and 89.3%. On the functional level, all the scores of quality of life and sexuality were significantly improved except anorectal scores CRADI and CRAIQ

Conclusions: This study confirms that PFC is an effective technique for the treatment of the urogenital prolapsed. On the anatomical levelresults are less good for the posterior compartment. On the functional level, our results do not plead in favour of an improvement of anorectal disorders

laparoscopic vecchietti technique for vaginal agenesis

To evaluate feasibility and surgical long term, anatomic and functional results of the laparoscopic Vecchietti procedure to treat women with vaginal agenesis. We reported six cases of patients with a Mayer-Rokitansky-Kster-Hauser syndrome. The surgical procedure was the same for all patients. The results have been evaluated on the operative time, the intra and postoperative complications, the antalgic drugs consumption, the transit recovery, the hospital stay, the neovagina length, and the post operative sexual satisfaction. The mean operative time was 77.5 minutes. The mean paracetamol consumption was: 9.8 g. The mean transit recovery, and hospital stay were: 2 days, 9.8 days, respectively. No intra or postoperative complication occurred. The mean neovagina length evaluated at one year follow-up visit was 7.5 cm. Five patients have regular sexual activity. Three of them reported sexual satisfaction and showed having orgasm [clitoral: 3 cases, clitoral and vaginal: 2 cases]. The 2 remaining patients reported dyspareunia. The global satisfaction index was of 71.6%. This surgical technique appeared to be safe, effective and reproducible. It allowed to obtain a neovagina with enough length and have encouraging results on sexual functioning Laparoscopy reduces the psychological and aesthetic consequences of surgery, especially for these young patients already distressed by their malformation

[Delivery in twin pregnancies. The experience of the obstetrics department of Aziza Othmana's hospital, about 117 cases]

The conduct and delivery of twin pregnancies are interspersed with as well as maternal fetal and neonatal complications. The obstetrician is faced with the birth of 2 children often fragile and a uterus often exposed to dynamic dystocia. To study the maternal and newborn morbidity and mortality in twins, in order to clear the optimal route of delivery in such circumstances. A retrospective study over a period of 3 years [1 January 2005 to December 31, 2007], about 117 twin pregnancies. Inclusion criteria were a term exceeding 28 weeks and fetuses alive. We analyzed maternal complications during and after delivery and neonatal complications. Maternal complications were significantly more frequent in case of caesarean section. The frequency of perinatal complications [Apgar score, respiratory distress, immediate neonatal resuscitation and neonatal intensive care unit transfer] in the first twin was not influenced by the route of delivery as opposed to the second twin which Apgar score's alters when vaginally. The newborns of low birth weight [<1,500 Kg] and those whose term was less than 32 weeks were more at risk of an Apgar score <7 [at 1 and 5 minutes], respiratory complications, need for immediate resuscitation and transfer to intensive care and that statistically significant both for the 1st and the 2nd twins. The twins pregnancies' morbidity appears to be more related to prematurity and intra uterine growth retardation] more than to the mode of delivery and hence the interest to detect and prevent its anomalies. It seems that vaginal delivery has a deleterious effect at least for the second twin but cesarean section doesn't seem to be the solution. Better learning techniques and obstetric maneuvers would reduce morbidity

[ retrospective study of 339 ICSI cycles: assessment of the two first years of activity of the assisted reproductive technology's center of Aziza Othmana's hospital]

Intracytoplasmic sperm injection [ICSI] is a micro-manipulation-assisted fertilization, whereby one spermatozoon is injected into the oocyte cytoplasm. Initially, ICSI was the treatment of choice for male factor infertility. However, because of the high fertilization and pregnancy rates achieved with this technique, the scope of the procedure has been widened to include couples with other causes of infertility. The aim of this study was to study the progression of the activity of the assisted reproductive technology's center of Aziza Othmana's Hospital and the ICSI results during the first two years. Our study included 269 infertile couples who underwent 339 ICSI cycles between 1st May 2001 and 30 April 2003. Cycles with no oocytes obtained at the follicular aspiration and women aged over 40 years were excluded from this study. The number of ICSI cycles progressed in our center: 150 ICSI cycles in the 1st year, 189 ICSI cycles in the 2nd year. The mean number of picked-up oocytes was 8,8 +/- 5,6. The fertilization rate was 62. The mean number of transferred embryos was 3,1 +/- 1,5. The pregnancy rate per transfer was 32,4%. The miscarriage rate was 28,4%. The take home baby rate was 67,9%. The number of couples undergoing ICSI cycles in our center is increasing. The fertilization rates and pregnancy rates in our center are similar to those published in the literature

[Are there any predictive factors for successful intracytoplasmic sperm injection. Statical analysis of 339 cycles]

Intracytoplasmic sperm injection [ICSI] outcome is tightly depinding of male and female factors. The assessment of several clinical and laboratory parameters may predict results of ICSI. This study aimed at investigation which parameter[s] may predict successful intracytoplamic sperm injection for infertility. We restrospectively analysed patients who had intracytoplasmic sperm injection for male or female factor infertility. The clinical and laboratory factors that influenced the fertilization, pregnancy and implantation rates were also analysed. Three hundred and thirty nine cycles in 269 couples were analysed. Women's age, etiology of infertility, duration of infertility, number of retrived oocyts, sperm parametres and number of transferred embryos were evaluated. Optimal pregnancy rates were observed in women aged 25-35 years, with gradual decline with advanced age [p=0.049]. The pregnancy/transfert rate was statistically depending of, the number of retrieved oocytes [p<0.001] and the number of transferred embryos [p<0.001]. However, transferring more than three embryos was no significatively superior to two or three. Etiology of infertility had no influence in fertilization and pregnancy, but may predict the implantation rate [p=0.042]. The duration of infertility was of no value in predicting the fertilization, implantation or pregnancy rates, and neither seems to be the sperm parameters. The only statitically significant variables of ICSI outcome were women partner's age, number of retrived oocytes and number of transferred embryos

[Intrauterine insemination with conjoint semen. How to increase the success rate?]

Intrauterine insemination is usually proposed as the first line therapy for infertility related to cervical hostility, male factor, unexplained infertility or mild endometriosis. The overall success rate of IUI is about 10-20%clinial pregnncy per cycle. The Aim of this study is to evaluate factors that increase the succes rate of IUl. We restrospectively analysed 206 cycles of JUl with partner's semen in 138 infertile couples. The clinical and laboratory factors that may influence the pregnancy rates were analysed women's age, etiology of infertility, duration of infertility, ovarian stimulation, day of hGC and sperm parametres. The per-cycle clinical pregnancy rate was of 14.56%. Optimal pregnancy rates were observed in less than 38 years old women [18.29%vs 9.52%. p<0.05]. The succes rate was statistically depending of the number of IUI cycles until three [p<0.05], the day of hGC [p<0.05] and the sperm count after conventionally prepared semen [p<0.05]. Sperm parameters was of no value in predecting the pregnancy rates, and neither seam's to be the total dose of administrated Gonadotrophin or the etiology of infertility, but it seams that, when a cervical factor or PCO were involved, the succes rate is higher. Besides, getting three or more than three follicles may increase the succes rate but expose to a warrying risk of multiple pregnancy. According to this study, the only statitically significant factors that are associated with successful IUI were, women partner's age [<38 ans], number of IUl cycles [during the first three JUl cycles], day of hGC [>J13] and sperm count after conventional semen preparation [>1.10[6]/mL]

prise en charge des thrombopenies severes au cours de la grossesse et de l'accouchement. A propos de 14 cas et une revue de la litterature

Thrombocytopenia occured in 14 of 5557 pregnant women [0,25%] in our hospital over 4-year interval. The patients with thrombocytopenia could be devided into two groups' healthy women 2 patients [14,28%] hypertensive patients and patients with immune thrombocytopenia 12 patients [85.72%]. Cesarian section rate for delivery was 35,7%. Six foetal loss were observed. Foetal morbidity is represented by prematurity and low weigh at delivery [3 cases] and in one case cerebral bleeding was observed.

Fibromes uterins: fertilite apres myomectomie. A propos de 41 cas

Fibromyomas are among the most frequent pathologies of women in their reqroductive years; that's why clinicians studied their impact on fertility especially when no other cause is found. In this retrospective study of 41 infertile patints between January 1996 and December 1999, the authors tried to define the asses of myomectomy in these cases and the relevant factors that influence the post-operative results in terms of fertility. 24 patients were operated by laparotomy, 7 by laparoscopy and 10 by hysteroscopy. Once surgery was performed, 19 women conceived [46,34%] with delays ranging between 3 and 36 months [mean delay: 15.5 months]. An age of less than 40, a sterility of less than 5 years duration and the absence of associated factors seems to enhance the chances of these patients to conceive after mytomectomy. No significant difference was noted in terms of subsequent fertility between the group of primary infertility and that of secondary sterility; neither concerning the myomas' number, size or place. Pregnancy rates after sugery were equivalent wether the myomectomy was performed by laparotomy or laparoscopy. It is, then, reasonable to propose to infertile patients with uterine myomas, a conservative surgery especially if they are young and if their sterility is unexplained for less than five years

Epilepsie et grossesse: Necessite d'une prise en charge combinee.

Pregnant women with epilepsy are at risk for a variety of complications, that require an interdisciplinary cooperation between neurologists, pediatricians and obstericians. We report a retrospective study of 50 pregnant women with epilepsy over a 5 year period. Phenobarbital is largely the most used [74%]. During pregnancy, an increase in seizure frequency was noticed in 27 cases [54%]. Baribituric were essentially maintained in 74% of cases. We have reported a relatively high intervention rate during the delivery. Forty eight babies [96%] were born at term. There were no cases of neonatal haemorrhage or perinatal death. Symptoms of drug impregnation were found in 7 cases [14%]. Four children born to epileptic mothers treated during pregnancy had congenital malformations. Pregnancy doesn't have a catastrophic effect on the course of epilepsiy apart from the risk of an increase in the frequency of the fits. This risk must be reduced thanks to an optimal use of an anti-convulsive therapy before and during pregnancy. The major risk being foetal, mainly foetal malformations and hemorrhages