[Management of ovarian endometriomas: intraperitoneal cystectomy versus fenestration and coagulation]

Ovarian endometriomas is a common condition among women of reproductive age and represents a major cost in terms of public health. Despite these implications for public health, it remains difficult to arrive at a consensus on the optimal surgical treatment. To study the clinical and paraclinical characteristics of this pathology and to compare two major surgical techniques: the intraperitoneal cystectomy and fenestration -coagulation in terms of recurrence and prognosis for future fertility. A retrospective study of 31 patients who underwent surgical treatment for ovarian endometrioma histologically proved. The study period covers 10 years from January 2000 to December 2009. Laparoscopy was performed in 27 patients. The endometrioma was located to the left side in 64% of cases. The main strategy performed is intraperitoneal cystectomy in 18 patients [58.8%]. In second place we find the fenestration-coagulation. The mean duration of postoperative follow-up is 10.3 months. The recurrence of the cyst and the persistence of pain symptoms were significantly less frequent in the group of patients who underwent intraperitoneal cystectomy. The laparoscopic surgery remains the first line approach in terms of ovarian endometrioma.Cystectomy offers performance equal or superior to the fenestration-coagulation technique, and exposes to fewer recurrences. For these reasons, it should be recommended. The fenestration-coagulation is possible in case the cystectomy is difficult or incomplete

[Delivery in breech presentation: what way should we choose?]

The breech delivery is considered dangerous because of the higher rates of perinatal mortality and morbidity which become attached to it, consequences of obstetric traumas bound to the obstetric operations. What way of delivery is it necessary to privilege? What are the arguments which we have to support our choice? To assess the maternal and fetal outcome according to the way of delivery. In this retrospective study, 194 women with a singleton pregnancy in a breech presentation delivered at term in our maternity unit in Ariana's Hospital from January 2007 to December 2009. Breech presentation was noticed in 2, 59%. The main factors favoring this presentation are: the primipara, the uterine deformations, the pathological ponds, the abnormalities of the amniotic liquid, the fetal weight and the fetal deformations. Vaginal delivery was accepted in 57,7% of women and 75% from them delivered in natural way. The rate of caesarians was 56,7 %. Among these patients, 74, 5 % were indications in a cold caesarian [scar womb, pathological pond, RPM > 12 hours, estimated [esteemed] fetal weight > 3800g]. The Apgar's score was superior to seven in 97.6% of cases. There was no significant difference in fetal morbidity, Apgar's score or in the need of transfer in intensive care unit. When the acceptance conditions of the vaginal delivery are combined and when the surveillance of the labour is rigorous, it seems that there is no excess of neonatal risk by the natural ways

[Cervical incompetence: diagnosis ; indications and strapping outcome]

Cervical incompetence, a major cause of late abortions and preterm delivery is a diagnosis increasingly easy to establish.Strapping is deemed effective to prevent recurrence of such accidents midwifery. To evaluate the relevance of the diagnosis of cervical incompetence, check the main indications of banding and study the outcome of rimmed pregnancies. A retrospective study about 103 rimmed pregnancies collected in the service of Motherhood Hospital Mahmoud El Matri Ariana to the period of January 2001 until December 2008. The diagnosis of cervical incompetence is suspected in a body of evidence linking ATCD of late abortions or premature births found in respectively 46.2% and 31.1% of our patients in our series, 16.98% are carriers of known uterine defects. 8.49% are classified as high risk front of 3-ATCD of late abortions or preterm delivery and were circled systematically. 2.83% are rimmed after confirmation the incompetent cervix by calibration of the cervix and 55.99% because of clinically short cervix. The strapping has reduced the rate of late abortion which decreased from 46.6% before strapping to 7.6% after. As for preterm delivery, it is reduced from 31.1% before strapping to 18.5% after. This difference is statistically significant. The average term of confinement in our series is 36SA six days. 68 cases were delivered at term. Among patients in whom we have accepted the vaginal delivery, 74.2% had spontaneous labor. One case of rupture of the anterior lip of the cervix was noted. The indication of a cervical strapping needs a well established diagnosis involving data from history, clinical examination and possibly endo-vaginal ultrasound to confirm the high-risk of cervical incompetence. The strapping participates significantly to prolong the duration of pregnancy, to lower rates of early major premature and to improve the chance of viability and prognosis of fetuses without serious repercussions on the workflow

[Exploration of infertility: Correlation hysterography hysteroscopy]

In literature, a uterine lesion in found in half of the infertile womenTo compare the results of the hysteroscopy and the hysterosalpingography in the study of the uterine cavity as exploration of feminine infertility. Retrospective study, over a period of four years from 1 January 2005 to 31 December 2008however, on 140 cases of infertile patients explored in the gynecology obstetrics department in Mahmoud El Matri hospital. Compared with hysteroscopy, hysterography had an overall sensitivity of 76.56%, a specificity of 77.63%, a PPV of 74.24%, an NPV of 79.72% and a very strong correlation with coefficient of 0.83. Best correlations between the two examinations were found with polyps, fibroids and synechia. Hysterosalpingography remains the first line examination in the exploration of feminine infertility. However, hysteroscopy must be realized as a second examination in case of lesions found at the hysterography or at once in certain cases

[Immature t eratoma of the ovary and pregnancy]

Composing of less than 1%of all ovarian cancers, immature teratoma is a malignancy that mainly affects the young. Immature teratoma of the ovary together with pregnancy is rare. To nor knowledge, this association was reported only in twelve cases. We Report two cases of immature teratoma of the ovary diagnosed during pregnancy and their respective issue. Observation 1st case. A 28 years old woman gravida 1 with an immature teratoma of the ovary discovered during delivery by caesarean section. The treatment was conservative including salpingo-oophorectomy, omentectomy. aortic lymph node dissection and appendectomy. This patient had a second pregnancy with a good outcome. She delivered by cacsarean section in order to perform radical treatment: hysterectomy and oophorectomy of the remaining ovary. 2nd case. A 22 years old woman gravida I with adnexal mass diagnosed during an ultrasonography exam at 15 weeks gestation. A conservative treatment was indicated, including salpingo oophorectomy, omentectomy, aortic lymph node dissection, appendectomy and biopsy of the resnaining ovary. The patient bad a normal vaginal delivery. Immature teratoma is graded from 1 to 3. The management of this association is discussed, but it takes in consideration the surgical staging, the grade and the secretion of alpha FP. Conservative treatment without associating chemotherapy can be tempted in tumours with a stade Al and a low grade

[Prenatal diagnosis and management of fetal megacystis]

Prenatal diagnosis of fetal megacystis particularly in the first trimester requires assessement of pronostic and aetiotogycal criteria. Report anew case we report a case of severe megscystis in female fetus diagnosed at 23 weeks of gestation. There are no other associated ultrasound findings. Fetal karyotyping was normal [46XX]. Termination of pregnancy for medical indications was realised because of progressive enlargement of the fetal bladder. Post-mortem examination showis megacystismicrocolon-in testinal hypoperistalsis syndrome. Fetal megacystis is a severe condition when diagnosed early in pregnancy. Ultrasonography follow-up and fetal karyotyping are important to evaluate prognosis

[Polycystic ovary syndrome with infertility]

The definition of the polycystic ovary syndrome has been controversial for a long time. Rotterdam consensus established precise criteria since two among three set the definition as follow: anovulation, hyperandrogenism and polycystic ovaries. of this study is to stress on the particularity of ovarian dystrophy and the management of the resulting infertility that represents an important rate of medical counselling of women desiring pregnancy. Literature review. Management consists in two parts: treating hyperinsulinism and stimulating ovulation. The "step up low done" protocole is now taking the place of the classical "step down" protocole. Ovarian drilling have to be considered in case of resistance to Citarate of Clomifen. The hyperstimulation syndrome is the common complication to avoid by a regular following. The "coasting" represents an interesting alternative in case of an explosive response in order to obtain a controlled follicular failure. Clinical management of the PCOS have to be organized in regard to patient's age, history, desire of pregnancy and medical staff experience