[Role of the hysteroscopy and laparoscopy in managementof the female infertility: about 200 cases]

Infertility is a common disease which affects nearly 10% of women at reproductive age. The hysteroscopy and laparoscopy are becoming very important in the management of this pathology. We tried to assess the current results of both hysteroscopy and laparoscopy, to study the prognosis factors as well as operating techniques and to clarify their contribution in comparison with other therapeutic techniques. This is a retrospective study about 200 cases of hysterolaparoscopy performed for female infertility in women admitted at the department of Gynaecology and Obstetrics in Mongi Slim's Hospital La Marsa. The hysteroscopy was abnormal in 75% of cases: the uterine synechias [23%], endometria hypertrophy [19%], endometrial polyps [10%], uterine fibroids [9%], atrophy [7.5%] and malformations [3.5%]. The operating hysteroscopy procedure was performed in 27.3% of cases with a rate of subsequent pregnancy in 34.9%. There is different data between the hysterosalpingography and hysteroscopy in 34.8%. The operating laparoscopy was performed in 70% of cases divided between adhesiolysis [27.2%], tubal surgery [37.8%], electrocoagulation or excision of endometriosis nodule [17.2%] and ovarian drilling for PCOS [17.8%]. The rate of pregnancy is 39.9% after laproscopic surgery [divided between intrauterine pregnancy 37.1% and ectopic pregnancy 2.8%]. The data of the hysterosalpingography and laparoscopy are different in 21.1%. Hysteroscopy and laparoscopy are diagnosing and treating both uterine and tubal infertility as well as some ovarian abnormalitis.They have, thus, the main role in diagnosis and treatment of female infertility.They permit to correct data from the HSG in more than a quarter of cases and to improve the rate of pregnancy in more than one third of cases

[Large placental chorioangioma]

The large placental chorioangioma is a non-trophoblastic vascular tumor of placenta which size is more than 4 cm. It's rare tumor, the incidence is between 1/3500 and 1/9000 birth. We analyze, on base of our case and from a literature review, the ultrasonic aspects of this tumor; we bring out also the physiological mechanisms of maternal and fetal complications and finally we detail the therapeutic possibilities. Chorioangioma appears in ultrasound scan like a thoroughly limited hypoechogene zone. The vascular origin of the tumor can be confirmed by color Doppler. A left-right shunt effect results from arterio-venous communications and causes backwardness growth and fetal death in-utero The fetus is exposed to anemia and microangiopathic thrombopenia The maternal complications are hydramnios, abruption placenta, premature ruptured membrane. Therapeutic possibilities are reduced: In several fetal anemia, an exsanguinous transfusion can be done. Some techniques for tumor devascularization are be tried by someone

[Abruptio planeentae]

Abruptio Placentae is one of the most typical obstetrical emergencies. We present a retrospective study about 45 cases of placental abruption. The diagnosis was confirmed in all cases by both clinical and anatomopathological findings. Study the epidemiological profile of the patient, the circumstances of diagnosis, the modes of delivery and the fetal morbidity. The prevalence of placental abruption was about 0.34%. Patients were primiparous in 40% of the cases. This problem occurred during the third trimester in 97.8% of the cases. Elevated blood pressure was found in 44.4% of the cases. The incomplete form represented 77.8% of cases. Blood clotting disorders were detected in 8 patients. Fetal death rate was 37.77%. This problem remains unpredictable and sudden. Both maternal morbidity and fetal mortality rates remain high

Association fibrome uterin et grossesse. A propos de 23 cas

The coexistence of leiomyoma and pregnancy may lead to complications with unequal gravity. Material and methods: The authors propose a retrospective study about 23 cases of association of fibromyoma and pregnancy collected over a period of seven years. Study of the effect of fibromyoma on pregnancy and vice-versa. Analysis mode of delivery. Aseptic necrobiosis: 21.7%. Urinary tract compression: 4.3%. Miscarriage: 13%. Threatened premature birth: 26%. Caesarean section: 47.8%. Premature birth: 8.6%. Neonatal death: nil. Maternal morbidity due to this association is important. It is essential that pregnant women be aware of the importance of prenatal consultation during the first trimester of pregnancy

Reflexion sur l'association de la maladie de Recklinghausen et grossesse. A propos de six cas

Recklinghausen's neurofibroimatosis is a phacomatosis with dominant autosomal transmission and variable expression. The authors propose an analysis of six cases of Recklinghausen's disease associated to the pregnancy. From these observations and review of the literature, they release the particularities of this association. The appearance of high blood pressure seems more frequent at the patients affected by Recklinghausen's disease than in the unhurt population. A disease prevention of hypertensive complications by the use of low dose of Aspirine can be proposed in the presence of gravity's criteria

tumeur de Brenner maligne: Particularites et prise en charge

Brenner's tumour of the ovary is rare, mostly benign. It was described for the first time by mac naughton jones in 1898. von numers listed the first malign form in 1945 that represents 2% of tumours. On the basis of a personal report and of 160 cases listed in the literature, we propose to study anatomoclinical and epidemiological elements of this hurt and to study histological particularities and various therapeutic processes. Malignant brenner's tumour arises mostly in peri and postmenopausal period. Clinical signs are not specific. Histological exam puts the problem of the choice of the histological malignant criteria. Metastasis occurs in half of cases. They are mostly loco-regional. The treatment is essentially surgical. The efficiency of an additive treatment seems to be debatable

[Maternal and neonatal metabolic complications in gestational diabetes]

We present a retrospective study of 140 cases of gestational diabetes. The objective of our study was to evaluate the frequency of infant and maternal metabolic complications associated with gestational diabetes. Maternal hypoglycaemia was the most frequent complication [11 %], while ketoacidosis was rare and occurred in only one case [0,9 %]. Neonatal metabolic complications were mostly hypoglycemia [19 %] and hypocalcemia [7%]. Pregnancy in diabetic women entail more risks than normal pregnancy. But these risks are actually limited

Duplicite utero - vaginale complete avec hematocolpos et agenesie renale homolaterale

We relate one observation about a rare case of genital malformation, where is on association of unilateral hematocopos, bicorn uterine and homolateral renal agenesis. The diagnostic was suspected upon the association with a progressive dysmenorrhe and vaginal mass. Il was confirmed by ethnographie and IRM. The treatment has been conservative and consisted only in the section of the vaginal partition