Lower incidence of hypotension following spinal anesthesia with 6% hydroxyethyl starch preload compared to 9% saline solution in caesarean delivery

Hypotension is a common complication following spinal anesthesia for cesarean delivery. Techniques to prevent hypotension include preloading intravenous fluid. To compare the effect of two preloading regimens: 6% hydroxyethyl starch [HES] and 9‰ saline solution, to prevent hypotension after spinal anesthesia in cesarean delivery. 105 patients undergoing intrathecal anesthesia for elective cesarean delivery were randomized and allocated to receive a preload of 500 ml HES 130/0.4 [HES Group] or a preload of 1500 ml 9‰ saline solution [CR group]. Blood pressure and heart rate were recorded at baseline and after spinal anesthesia [every minute for the first 10 min, every 3 min for the next 10 min, and then every 5 min for the last 20 min]. The primary outcome was to compare the incidence of hypotension [defined as a 20% reduction in systolic arterial pressure from baseline] between the two preloading regimens. Vasopressor requirements [i.v. bolus of 6 mg ephedrine] were also compared. The incidence of hypotension was 87% in the CR group and 69% in the HES group [p= 0.028]. Ephedrine requirement, incidence of nausea, and/or vomiting and neonatal outcome did not significantly differ between the two groups. The incidence of hypotension was lower after preloading of 500 mL of HES 130/0.4 than preloading with 1500 mL of 9‰ saline solution

[Lower urinary trauma complicating gyneacological and obstetrical surgery]

The trauma of the lower urinary tract in gynecologic and obstetrics surgery is rare. Discover the circumstances of their happening, their symptoms, and their methods of diagnostic and their treatment. Authors report 24 cases observed over a 12 years period. These lesions consisted on 20 bladder lesions and 4 ureteric lesions. The frequency of these urological complications was 0.21% among the 12000 surgical operations performed between 1992 and 2003. The most causal operation was caesarean and abdominal hysterectomy. Urinary trauma was more frequent in patients with history of abdominal surgery. Post operative course was uneventful in most cases. Trauma of the lower urinary tract in gynecologic and obstetrics surgery is rare but their ignorance may seriously affect the functional urinary prognostics

[Cesarean deliveries in the maternity of military hospital of tunis. indication and prognosis: about 5008 cesareans]

The rates of cesareans increased in many countries, these last years. we propose to evaluate the indications, and the maternal and foetal prognosis. it's a retrospective study of 5008 cesareans during 10 years period, collected in the maternity of the military hospital of Tunis. Cesarean section rate is 21, 59%. The cicatricial uterus constitutes the dominant indication [34%]. In the event of noncicatricial uterus, the fetal suffering [24, 7%], the failure of the trial of labour [14. 2%], and the breech presentation [12, 7%] are'the principal indications. The hemorrhage constitutes the major complication into per- operational [2%]. The post-operative complications are noted in 15, 5%. Maternal mortality is 0, 13%; perinatal mortality is 1, 06%; perinatal morbidity is 9, 68%. The increase of cesarean rate improves fetal and neonatal prognosis however it was associated to an increase of maternal

[ approach diagnosis of ovarian tumors by echography]

In more of positive diagnosis, echography makes it possible to approach the histological nature of ovarian tumors. From a series of 106 cases of ovarian tumours, we propose to evaluate this approach by analysing the various echographic signs according to histological types'. The serous cysts are anechogen in 77,7% of the cases. The mucinous cysts are anechogen in 71,4% and finely echogen in 28,5% of the cases. The dermoid cysts are echogen in 47,3% and heterogeneous in 26,3%. The endometriosic cysts can be finely echogen [45%]. heterogeneous [25%] or echogen [20%]. The malignant tumors are of mixed aspect in 54.55% of the cases. The sensitivity of echography for the malignant tumors is 81,82% Whereas specificity is 75,79%. The negative predictive value is 97,3%, and the positive predictive value is 28,13%. The size of the tumor, the vegetations and the partitions are also studied; a size lower than 5 cm and the absence of partition and vegetation are synonymous with benignity in all the cases

Pronostic maternel et foetal au cours de la toxemie gravidique severe

Severe gravidic toxemia leads to heavy maternal and foetal morbidity and mortality. The purpose of our study is to loosen the factors of bad maternal and foetal prognosis. It's a retrospective study about 100 cases of severe and complicated gravidic toxemia repertorieted in the maternity of Military Hospital of Tunis. Maternal morbidity is dominated by the complications of hypertension and blood disorders. We raised 4 cases of eclampsia, 9 cases of retro placental hematomas and 5 cases of HELLP syndrome. We don't deplore any maternal death. Perinatal mortality is 28,8%. The rate of delay intra-uterine growth was 43,8% and the prematurity 65,9%. The more toxemia appears early during pregnancy more maternal and foetal prognostic is compromised

Syndrome de Potte. Etude analytique a propos de 4 cas

Potter's reno facial syndrome is a rare innate abnormality. We bring 4 observations repertoried at the maternity of military hospital of tunis over a period of 6 years [1997 - 2002]. The purpose of our work is to determine after a review of the literature the echographic and foetopathologic characteristics, and the forecast of this syndrome. The frequency of the bilateral renal agenesis is of 0.27 per thousand positive diagnosis bases essentially on the ultrasound of the 2 th, or the 3-th trimester. The signs of appeal are essentially the oligoamnios associated to an hypotrophy the caryotype is systematic to eliminate an associated chromosomic abnormality. Foetopathologic exam is usefull for the diagnosis. Main abnormality except the urinary pathology is the lung hypoplasia. Therapeutic interruption of the pregnancy in this situation not compatible with the extra-uterine life. Only type IV authorize the development of the pregnancy according to echographic data and of foetal urinaire biochemistry. We insist on the early practice of the morphological ultrasound between 20 - 22 weeks for the diagnosis of foetal abnormalities and the place of the gentic advice in association with the geneticist in the coverage of the couple

Interet du curetage biopsique dans l'exploration de l'endometre. A propos de 200 cas

The aim of this study is to evaluate the reliability of the uterine curettage in endometrial pathology. It is a retrospective analysis of 200 uterine curettages carried out in the military hospital of tunis over 4 years [1994-1998]. The reasons of consultation were genital hemorrhage, sterility and amenorrhea. Histological lesions were classified as follows: 40.8% hyperplasia, 8.4% atrophy, 1.34% endometrite, and 1.34% adenocarcinoma. uterine curttage associated to hysteroscopy is far the best technique for the diagnosis of intrauterine lesions