[Evaluation of different techniques for vaginoplasty in the treatment of the syndrome of Mayer-Rokitansky-Küster-Hauser]

Rokitansky syndrome is an utero-vaginal aplasia with a frequency of 1 / 5000 female births. To correct this anomaly whose prognosis is mainly functional and psychological numerous surgical techniques have been described. To report our experience about 13 patients with Rokitansky syndrome and having benefited from a vaginoplasty between 1993 and 2008 and to evaluate the results of the various anatomical techniques. This is a retrospective study of 13 patients who underwent a vaginoplasty in the center of maternity and neonatal units, over a period from December 1993 to April 2008. During this period, two operative techniques were used: the technique of Mac-Indoe and the technique of Davydov. The mean age at the time of surgery was 22 years [15 years-32 years]. In 6 patients operated using the technique of Davydov the average depth of neovagina was 6.83 cm, one treatment failure was noted. Among the 7 patients operated using the technique of Mac Indoe the average length of neovagina was 7 cm, 3 treatment failures were noted. It was noted that there was no failure of the anatomical results in patients who have had regular sex after surgery. It was noted that there was failure of the anatomical result in 4 of 9 patients who did not have sexual intercourse after the procedure regardless of the technique used, a failure rate of 44%.The choice of technique will be based on the experience of the teams as each technique has similar anatomical and functional results in the literature. Both anatomical and functional, the main factor that determines the success of treatment seems to be the motivation of the patient to have a married life and sexual relationship

[Fibroid and pregnancy: the complications]

To study the maternal and fetal morbidity in the association fibroid and pregnancy and the management in this case. A retrospective study of 80 cases of fibroids associated to pregnancy. These cases were taken from the department "C" of gynecology and obstetrics in the center of maternity and neonatology of Tunis. We studied 80 cases of fibroid associated to pregnancy in our study. The mean age of the patients was 32 years old. 45% of the patients were primipares. The interstitial fibroids [68%] are the most frequent. The average number of fibroid is 1, 7 in each pregnancy. The aseptic necrobiosis is the most frequent complication of the fibroid whereas for the mother the main complications are the premature delivery, the premature rupture of membranes and the placenta praevia during the third term of pregnancy. The dystocic presentations are more frequent than in the general population, responsible of a higher rate of caesarian sections. The delivery hemorrhage constitutes the most frequent complication of the post partum. The fetal prognosis is globally good with a morbidity dominated by growth restrictions but with no superior mortality rate. The myomectomy was practiced during the caesarian section in 3 cases, the abstention being the rule for the other patients. The association fibroid and pregnancy is not rare, the complications are frequent that is why it is considered as a high risk pregnancy. An early detection of the complications and a prevention of delivery hemorrhage would reduce the maternal and fetal morbidity

[Management of liver disease during pregnancy]

Several liver diseases can be observed during pregnancy. Some are proper to pregnancy and others are not. To study and to analyze the different liver diseases encountered during pregnancy and describe their management. Retrospective study of 97 patients having a liver disease during their pregnancy, the cases were managed in the department "C" of obstetrics and newborn of Tunis. The prevalence of hepatopathy associated to pregnancy was 1.61 in our study. The mean term was 35 weeks of amenorrhea. 45% of labors were induced prematurily. 21 patients were transferred to intensive care unit after delivery due to the severity of their pathology. No maternal death was noted. The better comprehension of physiopathology of this association can help to improve the patients care

[Borderline tumors: diagnosis and management: about 10 cases]

Since their discovery in 1929 by Taylor border tumors of the ovary, also known as borderline tumor [TOLM] inspired confusion, apprehension and disagreement. Identify epidemiological, clinical and therapeutic particularities of borderline tumors of the ovary.-Study the different surgical approaches for borderline tumors of the ovary.-Assess the value of frozen section in this pathology. This is a retrospective study of 10 patients operated for borderline tumor of the ovary and collected at the department C of the center of maternity and newborn in Tunis. The average age of our patients was 35.6 years Pelvic pain was the main circumstance of discovery, it accounted for 50% of the cases. The discovery was fortuitous in 40% of the cases Ultrasound has shown purely cystic tumors in 70% of cases and solido-cystic ones in 30% of cases. There was a tumor in the controlateral ovary in only one case. The surgery was conservative whenever possible. Histological examination concluded to 6 cases of serous tumor and 4 cases of mucinous ones. Among the 10 patients, 8 were classified as stage la, one stage Ib and one stage Ic. The frozen section was performed in 8 cases. The diagnosis of borderlines tumors of the ovary remains difficult. The laparoscopy is of great use in the management of this pathology. Histological examination is an interesting addition and the conservative treatment is the more appropriate treatment

[Prognosis of delivery on a scar womb: about 123 cases]

During these last two decades, the practitioners are more and more confronted to pregnancies on scar womb. To analyse the behaviour to be held in front of a scar womb and to estimate materno-foetal preview after childbirth [delivery] by vaginal delivery or after a caesarean section at cold. It is about a retrospective study held over 123 cases of patients with a scar womb who gave birth in the department "C" of the CMNT over a period of 2 years. Among the 123 cases of scar womb, 70 patients had a preventive caesarean section. The main indication was a pathological pond. Uterine scar was accepted in 53 women. 25 among them gave birth by vaginal tract and 28 had a casarien section of 2nd intention. There were 4 cases of dehiscence of the scar. 8% of the newborns from vaginal delivery had an apgar < 7 in the 5th mn against [10% in the group of the newborn children stemming from a preventive caesaran-section. Pregnancy on scar womb is a pregnancy at high risk requiring an adapted coverage

[Management of ovarian cyst associated to pregnancy]

The problem of the association of the ovarian cyst and pregnancy is to determine whether the cyst is functional or organic? To draw up the epidemiological profile of the patients having a cyst of the ovary, show the peculiarities of this association; and to clarify the therapeutic methods and its effects on the progress of the pregnancy. A retrospective study concerning a period of 5 years and interesting 25 patients. The average age of the patients was of 34 years, the average parity was of 2. The discovery of the cyst was in 68%of cases in the first 3 months. On the clinical plan the circumstances of discovery were pelvic pains in 48%of cases and complications in 6%of cases ; such us twisting of the cyst.. 61%of the patients had a laparoscopy, 44%a laparotomy and a case of guided ultrasound punction, 4%of the patients underwent a pregnancy interruption, 17 pregnancies were led till the end, we noted an intrauterine death of the foetus and a case of late abortion at 22SA. Problems due to the association of the ovarian cyst and pregnancy are especially of diagnostic and therapeutic order. Obsession was to underestimate a malignant tumour; that's why we should perform a surgical investigation in front of any persevering cyst beyond the first three months of the pregnancy

[Hemorrhage delivery: about 65 cases]

The delivery haemorrhage is actually a problem of public health. It is responsible of 31.5% of the maternal death in Tunisia. The goal of this work is to study the frequency of this complication, its gravity, its risk factors, its etiologists and its methods of treatment. It is a retrospective study, of 65 cases of delivery haemorrhage recorded to the obstetric gynaecology service < C > of the centre of motherhood and neonatology of Tunis during 4 years. The frequency of the delivery haemorrhage in our study is 1.19%. The middle age of the patient is of 31 years. Their middle parity is 2.4. Factors of risk taking out again our set are: gestational toxemia [35.4%]. primiparity [33.8%], advanced maternal age [30.7%]. pre-existent anaemia [24.6%]. the uterine surdistension [21.3%], an abnormal middle length of labour [69.6%]. use of oxytocin during labour [34%]. induction [21.5%]. Etiologists in our set are atone in 63% of cases, retained placenta in 31.2% des cases, coagulopathie [9.2%], placenta previa [1.5%], uterine inversion [1.5%]. The hold must be in charge multidisciplinary, systematized, precocious and dynamic

[Coelioscopy in gynecologic emergencies. About 239 cases]

The goal of this study was to determine the efficiency of lapaorscopy as method of diagnosis and treatment of gynecologic emergencie. A laparoscopy was performed in two hundred and thirty-nine patients who presented in emergency with signs like acute pelvic pain, uterine bleeding or fever. Diagnosis and treatment are presented in a retrospective study. The median patient age was 30.4 years and median parity was 14, sonography was performed in all patients and bHCG rate was positive in 101 patients. The most suspected diagnosis was ectopic pregnancy [42%] followed by complicated cysts [30%] and high genital infections [27%] At laparoscopy 92 cases of ectopic pregnancy, 66 cysts complicated or not and 47 high genital infections were found. Laparoscopy didn't show any evident pathology in 6.6% of patients. We didn't note any anesthesial or surgical complication. Laparoscopy for gynecologic emergencies can be satisfactorily performed in the majority of patients, regardingly to low fiability of usual diagnostic methods. It is useful for diagnosis and treatment. The rate of it's overall complications is relatively low

[ value of ambulatory hysteroscopy diagnostic. About 292 cases]

This is a retrospective study including 292 ambulatory diagnostic hyst‚roscopies realised during a period of 1 year and a half. The mid age of our patients is 44 years. The main indications are haemorrhage, infertility and abnormal ultrasound findings. The exams are carried out under analgesia. Its sensibility is good concerning the endom‚trial pathology. As a matter of fact, it equals 100% for ad‚nocarcinomas, it varies from 56.5 to 77.3% for hyperplasia, 100% for endom‚trial polyps and from 88 to 90% for endom‚trial atrophy. In contrast, it is worse for the myometrial pathology such as ad‚nomyose and sub mucosal myomas. Besides its sensibility, the tolerance of this exam allows its ambulatory realisation permitting a considerable economy