[Epidemiological profile, etiological diagnosis and prognosis of uterine synechias: Report of 86 cases]

Uterine synechias may pose real problems for fertility prognosis. It depends mainly on its etiology. To study the epidemiological profile of patients, describe the circumstances of discovery of uterine synechias, specify the diagnostic procedures for pelvic ultrasound, hysterography and hysteroscopy and estimate the benefits on fertility. A retrospective study over a period of 10 years from 1 January 2000 to December 31, 2009 in the department of obstetrics gynecology B Charles Nicolle's Hospital in Tunis. We collected 86 patients. The age average was 35.42 years, gestit average of 1.36 with 37.2% of nulligeste and an average parity of 0.67. The uterine revision was the main etiology [55.8%]. The main circumstance of discovery was the exploration of infertility [60%]. Hysterosalpingography showed a luminal filling defect in 79% of patients mostly fundic location [37.3%]. Faced with data from the hysteroscopy sensitivity of HSG was 78% and positive predictive value was 100%. For the seat of the synechia its sensitivity is only 40%. The surgical procedure took place in one time in 74 cases. Our complication rate is 8.14%: 2 uterine perforations, 2 falseroads and 3 cases of hemorrhage stopping surgery. The main etiology is a history of uterus revision. The main circumstance of discovery is the exploration of infertility. Anatomic results were generally good as testified hysteroscopy control

[Diagnostic value of immunohistochemistry in ovarian sex cord-stromal tumors]

The ovarian tumors' diagnosis is bused on biological and radiologic tests but only the histological examination associated to an immunohistochemical study allow best diagnosis. The purposes of this study is to examine inhibin and other markers immunoreactivity to ovarian sex cord-stromal tumors and their histological mimics and to discuss its value in the differential diagnosis. We report a retrospective study of 31 cases of ovarian sex cord-stromal tumors and review the clinical, pathologic and immunohistochimical features of these tumors. The average age of our patients was 51.3 years with an average size of 8,4 cm. Immunostaining for inhibin was positive in 66% of granulosa cell tumor, in 50% of Sertoli-Leydig cell tumor and in 54% of thecoma-fibroma group. Inhibin immunoreactivity was more important than with cytokeratin and epithelial membrane antigen, but less marked than with CD99, vimentin, smooth muscle actin, desmin and 5-100 protein. The results of this study show that although it is not complete specificity, inhibin, contrarily to the other markers, can be used to help in the distinction between ovarian sex cord-stromal neoplasms and the other primary and metastatic tumors

[Conservative management of cervical pregnancy. Case-report]

Cervical pregnancy is one of the rarest ectopic locations. It can be responsible of spontaneous haemorrhage enquiring hysterectomy. Ultrasonography technical improvements allow early diagnosis and conservative treatment. This study aims to report a new case of cervical pregnancy treated conservatively. Patient with cervical pregnancy diagnosed on ultrasonography and treated by one dose systemic methotrexate requiring a second injection because of no decreasing of serum beta human chorionic gonadotrophin level leading to expulsion of the pregnancy one month later. Methotrexate is the standard treatment of early diagnosed cervical pregnancy. When haemorrhage occurs, many therapeutic methods allow conservative treatment in order to preserve fertility

[Neonatal prognosis of second twin]

Twin pregnancy is associated to high neonatal morbidity particularly for the second twin. To assess twin delivery practice in our department and prognosis of second twin. retrospective study of medical files of parturition women with twin pregnancy between January 2003 and December 2006. Were excluded women delivered before 28 weeks gestation, twin pregnancies with death or malformation of one of twins. Descriptive and comparative analyses were realised. one hundred forty six twin pregnancies were counted. Vaginal delivery was attempted with 90 parturition women with 85,5% of success. Caesarean section delivery rate was 47,2%. Overall there's no difference between twins considering neonatal complication. In case of vaginal delivery, the second twin's 5 minutes Apgar score was statistically under the one of the 1st twin if compared to the caesarean section delivery. This difference was no more significant if regarding the Apgar score under 7 at 5 minutes. Apgar score of the second twin was also under the one of the first twin in non cephalic presentation. vaginal delivery of twin pregnancy was not associated to high risk for twins. Obstetrical manoeuvres should be well controlled to reduce obstetrical trauma

[Prospective epidemiologic study of group B streptococcus vaginal colonization in pregnant woman]

Group B streptococcus is known to be the principal medium responsible of maternal and severe neonatal infection. Assessing the prevalence of group B streptococcus [GBS] in our population, emphasize risk factors of GBS vaginal colonization and main characteristics of isolated strains. Prospective study of GBS vaginal colonization at admission for delivery upper to 34 amenorrhea weeks. Two hundred and seven vaginal swabs were carried out. Prevalence of GBS was 13%. Primigravida represents a risk factor of GBS vaginal colonization regarded to multigravida. False negative rate was 1,6%, All isolated strains were susceptible to penicillin C and to ampicilin, 44,4%were resistant to erythromycin. Systematic screening of GBS must be introduced in our population. Per partum antibioprophylaxis must consider susceptibility of isolated strains to antibiotics

Adenomyosis at hysterectomy

adenomyosis is a frequent gynecologic pathology which affects women particularly in the fifth decade. It is responsible of abnormal uterine bleeding and pelvic pain. The diagnosis can be difficult especially when it's associated to other gynaecologic pathologies. Contribution of transvaginal sonography and magnetic resonance imaging made preoperative diagnosis possible. The aim of this study is to report frequency, epidemiologic profile, clinical signs and diagnostic and therapeutic methods of adenomyosis. This is a retrospective study about 52 cases of adenomyosis diagnosed upon 336 hysterectomies for benign pathologies. Descriptive analysis of epidemiologic, clinical, diagnosis and therapeutic data was performed. prevalence of adenomyosis was 15% and multiparity observed for 90% of women was the main risk factor. women desirous of pregnancy and affected by adenomyosis can benefit from conservative treatment, but hysterectomy remains the reference treatment