[Uterine rupture during labor following surgical hysteroscopy]. / Ruptures utérines lors d'accouchements après hystéroscopie opératoire.

Two cases of obstetrical uterine rupture after operative hysteroscopy without perforation are described. One was treated for uterus septus, the other one for synechia. However, the uterus could have been fragilized in both cases: one had been perforated by a uterine device, the other case had a past history of repeated curetage. A review of the literature shows 7 other similar cases, published over last ten years, 6 of them having a past history of perforation during the operative hysteroscopy (5 cases) or by an intra-uterine device. These obstetrical complications, although rare, can lead to consider a uterus treated by hysteroscopy as being at risk for obstetrical rupture.

Results of planned in-vitro fertilization programming through the pre-administration of the oestrogen-progesterone combined pill.

The use of an oestrogen-progesterone combined pill permits the induction of ovulation in the absence of any developing follicle. Two treatments were compared. In the first, patients received no prior treatment before stimulation. In the second, combined oestrogen-progesterone treatment was given during approximately two menstrual cycles prior to stimulation. No differences between the two groups were found in relation to oocyte maturity, fertilization in vitro, cleavage, replacement and pregnancy. Fewer luteinizing hormone surges occurred in patients pre-treated with steroids. The utilization of the oestrogen-progesterone combined pill prior to induction of ovulation facilitates the forward planning of patients for in-vitro fertilization.

PIP: In order to facilitate the scheduling and management of cases for in vitro fertilization, a trial of pre-administration of a combined oral contraceptive was conducted. 103 women took 2 mg norethisterone acetate and 0.05 mg ethinyl estradiol for 45 to 70 days before induction of ovulation, allowing 5 days between treatments. This group then received either Clomid 100 mg for 6 days and HMG 225 IU on days 5, 7 and 9 (34 women), or HMG only (dose not specified, 69 women). The control groups were given identical ovulation induction regimens: Clomid and HMG (130 women) or HMG only (188 women). 70 of the patients selected for preliminary inhibition of ovulation had irregular menstrual cycles with normal prolactin; the others were picked for scheduling reasons only. No differences were documented between the groups in oocyte maturity, fertilization in vitro, cleavage, replacement and pregnancy. Pregnancy rates ranged from 10 to 16.6% in the 4 subgroups. Fewer LH surges occurred in patients pretreated with steroids. Thus the pretreatment of candidates for in vitro fertilization with ovulation blocking steroids has no quantitative effect on results, but does facilitate scheduling patients for the procedure.

[Do's and don'ts concerning an amenorrheic patient after pregnancy termination]. / Faites. Ne faites pas devant une amenorrhee apres I.V.G.

PIP: Suggestions are offered for treatment of postabortal amenorrhea. In the absence of bleeding immediately after the procedure, a careful gynecological examination should be conducted to determine the size, consistency, and sensitivity of the uterus and the suppleness and vacuity of the lateral cul-de-sacs. A sonogram should be obtained if the results are abnormal, and a plasma dose of human chorionic gonadotropin should be administered after 12 days in case of doubt. If the sonogram suggests retained uterine contents a 2nd uterine evacuation should be carried out and appropriate antibiotic treatment should be initiated. The possibility of unsuccessful abortion must be considered, as must that of placental retention, hematoma, or ectopic pregnancy. A 2nd intervention should be carried out without hesitation if necessary. In the case of secondary amenorrhea more than 4 weeks after the intervention, a complete gynecological examination should be conducted, a serum human chorionic gonadotropin pregnancy test should be administered, incipient adhesions should be sought through X-ray or laparoscopy and perhaps removed, and symptoms appearing after the abortion, such as insomnia, irritability, weight loss, or consumption of drugs should be investigated. The possibility of another pregnancy should be investigated, adhesions should not be allowed to develop, and the possibility of psychogenic amenorrhea resulting from ambivalence about the abortion should be considered.^ieng

[True and false regarding the risk of infection in contraception]. / Le vrai et le faux sur le risque infectieux en contraception.

PIP: Contraception is certainly less responsible for the recrudescence of venereal diseases than are other social factors, such as the increased sexual freedom among adolescents. The condom and all topical spermicidal agents provide a valuable barrier against the risk of venereal infections. Genital infection, especially moniliasis, is more frequent among oral contraception (OC) users than among nonusers. The exact etiology of this phenomenon is not known; it is probable that OC exercises an influence on vaginal pH, which varies between 3-4.5 in OC users, and between 5.5-6.5 among nonusers. Risk of infection in IUD users is increased by prior genital and pelvic infections, which remain an absolute contraindication to IUD use. Copper IUDs have the lowest rate of infection, and the Dalkon Shield has the highest; rate of infection is 2 times higher in wearers for over 5 years. Since pelvic infection can have a negative influence on tubal permeability, IUD use is not recommended for nulliparous women.^ieng

[A comparative study of salpingotomies with or without suture. An experimental microsurgical research carried out on rabbits' tubes (author's transl)]. / Etude comparée des salpingotomies avec ou sans suture. Recherche microchirurgicale expérimentale sur la trompe de lapine.

Two techniques of salpingotomy have been compared in two series of rabbit experiments with the aim of finding out whether, when carrying out conservative surgery in extra-uterine pregnancy with rupture of the tube, it is better to suture the salpingotomy or to leave it open without suture. The two series show that there is no difference as far as the frequency of large adhesions, as far as ovulation and the strength of the scar and the pregnancy rate g out conservative surgery in extra-uterine pregnancy with rupture of the tube, it is better to suture the salpingotomy or to leave it open without suture. The two series show that there is no difference as far as the frequency of large adhesions, as far as ovulation and the strength of the scar and the pregnancy rate g out conservative surgery in extra-uterine pregnancy with rupture of the tube, it is better to suture the salpingotomy or to leave it open without suture. The two series show that there is no difference as far as the frequency of large adhesions, as far as ovulation and the strength of the scar and the pregnancy rate following the two methods. On the other hand, implantation is less good when the tube is left open than when the salpingotomy is sewn up. In the first series there was a significant difference between the side that was operated on and the control side, whereas the second series there was very little difference. In spite of the fact that the scar seemed to be apparently of the same type, the eggs were able to descend more easily in the oviduct when it had been sutured.

[A survey on serious accidents associated with abortion before and after the law of 1975]. / Enquete sur les accidents graves de l'avortement avant et apres la loi de 1975.

PIP: To investigate the effects of the law legalizing abortion, passed in France in 1975, on serious complications caused by the procedure, the authors have investigated 2 such complications, acute renal failure, and tetanus. Such complications are treated only in specialized reanimation centers, therefore it was possible, through the medical dossiers, to statistically measure the number of cases treated before and after the 1975 law. The number of cases of acute renal insufficiency began to drop in 1973, possibly due to the fact that many women would then go to Britain to seek abortion, where it had already been legalized. After 1975 the number of cases treated went from 233 to 45, and cases of death went from 34 to 4. Only 8 cases of tetanus were reported, and all before the 1975 law. These conclusions agree with other data published in the literature on the effects of the legalization of abortion on its medical complications.^ieng

[Before metropathia caused by induced abortion: the do's and do not's]. / Devant des metrorrhagies apres I.V.G.: faites...ne faites pas...

PIP: The author presents a list of do's and do not's to be observed in the case of before metropathia following induced abortion. For the diagnostic, the doctor should conduct an in depth interrogatory concerning the details of the operation and of the symptoms. A complete examination must be performed. The doctor should not perform a new curettage automatically nor prescribe antibiotics without having carefully examined the patient. He should also watch for the possibility of GEU. As a preventive action, the doctor should work with utero-tonics, check the uterine cavity, eliminate the possibility of GEU, examine the ovular remains and see the patient again within 10 days for a check-up. He should not consider induced abortion as a minor operation. As a treatment, the doctor should perform a laparoscopy in the case of a doubt; in the case of fever, pain, metrorrhagia and soft, tender uterus, he should prescribe an antibiotherapy plus a control curettage. In the case of fever with pain, metrorrhagia, painful cul-de-sac and well retracted uterus, he should perform NFS, VS, ECBU and laparoscopy if there is a possibility of adnexitis. He should not send the patient home without having made sure of the absence of the above mentioned complications.^ieng

[Early pregnancy exposure to exogenous female sex hormones].

PIP: Malformations in a newborn are often attributed to the use of hormone pregnancy tests in the early stages of pregnancy. From the review of the different studies on this subject it is impossible to establish with any certainty whether estroprogestational agents have a teratogenic influence, especially because no specific product has yet been identified as responsible for such malformations. It would in all cases be much safer to substitute hormone pregnancy tests with immunologic ones.^ieng