COVID-19 reinfection after pregnancy.

BACKGROUND: There have been reports of COVID-19 reinfections, but the immunological characterization of these cases is partial. We report a case of reinfection with SARS-CoV-2, where the first infection occurred in the course of late pregnancy. CASE PRESENTATION: On May 27, 2020, a 37-year-old woman gave birth at full term, 3 hours after full dilatation. She developed fever (38.3°C) after delivery. Mild biological anomalies compatible with COVID-19 were observed: lymphopenia, thrombocytopenia, elevated D-Dimers, CRP, and LDH. At 6-month follow-up, she reported having contracted COVID-19 with high fever, rhinorrhea, hand frostbites, cough, headache, dysgeusia and anosmia. CONCLUSIONS: We report a case of COVID-19 reinfection with a first mild infection during late pregnancy and a more aggressive second infection 5 months later.

[Uterus transplantation, current prospect and future indications. State of art with review of literature]. / La transplantation utérine : essor de la technique chirurgicale, nouvelles indications. État de l'art avec revue de la littérature.

OBJECTIVES: The aim of this review is to summarize the development of UT on worldwide and to develop the new questions posed by this technique in 2020. METHODS: According to the PRISMA model, via Pubmed, we searched for publications containing the keywords: uterus transplantation; UT and cryopreservation from 2000 to 2020. RESULTS: At least 76 UTx have been carried out around the world and 19 healthy babies were born. The main indication remains the uterine agenesis (MRKH Syndrome>85% cases) then the history of hysterectomy (hemorrhage of the delivery or cervical cancer) and the non-functional uterus (Asherman's syndrome, diffuse adenomyosis). The 2 types of donors (living and deceased) are developed representing respectively 75% and 25% of the TU; the success rate in terms of return of rules is better in the living donor group and is 79% vs 68% in the deceased donor group. The choice of donor type must take into account the constraints of both procedures. Surgical complications (grade III) for the donor are estimated to be 14% mainly represented by ureter wounds. Technical simplifications concerning the venous return of the graft but also the carrying out of robot-assisted surgery would reduce the operating time for the donor and facilitate the collection process. CONCLUSION: TU is a complementary alternative to GPA and adoption allowing patients to be surrogates, legal and biological of the baby. An extension of the indications to patients with non absolute uterine infertility is in the process of democratization.

[Assessment of pelvic floor muscle training programs and urinary incontinence in women: A literature Review]. / Évaluation des programmes d'entraînement musculaire du plancher pelvien et incontinence urinaire chez la femme : revue de la littérature.

OBJECTIVES: Pelvic floor rehabilitation is efficient for the first line treatment of urinary incontinence in women. However, several questions remain as regards the best pelvic floor muscle training program to recommend. The objective was perform a literature review regarding the muscular strengthening program to recommend to treat stress or mixed urinary incontinence in women. METHODS: We performed a systematic review of studies on the topic using Medline's database covering the 10 last years. Among the 1130 articles that were identified, we retained 6 for our analysis. RESULTS: Given the heterogeneity of the exercise programs, it was impossible to exhaustively and comparatively analyze their efficacies. However, a significant improvement is noted when the exercises are based on the muscular training principles of the American College of Sports Medicine. They combine long and short contractions with the practice of the knack in situations of pressure exertion and are part of a self-rehabilitation program based on the needs of the patient and the individual's progression. CONCLUSION: Current knowledge does not allow us to recommend an optimal muscle training program to treat female urinary incontinence. Research must be conducted to evaluate different muscular training regimens but also their integration into a program based on personal needs as well as factors of adherence to the treatment of patients.

Risk factors and management of persistent postpartum urinary retention.

INTRODUCTION AND HYPOTHESIS: Our objective was to identify the risk factors for persistent postpartum urinary retention (PUR). MATERIAL AND METHODS: This multicenter retrospective case-control study included 91 women with PUR exceeding 400ml during the first urinary catheterization performed after delivery, from 2010 through 2015. Two groups were defined: one included 25 women with PUR that persisted longer than 3 days, and the other, comprising 66 women with PUR that lasted three days or less. We compared the two groups to define the risk factors. We also studied the outcome of the women with persistent PUR. RESULTS: The time until diagnosis/management and the urinary volume at the first catheterization after delivery were both significantly greater in the group with persistent PUR (11h vs 7.8h and 1020ml vs 715ml, P<0.05). Multivariate logistic regression indicated that cesarean delivery, perineal tear or episiotomy, and fluid administration in the delivery room were also associated with the persistence of PUR (P<0.05). CONCLUSION: Time in the management of urinary retention can cause bladder overdistension that can substantially delay its resolution. More attentive monitoring of voiding, could reduce the duration of this complication and thereby improve patient comfort and minimize long-term complications. BRIEF SUMMARY: This multicenter retrospective study show that the time in the management of urinary retention is a major factor of persistent urinary retention.

Uterine transplantation: Review in human research.

Uterine transplantation is the solution to treat absolute uterine fertility. In this review, we present the historical, medical, technical, psychological and ethical perspectives in human uterine transplantation research. We reviewed the PubMed database following PRISMA guidelines and added data presented by several research teams during the first international congress on uterine transplantation.

[Comparative study about enhanced recovery after cesarean section: What benefits, what risks?] / Étude comparative sur la réhabilitation améliorée postcésarienne : quels bénéfices, quels risques ?

OBJECTIVE: The post-caesarean enhanced recovery protocol's goal is to allow a quick recovery of previous physical capabilities and increase the chances of an early release and return to normal activities. METHODS: At the Foch Hospital, we performed a case control survey including 2 consecutive groups of patients. The first group was composed of 83 patients that experienced the regular post c-section treatment and the second group of 84 patients that benefited from the enhanced recovery treatment. The characteristics of both groups were comparable. We monitored the complications, hospitalization time and full recovery time for each group. RESULTS: The average hospitalisation time for the patients that received the enhanced recovery treatment was significantly lower than for those that received the standard treatment (3,92 days vs 4,34 days P<0,01). The autonomy for the toilet and the mobility was improved. The average number of complications was not greater for the enhanced recovery group, except for acute retention of urine which were all treated with a simple urine sample return. CONCLUSION: The post-cesarean enhanced recovery seams to allow the significant improvement in recovery of autonomy and length of hospitalization stay without increasing significantly the rate of complications except for the acute retentions of urines which involve in postpartum period close monitoring patients' urination.

Single-port approach to benign gynecologic pathology. A review.

Laparoscopy is the gold standard in gynecological surgery. Single-port laparoscopic surgery, has been developed in order to improve minimally invasive surgery. We analyzed single-port approach in benign gynecologic pathology and made a bibliographic research on Pubmed and Medline from January 2000 to January 2015. From what emerges from the papers taken into consideration, single-port laparoscopy can be used for salpingostomy or salpingectomy to treat tubal ectopic pregnancy, benign adnexal disease (ovarian cystectomy, salpingo-oophorectomy), and for hysterectomy. We do not have enough data for complex procedures like myomectomy or hysteropexy. Robotic single-port laparoscopy seems to be a very attractive perspective and its use in benign gynecology surgery is expanding. More and more ergonomic limitations of single-port laparoscopy are corrected by development of articulated or flexible instruments and camera. Beyond these preliminary results, more ample prospective studies with an adapted and standardized instrumentation are thus essential to highlight real profits.

Vesicoovarian fistula on an endometriosis abscessed cyst.

We report the case of a patient who developed a vesicoovarian fistula on an endometriosis abscessed cyst. The patient presented with an advanced endometriosis stage IV complicated with a right ovarian abscessed cyst of 10 cm. A first coelioscopy with cystectomy was realized. After surgery, a voiding cystography highlighted a fistula between the ovarian abscess and the bladder. A second surgery by median laparotomy was realized with the resection of the right ovarian abscess and the resection of vesical fistula.

Robotically Assisted Hysterectomy versus Vaginal Hysterectomy for Benign Disease: A Prospective Study.

Objectives. A prospective study was carried out to compare vaginal hysterectomy (VH) and robotically assisted hysterectomy (RH) for benign gynecological disease. Materials and Methods. All patients who underwent hysterectomy from March 2010 to March 2012 for a benign disease were included. Patients' demographics per and post surgery results were collected from medical files. A questionnaire was also conducted 2 months after surgery. Results. Sixty patients were included in the RH group and thirty four in the VH one. Operative time was significantly longer in the RH group (132.1 ± 5.7 versus 75.3 ± 6.7 min; P < 0.0001). Blood loss and length of hospital stay were significantly reduced: 47 ± 7 versus 125 ± 20 ml; P < 0.01, and 2.4 ± 0.1 versus 3.3 ± 0.2 days; P < 0.0001, respectively. Less pain was reported at D1 and D2 by RH patients, and levels of analgesia were lower compared to those observed in the VH group. No differences were found regarding the rate of conversion to laparotomy, intra- or postoperative complications. Conclusion. Robotically assisted hysterectomy appears to reduce blood loss, postoperative pain, and length of hospital stay, but it is associated with longer operative time and higher cost. Specific indications for RH remain to be defined.

Germline RAD51C mutations in ovarian cancer susceptibility.

Several genes might explain BRCA1/2 negative breast and ovarian family cases. Deleterious mutations in few genes involved in the Fanconi complex are responsible for Fanconi anemia at the homozygous state and breast cancer (BC) susceptibility at the heterozygous state (BRCA2, PALB2, BRIP1). RAD51C plays an important role in the double-strand break repair pathway and a biallelic missense mutation in the RAD51C gene was found in a Fanconi anemia-like disorder. Subsequently, six monoallelic pathogenic mutations were identified after screening 480 BRCA1/2 negative breast and ovarian cancer (BC/OC) pedigrees. Several reports were unsuccessful to replicate these results. To investigate whether germline mutations in RAD51C are associated with an increased risk of developing BC/OC, we screened, by Sanger sequencing of the coding sequence, 117 index cases of breast and ovarian families from French or European origin, and negative for BRCA1/2 mutations. In our study, we found 3 pathogenic mutations among 117 families screened which corresponds to a 2.6% frequency. Our results confirm that RAD51C is a susceptibility gene for ovarian and BC and that this gene should be screened for mutations in families with multiple BC/OC.

[Robot-assisted coelioscopic proximal tubal reanastomosis]. / Réanastomose tubaire proximale en cœlioscopie robot-assistée.

We report two cases of robot-assisted coelioscopic proximal tubal reanastomosis after proximal tubal ligature. Patients were aged 43 and 34 years respectively and had previously undergone proximal tubal ligation by coagulation section at 37 years of age for the first patient, and by Filshie clip at 24 years for the second one. Both had regular menstrual cycles and their ovarian reserve was good. Their partners were presenting with normal sperm criteria. Proximal tubal reanastomosis was carried out in September 2010 by robotic coelioscopy with five extramucous vicryl 5-0 stitches on each tube and positive blue testing. Total durations of the interventions were 200 and 220minutes respectively. Postoperative outcomes were simple and patients had spontaneous pregnancy at 4 and 2.5 months respectively. Both pregnancies show normal progress currently. This is a contribution to literature data meant to determine the role of robotics in proximal tubal reanastomosis.

[An ovarian mucinous borderline tumour with mixed mural nodules]. / Une tumeur ovarienne mucineuse borderline avec des nodules muraux mixtes.

The occurrence of mural nodules in serous or mucinous ovarian tumours is not frequent. Mural nodule can be developed in benign, borderline or malignant tumours. They can be benign, malignant or mixed type. Thus the prognosis of the ovarian tumour can be dramatically modified by the presence if these nodules. Eighty-two cases of mural nodules were reported in the literature, among which we account four cases of mixed nodules type. We report an additional case of mixed type mural nodules of anaplastic carcinoma and sarcoma-like developed in an ovarian mucinous borderline tumour at a 60-year-old woman.We give details about the classification, the differential diagnosis and prognosis of theses nodules.

[Uterine rupture: risk factors, maternal and perinatal complications]. / Rupture utérine : facteurs de risque, complications maternelles et foetales.

OBJECTIVES: To determine risk factors, maternal and perinatal morbidity and mortality associated with uterine rupture in women with previous caesarean delivery. MATERIAL AND METHODS: We conducted a population-based, retrospective cohort analysis, comparing deliveries with and without uterine rupture in women with uterine scar during a 12-year period. Women attempting a trial of labour were selected with precise criterion. We analysed obstetric history, characteristics of labour, mode of delivery, maternal and perinatal complications. RESULTS: Thirty-six uterine ruptures were registered of which 11 were complete. These complete ruptures occurred at a rate of 0.4% among deliveries in women with previous caesarean delivery (n=2718) and 0.5% among women attempting a trial of labour (8/1440). Twenty-one ruptures (58%) were diagnosed during a trial of labour. Some risks factors were identified like a labor after 41weeks of amenorrhea and no medical history of natural childbirth. There were neither maternal nor neonatal deaths. The major maternal complications were postpartum haemorrhage (13.8%, n=5) and blood transfusion (8.3%, n=3), significantly most frequent than in the control group (p<0.01). No hysterectomy was required. Concerning neonatal morbidity, mean lactate rate was significantly higher for the rupture group. CONCLUSION: The low rate of uterine rupture, maternal and neonatal complications supports a rigorously selection of women attemping a trial of labor. A labor after 41weeks of amenorrhea and no medical history of natural childbirth should be added to common criterion.

[Postpartum perineal pain: effectiveness of local ropivacaine infiltration]. / Douleur périnéale du post-partum: intérêt de l'infiltration locale de ropivacaïne.

GOAL: To assess efficiency of local ropivacaine infiltration in perineal pain after episiotomy and perineal tear during the first 24 h after vaginal delivery. MATERIALS AND METHODS: Case control survey, including 62 consecutive patients with episiotomy and/or perineal tear during two consecutive periods: the ropivacaine group from February 2, 2008 to March 27, 2008 (n=31) and the control group from December 27, 2007 to January 1, 2008 (n=31). In the ropivacaine group, patients received 10 ml of ropivacaine 7,5mg/ml as a local infiltration along the perineal damage. In the control group no injection was done. A numerical pain rating scale (0-10) at four (H4), eight (H8), 12 (H12) and 24 h (H24) was used to evaluate patients post-partum perineal pain. A numerical rating scale was used to evaluate patients satisfaction (0: no satisfied, 5: very satisfied). RESULTS: Numerical pain rating scale for perineal pain evaluation was significantly lower in the ropivacaine group than in the control group at H4 (1.9+/-0.3 versus 3.6+/-0.5, p=0.006), H8 (3.3+/-0.4 versus 5.2+/-0.4, p=0.003), H12 (2.8+/-0.4 versus 5.2+/-0.4, p=0.0001) and H24 (2.6+/-0.4 versus 4.3+/-0.4, p=0.006). Numerical rating scale for satisfaction evaluation was significantly higher in the ropivacaine group (4.2+/-0.2 versus 3.5+/-0.2, p=0.004). CONCLUSION: Local ropivacaine infiltration in episiotomy and/or perineal tear reduce post-partum perineal pain within the first 24 h.

[Vaginal or laparoscopic assisted vaginal myomectomy: interest in the double way]. / Myomectomie par voie vaginale ou coeliovaginale : intérêt de la double voie d'abord.

OBJECTIVES: To evaluate vaginal and laparoscopic-assisted vaginal myomectomy in order to find interest and indications of this two-way approach of myomectomy. PATIENTS AND METHODS: Retrospective study of 60 patients operated of a myomectomy by vaginal or laparoscopic-assisted vaginal way between December 1999 and January 2007. RESULTS: Thirty-three patients (55%) profited from an exclusive vaginal myomectomy (group 1) and 27 (45%) from a laparoscopic-assisted vaginal myomectomy (group 2). The vaginal gesture in group 2 was carried out mainly because of difficult dissections of deep interstitial myomes (60%) or for the closing of hysterotomies not accessible by coelioscopic way (40%). Mean operating time, blood loss and length of hospital stay were 120 minutes, 431 ml, 3.2 days in group 1 and 180 minutes, 437 ml, 5.1 days in group 2, respectively. Laparoconversions and notable complications rates were 9% in group 1 and 15% in group 2. DISCUSSION AND CONCLUSION: Laparoscopic-assisted vaginal myomectomy is interesting to widen indications of laparoscopic way for myomectomy. However, considering complications and rate of laparoconversion, it is necessary to define situations against indicating this gesture. The methods of prevention of the infection also remain to be found.

[Candida glabrata chorioamnionitis following in vitro fertilization]. / Chorioamniotite à Candida glabrata après fécondation in vitro.

We report one case of severe Candida glabrata chorioamnionitis and septicemy occurring in a twin pregnancies achieved by in vitro fertilization techniques which resulted in pregnancy loss after preterm rupture of the membrane at 22 weeks of gestation despite a treatment with amphotericin B.

[Vasa previa: one case]. / Vasa praevia: à propos d'un cas.

Vasa previa is a rare condition (1/2000 to 1/5000) in which the rupture of membranes may result in fetal haemorrhage (Benckiser's haemorrhage). We report one unusual case of delayed Benckiser's haemorrhage 12 hours after rupture of membranes. We point out the risk situations in which prenatal diagnosis should particularly be sought: low-lying placenta at routine second trimester ultrasound screening, bilobate or succenturiate placenta, velamentous insertion of the umbilical cord, in vitro fertilization. A universal screening, as proposed by certain authors, is also discussed.