[Effects of a policy for reasonable use of oxytocin during spontaneous labor at term]. / Impact d'une politique d'utilisation raisonnée de l'oxytocine de synthèse lors du travail spontané à terme.

OBJECTIVE: To assess the effect of a modified definition of dystocia and of a different timing of interventions during spontaneous labor on the rate of oxytocin use and on its consequences on labor outcome. METHODS: We compared oxytocin use and labor outcome before and after the introduction of a new protocol for the management of spontaneous labor. By protocol, oxytocin use and/or artificial rupture of the membranes was restricted to cases without progress in cervical dilatation for≥1h and/or no progress of fetal descent for≥1h at full dilatation. The main outcome measure was the rate of oxytocin use. Secondary outcome criteria were the consequences on labor (duration of labor, tachysystole and uterine hyperstimulation, abnormal fetal heart rate, cesarean delivery rate) and neonatal outcome. RESULTS: Oxytocin use was strongly reduced from 2015 (69.2%) to 2016 (39.8%; P<0.01) and 2017 (31.9%; P<0.01). Abnormal FHR rates decreased simultaneously (respectively 52%, 37% et 29%, P<0.05), as well as uterine hyperstimulation (respectively 33.6%, 21.3% et 23.0%; P<0.05). The cesarean delivery rate did not vary significantly from 2015 (11.5%) to 2016 (8.4%; NS) but it decreased from 2015 to 2017 (11.5% to 2.6%, respectively; P<0.05). No difference was found in postpartum hemorrhage rates or in neonatal outcome. The duration of labor was significantly longer for women who delivered in 2017, compared with 2015 (372 minutes versus 306 minutes, respectively; P<0.05). After multivariate analysis, FHR abnormalities were reduced (aOR 0.65 IC 95% [0.49-0.86]) as well as cesarean deliveries during labor (aOR 0.5 IC 95% [0.26-0.97]) in 2017 only, compared with the reference year 2015. CONCLUSION: A simple and easy-to-use definition of dystocia and of interventions required during labor allowed a strong reduction of oxytocin use during labor with subsequent benefits such as reduced rates of FHR abnormalities, uterine hyperstimulations and cesarean deliveries, at the cost of a limited prolongation of labor, mainly in nulliparous women.

[Protective effect of diclofenac towards the oxidative stress induced by paracetamol toxicity in rats]. / Effet protecteur du diclofénac contre le stress oxydatif induit par la toxicité du paracétamol chez le rat.

Association of paracetamol (PARA) and diclofenac (DiCF) is the aim of our study. 60 male rats "Albinos wistar" were treated by oral gavage (per os) during seven days. A control group was treated by mineral water (0+0) mg/kg and a second group was treated with only a toxic dose of 100 mg/kg of PARA (100+0). Remaining lots were treated with a combination of different toxic doses of PARA and a therapeutic dose of DiCF (15+3, 100+3, 200+3 and 400+3) mg/kg. Plasma concentration of amiotransferases (ASAT, ALAT), alkalines phosphatase (ALP), glutathione peroxidase (GPx), glutathione reductase (GR), glutathione (GSH), glucose, cholesterol, creatinin, direct and total bilirubin, significantly varied in the treated rats regarding to the witness's rats. The toxicity of PARA revealed by a dose dependant blood increases of ASAT, ALAT, ALP, GPx, GR, glucose, creatinin, bilirubin, and by decreases of cholesterol concentration and tissue GSH in comparisons to controls. The depletion of GSH and the increase of the oxidative stress enzymes (GPx and GR) suggest a detoxification function of the glutathione system. The association (PARA + DiCF) revealed a protective effect, resulting in the increase of the concentrations of ASAT, ALAT, ALP, GPx, GR, bilirubin and the increase of GSH. Regarding to all these results, it has been suggested that DiCF has a protective action towards the toxic effects of PARA.

[Management of ovarian cysts]. / Prise en charge des kystes ovariens.

Ovarian cysts occur frequently in women of reproductive age. These are usually functional cysts which resolve spontaneously and whose evolution can be followed with ultrasound. Non-functional cysts have diverse histologic origins. The most common are serous and mucinous cystadenomas which arise from the epithelial wall of the ovary, endometriomas which arise in the setting of pelvic endometriosis, and dermoid cysts which arise from the germinal cells of the ovary. Endovaginal ultrasound with Doppler enhancement is the best imaging technique to establish the nature of cysts and to distinguish cysts suspicious for malignancy which require more invasive investigation. Pelvic laparoscopy is the surgical approach of choice for the treatment of non-functional benign ovarian cysts. Conservative treatment to shell out the cyst and preserve functional ovarian tissue should be reserved for women desirous of future pregnancies. The risk of ovarian cancer remains a major preoccupation of the surgeon. Where malignancy is suspected, laparoscopy is contraindicated and a median laparotomy is appropriate for radical extirpative surgery. This article describes the diagnostic techniques which allow a laparoscopic approach to presumably benign cysts and discusses surgical techniques specifically adapted to their different histologic nature of ovarian cysts.