[Endometriosis with massive hemorrhagic ascites: a case report and review of the literature]. / Endométriose et ascite hémorragique massive récidivante: cas clinique et revue de la littérature.

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. It generally involves the peritoneum, ovaries and rectovaginal septum. Its characteristic symptoms include dysmenorrhea, pelvic pain, deep dyspareunia and infertility. It may also involve the gastrointestinal tract, urinary tract or extra abdominal sites, giving rise to a wide variety of clinical symptoms such as bloody stools, renal haemorrhage, hemoptysis and pleural effusion during menstruation. Recurrent hemorrhagic ascites secondary to endometriosis is an unusual occurrence, 41 cases have been reported since 1954. Here we report an additional case, in order to draw attention to this condition. A 28 years-old black nulligravida woman was seen for the first time in april 2000 with a chief complaint of infertility. Her past medical history was unremarkable. She had regular menses but associated with severe dysmenorrhea. She also recalled abdominal and pelvic pain for several years. She underwent an ovulation induction with gonadotrophin, which resulted in a progressive increase of pelvic pain. A first laparoscopy was performed, revealing voluminous ascites (10 I). Two years later the ascites recurred spontaneously. Ultrasound examination revealed suspect "para uterine masses". A second exploratory laparoscopy showed a voluminous bloody ascites (71), and extensive adhesions. On histologic examination all specimens (peritoneal biopsies) were compatible with endometriosis and ruled out malignancy. Treatment with Gn RH analog was performed and full remission was obtained after 6 months. One year later the ascites recurred again spontaneously, leading to a third laparoscopy in an other medical institution. Histologic examination showed endometrial stromal tissue and fibrous proliferation. Later she became pregnant after in vitro fertilization. In the first trimester of pregnancy, the pelvic ultrasound showed only a small effusion in the pouch of Douglas. Still, the ascites did not progress during pregnancy. The patient was hospitalized from 27 to 33 weeks of gestational age for threatened labor, but she finally had a normal vaginal delivery at 36 weeks of gestational age. Four months later, she had no complaint, but the pelvic ultrasound showed the recurrence of the ascites. She will have a drainage. The future treatement will consists of GnRH analog for about six months, which will be relayed by a long term progestative therapy. A diagnosis of endometriosis should always be considered in middle-age women who presents with bloody ascites. Long follow-up is advisable for patients who undergo conservative treatment because of thehigh risk of recurrence.

[Human immunodeficiency virus and pregnancy: a retrospective study of 124 women]. / Infection à VIH et grossesse : étude retrospective de 124 cas.

The objective is to describe medical and obstetrical prenatal care of 124 HIV-infected pregnant women in the Hôpital Delafontaine, Saint-Denis, France, between 1995 and 2001.Demographic, clinical and biological characteristics of study population were retrospectively collected. Three (2,4%) children were infected.

[Rheumatoid purpura (or Schoenlein-Henoch syndrome) and pregnancy. Review of the literature and a case report]. / Purpura rhumatoïde (ou syndrome de Schönlein-Henoch) et grossesse. Revue de la littérature à propos d'un cas.

Schönlein-Henoch purpura is a clinical syndrome of generalized vasculitis manifested by a petechial or ecchymotic purpuric skin rash, renal manifestations, abdominal pains (or gastro-intestinal bleedings) and arthralgias. This syndrome of unknown etiology usually occurs in children, predominantly in males, but has been reported in adults. Very little is known about the effect of this disorder on pregnancy and vice-versa. We report here our first case of Schönlein-Henoch purpura in a pregnant woman. A-38-year-old maghrebin woman gravida 4 para 3 was admitted to the hospital at 23 weeks'gestation with symmetrical arthralgias of the knees and ankles, and skin rash. Crops of nontender purpura were present on legs, buttocks and arms. The skin biopsy specimen revealed leukocytoclastic vasculitis with immunoglobulins A deposits. The prognosis has been excellent, kidney function was not compromised, and the outcome of the pregnancy was good. Only eight previous reports of Schönlein-Henoch purpura in pregnant women have been noted in the literature. The effect of pregnancy on the course of this syndrome remains unclear, and the treatment of relapses during pregnancy is unknown. Generally treatment is symptomatic only. The efficiency of steroid therapy has not been proved. During pregnancy the course of this disease is unforeseeable. Some patients' symptoms remain stable, other patients can suffer either new onset or exacerbation of the syndrome. The third trimester can be complicated by superimposed pregnancy induced hypertension, pre-eclampsia or eclampsia.

[Placenta membranacea. Review of the literature, a case report]. / Placenta membranacea. Revue de la littérature, à propos d'un cas.

Placenta membranacea or placenta diffusa is a rare abnormality in which all or most of fetal membranes remain covered by chorionic villi, because the chorion has failed to differenciate into chorion laeve and chorion frondosum. This condition is associated with recurrent antepartum bleeding, abortion in the second trimester of the pregnancy, preterm delivery, fetal death, intra-uterine growth retardation, post partum haemorrhage and placental retention. In this paper, we report our first case of placenta membranacea. A 30-year-old black woman, gravida 3, para 1, was admitted at 23 weeks of gestation for vaginal bleeding. She was placed on complete bed rest. Ultrasonographic examination showed a placenta covering the anterior and posterior uterine walls and the internal cervical os. At 28 weeks and 34 weeks of gestation, ultrasound examination showed the same findings: total placenta previa covering the entire uterine wall and presenting many lacuna. At 38 weeks, she underwent a cesarean section. The placenta adhered firmly to the myometrium. Because the attempts to remove the placenta was unsuccessful, it was performed a total hysterectomy. The total blood loss was 7000 ml. Anatomo-pathologic examination of the placenta led do the diagnosis of placenta membranea, total previa and increta. In the literature, 35 cases of placenta membranacea have been reported; of these, there are ten cases associated with total hysterectomy.

[Peritoneal and tubal Schistosoma haematobium bilharziasis. Two case reports]. / Bilharziose péritonéo-tubaire à Schistosoma haematobium. A propos de 2 cas.

It is now recognized that eggs of Schistosoma haematobium are most commonly found in the bladder because this parasitic infestation usually affects the urinary tract. However, numerous papers have been published on the occurrence of schistosomiasis of the female genital tract. The frequency of distribution of schistosomal disease of the genital tract has not been estimated because only cases with overt disease are usually considered. The involvement of Fallopian tubes is not rare in endemic areas and may predispose to ectopic pregnancy and infertility. In this paper, we report two cases of Schistosomiasis in black African women due to Schistosoma haematobium localized in the peritoneum and the Fallopian tubes. Our first patient had primary infertility associated with bilateral hydrosalpinx and peritoneal inflammatory reaction. Our second patient had an ectopic pregnancy associated with chronic salpingitis. In the both cases, histological examination showed the presence of schistosomal eggs in the peritoneum and the Fallopian tubes. These cases suggest that bilharziasis should now be considered as a urogenital disease and not only as an urinary tract disease.