[Ultrasonography in the management of massive postpartum hemorrhage by Blakemore tube tamponade]. / Apport de l'échographie dans le tamponnement intra-utérin par sonde de Blakemore en cas d'hémorragie grave de la délivrance.

A previous study (2004) evaluated the efficiency and specified the indications of the Blakemore tube tamponade used in the treatment of massive postpartum haemorrhage. During the management of the last case, the insertion of the Blakemore tube was controlled by using ultrasonography. The use of ultrasonography could be helpful to diagnose and explain more quickly the cases of failure, improve the technics by adapting the volume of balloon catheter for optimal tamponade treatment and propose the creation of a new specially designed ovoid balloon catheter.

Use of Sengstaken-Blakemore tube in massive postpartum hemorrhage: a series of 17 cases.

BACKGROUND: To evaluate the efficacy and identify the indications of intrauterine tamponade with a Sengstaken-Blakemore tube in acute postpartum hemorrhage. METHODS: Retrospective study was performed in 17 female patients with massive postpartum hemorrhage despite appropriate medical treatment, and requiring surgery (embolization techniques were not available in our hospital). Patients were treated by inserting a Sengstaken-Blakemore tube in the uterus through the vagina in case of vaginal delivery or through the hysterotomy incision in case of cesarean section. The esophageal balloon was inflated with 250 ml of isotonic saline solution. Patients underwent regional or general anesthesia. A preventive treatment with broad-spectrum antibiotics was systematically administered. RESULTS: Tamponade treatment prevented surgery in 88% of patients, hemorrhage was controlled in 71% of cases (reducing the need for embolization by 80%), and waiting for a transfer for embolization was made possible for 18% of patients. CONCLUSION: Intrauterine tamponade with a Sengstaken-Blakemore tube appears as a simple, low-cost, readily available and effective means of treating life-threatening postpartum hemorrhage. The only apparent contraindication is the discovery of an infection during delivery.

[Recurrent cholestasis in pregnancy. Apropos of 6 case reports]. / Cholestase récurrente de la grossesse. A propos de 6 observations.

The follow-up of several cases of pruritus during pregnancy in 15 months in our department, gives us the opportunity to discuss pregnancy related jaundice. In comparing the frequency figures in the literature, our rate of cholostasis during pregnancy is abnormally high (1/270th). This picture is characterized by a gradually increasing pruritus. Jaundice may be absent, usually moderate. The laboratory tests are dominated by the cholostasis; the cytology is non-existent or moderate, which differentiates it from viral and toxic jaundice. The maternal prognosis is good and usually return to normal occurs 8 to 15 days after delivery. The fetal prognosis is unpredictable and reserved. We noticed: frequent fetal distress, with the possibility of fetal death; the treatment is only symptomatic and includes: the association pregnancy-cholostasis makes this pregnancy a risk pregnancy--when fetal maturity is acquired, the choice between high approach and low approach depends on the circumstances-contraception.

[Evolution of the indications for cesareans. Comparison of 1971-1976 and 1976-1979 at the Maternity Center of the Louis-Mourier Hospital. Review of the literature]. / Evolution des indications de césariennes. Comparaison entre 1971-1976 et 1976-1979 à la Maternité de l'Hôpital Louis-Mourier. Revue de la littérature.

Changes in the indications for caesarean operations were studied over a period of 9 years from 1971-1979 and two periods from 1971-1975 and 1976-1979 were compared. The principal changes that show up are: an increase in the total number of caesarean sections from 5.3% in 1971 to 15.4% in 1979; modifications in the indications which were mainly due to much greater use of electronic means of monitoring the fetus and an improvement in the methods of resuscitation of the newborn (there were approximately the same number of caesareans for breech presentations, an increase in the number of repeat caesarean operations and of caesarean operations for fetal distress and for dystocia as well as for toxaemia of pregnancy); the improvement in the state of infants at birth seems to be parallelled by the increase in the number of caesarean operations. Though there was 8% neonatal morbidity, only 1% of these at the most could be put down to the caesarean; no maternal death occurred, although caesarean section is accompanied by an increased maternal morbidity of 27%. Reviewing the literature shows that the same tendencies occur in other places. This makes it possible to point out the ways in which action can be taken to limit the number of caesareans in those categories where the indications seem to be most frequent, namely dystocia, repeat caesareans, fetal distress and breech presentation. The optimum level of caesarean sections at 15% with 9% being first caesareans and 6% repeat caesareans should be kept to.

[Assay of plasma hCG. Our experience with the diagnosis of extra-uterine pregnancies. Apropos of 45 cases]. / Dosage de hCG plasmatiques. Notre expérience dans le diagnostic des grossesses extra-utérines. A propos de 45 observations.

Two groups of patients who were admitted to hospital with a possible diagnosis of ectopic pregnancy were compared. The levels of HCG in the plasma were obtained as an emergency in the first group (45 cases). The levels were not obtained in the second group (34 cases). Only those cases in the first group where the assays had shown the presence of HCG underwent laparoscopy: 12 laparoscopies revealed 7 extra-uterine pregnancies. In the second group, on the other hand, all 34 patients had laparoscopy; only 8 extra-uterine pregnancies were discovered by this method. Because of this study we found that when HCG assays were carried out there was no false positive or negative. When we wanted to rule out an L.H. peak in a doubtful case the assay was repeated. The comparison between the two groups underlines the importance of carrying out the assay: it avoids useless laparoscopies but it also shortens the length of stay in hospital.

[Genital prolapse in elderly women (150 cases) (author's transl)]. / Les prolapsus génitaux de la femme du troisième âge (150 cas).

A series of 150 operations, by the same surgeon, for genital prolapse in women over 60 years of age (range to 85 years), represented 36% of the total number of operations for prolapse performed. A total of 32 women had had previous prolapse operations, 24 developed prolapse after hysterectomy, and 11 had postoperative colpoceles. This means that 45% had iatrogenic lesions, term in fashion at the present time but which strongly emphasizes the role played by insufficiently defined operative indications, and operations conducted without sufficient rigour. The most frequent lesions, were firstly cystoceles, then external prolapses, followed by hysteroceles. Urinary incontinence was evident in 15%, and potential in at least 10% of continent women. The lower approach was employed for the operation, either obturating or conservative, in most cases. When the upper approach was used, this was mainly for pathogenic purposes, and adapted to the lesion. Overall results were excellent, and only two irreversible accidents occurred. Recurrences were mainly in the form of cystoceles, micturition disorders, or sometimes rectocele sequelae. Increased life-span and improved operative treatment should make the surgery of prolapse in elderly women even more effective.

[Automatic measuring of uterine activity in labour. The relationship between this new parameter, fetal cardiac rhythm and the state of the infant at birth]. / La mesure automatique de l'activité utérine pendant le travail. Relations entre ce nouveau paramètre, le rythme cardiaque foetal, et l'état de l'enfant à la naissance.

In 163 cases uterine activity in labour was measured in 15 minutes periods, thanks to a new monitoring apparatus that works out the sum of the areas of uterine contraction (A U 15). In this way a regular statistical estimation of labour is given in kilopascals x second. The fetal state during labour and at birth is studied as a function of this new parameter. The following important therapeutic consequences can be derived from it: 1) Uterine activity should be damped down when this exceeds 1,500 kilopascals x second over 15 minutes. In fact, fetal cardiac rhythm alterations occur very frequently in these cases during the first stage of labour (55% of cases). 2) In labour it would seem to be worth while, if caesarean operation has not been judged to be necessary, to deliver the baby by instruments (to lessen the length of time of expulsion) when the mean of uterine activity over the 15 minutes (m A U 15) has exceeded 1,500 kilopascals x second, if this has been associated with even the smallest variations of the heart rate during the first stage of labour. In fact, a low apgar score and an acidotic pH occur frequently in these cases.

[Suppurative endometritis of a pregnancy. A diagnosis made during a caesarean operation (author's transl)]. / Endométrite gravidique abcédée. Un diagnostic au cours d'une césarienne.

An endometritis with abscess formation in pregnancy is very rare. A case that was discovered during a caesarean operation is described. The diagnosis is difficult because there is not much in the way of symptoms. The aetiology could be an infection of the cervix and vagina, a long-standing endometritis or a maternal extra-genital infection. Apart from antibiotic therapy the best treatment seems to be as conservative as possible.

[The advantages and disadvantages of ultrasound scanning in the diagnosis of ectopic pregnancies (author's transl)]. / Intérêt et inconvénients de l'échograhie dans le diagnostic des grossesses extra-utérines.

There is no need any more to demonstrate the value of echotomography in the diagnosis of extra-uterine pregnancies. All the same, the authors want to point out in the light of two cases they have had the rare, but real risk of errors made because of deficiencies in echography, which because they have excluded extra-uterine pregnancy lead to a delay which can be considerable in diagnosis. The first section deals with the features of diagnosis to be considered in extra-uterine pregnancy (an empty uterine cavity or, on the other hand, the presence of a pregnancy sac in the uterus; rarely the picture of an ovum in an ectopic position, but more often the picture of a haematosalpinx or a haematocoele). The risks of making mistakes because of insufficient information are described. These mistakes can be of serious consequence because they delay using the laparoscope (particularly likely to occur if there is the presence of a pseudo-sac of pregnancy due to separation of the decidua). Finally, the risks of making mistakes by having too much information are spelt out. These are less serious because they do lead to the use of the laparoscope. (They are wrongly diagnosed ovarian cyst, hydrosalpinx and double uterus.) In the last section the statistics given by various authors are reviewed.