[Management of other ectopic pregnancies (cornual, interstitial, angular, ovarian)]. / Prise en charge des autres ectopies annexielles (cornuale, interstitielle, angulaire, ovarienne).

OBJECTIVES: To provide recommendations for management of interstitial and ovarian pregnancies. MATERIALS AND METHODS: A Medline search was conducted and discussed by a study group of experts. RESULTS: Ovarian and interstitial pregnancies are rare forms of ectopic pregnancy. Diagnostic criteria and methods are described on the basis of a review of the literature. Surgery is the usual management of interstitial pregnancy. Conservative treatment has replaced hysterectomy. Laparoscopy is an attractive way to manage interstitial pregnancies but laparotomy may still be used. Cornual resection is required. Medical treatment with methotrexate is another alternative. Local MTX seems to be more efficient than systemic administration. Management of interstitial pregnancy under laparoscopic control is an attractive way if feasible. Strong recommendations cannot be established due to the small number of reported cases reports. The pre therapeutic score cannot be used as doses are still not clear for interstitial pregnancies. For ovarian pregnancy, management is often surgical. Laparoscopy is more and more used for small gestational sacs. Methotrexate has also been used for ovarian pregnancies. Laparoscopic treatment associated with systemic MTX seems to be the more efficient way. CONCLUSION: Because of limited data it is very hard to establish recommendations from low power studies (NP 5).

Patient-controlled epidural analgesia during labor: the effects of the increase in bolus and lockout interval.

UNLABELLED: Most studies use a bolus size of <6 mL of 0.125% bu- pivacaine for patient-controlled epidural analgesia (PCEA) during labor. In this double-blinded, randomized study, we compared the efficacy of a larger bolus injected via a PCEA pump to a conventional PCEA setting. By using a combination of 0.125% bupivacaine with 1:800,000 epinephrine and 0.625 microg/mL sufentanil, the first PCEA setting was typical (4 mL/8 min), whereas the other combined a 12-mL bolus dose and a 25-min lockout interval, i.e., similar maximal hourly dose. Rescue analgesia was provided with 6 mL of 0.25% bupivacaine. Patient satisfaction and pain were scored on verbal and visual analog scales. Data were analyzed from 103 parturients in the 12-mL/25-min group and 100 in the 4-mL/8-min group. In the 12-mL/25-min group, the median pain score on a 0- to 10-cm visual analog scale was lower at 6-cm cervical dilation (1 [range = 0-8] vs 3 [0-8]) and at delivery (1 [0-10] vs 2 [0-10]). Satisfaction was also better (70% vs 38% "excellent" opinions, at 6-cm cervical dilation). Use of the pump (ratio of successful and total demands) was high and similar in both groups. Rescue analgesia was comparable. Doses of analgesics were greater in the 12-mL/25-min group (hourly bupivacaine dose = 13.9 +/- 5.3 [mean+/- SD] vs 9.4 +/- 4.1 mg). No differences were noted between groups for the severity of hypotension, ephedrine requirement, outcome of the delivery, and Apgar scores. IMPLICATIONS: A patient-controlled epidural analgesia setting that allows a parturient to receive an increased analgesic dose improves satisfaction with patient-controlled epidural analgesia during labor.

Induction of labor with mifepristone (RU 486) in intrauterine fetal death.

In a double-blind controlled multicentric study involving 94 patients with an intrauterine fetal death, we investigated the efficacy and tolerance of mifepristone (RU 486), a steroid compound that antagonizes progesterone action at the receptor level. Success of treatment was defined as the occurrence of fetal expulsion within 72 hours after the first drug intake. Mifepristone treatment (600 mg per day for 2 days) was considered to be effective in 29 of 46 patients (63%). There were only eight successes in 48 patients (17.4%) in the placebo group (p = 0.001, chi 2 test). Tolerance was good in the mifepristone group. In the placebo group, disseminated intravascular coagulation occurred in one woman for whom the investigator waited several weeks for spontaneous expulsion. This large double-blind controlled study provides evidence that mifepristone is of interest in the management of intrauterine fetal death. It could provide a pharmacologic alternative to the use of prostaglandins in this indication.

[Antithrombin III deficiency and pregnancy. Apropos of a case]. / Déficit en antithrombine III et grossesse. A propos d'un cas.

Congenital deficiency of antithrombin III is a disease inherited as an autosomal dominant which predisposes to thromboembolism. Pregnancy and the postpartum period constitute a major additional risk factor for thromboembolism in deficient women. However, pregnancy may be envisaged without risk since there has been an improvement in knowledge concerning the physiology of the AT III molecule, its exact role in coagulation, the application of accurate laboratory tests which measure the deficiency, and especially the programming of pregnancy under cover of preventive treatment consisting of the perfusion of AT III concentrate in association with heparin. The treatment is restricting and costly but is, nevertheless, the only one to recreate conditions that are similar to physiological conditions, and its effect is therefore more certain.

Renal, pancreatic and hepatic dysplasia sequence.

A renal, pancreatic and hepatic dysplasia sequence (RPHD sequence) was found in a male premature baby who died a few minutes after birth. Autopsy documented multicystic dysplastic kidneys, a dysplastic pancreas with dilated ducts, cysts, fibrosis and inflammatory infiltrates, prominent portal tracts containing dilated bile ducts and hypoplastic lungs. Other organs were normal. This triad constitutes a "dysplastic sequence" and was first reported by Ivemark et al. as "familial dysplasia of kidneys, liver and pancreas". Since then, this combination of abnormalities has been named "polycystic dysplasia" and "renal-hepatic-pancreatic dysplasia", but mostly "Ivemark syndrome", at the risk of being confused with asplenia-cardiac anomaly syndrome, which was reviewed by Ivemark et al. and also bears Ivemark's name.

[Anorexia nervosa and pregnancy]. / Anorexie mentale et grossesse.

We report the case of a pregnancy associated with severe anorexia nervosa. The patient weighed 33 kg for 1 m 51 at conception. The pregnancy was obtained during a spontaneous cycle. Despite nutritional and psychological case, the patient continued to lose weight and weighed only 28 kgs at 33 weeks of amenorrhea, when she gave birth to a hypotrophic child of 1130 gr after artificial starting. The case provides discussion of the relation ship between anorexia nervosa and pregnancy.

[Uterine rupture after tubal reimplantation]. / Rupture utérine après réimplantation tubaire.

The authors report a case of rupture of the right cornu of the uterus in the ninth month of pregnancy in a woman who had had her right tube implanted into her uterus. This complication is considered, in the discussion, to be rare. It is very difficult to prevent it happening during pregnancy. It would seem that a prophylactic caesarean operation should be carried out if the insertion of the placenta is in the area of the implantation.

[Cancer of the ovary and pregnancy. Apropos of 4 cases]. / Cancer de l'ovaire et grossesse. A propos de 4 cas.

The value and the limitations of echo scans and extemporaneous examination in four cases are reported. Any adnexial organic tumour should be treated in the knowledge that it could be a cancer of the ovary. This is the only possible approach for avoiding contamination during surgery insufficient exoresis and the necessity of further intervention.

[Pregnancy in the diabetic woman]. / La grossesse chez la diabétique.

The authors review ten years of caring for pregnant diabetic women. They adhered rigidly in these ten years to two fundamental principles, which were the need to ensure rigorous control of blood sugar levels, and the value of waiting to the 37th or 38th week before starting labour whenever the fetus did not seem to be particularly at risk. Their attitude, which has stayed remarkably constant, is different from that of many other authors who during this same period started by stopping the pregnancy prophylactically between the 34th and 36th week but later allowed labour to start sometimes spontaneously at a later stage as knowledge of feto-maternal mechanisms increased and methods of supervising these patients improved.

[Transitory hydronephroses after the Marshall-Marchetti operation. A case history (author's transl)]. / Hydronéphrose transitoire après opération de Marshall-Marchetti. A propos d'un cas.

The authors report an unusual complication following the correction of a case of stress incontinence by vesico-urethral suspension using the Marshall-Marchetti procedure. They observe the rapid onset of an unilateral uretero-hydronephrosis which was due to oedema of the right vesico-ureteral junction and which was cured by a short treatment, with corticoids.