[Postpartum depression: prevalence and risk factors. A prospective Study concerning 302 Tunisian parturients]. / La dépression du postpartum: prévalence et facteurs de risque Etude prospective concernant 302 parturientes tunisiens.

BACKGROUND: Depression is a common condition especially in the postpartum. It exposes mothers, newborns and couples for psychosocial complications. AIMS: They were to estimate the prevalence of the depression in postpartum in a population of 302 Tunisian parturients and to identify its associated factors. METHODS: Our study was prospective, in two stages: at the first week (T1), then between sixth and tenth week of the postpartum (T2). The study was conducted at CHU Hédi Chaker in Sfax, Tunisia. We used the Arabic version and validated the Edinburgh Postnatal Depression Scale (EPDS) for screening for postpartum depression. We used the scale MSSS. "Maternity Social Support Scale"to assess the social and family support and the Azrin scale to evaluate the satisfaction of the conjugal relationship. An epidemiologic questionnaire was used to collect the sociodemographic and clinical data. RESULTS: At T1, 302 women were examined. At T2, 139 were reexamined (46% of the initial population). In the first stage, the prevalence of the intense postpartum blues, according to EPDS, was 19,2%. In the second stage, the prevalence of the postnatal depression was 12, 9%. Factors associated with postpartum blues intense were the low socioeconomic status (p =0, 01), a lower educational level (p = 0,017), the poor marital relationship (p =0, 04), an insufficient social support (p 0,001), the difficulty to accept pregnancy (p =0,001), the presence of psychiatric the presence of psychiatric history (p =0,001), the prematurity (p =0,001) and an ill newborn birth (p =0,001). Factors associated with the post natal depression were the low socioeconomic status (p =0,01), the poor marital relationship (p =0,034), difficulty with pregnancy (p =0,001) and the presence of psychiatric history (p =0,001). CONCLUSION: Postpartum depressions are common. It seems to be the result of the interaction of several biological, psychological and social factors. This suggests the importance of screening for women having such risk factors to prevent the installation of this depression. This detection should be done early in postpartum or else in the later postnatal consultations. This allows an adequate treatment for the mothers, for the relationship mother-new born and later, for the psychological equilibrium of the child.

The effects of backpack load and carrying method on the balance of adolescent idiopathic scoliosis subjects.

BACKGROUND CONTEXT: Concerns have been raised about the effect of backpack carrying on adolescent balance. For adolescent idiopathic scoliosis (AIS) subjects, the effect of backpack carrying method on their balance has not been determined. Our aim is to examine the effects of backpack load and carrying method on AIS subjects' balance. STUDY DESIGN/SETTING: Paired sample matched for age and sex. PATIENT SAMPLE: Twelve healthy adolescents matched for age and sex with 14 adolescents with mild AIS participated in this study. OUTCOME MEASURES: A test battery including clinical examination, radiological assessment, and stabilometric measurements of the postural sways in the upright standing posture were conducted. METHODS: Center of pressure excursions of our subjects were recorded with a stabilometric platform during the upright standing posture without a backpack and while carrying a backpack symmetrically and asymmetrically on each shoulder. For each carrying method, the backpack is loaded at 10% and 15% of body weight (BW). RESULTS: Our results indicated that postural sways increased with increasing backpack load. These postural sways were observed when normal adolescents carried a backpack loaded with 15% BW load, whereas, for age- and sex-matched AIS subjects, these postural responses were observed for the 10% BW load. The symmetrical backpack carrying induced better balance compared with the asymmetrical one. Asymmetrical carrying on the convex side of the scoliotic curve affects AIS subjects' balance more than carrying it on the concave side. CONCLUSIONS: Load carriage of 10% BW seems to alter AIS subjects' balance. Asymmetrical carrying should be avoided especially on the convex side of the scoliotic curve because it causes balance impairments that may increase spinal pain.

Gonadal dysgenesis and the Mayer-Rokitansky-Kuster-Hauser Syndrome in a girl with a 46, XX karyotype: A case report and review of literature.

Mayer-Rokitansky-Kuster-Hauser (MRKH) is a characteristic syndrome in which the Mullerian structures are absent or rudimentary. It is also associated with anomalies of the genitourinary and skeletal systems. Its association with gonadal dysgenesis is extremely rare and appears to be fortuitous, independent of chromosomal anomalies. We report such a case in a 21-year-old girl who presented primary amenorrhea and impuberism. The endocrine study revealed hypergonadotrophic hypogonadism. The karyotype was normal, 46, XX. No chromosome Y was detected at the fluorescence in situ hybridization (FISH) analysis. Internal genitalia could not be identified on the pelvic ultrasound and pelvic magnetic resonance imaging. Laparoscopy disclosed concomitant ovarian dysgenesis and MRKH syndrome. There were no other associated malformations. Hormonal substitution therapy with oral conjugated estrogens was begun. The patient has been under regular follow-up for the last two years and is doing well.

Antenatal macrosomia prediction using sonographic fetal abdominal circumference in South Tunisia.

INTRODUCTION: Identifying newborns who weight 4000 g or more is important because birth of macrosomic fetuses is associated with adverse peripartum outcomes. Ultrasound is widely used for this purpose Our objective was to evaluate the diagnostic value of sonographic measurement of fetal abdominal circumference (AC) over 350 mm for the prediction of fetal macrosomia and shoulder dystocia, to specify factors that could generate errors in its measure. METHODS: A retrospective clinical trial was conducted at the Department of Obstetrics and Gynecology, Hédi Chaker Hospital, Sfax, Tunisia. The study consisted of comparing two groups of singleton newborns: the first group (n=465) includes macrosomic babies and the second group (n=465) includes the non macrosomic ones. All women underwent sonographic measurements of the fetal abdominal circumference (AC) within 72 hours before delivery. The AC values were correlated to actual fetal birth weight. The cut-off value of AC for predicting of fetal macrosomia was analyzed. RESULTS: A cut-off value of abdominal circumference ≥ 350 mm, in predicting of fetal macrosomia., had a sensitivity, specificity, accuracy, positive predictive value, and negative predictive value: 78.7%, 76.8%, 77%, 92.6%, and 49.2%, respectively. In macrosomic group obesity was significantly more frequent when AC ≥ 350 mm. CONCLUSION: The fetal AC measurement was useful in predicting of fetal macrosomia. An AC measurement AC ≥ 350 mm could help to suspect shoulder dystocia.

[Sexuality and contraception: a prospective study of 85 cases]. / Impact de la pilule œstroprogestative sur la sexualité: Étude prospective à propos de 85 cas.

BACKGROUND: Contraception opposing procreation interferes with the primary purpose of sexuality. Few studies have yet been made on the actual interaction between contraception and sexuality. AIM: To study contraceptive practices ie non medicalized contraception and oral contraception, study aspects of women's sexuality and to study the physiological impact and psychological contraception on women's sexuality. METHODS: Prospective and analytical study conducted over a period spanning from October 2008 to February 2009. This study was based on a survey, carried out through an oral questionnaire to 85 women in reproductive age, married, with contraceptive-based pill or natural birth control for at least one cycle, having experienced during their personal background a sexuality contraception or at least one contraceptive method other than its current average. RESULTS: Comparison between the group of women using oral contraception and women not using contraception medicalized showed significant differences in outcomes relating to: the average frequency of intercourse / month (p = 0.01), sexual desire ( p = 0.01), sexual pleasure (p = 0.03). The comparison of the different parameters of sexuality among the group of women using intra uterine device and women using oral contraceptives showed no significant differences in the parameters of sexuality. CONCLUSION: The awareness of the big importance of the interaction between sexuality and contraception, in one way or another, could help us tailor our applications to contraceptive practices of each woman.

[Female sexuality during pregnancy and postpartum: a study of 80 Tunisian women]. / Sexualité féminine au cours de la grossesse et en post-partum: a propos de 80 femmes Tunisiennes.

AIMS: To investigate the impact of pregnancy and the post partum period on the female sexuality and the coupledom, and to evaluate the quality of information and dialogue about this subject. METHODS: A prospective descriptive and analytical study included patients from the department of obstetrics and gynecology in the university hospital Hédi Chaker during July and August 2010. We choose randomly 80 Tunisian women, whatever the reasons for consultation. Data were obtained via questionnaires containing 45 questions about sexual behavior during the last pregnancy and the postpartum period, the influence on coupledom, and the quality of information and dialogue about this subject. Statistical analysis was conducted using SPSS for Windows version 17. Statistical significance was defined as a p value 5% using the X2 test. RESULTS: The average age was 31.64 (± 6) years. Before pregnancy,sexuality was qualified as "satisfactory" by nearly the half of the sample (48, 5%) against 78.8% by their partners. 18% of women thought it was not possible to have intercourse during pregnancy. This idea doesn't correlate with the education (p=0.151) neither the geographic origin (p=0.064). 54.5% of women mentioned a decrease on their sexual interest and activity during pregnancy. The three main causes of this decline were: the physical symptoms (83%), the fear to harm the fetus (66.7%) and the women hypoactive sexual desire (33.4%). After delivery, sexual interest and activity tends to be reduced in 64% of women. The resumption of normal sexual activity was about 4 months around the delivery (with variations between 1 month and 2 years). Sexuality was considered as taboo by 81, 8% of women. The information on sexuality by health professionals was deemed insufficient by 78.8% of women. CONCLUSION: Sexuality remains a taboo for the most of woman. Their belief in the impossibility of intercourse during pregnancy doesn't correlate with education neither with origin. The period of pregnancy and the postpartum changes the sexual behavior, interferes with the quality of life and disturbs the coupledom. However information and the support of women in this period are still insufficient.

[Prospective study of 45 cases of disseminated intravascular coagulation]. / Etude prospective à propos de 45 cas de coagulation intra vasculaire disséminée.

BACKGROUND: Disseminated intravascular coagulation (DIC) in obstetric disorders is a severe complication. AIM: To study the frequency and means of diagnosis of DIC and the therapeutic care and maternal morbidity induced. METHODS: Monocentric, prospective and descriptive study about 45 cases of intravascular coagulation in an obstetrical service collected at the University Hospital of Obstetrics and Gynecology Hedi Chaker of Sfax over a period ranging from June 2007 to June 2010. All the pregnant patients who have given birth beyond 28 weeks and have presented a DIC were selected for this study. RESULTS: The mean age of patients was 31.4 years. The mean parity was 2.6. The main diseases during pregnancy were: severe preeclampsia (22.2%), diabetes (28.8%), intrauterine fetal death (17.7%), previa placenta (8.8%). The main causes of DIC were: uterine atony (44.4%), abruptio placenta (22.2%), Hellp syndrome (11.1%) and uterine rupture (6, 6%). The lowest rate of platelets was 21000/mm3. The fibrinogen level was <0.5 g in 40% of cases. Despite reanimation and transfusion with blood products, surgical treatment was necessary in 77.7% of cases. All the patients were transferred in intensive care unit with an average stay of about three days. No maternal death was reported. CONCLUSION: DIC is a frequent complication of many obstetrical diseases. The treatment is urgent. It requires first to the cause and the shock by massive transfusions of packed red blood cells, fresh frozen plasma, and platelets, associated with antifibrinolytic drugs, if necessary.

[Pregnancy in dermatomyositis and polymyositis]. / Grossesse au cours des dermatomyosites et polymyosites.

AIM: To determine the incidence of pregnancies during the inflammatory myopathy (IM), its influence on this disease and the influence of IM on the pregnancy's outcome. METHODS: From 1979 to 2007 we have collected retrospectively 67cases of IM (53 women and 14 men) in the department of internal medicine CHU Hedi Chaker of Sfax (Tunisia). Diagnosis criteria were those and Peter. We have included pregnancies occurring after diagnosis of DM or PM and cases of IM occurring during pregnancy or postpartum. RESULTS: Five women (4DM and PM), average age 30.6 years (range 26 - 41 years) conducted 10 pregnancies (9.4%). The fertility rate is 2 pregnancies per patient. Nine pregnancies occurred after the diagnosis of myositis in 4 women. IM was inactive at conception in all this cas.No flare-up in IM has been noted during these pregnancies. The DM was revealed to the 10th day post-partum in one patient. Therapeutic interruption of pregnancy was needed in 3 cases. 4 pregnancies were completed without incident and resulted in the birth of healthy newborns. Foetal complications were observed in the other two pregnancies occurring in one patient who also presents an APS associated with DM. It was a foetal death in utero and premature delivery of a newborn who died in 3rd day after birth. CONCLUSION: Pregnancy in the MI is rare. Its influence on the activity of the disease is variable, both during the pregnancy than postpartum. The foetal prognosis is good when the the disease is in remission. However foetal complications are important in case of active IM.

[Emergency peripartum hysterectomy: indications and prognosis]. / Hystérectomie d'hémostase : Indications et pronostic

AIM: Detect the risk factors, indications and maternal morbidity of haemostatic hysterectomy. METHODS: A retrospective study of 46 women who had haemostatic hysterectomy between 2005 and 2009. RESULTS: The mean age was 33.3 years. The mean parity was 3.5. 35% of patients had a previous cesarean section. The mode of delivery was: vaginal delivery (47.8%), cesarean delivery (52.2 %). The hysterectomy was subtotal in 39 cases (85%). The indications of haemostatic hysterectomy was: uterine inertia (44%), disseminated intravascular coagulation (26%), placenta accreta (8.7%), Placenta praevia (13%), uterine rupture (8.7%).Three patients were dead. Five patients had a depression. Six patients had a dyspareunia. Five patients had a decrease of sexual desire. CONCLUSION: Haemostatic hysterectomy is a mutilating surgery giving an irreversible infertility. The development of arterial embolization avoid the appeal to this surgery.

Mullerian adenosaroma of the cervix with sarcomatous overgrowth and heterologous elements presenting as a recurrent cervical polyp.

Mullerian adenosarcoma of the cervix is a rare tumor composed of benign epithelial and malignant stromal components. Sarcomatous overgrowth and heterologous elements in cervical adenosarcoma are extremely infrequent. We report the case of a 26-year-old woman admitted at the gynaecology department for a painless mass protruding from her vagina. The initial pathological exam concluded to endocervical polyp. Six months later, the patient was readmitted with a recurrence of the polyp. The pathological exam demonstrated interlacing fascicles of elongated spindle cells with few mitotic activity and no glandular formation. After reviewing of the initial polyp the diagnosis of mullerian adenosarcoma was suggested. A second recurrence of the polyp was noted one month later. Histopathological exam of the recurrent polyp confirmed the diagnosis of adenosarcoma with sarcomatous overgrowth and heterologous elements. The patient was lost for follow-up. Cervical adenosarcoma with sarcomatous overgrowth and heterologous element is a rare tumor that occurs in younger age in contrast to endometrium/corpus uterin mullerian adenosarcoma. In young women with recurrent cervical polyp, mullerian adenosarcoma must be considered and should be excluded by careful histopathological exam. Sarcomatous overgrowth and myometrial invasion are the most important prognostic factors. Treatment strategy is still unclear.

[Cervical ripening at term. A randomized and prospective study: Misoprotol versus dinoprostone]. / Maturation cervicale à terme. Étude prospective randomisée: misoprostol versus dinoprostone.

AIM: To compare the efficacy and safety of cervical ripening at term by vaginal Misoprostol and Dinoprostone. METHODS: We performed a prospective randomized study on cervical ripening with misoprostol and dinoprostone in the third trimester of pregnancy. 300 patients have been divided into two groups: one consisted by 150 patients who received Misoprostol (Cytotec ®) and the second consisted by 150 patients who received Dinoprostone (Prépidil ®). RESULTS: Analysis of our results allowed to reveal: a significant decrease in the time of entry into work for the Misoprostol group (9.08 hours versus 12.51 hours, p = 0.007), a significant reduction delivery time (14.48 hours versus 19.30 hours, p = 0.001). Moreover, the birth rate in the first 24 hours after the first dose was significantly higher in the Misoprostol group (86.7% versus 72.7%, p = 0.003). The use of oxytocin was significantly reduced with Misoprostol (44% versus 58.7%, p = 0.01). The mode of delivery was not influenced by membership in one or other of the two groups. CONCLUSION: Misoprostol seems an interesting molecule for cervical ripening and labor induction.

[Ligation of internal iliac arteries for severe hemorrhage in obstetric]. / Ligature des artéres iliaques internes dans la prise en charge des hémorragies du post partum.

AIM: To assess the efficiency of arteries ligation in intractable obstetrical hemorrhage. METHODS: Prospective study which concerned 53 patients who underwent internal iliac arteries ligation for persistent and severe obstetrical hemorrhage from January 2007 to June 2010. RESULTS: The average age of patients was 29.3 years. The mean parity was 2.2. Main etiology of hemorrhage were: uterine atony (62.2%), abruptio placentae (15.1%). Coagulation disorders and hypovolemic shock were observed respectively in 20.7 % and 37.7%. Blood transfusion was performed in all cases. Internal iliac arteries ligation allowed hemorrhage control in 90.5 % of cases. In five cases a hysterectomy was necessary to control bleeding.. No peroperative complication were observed. CONCLUSION: Internal iliac arteries ligation is a prerequisite treatment of severe postpartum hemorrhage. It is a good alternative to arterial embolization.

[Anatomic and functional results after surgical treatment of uro genital prolapse: prospective study about 93 cases]. / Résultats anatomiques et fonctionnels après cure chirurgicale de prolapsus uro-génital : étude prospective. A propos de 93 cas.

BACKGROUND: genital polapse is a frequent olisease several techniques were described. AIM: To evaluate the anatomical and functional results of surgery for genital prolapse by vaginal and abdominal approach. METHODS: Prospective study on 93 patients operated for urogenital prolapse (50 by high and 43 vaginal approach) in the department of obstetrics and gynecology of Sfax. Anatomic results and postoperative patient satisfaction was assessed. Quality of life was assessed using the French versions of the questionnaires Pelvic Floor Distress Inventory (PFDI 20), Pelvic Floor Impact Questionnaire (PISQ 7). RESULTS: The mean age of patients was 59 years. 85.9% of our population consisted of postmenopausal women. The results of the postoperative visit, after a mean of 28.7 months, showed about the anatomical level, a success rate for the treatment of prolapse by high 82% against 72.1% for vaginal delivery, but the difference is not significant (P = 0.45). For prolapse of grades 1 and 2, surgical treatment by high and low has corrected all the elements of prolapse. For prolapse of grades 3 and 4, high surgery has resulted in a satisfactory anatomical result in 86%, while the lower channel yielded a significant result in 76.5%, and recurrence were interested mainly the anterior stage. The questionnaire PFDI 20, showed an improvement in the quality of life after surgery significantly in both groups (p<0.003). The improvement was more significant PFDI 20 after surgery by high versus vaginal surgery (p <0.002). Regarding PFIQ 7, improved quality of life was observed after surgery without significant differences between the two groups. CONCLUSION: The treatment of urogenital prolapse is mainly based on surgical and reconstructive surgery to restore anatomical and functional surgery also in order to improve the quality of life of patients.

[Obstetrical prognosis following ligation of hypogastric arteries]. / Pronostic obstétrical après ligature des artères hypogastriques.

BACKGROUND: Ligation of hypogastric arteries is a conservative surgical treatment in cases of postpartum hemorrhage. AIM: To study the fertility and pregnancies outcome in women who required hypogastric artery ligation for severe post-partum haemorrhage in our hospital. METHODS: The fertility and pregnancy outcome parameters were retrieved from medical files and telephone interviews RESULTS: 34 patients required hypogastric ligation on this period. 39 pregnancies were observed with 30 term deliveries, 1 ectopic pregnancies and 8 miscarriages. Two patients had infertility and pregnancy was obtained in less than 10 months most once desired.Pregnancy outcome was normal. 73,3% of deliveries were by caesarean. CONCLUSION: Hypogastric artery ligation for post-partum haemorrhage is not responsible for secondary infertility. Following pregnancies do not suffer complications from the ligation.

[Prospective study of the correlation of ultrasonography and CA125 in the management of ovarian cysts: a study of 77 cases]. / Confrontation échographie - CA125 - histologie dans la prise en charge des kystes de l'ovaire : Etude prospective à propos de 77 cas

AIM: To study the correlation between ultrasound, Doppler,measurement of CA 125 and histology in the preoperative diagnosis of ovarian cysts. METHODS: Prospective and analytical study about 77 patients in whom we analyzed the contribution of ultrasound, the assay of CA125, the couple CA125 ultrasonography and laparoscopy in the diagnosis and management of cysts the ovary. The value of CA125 was considered pathological like the one adopted by our biochemistry laboratory of the CHU Habib Bourguiba, Sfax (> 35 UI / ml). RESULTS: The mean age was 35.6 years. On the whole, ultrasound has a sensitivity of 71.41% and a specificity of 80%. The positive predictive value was 35.71% and negative predictive value was 96.55%. The sensitivity of CA125 to detect malignant lesions among ovarian cysts was 85.71% and a specificity of 85.93%. The PPV was low (42.85%). The combination Ultrasound-CA125 had a sensitivity of 85.7%, a specificity of 82.8%, a PPV and NPV respectively 35.3% and 98.1%. The concordance between the macroscopic perlaparoscopic and histological diagnosis of different tumors was 83.3% for functional cysts, 77.7% for serous cysts, and 100% for dermoid cysts, endometriosis and bleeding. CONCLUSION: The contribution of Doppler ultrasound and tumor markers is essential in the diagnosis of ovarian cysts.

[Genital prolapse in young women: a study of risk factors]. / Etude des facteurs de risque du prolapsus genital chez les femmes jeunes.

AIM: To determine the risk factors for genital prolapse in a group of 33 young women less than 45 years old. METHODS: We studied 33 young women who had been operated for genital prolapse, whereas the control group consisted of women operated for benign gynaecologic disorders. RESULTS: In the study group the number of pregnancies and deliveries, the babies'weight, the positive family history of prolapse were heavier than in the control group. The women with prolapse had more often chronic pulmonary diseases, asthma, as well as operations for abdominal hernias. The mode of delivery, be it a cesarean section or the use of forceps, and the active second stage of labor had no effect whatever on the occurring of genital prolapse in young women. CONCLUSION: Our data support the suggestion that multiparity, babies weight and congenital factors are responsible for a higher rate of genital prolapse in young women.

[Factor V deficiency and pregnancy: a case report]. / Déficit constitutionnel en facteur V et grossesse : à propos d'un cas.

The factor V deficiency is a very rare hereditary disease of the coagulation, which is accompanied by a high hemorrhagic risk in the event of delivery and in the post-partum. We report the case of a woman having a factor V deficiency which had a pregnancy, and which gave birth by Cesarean, as replacement therapy we proposed the transfusion of 20 mL/kg of fresh frozen plasma before surgery and of 5 mL/kg by 12 h during 7 days in post-partum, this attitude allowed to avoid the hemorrhagic complications.

[Exploration of post-menopausal uterine bleeding. Hysteroscopy-histology correlation in 94 cases]. / Exploration des métrorragies postménopausiques par hystéroscopie : à propos de 94 cas.

INTRODUCTION: Post-menopausal uterine bleeding is the reason for nearly 70% of gynaecological consultations. Because the cause may be a malignant disease, a thorough work-up is necessary to attempt to identify an organic cause. PATIENTS AND METHODS: This retrospective study examined 94 cases of post-menopausal bleeding in which both a hysteroscopic and a histological examination were performed in the gynaecology and obstetrics department of the Hedi Chaker University of Sfax from 1 January 2004 to 28 February 2005. We examined correlations between the hysteroscopy and histology findings as well as the causes determined. RESULTS: By hysteroscopy, we observed atrophic uterine linings in 53 patients (56%), endometrial polyps in 43 patients (45%), endometrial hyperplasia in 23 patients (24%) and myomas in 24 patients (25.5%). This examination suggested malignancy in 12 patients, among 6 of whom endometrial cancer was confirmed histologically. The sensitivity and specificity of hysteroscopy were relatively poor for the diagnosis of endometrial atrophy (about 48.7% and 68.5%), acceptable for endometrial polyps (75% and 86.6%), endometrial hyperplasia (64.7% and 85.5%), and endometrial cancer (60% and 92.7%). CONCLUSION: Hysteroscopy is the most reliable technique for exploration, offering a direct view of the uterine cavity and allowing direct biopsy. Its sensitivity varies according to the indication and diagnosis and is sometimes very good. However, histology remains the reference examination for diagnosis of the cause of post-menopausal uterine bleeding.