Antepartum detection of macrosomic fetus: the effect of misdiagnosis.

AIM: To determine the effect of misdiagnosis of macrosomia on maternal and perinatal outcomes. METHODS: We conducted a retrospective study ,between January 2007 and December 2008 of women (n = 464) who delivered singleton neonates with actual birth weight over 4000g and in whom fetal weight was estimated, by both methods :sonographic and clinical, up to 3 days before delivery.Statistical comparisons were made between patients in whom fetal macrosomia was predicted : «prediction ¼ group (n=336)and those in whom it was not « non prediction ¼group (n=128) for outcome variables. RESULTS: The cesarean delivery was performed in 35.9% in « non predicted ¼ group, and in 35.7% in the « predicted ¼ group.The difference was not statistically significant. Failure to detect macrosomia was associated with higher rates of maternal and fetal complications in the group « non predicted ¼ compared with the group « predicted ¼ :perineal trauma,post partum hemorrhage, 5- minute Apgar scores less than 7, and shoulder dystocia, mostly related to the higher rate of surgical vaginal deliveries. CONCLUSIONS: The misdiagnosis of fetal macrosomia substantially did not modify the cesarean section rate but leads to increase the maternal and neonatal complications.

[Sexuality of the couple during pregnancy stemming from a medically assisted procreation]. / Sexualité du couple lors de grossesse issue d'une procréation médicalement assistée.

OBJECTIVE: We studied the impact of pregnancy stemming from a medically assisted procreation on the sexuality of the couple. PATIENTS AND METHODS: Our study was forward-looking realized in the maternity of Sfax on duration of nine months. Its methodology is based on a questionnaire distributed to 40 women and on a review of the literature. RESULTS: Our patients continued to have a sexual activity during their pregnancy in the majority of the cases (at least 65% of the cases) but with a decrease of libido in 80% of the cases as well as a net decrease of the frequency of the sexual intercourse. DISCUSSION AND CONCLUSION: In front of these difficulties of the consequent sexual life noticed also in the literature, a psychological support of these couples is so recommended that a sexologic care adapted to the particular context of the medically assisted procreation countered justified.

[Role of deambulation during labour: A prospective randomized study]. / Intérêt de la déambulation au cours du travail obstétrical : étude prospective randomisée de 200 cas.

OBJECTIVE: To assess the effects of ambulation during the first stage of labor on the duration of labor and other maternal and infant outcomes. PATIENTS AND METHODS: A prospective randomized trial conducted from 1st November 2008 to 31st March 2009 at the department of obstetrics and gynecology, CHU Farhat Hached, Sousse, Tunisia. Two hundred mothers with uncomplicated term pregnancies were randomly assigned to one of two groups: first group (100 parturients) authorized to ambulate until 6cm of cervical dilation and a second group (100 parturients) confined to bed in dorsal or lateral recumbence. RESULTS: Upright position reduces significantly (for about 34%) the duration of the first stage of labor (P<0.0001), the pain intensity, the oxytocin consumption (P=0.001), the rate of delivery by cesarean section and of instrumental deliveries. Upright position leads also to a net improvement of the maternal outcome (7% side effects versus 13%) and the fetal outcome (net improvement of the Apgar's score at first and fifth minute, and reduction of a factor 5 of the rate of transfer to the neonatology clinical care unit. CONCLUSION: Our study allowed to confirm the benefits of ambulation on labor progress as well as on the maternal comfort and the maternofetal outcome.

[Yolk sac tumor revealed by an ascite of great abundance]. / Tumeur vitelline de l'ovaire révélée par une ascite de grande abondance.

We report the case of a 16-year-old girl explored for an ascite of great abundance responsible for a respiratory embarrassment. Its symptomatology proved to be secondary to a vitelline tumour of the ovary. It required several drainings of ascite before surgical operation. She had a conservative treatment followed up by a chemotherapy which allowed a clinical and biological remission. We report this observation considering the originality of the mode of revelation of the tumour. We insist in addition on the possibility of a conservative treatment.