[Acute adrenal gland decompensation in the immediate postpartum]. / Décompensation surrénalienne aiguë dans le post-partum immédiat.

We report the case of acute adrenal gland failure which occurred one hour after cesarian section for the delivery of a child after 31 weeks of amenorrhoea. The clinical picture of the mother was immediately severe and was dominated by neurological features: profound coma with a bilateral Babinski's sign. The laboratory tests however only revealed severe hypoglycaemia among the classical signs of adrenal gland failure. It was extremely difficult to correct the blood glucose level without concomitant administration of corticosteroids.

[A fatal gas embolism during a hysteroscopy-curettage]. / Embolie gazeuse fatale lors d'une hystéroscopie-curetage.

A 26 year old woman without any pathological history except metrorrhagia underwent a hysteroscopy under epidural anaesthesia and uterine cavity dilatation by saline solution. A respiratory distress and cardoffirculatory arrest occurred at the end of the procedure. Despite several attempts of cardiorespiratory resuscitation the patient deceased. The diagnosis retained was a gas embolism caused by blast effect from reintroduction of the hysteroscope into the uterine cavity. Different mandatory security measures are evoked.

[Rheologic and cytologic study of autologous blood collected with Cell Saver 4 during cesarean]. / Etude rhéologique et cytologique du sang autologue recueilli par le "Cell Saver 4" au cours de césarienne.

Intra-operative autologous transfusion has been frequently used in vascular and traumatic surgery for about ten years. The technique would be justified in other procedures when intra-operative bleeding is significant and the quality of retrieved blood is satisfactory. We have studied the potential use of intra-operative autologous transfusion during caesarean section of 15 parturients. The quality of autologous blood (at different stages of the procedure) was assessed after being recovered and washed by "Cell Saver 4" (Haemonetics). Blood quality was assessed through 1) measuring the following: erythrocyte deformability with Erythrometer and Hemorheometer; blood and plasma viscosities; ATP, 2.3 DPG and plasma hemoglobin rates; and RBC morphology through SEM; 2) bacterial detection and identification; 3) detection of foetal cells which could create immunological disturbances if reinjected into the mother. The results showed: 1) little variation in RBC deformability properties with ATP and 2.3 DPG rates which, apart from a slight decrease, remained within the normal range; 2) a 20 fold increase in plasma hemoglobin persisting, despite successive washes, in 80% of cases; 3) positive Staphylococcus epidermidis hemoculture clinically irrelevant in the reinjectable bag in 90% of cases; 4) close to 1% foetal cells in the reinjectable bag in 20% of cases; 5) 8% abnormal cells as seen on SEM (Stage I echinocytes) and a slight swelling of the RBCs, which could account for their fragility. These preliminary results show that intraoperative autologous transfusion could be used in obstetrical surgery, provided that certain precautions are taken to minimize the aforesaid drawbacks.

[Peridural obstetrical analgesia using an electronic syringe]. / Analgésie obstétricale par voie péridurale à la seringue électrique.

The authors present a study of 20 cases of epidural obstetrical analgesia. A Bupivacaine-Fentanyl mixture was given by continuous flow to bring about this analgesia. After an initial injection of 10 ml (9 ml of 0.25% Bupivacaine and 0.05 mg Fentanyl), a mixture of 45 ml of 0.25% Bupivacaine and 0.25 mg Fentanyl was perfused into the epidural space using an electronic pump syringe, delivering at a rate of 5 ml/hr. The mean time of analgesia until the delivery is 4 h 40 mn and the women in labour received a mean of 31.14 ml of 0.25% Bupivacaine (77.85 mg) and 0.173 mg Fentanyl. It took only 5 1/2 minutes to set up this form of analgesia. Not a single patient had any pain the first stage of labour nor in the second stage, and 95% of them were able to push efficiently. There are no detectable changes in the haemodynamic parameters in either the mothers or the fetuses and no depression of maternal respiration was found. In each case the Apgar score was 10 after 5 minutes. In summary, the use of an electronic pump syringe to deliver a Bupivacaine-Fentanyl mixture in obstetrical labour is a great improvement in analgesia without any secondary effects in the mother and child.