[The value of the administration of prostaglandin E2 on the biodegradable support of the maturation of the cervix uteri and the induction of labor]. / Intérêt de l'administration de la prostaglandine E2 sur un support biodégradable pour la maturation du col et le déclenchement du travail.

We report the results of a prospective randomized study concerning the effects of prostaglandin E2 on cervical ripening and/or induction of labour. Between August 1988 and April 1989, 100 women underwent induction of labour for medical reasons. These women were divided into 4 groups. In those with Bishop's score below 4, we compared the intracervical dinoprostone 0.5 mg gel (Gr 1, n = 24) with an intracervical administration of PGE2 1.5 mg on Surgicel Gr 2, n = 26). In women with Bishop's score between 4 and 6, we compared the intracervical dinoprostone 0.5 mg gel (Gr 3, n = 28) with administration of PGE2 2.25 mg on a Spongel introduced into the posterior vaginal fornix (Gr 4, n = 22). Induction was authorized only for women with Bishop's score above 6. If this was not the case, a second administration of PGE2 was allowed 12 hours later, depending on maternal and foetal tolerance. The 4 groups were similar in mothers' age, gestational age and parity. The results obtained showed a significant increase in Bishop's score 12 hours after cervical ripening, irrespective of the way PGE2 was administered: from 2.3 +/- 1.0 to 5.2 +/- 2.5 vs 2.2 +/- 1.2 to 5.0 +/- 2.6 for groups 1 and 2, and from 4.4 +/- 0.6 to 6.7 +/- 2.3 vs 4.2 +/- 0.4 to 6.8 +/- 2.4 for groups 3 and 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Cervical intraepithelial neoplasia III treatments by carbon dioxide laser.

162 women underwent one or more carbon dioxide laser conservative treatments for lesions of severe dysplasia and cervical intraepithelial neoplasia (CIN III) between 1982 and 1987. Therapy involved destruction of lesions by vaporisation in 45% of cases and excisional conisation in 55% (32% performed with a hand-held apparatus and 23% colposcopically guided). Rates of cure were, respectively, 93, 96.1 and 94.4%, with an overall rate of 2.5% for dropouts. Recurrences (rates, respectively, of 8.5, 5.8 and 5.5%) were associated with human papilloma virus in 92% of cases. The increasing numbers of very young women affected, as well as the spread of intraepithelial and condylomatous neoplastic lesions along the endocervical canal, are major reasons for the use of colposcopically guided carbon dioxide laser treatment.

[Birth before 33 weeks gestational age. The significance of in utero-to-birth transfer in the Department of Perinatology]. / Naissance avant 33 SA. Intérêt du transfert in utéro au sein d'un Département de Périnatalogie.

Systematic transfer of any woman presenting a high risk of delivery before 33 weeks of amenorrhea, for birth within a Perinatology department which was 5 advocated since 1985 (especially at 31 and 32 weeks of amenorrhea) in order to minimize the neurological consequences of the haemodynamic disorders induced by the transfer of these premature babies, has permitted to increase to 40 live newborns without any severe sequelae. This improved management, noticed in three departments (121 PNB in 1988, or a 73 p. cent progression in 4 years), must now take place as early as the 25th week and before the stage of imminent birth, in order for the couple mother-fetus to take advantage, in the same location, of physicians (obstetricians and pediatricians) and technical means suitable for this rare and severe pathology that is prematurity.

[Endosalpingosis or microcystic and proliferating glandular inclusion disease of the genital tract and peritoneum. Apropos of 6 cases]. / L'endosalpingiose ou maladie des inclusions glandulaires microkystiques et proliférantes du tractus génital et du péritoine. A propos de six observations.

Endosalpingosis, defined by the presence in an ectopic site of epithelium comparable to that of the tubal mucosa, is not a well-known entity. In reference to 6 cases of our department, the authors have been able to assess this lesion. Clinical manifestations and laboratory tests offer no arguments. Cytology represents a diagnostic trap. The diagnosis may only be made histologically and is very often fortuitous. This benign lesion is often the result of a metaplasic process but, considering the difficulty of the diagnosis, the treatment is often surgical (total hysterectomy with castration). The course is uneventful.

[Treatment of upper genital infections in women. Multicenter study of the comparative efficacy and tolerance of an amoxicillin-clavulanic acid combination and of a triple antibiotic combination]. / Traitement des infections génitales hautes de la femme. Etude multicentrique de l'efficacité et de la tolérance comparées de l'association amoxicilline-acide clavulanique et d'une triple association antibiotique.

Eighty-two patients with laparoscopically confirmed salpingitis were randomly divided into two groups in a multicentre and prospective trial. Single drug therapy with the amoxicillin-clavulanic acid combination was used in 42 patients (group A). The other 40 patients were given a combination of penicillin, aminoside and metronidazole (group B). For each case a secondary prescription for a tetracycline was discussed. Clinical results were comparable in both groups: sooner (at the end of the hospitalization period) in group A: 10 cured, 30 improved and 2 failures against 9 cured, 30 improved in group B. Later (evaluation after 5 to 8 weeks) a relapse was noted in five patients in group A and included one case of angioedema in group B. It is concluded that amoxicillin-clavulanic acid combination is a satisfactory alternative to the penicillin-aminoside-metronidazole combination, especially as it is simpler to use.

[Endometriosis and fertilization in vitro. Apropos of 40 cycles]. / Endométriose et fécondation in vitro. A propos de 40 cycles.

The physiopathology and the role of endometriosis in infertility is still unclear. The use of in vitro fertilization (IVF) could be a good model for the understanding of etio-pathology and treatment when fecundity is desired. We compare results of IVF procedure in patients with endometriosis after ovulation induction with clomiphene-HMG (group 1) and Gn-Rh analog's short administration using regimen and HMG (group 2). Forty cycles have been conducted for 18 patients. Mean duration of infertility is 6.9 years and mean age of patients is 34.8 years. We observed no difference in terms of results of ovulation induction in Gr 1 or in Gr 2 compared with IVF patients without endometriosis and after the same treatment regimen, except a non significant decrease in the number of recovered oocytes. As for IVF patients without endometriosis, the use of Gn Rh analogs permits an improvement of results in terms of suppression of spontaneous premature LH surge, and increase of number of follicles and cleaved embryos. The fertilization and cleavage rates are not affected by the presence of endometriosis when compared to IVF patients without endometriosis. The number of recovered oocytes decreases with the severity of endometriosis (RAFS classification), but the pregnancy rate is not affected. Overall Third trimester pregnancy rate is 12.5% per induction cycle and 21.7% per embryo transfer. We may conclude that the presence of endometriosis does not affect the quality of the oocyte and is not a cause of exclusion in an IVF program.

[Conservative treatment of grade 3 intra-epithelial cervical neoplasms. Comparative study of CO2 laser vaporization, laser conization and cold scalpel conization]. / Traitements conservateurs des CIN III. Etude comparative des vaporisations au laser CO2, des conisations laser et des conisations au bistouri froid. A propos de 141 cas.

Carbon dioxide laser was used in 79% of the 141 conservative treatments carried out for grade 3 cervical intra-epithelial neoplasia (CIN III) between the years 1982 and 1986 (41% vaporized and 38% coned out by using the laser as against 21% that were treated by scalpel conisation. The mean age of the women treated in this way by the laser was low (28.5 years of age and 32.5 years as against 38.1). Their parity was also low (0.8 and 1.2 as against 2.2). The lesions were very often spread out on the ectocervix and sometimes going into the vagina (26 and 9% as against 26%) or associated with koilocytosis (65.5 and 47.2% as against 41.3%). In one out of two cases vaporisation of the lesion is contra-indicated and the three diagnostic methods that are used (an ecto and endocervical smear, colposcopy and multiple directed small biopsies) do not make it certain that there is no underlying invasion of the tissues. Vaporisation and conisation are easily carried out under colposcopic control and are associated with widespread lesions at the squamo-columnar junction. These treatments sometimes have to be repeated; then they give a cure rate of 92-96% as against 96%. They are more reliable than conventional surgery for widespread lesions and they do make it possible to keep to the morphology of the cervix and thus make it possible for the cervix that is treated to behave more physiologically. It is also much easier and more reliable in these cases to carry out follow-up for carcinoma. This follow-up should be carried out on two occasions. The triple diagnostic method should be carried out again at the third month (2 smears, colposcopy and colposcopically directed small biopsies). This makes it possible to diagnose and treat early the cases where there has been failure of the original treatment. Then ecto and endocervical smears should be repeated at 3-monthly intervals, then at 6-monthly intervals and finally annually to screen for recurrences of these neoplastic conditions, and for koilocytosis which sometimes repeat themselves in an extensive manner.

[Circulating anticoagulants and pregnancy: a risky combination]. / Anticoagulants circulants et grossesse: une association à risque.

In the last ten years the relationship between the presence of lupus type anticoagulants in the blood and some obstetrical complications, in particular spontaneous abortions, repeated fetal deaths in utero and intra-uterine growth retardation, has been well documented. A study of the literature shows that there were only twenty live-born children out of 280 pregnancies in 71 women who had the lupus type anticoagulant factor. The presence of the factor in high levels in a pregnant woman was seen to be of poor prognostic significance for the obstetric outcome. Biologically the lupus type circulating anticoagulant should be suspected when there is a five to six seconds prolongation of clotting time and it is highly suspicious if the time is prolonged by more than seven seconds. Its presence should equally be suspected by testing for the activated partial thromboplastin time (APTT). It has been shown that early treatment directed to lessen the activity of the lupus type factor (the use of corticoid-immunosuppressors) and forestalling as far as possible placental insufficiency (by giving heparin, aspirin and dipyridamole) could help, thus enabling some women to have live children who would not otherwise be able to do so.

[Prenatal diagnosis of pulmonary hypoplasia camptodactyly syndrome. Hypothesis concerning the origin of hydramnios]. / Diagnostic prénatal du syndrome hypoplasie pulmonaire camptodactylie. Hypothèse concernant l'origine de l'hydramnios.

Camptodactyly and pulmonary hypoplasia syndrome was described for the first time in 1974. Today 15 cases have been found. None were subject to a prenatal diagnosis as any ultrasonography. The case we observe is a 27 years old woman, third gestation, showing a polyhydramnios at 25 weeks of gestation. The ultrasonographic examination showed deformation with a rounded abdomen, a narrow thoracic frame slightly concave, no gastric picture and hands in constant flexion. After elimination of the V.A.T.E.R.' syndrome the camptodactyly's syndrome with pulmonary hypoplasia was proposed. Because of the lethal character of this syndrome, the abortion was realised. The photos of the fetus were the same as the ultrasonographic pictures during the prenatal diagnosis. The absence of intrinsic (paralysis) or extrinsic (compression) movements of the fetus is very important in the genesis of "deformations". The severity of the deformities depends on the importance of akinesia.

[The onset of human labor]. / Déclenchement de la parturition humaine.

The authors reviewed the literature in order to try to work out the different mechanisms that are responsible for labour starting. A role seems to be played by the decidua of the uterus, by the placenta and by the fetal membranes as well as the very important role of prostaglandin synthesis. It does seem as though there is no single factor that is important for starting labour. If we knew more about the physiology of human labour it would perhaps be easier to control premature labour.

[Contraception using an intrauterine device inserted 1 month after delivery]. / La contraception par dispositif intra-utérin posé un mois après l'accouchement.

The authors report their experience of mechanical contraception using an intra-uterine device placed one month after delivery. The fact that perforation did not occur and there were no serious infectious complications, as well as that the method was well tolerated, that there was only 4.7% per year expulsions, and few failures (Pearl 2.96% per year) shows that this is a worth-while contraceptive method to recommend to women who have just delivered.