Circulating MMP-7 and VEGF as potential predictive biomarkers for recurrent implantation failures.

Recurrent implantation failure (RIF) is considered to be one of the major limiting factors of assisted reproductive technology (ART) programme success. The current study focused on the investigation of matrix metalloproteinases (MMPs), tissue inhibitors of MMPs (TIMPs), cytokines and cell adhesion molecules in peripheral blood (PB) and follicular fluid (FF) obtained from 44 women aged between 25 and 39 years old and undergoing intracytoplasmic sperm injection (ICSI). These women were divided into two groups: 22 RIF women with embryo implantation failures after the transfer of at least four fresh or frozen-thawed good quality embryos in a minimum of three ICSI cycles, and 22 ICSI success women (controls) who achieved a clinical pregnancy at their first ICSI attempt. The PB and FF samples were obtained from each patient on the day of oocyte retrieval. MMP-1, -2, -3, -7, -9, TIMP-1, -2, vascular endothelial growth factor (VEGF), leukaemia inhibitory factor (LIF), vascular cell adhesion molecule 1 (VCAM1) and intercellular adhesion molecules 1 (ICAM1) were analyzed using enzyme-linked immunosorbent assay of PB and FF. Our results showed significant decreases in PB MMP-7 and PB VEGF in the RIF group compared with controls [281.11 (33-614) pg/ml vs 119.92 (27-441) pg/ml; P-value = 0.030] and [82.54 (25.94-210.20) pg/ml vs 30.93 (13.62-193.33) pg/ml; P-value = 0.022; respectively]. Receiver operating characteristic (ROC) curve analysis showed informative area under the curve values for PB MMP-7, as well as for PB VEGF, making them able to be proposed as biomarkers of the RIF. Therefore, circulating MMP-7 and VEGF seem to play an interesting role in embryo implantation in in vitro fertilization (IVF)/ICSI cycles and could be proposed as circulating biomarkers of the RIF. These results could be helpful for clinicians and patients to choose the best rescue strategy and treatment to minimize implantation failure in women undergoing IVF/ICSI procedures after the first attempt.

[Early postpartum discharge: outcomes and risk factors of readmission]. / Sortie précoce en post-partum: résultats et facteurs de risque de ré hospitalization.

The objective of this study is to evaluate the practice of early postpartum discharge by analyzing maternal readmission rates and identifying readmission risk factors. This is a prospective and analytical study of 1206 patients discharged from hospital on postpartum day 1. For each patient we collected the epidemiological data, the course of pregnancy and childbirth. We identified the causes of readmission and their evolution. Cesarean delivery rate was 42%. Maternal readmission rate was 0.99%. The average length of stay in hospital after readmission was 26 hours. Intestinal transit disorders were the most frequent reason for consultation (50% of cases) followed by fever (25% of cases). The readmission risk factors identified in our study were: cesarean section (p = 0.004), emergency cesarean section (p = 0.016) anemia (P < 0.001) and thrombopenia (p = 0.003). Early postpartum discharge seems a safe option for the mother and their newborn children subject to the ability to clearly communicate health information to the patient and to the compliance with selection criteria.

[The opening of the internal cervical os predicts cervical ripening better than Bishop's score in nulliparous women at 41 weeks gestation]. / L'ouverture de l'orifice interne du col prédit mieux l'issue de la maturation cervicale que le score de Bishop chez les nullipares à 41 semaines d'aménorrhée.

INTRODUCTION: The objectif was to evaluate ultrasound measurement of the opening of the internal cervical os in the prediction of cervical ripening and to compare it with Bishop's score. METHODS: We conducted a prospective study of 77 nulliparous women admitted to hospital in labor at 41w gestation, with Bishop's Score < 6, over a 10-month period, between July 2012 and April 2013. The measurement of the opening of the internal cervical os was performed using transvaginal ultrasound and Bishop's score was determined by clinical examination. All patients received prostaglandins for cervical ripening. RESULTS: Cervical ripening was successful among 63 patients (81%). Bishop's score and the opening of the internal cervical os were statistically associated with the success or failure of cervical ripening. The success rate of cervical ripening was 100% when the opening of the internal cervical os was equal to or greater than 5 mm (sensitivity: 54%, specificity: 86%). ROC curves showed that the measurement of the internal cervical os was more predictive of cervical ripening than Bishop's score (area under the curve: 0.733 and 0.704 respectively). CONCLUSION: Compared to Bishop's score, echographic measurement of the opening of the internal cervical os is more predictive of the success of cervical ripening in nulliparous women at 41 weeks of pregnancy with an unfavourable cervix.

[Evaluation of different techniques for vaginoplasty in the treatment of Mayer-Rokitansky-Kuster-Hauser syndrome]. / Evaluation des différentes techniques de vaginoplastie dans le cadre du traitment du syndrome de Mayer-Rokitansky-Küster-Hauser.

BACKGROUND: Rokitansky syndrome is an utero-vaginal aplasia with a frequency of 1 / 5000 female births. To correct this anomaly whose prognosis is mainly functional and psychological numerous surgical techniques have been described. AIMS: To report our experience about 13 patients with Rokitansky syndrome and having benefited from a vaginoplasty between 1993 and 2008 and to evaluate the results of the various anatomical techniques. METHODS: This is a retrospective study of 13 patients who underwent a vaginoplasty in the center of maternity and neonatal units, over a period from December 1993 to April 2008. During this period, two operative techniques were used: the technique of Mac-Indoe and the technique of Davydov. RESULTS: The mean age at the time of surgery was 22 years (15 years-32 years). In 6 patients operated using the technique of Davydov the average depth of neovagina was 6.83 cm, one treatment failure was noted. Among the 7 patients operated using the technique of Mac Indoe the average length of neovagina was 7 cm, 3 treatment failures were noted. It was noted that there was no failure of the anatomical results in patients who have had regular sex after surgery. It was noted that there was failure of the anatomical result in 4 of 9 patients who did not have sexual intercourse after the procedure regardless of the technique used, a failure rate of 44%. CONCLUSION: The choice of technique will be based on the experience of the teams as each technique has similar anatomical and functional results in the literature. Both anatomical and functional, the main factor that determines the success of treatment seems to be the motivation of the patient to have a married life and sexual relationship.

Effects of hexavalent chromium on reproductive functions of male adult rats.

Hexavalent chromium is an environmental contaminant which may be associated with reproductive abnormalities in male rats. In the present study, we examined the effect of hexavalent chromium on male reproductive function of rats. Male Wistar rats received a daily intraperitoneal injection of potassium dichromate (1 or 2 mg/kg body weight) for fifteen consecutive days. A decrease in testis weight and an increase in seminal vesicles and prostate weights were demonstrated after chromium treatment. Moreover, a dose-dependent increase in blood and testis chromium levels as well as an increase in FSH and a decrease in LH and testosterone serum levels were detected in treated rats. Histological analysis revealed pronounced morphological alterations with enlarged intracellular spaces, tissue loosening and dramatic loss of gametes in the lumen of the seminiferous tubules of treated rats. In addition, a decreased sperm motility and number of epididymal spermatozoa together with an increased sperm abnormality rate was found in chromium-treated rats in comparison to controls. In rats receiving the higher chromium dose, histological images presented considerably increased areas filled with seminal vesicle and prostate secretions. The mucosal crypts of seminal vesicles and the typical invaginations of prostate were altered. The results suggest that subacute treatment of potassium dichromate promotes reproductive system toxicity and affects testicular function of adult male rats.

[Fibroids and pregnancy: complications]. / Fibrome et grossesse: les complications.

AIM: To study the maternal and fetal morbidity in the association fibroid and pregnancy and the management in this case. METHODS: A retrospective study of 80 cases of fibroids associated to pregnancy. These cases were taken from the department "C" of gynecology and obstetrics in the center of maternity and neonatology of Tunis. RESULTS: We studied 80 cases of fibroid associated to pregnancy in our study. The mean age of the patients was 32 years old. 45 % of the patients were primipares. The interstitial fibroids (68 %) are the most frequent. The average number of fibroid is 1, 7 in each pregnancy. The aseptic necrobiosis is the most frequent complication of the fibroid whereas for the mother the main complications are the premature delivery, the premature rupture of membranes and the placenta praevia during the third term of pregnancy. The dystocic presentations are more frequent than in the general population, responsible of a higher rate of caesarian sections. The delivery hemorrhage constitutes the most frequent complication of the post partum. The fetal prognosis is globally good with a morbidity dominated by growth restrictions but with no superior mortality rate. The myomectomy was practiced during the caesarian section in 3 cases, the abstention being the rule for the other patients. CONCLUSION: The association fibroid and pregnancy is not rare, the complications are frequent that is why it is considered as a high risk pregnancy. An early detection of the complications and a prevention of delivery hemorrhage would reduce the maternal and fetal morbidity.

[Management of liver disease during pregnancy]. / Prise en charge des hépatopathies chez les femmes enceintes.

BACKGROUND: Several liver diseases can be observed during pregnancy. Some are proper to pregnancy and others are not. AIM: To study and to analyze the different liver diseases encountered during pregnancy and describe their management. METHODS: Retrospective study of 97 patients having a liver disease during their pregnancy, the cases were managed in the department "C" of obstetrics and newborn of Tunis. RESULTS: The prevalence of hepatopathy associated to pregnancy was 1.61 in our study. The mean term was 35 weeks of amenorrhea. 45% of labors were induced prematurely. 21 patients were transferred to intensive care unit after delivery due to the severity of their pathology. No maternal death was noted. CONCLUSION: The better comprehension of physiopathology of this association can help to improve the patients care.

[Fine-wire localizations in non palpable breast lesions]. / Le reperage par harpon des lesions mammaires infra-cliniques.

BACKGROUND: Breast cancer represents a major health problem in Tunisia. Mammography allows screening and early diagnosis of breast cancer. The Harpoon allows the location of these small lesions in order to have a histological study and to adapt the management. AIM: To demonstrate on one hand, the feasibility and the safeness of the fine-wire localizations of breast lesions due to the collaboration of radiologists and gynecologists, and on the other hand, to show the possibility of outpatient management in these cases. METHODS: Our study is a retrospective study reporting 45 patients who had fine wire breast lesion localization, in the department "C" of the center of maternity and neonatology of Tunis, during a period of 5 years and a half. RESULTS: The rate of malignant lesions was 22.4 % among the patients who had screening mammographies with nine breast cancers among which two bifocal. The rate of in situ cancer was 33.3 % and invasive cancers 66.6 % allowing a less aggressive treatment of a third of the patients. The 38 patients were taken in charge in ambulatory reducing the cost of hospitalization. In our series, we didn't have any complication during the insertion of the harpoon. CONCLUSION: Fine wire breast lesion localization with harpoon is an easy elegant method, under expert hands, allowing a rapid diagnosis compulsory in breast cancers.

[Granulosa cell tumors: a study of 7 cases]. / Les tumeurs de la granulosa: a propos de 7 cas.

BACKGROUND: The granulosa tumors have been described for the first time in 1855 by Rokitansky. AIMS: To investigate the epidemiological and pathological characteristics of granulosa tumors, and the prognostic factors to determine therapy management. METHODS: Our study is retrospective about 7 cases of granulosa cells tumors treated and monitored at the department C of Gynecology and Obstetrics in the Center of Maternity and Neonatology of Tunis. RESULTS: The average age of our patients was 40 years. The circumstances of discovery are dominated by pelvic pain (3 cases); menometrorrhagia and post-menopausal bleeding (2 cases) and secondary amenorrhea (2 cases). The sonographic most frequent aspect was solido-cystic (3 cases). The final pathologic examination revealed 6 cases of granulosa adult type tumor and one juvenile type. Five tumors were classified as stage Ia, one tumor was stage Ic and one stage IIa. The treatment was conservative in most cases. An ilioobturator and para-aortic lymphadenectomy was performed in 3 cases. Two patients had adjuvant chemotherapy. Six patients were in complete remission at the last inspection. There were two cases of pregnancies carried till birth after surgical treatment. CONCLUSION: The granulosa tumors are characterized by their natural history with a slow and indolent character and their secretion of sex hormones.

[Management of postpartum vaginal haematomas by embolisation: two cases]. / L'embolisation radiologique dans le traitement du thrombus vaginal (à propos de deux observations).

Postpartum vaginal haematomas are a rare complication of delivery. The incidence of large haematomas is estimated at 1/4000 deliveries, and this complication can be life-threatening. We report two such cases. The diagnosis is suggested by shooting perineal pain with urinary tenesmus and vulvovaginal swelling or an unexplained haemorrhagic syndrome in the postpartum period. Rapid management is essential. Embolisation by interventional radiology is preferred to surgery. In the first case, arterial embolisation was performed after bilateral ligation of the hypogastric arteries failed. Arterial embolisation was the first-line treatment for the second patient. It was successful for both women.

[Borderline tumors : diagnosis and management : report of 10 cases]. / Les tumeurs borderlines : diagnostic et prise en charge. Apropos de 10 cas.

BACKGROUND: Since their discovery in 1929 by Taylor border tumors of the ovary, also known as borderline tumor (TOLM) inspired confusion, apprehension and disagreement. AIM: Identify epidemiological, clinical and therapeutic particularities of borderline tumors of the ovary. -Study the different surgical approaches for borderline tumors of the ovary. -Assess the value of frozen section in this pathology. METHODS: This is a retrospective study of 10 patients operated for borderline tumor of the ovary and collected at the department C of the center of maternity and newborn in Tunis. RESULTS: The average age of our patients was 35.6 years Pelvic pain was the main circumstance of discovery, it accounted for 50% of the cases. The discovery was fortuitous in 40% of the cases Ultrasound has shown purely cystic tumors in 70% of cases and solido-cystic ones in 30% of cases. There was a tumor in the controlateral ovary in only one case. The surgery was conservative whenever possible. Histological examination concluded to 6 cases of serous tumor and 4 cases of mucinous ones. Among the 10 patients, 8 were classified as stage Ia, one stage Ib and one stage Ic. The frozen section was performed in 8 cases CONCLUSION: The diagnosis of borderlines tumors of the ovary remains difficult. The laparoscopy is of great use in the management of this pathology. Histological examination is an interesting addition and the conservative treatment is the more appropriate treatment.

[Perigenital hematoma. Diagnosis and management]. / L'hématome périgénital: diagnostic et prise en charge.

OBJECTIVES: Discuss the clinical aspects and the management of perigenital hematoma, a rare complication of delivery that can engage the vital prognosis. CASES: We report 4 cases of peri-genital hematomas recorded in the department C of obstetrics and gynecology, in the maternity center of Tunis. In two cases, the patients had only medical treatment and in the two others arterial embolisation was performed. CONCLUSION: The diagnosis is evoked in front of an unexplained hemorrhagic choc with perineal pain. Upon diagnosis, the patient must be rapidly managed associating resuscitation, surgery and angiographic embolisation.

[Prognosis of delivery from a scared uterus: 123 cases]. / Pronostic de l'accouchement sur uterus cicatriciel: a propos de 123 cas.

BACKGROUND: During these last two decades, the practitioners are more and more confronted to pregnancies on scar womb. AIM: To analyse the behaviour to be held in front of a scar womb and to estimate materno-foetal preview after childbirth (delivery) by vaginal delivery or after a caesarean section at cold. METHODS: It is about a retrospective study held over 123 cases of patients with a scar womb who gave birth in the department "C" of the CMNT over a period of 2 years. RESULTS: Among the 123 cases of scar womb, 70 patients had a preventive caesarean section. The main indication was a pathological pond. Uterine scar was accepted in 53 women, 25 among them gave birth by vaginal tract and 28 had a cesarean section of 2nd intention. There were 4 cases of dehiscence of the scar. 8% of the newborns from vaginal delivery had an apgar < 7 in the 5th mn against 10% in the group of the newborn children stemming from a preventive cesarean-section. CONCLUSION: Pregnancy on scar womb is a pregnancy at high risk requiring an adapted coverage.

[Management of ovarian cyst associated to pregnancy]. / Prise en charge du kyste de l'ovaire et grossesse: a propos de 25 cas.

BACKGROUND: The problem of the association of the ovarian cyst and pregnancy is to determine whether the cyst is functional or organic? AIM: To draw up the epidemiological profile of the patients having a cyst of the ovary, show the peculiarities of this association; and to clarify the therapeutic methods and its effects on the progress of the pregnancy. METHODS: A retrospective study concerning a period of 5 years and interesting 25 patients. RESULTS: The average age of the patients was of 34 years, the average parity was of 2. The discovery of the cyst was in 68% of cases in the first 3 months. On the clinical plan the circumstances of discovery were pelvic pains in 48% of cases and complications in 6% of cases; such us twisting of the cyst. 61% of the patients had a laparoscopy, 44% a laparotomy and a case of guided ultrasound punction, 4% of the patients underwent a pregnancy interruption, 17 pregnancies were led till the end, we noted an intrauterine death of the foetus and a case of late abortion at 22SA. CONCLUSION: problems due to the association of the ovarian cyst and pregnancy are especially of diagnostic and therapeutic order. Obsession was to underestimate a malignant tumour; that's why we should perform a surgical investigation in front of any persevering cyst beyond the first three months of the pregnancy.

[Haemorrhage delivery. About 65 cases]. / Hémorragie de la délivrance: etude rétrospective a propos de 65 cas.

The delivery haemorrhage is actually a problem of public health. It is responsible of 31.5 % of the maternal death in Tunisia. The goal of this work is to study the frequency of this complication, its gravity, its risk factors, its etiologists and its methods of treatment. It is a retrospective study. of 65 cases of delivery haemorrhage recorded to the obstetric gynaecology service "C" of the centre of motherhood and neonatology of Tunis during 4 years. The frequency of the delivery haemorrhage in our study is 1.19%. The middle age of the patient is of 31 years. Their middle parity is 2.4. Factors of risk taking out again our set are: gestational toxemia (35.4%), primiparity (33.8%), advanced maternal age (30.7%), pre-existent anaemia (24.6%). the uterine surdistension (21.3%), an abnormal middle length of labour (69.6%). use of oxytocin during labour (34%), induction (21.5%). Etiologists in our set are: atone in 63% of cases, retained placenta in 31.2% des cases, coagulopathie (9.2%), placenta previa (1.5%), uterine inversion (1.5%). The hold must be in charge multidisciplinary, systematized, precocious and dynamic.