[Uterine ruptures. 32 cases]. / Les ruptures utérines. A propos de trente-deux cas.

On the basis of qqq 32 cases of rupture of the uterus observed over a 5-year period at the Monastir University hospital (Tunisia), the authors recall the high incidence of this obstetrical emergency: 1 incident per 548 deliveries. The usual aetiological factors were present: multiparity, caesarean scar, mechanical dystocia, oxytocic dystocia and obstetric manoeuvres. The foeto-maternal prognosis is poor with a maternal mortality rate of 3.13% and a perinatal mortality rate of 46.9%. Treatment should be conservative whenever possible. The authors attempt to define a prophylactic approach on the basis of the aetiological context.

[Maternal hydrocephaly and pregnancy. A new case report and review of the literature]. / Hydrocéphalie maternelle et grossesse. A propos d'une nouvelle observation et revue de la littérature.

The authors describe a fresh case combining hydrocephalus and pregnancy. The improved quality of the shunt used and neurosurgical methods available have transformed the prognosis for non-tumoral hydrocephalus. The ventriculo-peritoneal shunt malfunctioned during pregnancy in 50% of cases. In the absence of acute neurological complications at term due to distal malfunction of the shunt, vaginal delivery is to be preferred.

[Maffucci syndrome and ovarian tumor]. / Syndrome de Maffucci et tumeur ovarienne.

Maffucci's syndrome was first described in 1881 and results of a mesodermic dysembryoplasia, congenital but not hereditary. Pathogenic hypothesis are multiple. This syndrome is characterized by the occurrence of multiple haemangiomas in the soft tissue, and multiple enchondromas of the bones. The association of ovary tumor is however exceptional. Four cases are reported in the literature; we report the fifth case.

[HELLP syndrome. Epidemiological, nosological and prognostic aspects]. / HELLP syndrome. Apports épidémiologique, nosologique et pronostique.

The authors report a prospective and controlled study of hellp syndrome in two groups of patients: normal and preeclamptic. Hellp syndrome was seen only in the pre-eclamptic group (19.3 per cent). Maternal prognosis was poor when Hellp syndrome was confirmed. Several maternal complications were seen: severe hypertension, subarachnoid hemorrhage, coagulation disorders and renal failure. Maternal mortality was high (16.7 per cent). Hellp syndrome does not worsen fetal prognosis, which is already compromised by pre-eclampsia.

[Fetal prognosis in breech delivery. Statistical study of 543 cases]. / Le pronostic foetal de l'accouchement par le siège. Etude statistique à propos de 543 observations.

The authors report a retrospective study of 543 breech deliveries during a 4-year period (1987-90). The cesarean section rate was 18.4 per cent, and perinatal mortality 3.68 per cent. Poor prognostic factors were: multiparity, large fetus, cord prolapse, second stage of labour lasting more than 30 mins and obstetric manoeuvres. Prenatal care and obstetric evaluation before labour may improve fetal prognosis.

[Peripartum cardiomyopathy. Analysis of 3 cases and review of the literature]. / Cardiopathie du péri-partum. Analyse de 3 cas et revue de la littérature.

Peripartum cardiomyopathy is defined as a syndrome of cardiac failure occurring in the latter part of pregnancy or in the puerperium without obvious cause and without prior evidence of heart disease. Analysis of the particular features of this syndrome and a review of the literature indicate its similarity with other cardiomyopathies in terms of clinical features, natural history and treatment, but maternal and fetal prognosis is poor.

[Bologna operation]. / L'intervention de Bologna.

Thirty cases of urinary incontinence and genital prolapse have been treated using Bologna's method. The authors describe this operation. The post-operative controls were based on the clinical state of the patient and in ten cases on the urodynamic tests. Anatomical result was very satisfactory. In all but one case the abdominal pressure transmission defect to the upper urethral was corrected without deterioration of maximal urethral pressure.

[Hysteroscopic metroplasty of uterine septa]. / Les métroplasties hystéroscopiques des cloisons utérines.

A series of 23 patients with septate uteri who underwent hysteroscopic division of the septum between January 1990 and March 1992 were studied. Before operation 19 of the 23 patients had 50 pregnancies with 29 spontaneous abortions, 7 late abortions, 5 premature deliveries and 9 deliveries at term. Sixteen patients who were followed up for more than 6 months conceived 9 times. Six of these went to term with 4 normal deliveries and 2 caesarean sections for obstetrical indications. There are 2 pregnancies continuing at present (at 25 and 27 weeks of amenorrhoea) and one spontaneous abortion in the first trimester. Two patients had to be operated on again because a partial residual septum was found post-operatively.

[Evaluation of the method of delivery in breech presentation]. / Evaluation du mode d'accouchement dans la présentation du siège.

The authors report a retrospective study based upon 543 breech deliveries at term, collected between 1987 and 1990. The cesarean section rate was 18.4 per cent. It was prophylactic in 56 cases. When the possibility of vaginal delivery was accepted, cesarean section was performed in 9 per cent of cases. Fetal mortality and morbidity were higher with vaginal delivery. However, maternal morbidity was greater in the cesarean section group. Study of the literature shows that the increase in cesarean section rate in recent years is not the only factor responsible for improved fetal prognosis. It is therefore important to restrain this increase and find the optimum percentage rate.

[Problems posed by the delivery of twin pregnancies]. / Problèmes posés par l'accouchement de la grossesse gémellaire.

The authors present a retrospective study of 249 deliveries of twin pregnancies collected between 1987 and 1990. The incidence of twin pregnancies is 1.6%. Delivery is premature in 28.1% of cases and that of low birth weight is 51.7%. In 13.2% of cases, delivery was Cesarean and the Apgar score was significantly higher for the first twin than for second. Perinatal mortality was 7.2 percent. The authors compare these findings with those reported elsewhere in the literature.