[Management of endometriomas in France: A survey of practices]. / Prise en charge des endométriomes en France : enquête de pratiques.

OBJECTIVES: To present an overview of French practices for the management of endometriomas. METHODS: We carried out a nationwide survey of practices concerning the management of endometriomas between October 2021 and January 2022. This study was carried out by means of two questionnaires sent to surgical centers used to treat endometriosis (n=62) and to Assisted Reproductive Technology (ART) centers (n=102). RESULTS: At the end of the survey, 39/62 (62.9%) surgical teams from the centers contacted had given a response and 51/102 (50.0%) from ART centers. Laparoscopic cystectomy was the technique most frequently used by almost two thirds of the surgical teams (61%) when there was no known infertility, whereas it was the most common technique for only 14% of the ART teams. On the contrary, ultrasound-guided sclerotherapy was the most frequent technique for more than half of the ART teams (56%) and for only 8% of the surgical teams. In case of recurrence, 49% of surgical teams would choose ultrasound-guided sclerotherapy. Prior to IVF, 73% of ARP teams stated that they 'rarely' treated endometriomas. CONCLUSION: The results of our study show a certain variability in practices between different centers and depending on the presence or absence of infertility for the management of endometriomas in France.

The definition of Endometriosis Expert Centres.

Endometriosis is a common condition that causes pain and infertility. It can lead to absenteeism and also to multiple surgeries with a consequent risk of impaired fertility, and constitutes a major public health cost. Despite the existence of numerous national and international guidelines, the management of endometriosis remains suboptimal. To address this issue, the French College of Gynaecologists and Obstetricians (CNGOF) and the Society of Gynaecological and Pelvic Surgery (SCGP) convened a committee of experts tasked with defining the criteria for establishing a system of care networks, headed by Expert Centres, covering all of mainland France and its overseas territories. This document sets out the criteria for the designation of Expert Centres. It will serve as a guide for the authorities concerned, to ensure that the means are provided to adequately manage patients with endometriosis.

[Definition of endometriosis expert centres]. / Définition des centres experts en endométriose.

OBJECTIVES: The Collège national des gynécologues obstétriciens français (CNGOF), in agreement with the Société de chirurgie gynécologique et pelvienne (SCGP), has set up a commission in 2017 to define endometriosis expert centres, with the aim of optimizing endometriosis care in France. METHODS: The committee included members from university and general hospitals as well as private facilities, representing medical, surgical and radiological aspects of endometriosis care. Opinion of endometriosis patients' associations was obtained prior to writing this work. The final text was presented and unanimously validated by the members of the CNGOF Board of Directors at its meeting of October 13, 2017. RESULTS: Based on analysis of current management of endometriosis and the last ten years opportunities in France, the committee has been able to define the contours of endometriosis expert centres. The objectives, production specifications, mode of operation, missions and funding for these centres were described. The following missions have been specifically defined: territorial organization, global and referral care, communication and teaching as well as research and evaluation. CONCLUSION: Because of its daily impact for women and its economic burden in France, endometriosis justifies launching of expert centres throughout the country with formal accreditation by health authorities, ideally as part of the National Health Plan.

[Rectal administration of misoprostol for delivery induced hemorrhage. Preliminary study]. / Le misoprostol par voie rectale dans les hémorragies de la délivrance. Une étude préliminaire.

OBJECTIVE: Assess the efficacy of one misoprostol tablet (Cytotec) in severe delivery-induced hemorrhage on uterine atony after failure of syntocinon. PATIENTS AND METHODS: A descriptive study was conducted at the Djibouti Army Hospital from September to December 2000. Five patients with severe delivery-induced hemorrhage due to uterine atony unresponsive to syntocinon were give a tablet of misoprostol by rectal administration. RESULTS: The hemorrhage ceased in less than 5 minutes in all patients. No immediate side effect was observed. DISCUSSION: These preliminary findings are encouraging and suggest that further investigations would be useful to assess the beneficial effect of misoprostol by rectal administration for patients with severe delivery-induced hemorrhage due to uterine atony. Case-control studies with a sufficient number of cases should be undertaken to determine the real efficacy of misoprostol in this indication.

[Birth after two cesarean sections: the role of trial of labor]. / Utérus bicicatriciel: la place de l'épreuve utérine.

OBJECTIVE: To study the management of labor following two cesarean sections, we evaluated maternal and neonatal morbidity subsequent to this attitude. PATIENTS AND METHODS: A retrospective study was conducted over a 6-year period (1-1-1990 to 31-12-1995) in 184 women presenting two uterine scars. Trial of labor was allowed in 96 cases with cephalic presentation and a normal pelvis. RESULTS: The rate of vaginal birth was 65%. Three patients presented a uterine scar dehiscence and in one of them hemostasis hysterectomy for uterine atony was performed. Neonatal outcome was good in all cases. CONCLUSION: Trial of labor after two cesarean sections is possible in the majority of cases. Rate of vaginal birth is high and maternal and fetal morbidity is low.

[Examination of the vulva and the vagina: from clinics to biopsy]. / Examen de la vulve et du vagin: de la clinique à la biopsie.

The purpose of this article is to describe clinical and colposcopic examination of vaginal and vulvar pathologies. Diagnosis tests are described as Hewitt's test, Collins test and epicutaneous test. According to clinical aspect, samples for bacteriological or cytological examinations are performed. Biopsy sites are selected by colposcopy to exclude atypia or malignancy.

[Transmission of human immunodeficiency virus to the fetus during pregnancy]. / Transmission du virus de l'immunodéficience humaine à l'enfant pendant la grossesse.

Estimates of the rate of human immunodeficiency virus vertical transmission range from 15% to 40%, and the rate is lower in European and American studies than in African studies. There appears to be a relationship between maternal factors, mode of delivery and mother-to-child transmission. The risk factors or markers associated with increased vertical transmission are analyzed in this review. The use of zidovudine, administered to HIV-infected women during pregnancy and labour, and to the offspring for 6 weeks reduce the mother-to-infant transmission rate from 25% to 8%. Other strategies to alter transmission of HIV, including the use of combinaison of anti-retroviral drugs, immunoprophylaxis against HIV or obstetric interventions needs to be evaluated.

[Human immunodeficiency virus infection in pregnancy. General aspects]. / Infection par le virus de l'immunodéficience humaine chez la femme enceinte. Aspects généraux.

Seroprevalence of HIV infection in pregnancy is on the increase worldwide. Approximately 10 million infants will have been infected by the year 2000 and the majority of these children will have acquired infection by vertical transmission of HIV from infected mothers. Recent reports suggested that pregnancy does not accelerate the course of HIV infection. Prospective studies from industrialized countries where most women have asymptomatic HIV infection, have not shown an association with increased risk of adverse pregnancy outcome. Estimates of the rate of vertical transmission range from 15% to 40%.