[Is fetal fibronectin a valid test predictive of premature labor?]. / La fibronectine foetale est-elle un bon test de prédiction de l'accouchement prématuré?

This study sought to determine the value of oncofetal fibronectin as predictor of preterm delivery in patients presenting with preterm labor. Patients admitted for preterm labor with intact membrane between 24 and 34 weeks gestation were included. A dacron swab applied to the external os for 10 seconds. The fetal fibronectin is detected bill a biologic membrane test. 90 patients were included. 25 (28%) had positive fetal fibronectin, and 13 (52%) had preterm delivery (specificity and positive value 81% and 52% respectively). Among 65 (72%) with negative fetal fibronectin, only 12 (18%) had preterm delivery (sensitivity 81% and negative predictive value 81%: p < 0.001). Median interval between sampling and delivery was 5 days in the positive compared to 23 in the false negative group. The presence of fetal fibronectin in the cervico-vaginal mucus strongly suggest an eminent delivery within few days after sampling. The sensitivity of the test is the 62% and still more interesting the negative predictive value is 86% (p < 0.001). The fetal fibronectin is a useful test to help the obstetrician discriminating true from false labor in patients with high risk preterm delivery. A negative test is very reassuring according to its high negative predictive value. Allowing to avoid unuseful tocolyse and long hospital.

Strategie therapeutique dans le traitement des infections gynecologiques hautes

Les infections gynecologiques hautes sont dues a des germes varies; aerobies et anaerobies; mais souvent associees aux maladies sexuellement transmissibles. Le Chlamydia Trachomatis est plus frequemment retrouve que le gonocoque et le mycoplasme. La plupart des auteurs proposent une association d'antibiotiques: amoxicilline - acide clavulanique plus cycline; cephalosporine de 2eme et 3eme generation plus metronidazole et cycline; clindamycine et une cycline; et recemment; l'association ofloxacine et anoxicilline - acide clavulanique parait tres efficace. Le traitement anti-inflammatoire permet d'eviter les sequelles; et la coelioscopie garde sa place en cas d'abces

Modulation of immunoreactive somatomedin-C levels by sex steroids.

Among 28 menstruating women tested once randomly during the cycle, somatomedin-C (Sm-C) values were lower in the 10 women in normal follicular phase than in the 10 women in normal luteal phase or the 8 women with hyperandrogenism. Among these 28 subjects, Sm-C showed a positive correlation with testosterone and a positive correlation of borderline significance with oestradiol. A positive correlation was also evidenced between Sm-C and in progesterone among the 20 women of this group who were not hyperandrogenic. In 5 other normal women investigated daily throughout an entire menstrual cycle, Sm-C concentrations were higher during days +4 to +9 of this cycle (luteal phase) than during days -3 to -8 (follicular phase). In another group of 21 healthy women, Sm-C values were increased during medroxyprogesterone acetate (150 mg trimestrially) treatment. In 7 normal men, Sm-C decreased during ethinyl-oestradiol (1 mg daily for 5 days) administration. These findings suggest that circulating Sm-C levels are modulated by variations of sex steroids which occur during the menstrual cycle as well as by pharmacological doses of oestrogens and progestagens.

[Treatment of non-specific menometrorrhagia with naftazone]. / Traitement des ménométrorragies non spécifiques par la naftazone.

The authors carried out a double blind study of the action of naftazone in non-specific menometrorrhagias caused by a uterine device, the oral contraceptive and medroxyprogesterone, in 25 patients. They show a great improvement with the periods becoming normal and metrorrhagia disappearing in 12 out of 13 cases where naftazone was used and in only 1 out of 12 cases where the placebo was used.

[The reproductive function following a hydatidiform mole]. / La fonction de reproduction après une môle hydatiforme.

This paper starts with a short description of the history of the discovery of the hydatidiform mole ( Tulp in 1641) and of the treatment (before 1956, hysterectomy in most cases). After 1961 chemotherapy started to be used even in patients who had cerebral metastases. 72 patients who had attended Professor Hubinont 's department in the University Hospital of Saint-Pierre in Brussels between January 1971 and December 1981 were followed up. Questionnaires were sent to the patients and to their doctors who were treating them in order to try and find out what had happened in subsequent pregnancies and what the maternal and fetal consequences and complications were. The social class and the marital status of the patients was also considered as well as their wish to become pregnant again. Of the 72 cases that were followed up after evacuation 63 (87.5%) recovered while 9(12.5%) had clinical, biological or radiological signs of persistent non-metastatic (3) and metastatic (6 cases) active disease. The department asked patients not to become pregnant in the year following evacuation of the mole. 10% were sterilised, 4 by hysterectomy and 4 by tubal ligation. 42% used the oral contraceptive pill and 34% (24 cases) condoms. Control follow-up of patients who became pregnant was compared with a group of 2 529 pregnancies in Saint-Pierre Hospital during the year 1981. 44 out of the 72 patients who were followed up after hydatidiform mole became pregnant with a total of 52 pregnancies. Ten became pregnant in the first 6 months after attempting it, 11 between 6 and 12 months and 23 after a delay of 12 months. Out of the 52 pregnancies, 34 5%) had a live baby at term. 6 were premature and 31 out of 34 babies delivered at term were delivered vaginally and 3 by Caesarean. There were 9 spontaneous abortions (17%) and 2 terminations of pregnancy (4%). Three patients had repeated non-intentional abortions and one had a still-birth for which the cause could not be found. Only one other had a second mole. When these results are compared with the histories of these patients before they had the hydatidiform mole there did not seem to be any increase in the number of spontaneous abortions or premature labours, nor was there when this group was compared with a control group. Only one of the 38 live-born children showed a major congenital abnormality which was varus equinus. There was no possibility of picking out statistically anything of value as far as congenital malformations was concerned.

[Post-pill amenorrhea "syndrome" (author's transl)]. / Le "syndrome" amenorrhee post pilule.

PIP: This study attempted to identify factors related to development of postpill amenorrhea in 32 women who underwent diagnostic tests after 6-24 months of amenorrhea. Patients were aged 18-40, with a mean of 25 years. 27 had never been pregnant, 4 were primiparas, and 1 was a grand multipara. The physical examination was normal in most cases, but 7 were found to suffer from galactorrhea and 3 from abnormal hairiness. 28 had used a combined pill, 1 each had used sequential and biphasic pills, and 2 did not know what type they had taken. There was no apparent relationship between the duration of pill use and the duration of amenorrhea. 26 patients, or 53%, had had a late menarche (16 years or later) and irregular cycles before beginning pill use. 9, or 28%, had had irregular cycles but normal menarche and 2, or 6%, had had late menarche but normal cycles. Postpill amenorrhea is difficult to distinguish from spontaneous amenorrhea and its etiology is still unknown, although in general it may be due to the effects of combined pills on the hypothalamus. The rate of spontaneous remission is high; 12 of the 32 spontaneously resumed menstruating after 6-12 months. All of the 18 patients with different characteristics who were treated with either clomid, dexamethasone, and thyroid extract, or bromocriptin resumed menstruation and 10, or 55%, subsequently became pregnant.^ieng

Failures of laparoscopic sterilization by Hulka-Clemens clips.

PIP: The reasons for failure in a series of 544 laparoscopic sterilizations by Hulka-Clemens clips are analyzed. Patients were divided into 2 groups: 1) 327 women sterilized by clips, and 2) 217 women sterilized with clips simultaneous to suction abortion. Most patients were 31-41 years of age. 10 pregnancies were observed in the 4-12 month follow-up, most of which occurred 2-4 months after clip application. None of the pregnancies were ectopic. The higher failure rate in group 2 (7%) compared to group 1 (1.83%) is due to the larger uterine size in the pregnant women. Most failures were attributable to a lack of technical training on the part of operators. In most cases, the clips were applied to a structure other than the tube: round ligament (3 cases), fimbriae (2 cases), utero-ovarian ligament (1 case), twisted spring (3 cases). The cause for failure remains unknown in 1 case. Compared with other sterilization methods (e.g., diathermic coagulation, Yoon ring), the Hulka-Clemens clip procedure has a low rate of method failure. Other studies have noted the following reasons for failure: material, application in already pregnant patients, incomplete nipping of the tubal lumen, application on another structure, and decrease of pressure on the jaws of the clip. Subsequent pregnancies with this method can be avoided by attention to optimal presentation of the uterus during the procedure to facilitate tubal cupping, and adequate supervision when the procedure is done by an inexperienced operator.^ieng

[Genetic factors in gestational trophoblastic tumors]. / Les facteurs génétiques dans les tumeurs trophoblastiques gestationnelles.

Gestational trophoblastic tumours group together the complete hydatidiform mole (classical) and partial mole (with fetus), invasive mole and choriocarcinoma. Genetically, trophoblastic tumours can arise in different ways: they can derive from normal zygotes with the maternal and paternal haplotype (normal pregnancy), or from a triploid zygote (partial mole) or from an XX zygote possessing only a duplicated male haplotype and no maternal contribution (complete mole). The low malignancy rate in partial mole (2.4%) compared to the complete mole (10 to 20%) remains unknown. Further analysis of the genetics of these tumours may well contribute to the understanding of the process of carcinogenesis.

[Embryonal mole: value of echography. Apropos of 9 cases]. / Môle embryonnée: apport de l'échographie. A propos de neuf cas.

Hydatidiform embryonic mole is characterised by a special appearance of the placenta, the presence of an embryo or a fetus and a triploid caryotype. The authors report on ultrasound analysis of 9 hydatidiform moles in which the histological diagnosis was confirmed by careful anatomo-pathological examination (with suspicion of triploidy). The ultrasound diagnosis of a complete or partial hydatidiform mole can be made if the following criteria are noted: the placenta is larger and thicker than the placenta of pregnancies of the same duration and shows up with a partial molar appearance; there is the presence of an empty gestation sac or one that contains amorphous echoes suggesting a macerated fetus; a well formed fetus, which has died or is alive but has intra-uterine growth retardation; in early pregnancies, pregnancies that are usually not progressing; if there is a suspicion of a hydatidiform mole search should be made thoroughly for associated malformations (such as triploidy); the presence of lutein cysts of the ovary is a rarity.

[Pregnancy after celioscopic sterilization with Hulka-Clemens Clips (author's transl)]. / Grossesse apres sterilization coelioscopique par clips de Hulka-Clemens.

PIP: 544 women who had undergone voluntary tubal occlusion with Hulka-Clemens clips were reexamined 2-6 months after the procedure. 10 women were pregnant, or a sterilization failure of 1.83%. There were no ectopic pregnancies and failure of sterilization was clearly due in 6 cases to surgical error, in 3 cases to malfunction of the clip, and no reason was found for the remaining case. The operators had all been young doctors performing their 1st sterilization. According to the published literature, failure rates for female sterilization goes from 2-5.2/1000 for electrocoagulation, from 0.18% to 2-6/1000 with the Hulka clip, and it is about 0.33% with the Yoon ring. Causes for failure may be imperfect surgical equipment, procedure on a patient already pregnant, or surgical error. All surgical equipment must be carefully tested before all procedures, and young and yet unskilled operators must be checked during the procedure.^ieng

[The 'lost' intra-uterine contraceptive device (author's transl)]. / Le dispositif intra-utérin "disparu"

The authors report five cases of lost intra-uterine devices, which means that the threads were not visible at the external os of the cervix. This gives them an opportunity to review the literature and to conclude the following: 1. Ultra-sound is the treatment of choice to find the position of the IUD that has been lost, whether is is intra- or extra-uterine. 2. In doubtful cases an antero-posterior and a lateral hysterogram makes it possible to determine the relative position of the IUD to the uterine cavity. Laparoscopy gives useful complementary information. 3. If the IUD is intra-uterine, either totally so or partially, the treatment of choice is to remove it under hysteroscopic control. 4. Where perforation has occurred and the IUD has only entered incompletely into the pelvis, it is possible to pull it out under hysteroscopic control through the vagina if laparoscopy has demonstrated that there are no local adhesions attaching it to neighbouring organs. 5. Where perforation has been complete, laparotomy is preferable to laparoscopy as a technique to recover the lost IUD, in particular when this is a copper one. 6. Perforations occur particularly when the IUDs are inserted post-partum.