[Hysterectomy for benign lesions in Brittany: analysis of medical practices]. / Hystérectomies pour pathologie bénigne en région Bretagne: analyse des pratiques.

OBJECTIVES: By who, why and how are done hysterectomies for benign lesions. MATERIAL: and methods. The 413 medical files of all the patients who underwent an hysterectomy for benign lesion during the last trimester of 1997 were recorded by the Medical Information Departments of the 53 health establishments of the Brittany Region. Surgical procedures, medical indications, pathological findings were analyzed according to the guidelines encountered in the medical literature. RESULTS: Hysterectomies were done by many surgeons (112). Inaugural signs noted in the medical files were classical, but various and often associated without a main indication of hysterectomy. Histological diagnose were identical with those found usually in the literature. The abdominal route was mainly used, particularly when the operation was done by a generalist surgeon and in case of uterus weight superior to 250 g. The post operative outcome has revealed the same nature and frequency of complications as usually described. CONCLUSION: In this study, it appears that efforts remain necessary to clarify the indications for hysterectomy in the medical files (in order to promote the alternative procedures to the hysterectomy), and that the proportion of hysterectomies performed by the abdominal route should be reduced in aid of the others surgical routes.

[Socioeconomic approach to the practice of in vitro fertilization in the Brittany region in 1993]. / Approche socio-économique de la pratique de la fécondation in vitro en région Bretagne en 1993.

AIM OF THE STUDY: to estimate the social and economical point of view of the practice of in vitro fertilization (IVF) in Brittany in 1993. METHODS: we made a prospective study of 152 cases of IVF. We studied the medical history of sterility of the patients, treatments during IVF, hormonal and ultrasound monitoring, oocytes retrieval and embryo transfer, and the screening until beta-hCG > 1,000 UI or evidence of pregnancy with ultrasound scan. After analysing results of IVF, we studied the cost of all these steps, including hospitalization, transports and stoppage. RESULTS: we estimated the mean price of one IVF cycle at 11,084 francs. We analysed the portion of each step in the total cost and discussed with the view of literature. CONCLUSION: the cost of IVF seems reasonable in this context.

[Prognosis for delivery in women with previous cesarean section. Apropos of 209 cases]. / Pronostic de l'accouchement chez la femme antérieurement césarisée. A propos de 209 cas.

The authors have attempted to show the following with the help of 209 cases of delivery in women who had previously had Caesarean sections: Vaginal delivery is possible in approximately one out of every two cases, providing certain precautions have been taken and these are: Maternal morbidity rises to about 12% when a woman is delivered after a previous Caesarean section, whether the delivery is vaginal or, a repeat Caesarean. Furthermore, morbidity rises greatly after a failure of a trial of labour for which the indications should be very carefully considered. The outlook for the fetus is better after a vaginal delivery. In fact, this result seems to be allied to pathology which results from the surgical procedure itself. All the same, respiratory distress in the newborn is more frequent after Caesarean operation, which exposes the fetus to the risks of a uterine rupture and also of increased incidence of instrumental delivery following a previous Caesarean.

[Infectious complications of intrauterine devices]. / Complications infectieuses sous sterilet.

PIP: 5 descriptions of uterine infections caused by an IUD are given. The symptoms are leukorrhea and metroraghia. The antibiotic treatment must be accompanied by removal of the IUD. If symptoms are ignored, the infections become worse, with serious results. 2 of the cases needed drastic surgery and another became sterile. Close surveillance is necessary to avoid such infections and to provide careful treatment if they occur. Prevention should include avoiding IUD use in those who have never given birth, or at the time of curettage.^ieng