ABSTRACT
AIM: Detect the risk factors, indications and maternal morbidity of haemostatic hysterectomy. METHODS: A retrospective study of 46 women who had haemostatic hysterectomy between 2005 and 2009. RESULTS: The mean age was 33.3 years. The mean parity was 3.5. 35% of patients had a previous cesarean section. The mode of delivery was: vaginal delivery (47.8%), cesarean delivery (52.2 %). The hysterectomy was subtotal in 39 cases (85%). The indications of haemostatic hysterectomy was: uterine inertia (44%), disseminated intravascular coagulation (26%), placenta accreta (8.7%), Placenta praevia (13%), uterine rupture (8.7%).Three patients were dead. Five patients had a depression. Six patients had a dyspareunia. Five patients had a decrease of sexual desire. CONCLUSION: Haemostatic hysterectomy is a mutilating surgery giving an irreversible infertility. The development of arterial embolization avoid the appeal to this surgery.
Subject(s)
Emergency Treatment , Hysterectomy , Postpartum Hemorrhage/surgery , Adult , Female , Humans , Prognosis , Retrospective Studies , Risk FactorsABSTRACT
AIM: To compare the efficacy and safety of cervical ripening at term by vaginal Misoprostol and Dinoprostone. METHODS: We performed a prospective randomized study on cervical ripening with misoprostol and dinoprostone in the third trimester of pregnancy. 300 patients have been divided into two groups: one consisted by 150 patients who received Misoprostol (Cytotec ®) and the second consisted by 150 patients who received Dinoprostone (Prépidil ®). RESULTS: Analysis of our results allowed to reveal: a significant decrease in the time of entry into work for the Misoprostol group (9.08 hours versus 12.51 hours, p = 0.007), a significant reduction delivery time (14.48 hours versus 19.30 hours, p = 0.001). Moreover, the birth rate in the first 24 hours after the first dose was significantly higher in the Misoprostol group (86.7% versus 72.7%, p = 0.003). The use of oxytocin was significantly reduced with Misoprostol (44% versus 58.7%, p = 0.01). The mode of delivery was not influenced by membership in one or other of the two groups. CONCLUSION: Misoprostol seems an interesting molecule for cervical ripening and labor induction.
Subject(s)
Cervical Ripening/drug effects , Dinoprostone/therapeutic use , Misoprostol/therapeutic use , Term Birth , Administration, Intravaginal , Adult , Cervical Ripening/physiology , Dinoprostone/administration & dosage , Dinoprostone/adverse effects , Female , Humans , Labor, Induced/adverse effects , Labor, Induced/methods , Misoprostol/administration & dosage , Misoprostol/adverse effects , Obstetric Labor Complications/chemically induced , Obstetric Labor Complications/epidemiology , Oxytocics/administration & dosage , Oxytocics/adverse effects , Oxytocics/therapeutic use , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Complications/therapy , Term Birth/drug effectsABSTRACT
BACKGROUND: genital polapse is a frequent olisease several techniques were described. AIM: To evaluate the anatomical and functional results of surgery for genital prolapse by vaginal and abdominal approach. METHODS: Prospective study on 93 patients operated for urogenital prolapse (50 by high and 43 vaginal approach) in the department of obstetrics and gynecology of Sfax. Anatomic results and postoperative patient satisfaction was assessed. Quality of life was assessed using the French versions of the questionnaires Pelvic Floor Distress Inventory (PFDI 20), Pelvic Floor Impact Questionnaire (PISQ 7). RESULTS: The mean age of patients was 59 years. 85.9% of our population consisted of postmenopausal women. The results of the postoperative visit, after a mean of 28.7 months, showed about the anatomical level, a success rate for the treatment of prolapse by high 82% against 72.1% for vaginal delivery, but the difference is not significant (P = 0.45). For prolapse of grades 1 and 2, surgical treatment by high and low has corrected all the elements of prolapse. For prolapse of grades 3 and 4, high surgery has resulted in a satisfactory anatomical result in 86%, while the lower channel yielded a significant result in 76.5%, and recurrence were interested mainly the anterior stage. The questionnaire PFDI 20, showed an improvement in the quality of life after surgery significantly in both groups (p<0.003). The improvement was more significant PFDI 20 after surgery by high versus vaginal surgery (p <0.002). Regarding PFIQ 7, improved quality of life was observed after surgery without significant differences between the two groups. CONCLUSION: The treatment of urogenital prolapse is mainly based on surgical and reconstructive surgery to restore anatomical and functional surgery also in order to improve the quality of life of patients.
