[Diagnosis of fetal engagement by transperineal sonography: a preliminary Tunisian study]. / Diagnostic de l'engagement fœtal par l'échographie transpérinéale: étude préliminaire tunisienne.

INTRODUCTION: The assessment of fetal head engagement by digital examination is highly subjective even though this method remains the gold standard. Ultrasound could be a new way to specify the fetal head engagement with objective and reproductible measurements. OBJECTIVE: To compare the clinical data and the transperineal ultrasound results for the diagnosis of fetal head engagement. PATIENTS AND METHODS: We conducted a prospective longitudinal study on a series of 70 patients and compared the clinical assessment of fetal engagement to the ultrasound measurements. Ultrasound examination was performed in the delivery room. The probe was placed on the ano-vulvar area. The measure used was: distance perineum-external table of fetal head bone. RESULTS: The ultrasound measures of the distance [perineum-external table of fetal head bone] went from 13 to 75 mm; and the measures of the distance [perineum-succedaneum bump] went from 22 to 68 mm. We tried to retain a value threshold of the distance [perineum-external table of fetal head bone] above which the diagnosis of engagement would be countered. The threshold so proposed is of 55 mm with a positive predictive value in 98%, a sensibility in 87% and specificity in 93%. DISCUSSION AND CONCLUSION: Transperineal ultrasound is a simple and easy method to define fetal head engagement by measuring the distance between perineum and fetal head. This new tool can be very useful in the delivery room when clinical examination is inconclusive hampered, for example, by the presence of a succedaneum bump.

[Death of one fetus in multiple pregnancies during the second and third trimesters. Maternal-fetal complications]. / Mort in utero d'un foetus dans les grossesses multiples au cours du 2ème et 3ème trimestre. Complications materno-foetales.

The authors report 7 cases of death of one foetus during multiples pregnancies in 107 pregnancies during the second and the third quarter. The rate is 6.54%. Five cases are complicated by toxaemia which increased the caesarean rate. The placenta is monochorial in 4 cases. The hemostasis check up shows a drop of fibrinogen and the rate of thrombin, which normalised after delivery. One patient developed in septicaemia after caesarean delivery. Concerning the surviving foetus: 5 of them had en intra uterine under development, 2 of them were premature and one developed an encephalopathy.

[Subcapsular liver hematoma. Two case reports and review of the literature]. / Hématome sous capsulaire du foie. A propos de deux cas et revue de la littérature.

The authors report two cases of complicated toxaemia by subcapsular haematoma of liver in the gynaecology obstetrics ward of the Mongi Slim university hospital in Marsa, Tunisia during six years. The diagnostic was made after delivery in all cases. Evolution was been favourable only in one case, the other is complicated by superinfection which required surgical draining. The literature review determiner the poor prognosis of the subcapsular haematoma of the liver.