[Spontaneous uterine rupture of an unscarred uterus during labor: case report and review of the literature]. / Rupture utérine spontanée sur utérus sain pendant le travail: à propos d'un cas et revue de la littérature.

Uterine rupture during labor is a serious and uncommon obstetrical complication that can lead to severe prognosis for the mother and her child if not immediately diagnosed and treated. Most spontaneous uterine ruptures occur during labor in parturients with a scarred uterus and are much rarer on an unscarred uterus. We report the case of a uterine rupture on unscarred uterus to a 32 year-old woman after a labor induced by intravaginal prostaglandin and intravenous ocytocine injection. Our management is compared with the data from literature.

[Smoking and pregnancy: the role of the gynecologist-obstetrician and the obstetrical team]. / Tabac et grossesse: rôle des gynécologues obstétriciens et de l'équipe obstétricale.

Pregnancy is a particular period of life which changes the woman's smoking behavior. One-third of smoking women stop smoking spontaneously during this period and a large proportion request help with smoking cessation. Gynecologist-obstetricians who are concerned by the technical aspects of the pregnancy and other classical risk factors (gestational diabetes, hypertension) play an indispensable role, but together with the entire obstetrical team they must become more involved to fully take into account this toxic disease in their everyday practice. We report the experience of a level 1 maternity supported by the Lorrain Perinatal Network, the Association for Perinatal Prevention, Research and Information, and the work of our midwife anti-smoking team. The first step was better awareness. We shared our knowledge about the profile of the smoking mother and her expectations and about the usefulness of CO monitoring (prenatal consultations, hospital stay, delivery room). We then established a strategy for our entire healthcare facility involving minimal training for all categories of personnel, definition of screening and prevention modalities, and obstetrical care for smoking mothers. We also organized a smoking cessation supportive care program. Applied during outpatient consultations and hospital stays and in the delivery room, the program also included a smoking-cessation consultation with two midwives in the unit in cooperation with a physician and a dietitian working with smoking patients. A survey conducted in 24 maternity wards participating in the Lorrain Perinatal Network and five Perinatal Care Centers enabled an assessment of their participation in the smoking-cessation program and to evaluate their needs. Perinatal indicators are not satisfactory in France and it will be interesting to observe what changes can be achieved in each maternity ward after application of the smoking cessation care and support program.

[Irritable colon in children: dietary aspects]. / Côlon irritable de l'enfant: aspects diététiques.

Forty cases of irritable bowel syndrome with complete dietary histories were examined retrospectively. Included were infants and children aged 6 to 42 months, who had diarrhoea at least 4 weeks duration, a normal pattern of growth and no evidence of malabsorption or enteric infections. The majority (92.5%) of these patients had been on high carbohydrate, high protein and low fat diets prior to referral. Ten percent of the patients lost weight as a result of marginal caloric intake subsequent to restrictive dietary advice. In 19 of the 25 patients compliant to dietary recommendations, this modification was associated with the resolution of symptoms. Based on this study and previous others we suggest to carefully gather dietary intake information for all patients fulfilling the usual criteria for irritable bowel syndrome and recommend a therapeutic trial of increased dietary fat and diminished carbohydrates and even proteins intake.

[Diet in familial hypercholesterolemia type IIa. Grenoble survey 1983-1988]. / La diététique dans les hypercholestérolémies familiales type IIa. Enquête Grenobloise 1983-1988.

In 19 children with familial hypercholesterolemia type IIa measures to reduce the amount of saturated fat and cholesterol in the diet lead to a mean decrease of cholesterolemia of 15%, thus confirming the favorable effect of the diet previously reported in the literature. However, there were large variations in the efficacy of the diet from no effect up to a 30% decrease. "Non-responders", in whom the diet was not effective, require treatment with drugs. The diet must be individualised and should involve the whole family. Children must be followed in order to encourage compliance to the dietetic measures and to detect eventual side effects. Furthermore, the dietetic measures must be associated with steps to control the other risk factors of arteriosclerosis.