[The HELLP syndrome. 13 cases]. / Le HELLP syndrome. A propos de 13 observations.

The Hellp syndrome is a complication of raised blood pressure in pregnancy, haemolysis, a rise in liver enzymes and thrombopenia. In this retrospective study we report 12 cases of Hellp syndrome which occurred in the University Hospital Centre of Poitiers between 1982 and 1990 and we discuss causes, the progress, the prognosis and the management. Six patients were helped by prophylactic Caesarean operation. Two patients had eclamptic fits. Fortunately there was no maternal death. There were seven cases of intrauterine growth retardation, two of in utero fetal death and one of early neonatal death. When clinical and biological parameters of the Hellp syndrome come right following delivery, the outlook for the mother is quickly favourable, but the syndrome can continue and sometimes become worse after delivery. Stopping the pregnancy is the basic treatment and conservative treatment has only a very limited success. Finally, the prognosis for the future is usually good and it is unlikely to recur.

[Contribution of celioscopic surgery to vaginal surgery. 18 cases]. / Apport de la coelioscopie opératoire à la chirurgie vaginale. A propos de 18 cas.

Vaginal hysterectomy is better for patients because they have to stay in hospital for a shorter period of time and they are less likely to have thromboembolic complications, than if the hysterectomy is carried out abdominally. If laparoscopic surgery is carried out before the hysterectomy when the indications for vaginal operation are poor, more patients can be operated on vaginally with higher security and the procedures were made easier. We report 18 cases of laparoscopic operation preceding vaginal hysterectomy and these were considered because of previous laparotomies, or previous inflammatory conditions of the tubes. In 14 out of 18 cases it was possible to remove the uterus vaginally after carrying out laparoscopic procedures which made the operation much safer. There were no complications. The principal trouble with this technique is the length of time it takes because the laparoscopic procedures can be very difficult.

[Bilateral breast tuberculosis: a case report. Review of the literature]. / Tuberculose mammaire bilatérale: un cas. Revue de la littérature.

We report a case of bilateral tuberculosis of the breast that presented as masses and where the diagnosis could only be made from the histology. The outcome was good following antibiotics and antituberculous treatment. Tuberculosis of the breast is a very rare infection. The incidence of the disease is 0.025% of all disease of the breast treated surgically. The basis of treatment at the present time is antituberculous antibiotic treatment and surgery for any residual masses.

[The Hellp syndrome: is this a clinical form of thrombotic microangiopathy?]. / Le Hellp syndrome: forme clinique de la micro-angiopathie thrombotique?

There are similarities between the clinical, biological and histological features of thrombotic micro-angiopathy (TMA) when it is a complication of pregnancy and the "Help Syndrome" (HS). HS can be associated in pregnancy with pre-eclampsia, thrombocytopenia, micro-angiopathic haemolysis and hepatic cytolysis. We have analysed on the one hand biological features of six cases that occurred in the literature and two personal cases of thrombotic micro-angiopathy that had been proven histologically; and on the other hand the histological findings of the liver in two cases of the literature and in a personal case of HS. Demonstration that in HS deposits exist under the endothelium in the region of the hepatic biopsy suggest that the latter can only be a special clinical form of TMA.

[The value of antibiotic prophylaxis during intrauterine procedures during vaginal delivery. A comparative study of 500 patients]. / Intérêt de l'antibioprophylaxie lors de gestes intra-utérins au cours d'un accouchement par voie basse. Etude comparative à partir de 550 patientes.

This comparative study carried out on 550 patients has made it possible for us to show how valuable prophylactic antibiotic therapy is when certain intra-uterine manipulations (such as forceps delivery, manual removal of the placenta or exploration of the cavity of the uterus) are carried out during vaginal delivery. Furthermore, we have been able to show that there are certain risk factors of which the most important are premature rupture of the membranes, infected liquor, birth weight of the infant less than 2,500 g and epidural analgesia. The financial study has shown that it is cheaper to use prophylactic antibiotics when the comparison is made with the cost of treating complications of infection associated with these intra-uterine procedures.

[Pre-eclampsia and the nephrotic syndrome. Prognosis and management; apropos of a series of 23 cases]. / Pré-éclampsie et syndrome néphrotique. Pronostic et conduite à tenir; à propos d'une série de 23 cas.

In pregnancy pre-eclampsia can be complicated by the nephrotic syndrome. We report on the clinical findings in 23 patients who had the nephrotic syndrome in pregnancy with hypertension. None of these patients had any previous sign of nephropathy. In most patients clinical signs first showed up in the 3rd trimester. The prognosis for the fetus was poor. This was because of the degree of proteinuria and of uraemia (5 fetuses died). After delivery all signs cleared up, as they would have done in moderately severe pre-eclampsia. All patients were considered to be cured by six months. In spite of this the longterm prognosis is difficult to assess. It is necessary to find out whether the nephrotic syndrome was evidence of an underlying nephropathy or just was due to the pre-eclampsia. Treatment consists mainly of rest, control of hypertension, correction of low blood volume and delivery of the fetus with regard to the degree of maturity and the viability of the fetus.

[Marfan's disease and pregnancy. Apropos of a case]. / Maladie de Marfan et grossesse. A propos d'un cas.

Marfan's syndrome is a dominant autosome transmitted disease with different degrees of seriousness. When it is associated with pregnancy there is a considerable increase in the rate of cardio-vascular complications which are responsible for a serious rate of maternal mortality due to aortic dissection. It is therefore very important that the patient, before starting a pregnancy, should be examined very carefully clinically and with ultrasound. A woman with dilatation of the aorta less then 40 mm as measured ultrasonically and who has no major clinical signs can start a pregnancy but even then she should be considered as a high risk case. In other cases therapeutic termination of pregnancy or prophylactic surgical treatment of the condition should be considered. Apart from the serious genetic risks (50%) the risks for the fetus are dominated by prematurity and by fetal death resulting from maternal death.