[Diagnosis and management of uterine perforations after intrauterine device insertion: a report of 11 cases]. / Diagnostic et prise en charge des perforations utérines par dispositif intra-utérin: à partir de 11 cas.

OBJECTIVE: Intrauterine device insertion is common. It is however not harmless and uterine perforation can be serious. PATIENTS AND METHODS: Eleven cases of uterine perforation after intrauterine device insertion were listed at Tourcoing hospital between 2005 and 2009. They were analyzed to identify risk factors of uterine perforation and specify management. RESULTS: The main symptom was pelvic pain (4 cases), pregnancy occurrence (3 cases) or inability to remove the IUD (2 cases). The intrauterine device was set during the first 9 months of post-partum in 7 cases, 2 patients were still breastfeeding. Seven patients underwent laparoscopy, 2 needed switch for laparotomy, one was treated by laparotomy only and one was lost of follow-up. DISCUSSION AND CONCLUSION: Incidence of uterine perforation after IUD insertion ranges from 0,1 to 3/1000. Pelvic pain is the most revealing symptom. Fifteen percent of perforations complicate with adjacent organ lesion. Perforation incidence seems greater if the intrauterine device is set during the 6 first weeks of post-partum and breastfeeding, but non influenced by operator practical experience. Ultrasound follow-up of patients carrying intrauterine device is controversial. Facing a suspicion of ectopic intrauterine device, pelvic ultrasound examination is the first step imaging modality and using 3D could be useful. If it fails to localize the intrauterine device, an abdominal X-ray must be performed. Ectopic intrauterine device removal is recommended.

[Postpartum birth control: state-of-the-art]. / La contraception du post-partum: état des connaissances.

It takes some six weeks for menstrual flow to come back after delivery, but an ovulation may occur from the twenty-fifth day, especially in the absence of bottle feeding. That is the reason why postpartum birth control must be gets onto in maternity wards. Obstetricians and midwives are supposed to deliver update information about variant contraceptive means. They have to be able to diagnose any risk factor and to prescribe an efficient contraceptive option to every woman who wishes for it, before she leaves the maternity ward. Recent studies incite us to amend our medical behaviour regarding postpartum contraception, even if there is no consensus at present. In a normal context, without any add on risk factor, it is possible to prescribe a birth control pill containing low dosage of combined oral contraceptives. Doing that, you will not expose the patient to an increased risk of deep venous thrombosis nor to significant breastfeeding disruption. Low-dose progestin-only pills are also a good choice because there are no risks during the lactation. When the patient suffers from some disease which stops you from giving combined oral contraceptives, it is still possible to resort to progestin-only. It is now admitted to insert an intra-uterine device from the fourth or sixth week following the delivery. In certain conditions, it can be inserted over the 48 hours following a delivery, some obstetrician would even insert it during the caesarean section. The main purpose of these recent references is to simplify the contraceptive outline in order to ease its prescription and to avoid unwanted pregnancies.

[Contribution of ultrasonography to the diagnosis of non-hormonal acquired clitoromegalia: a case report]. / Place de l'échographie dans le diagnostic des clitoromégalies acquises non hormonales: à partir d'un cas.

We report the case of a 30-year-old woman, consulting for a painful clitoromegaly which developed progressively and rapidly. The gyneco-endocrinological assessment ruled out hyperandrogenism. Ultrasound examination of the clitoris revealed the presence of a clitoral cyst. Acquired clitoromegaly is a symptom which occurs in severe hyperandrogenism. Other organic etiologies include clitoral cysts of various nature and solid tumors. An ultrasonographic examination should be included in the diagnostic work-up for acquired clitoromegaly.

Postpartum cerebral angiopathy possibly due to bromocriptine therapy.

BACKGROUND: Eight cases of benign angiopathy of the postpartum period have been reported previously, none of which involved the administration of bromocriptine. CASE DESCRIPTION: We describe a case of benign cerebral angiopathy in a 20-year-old woman in the postpartum period occurring after bromocriptine therapy prescribed to suppress lactation. CONCLUSIONS: Other adverse effects due to vasoconstriction have been reported during bromocriptine therapy, such as myocardial infarction and arterial hypertension. This case suggests that a similar mechanism may be possible in cerebral arteries, although the cause of vasoconstriction remains uncertain.

[Oligo-amnios]. / L'oligo-amnios.

The amniotic fluid shares closely in the well-being of the future child and volume abnormalities represent a valuable factor in the screening of fetal pathology. Many publications have recently reminded of the importance of oligo-amnios as a prognosis factor in prenatal monitoring. Through an incomplete review of the literature, the author reminds of the physiology of amniotic fluid, diagnosis methods of oligo-amnios (essentially sonography), its causes and consequences, and finally its practical use as a monitoring parameter. A few possibilities of treatment are also discussed.

[Immunology and pregnancy]. / Immunologie et grossesse.

Immunology in pregnancy is a meeting ground between basic research in biology and daily medical practice. For gynecologists and obstetricians, the authors have attempted to synthesize the acquired knowledge and the current hypotheses on this very complex topic. Three main chapters will be successively approached: a reminder of the normal immune system and its development in the fetus, immunity in pregnant women and the dysimmune pathology during pregnancy, the feto-maternal immune relationship and its possible complications.