RESUMO
Between 1994 and 1999, of the 44 357 mothers delivered at the Riyadh Armed Forces Hospital (RAFH), 255 patients had four or more previous caesarean sections (CS). This comprised 0.5% of the obstetric population. One hundred and eighty-nine (74%) had four, 52 (20%) five, 12 (5%) six and two (0.4%) patients had seven CSs. Adhesions were severe in 128 (50%), moderate in 18 (7%), mild in 81 (32%) and no adhesions in 28 (11%) cases. The incidence of placenta praevia was five times that of the overall obstetric population (2.4% vs. 0.5%). One case of uterine rupture occurred, an incidence of 4/1000 cases. The incidence of placenta praevia rises with rising CS rate. Patients with multiple CS and placenta praevia should be counselled regarding the possibility of caesarean hysterectomy. Repeat CS is safe and tubal ligation should be advised, but not forced as it is not an absolute indication for sterilisation.
RESUMO
We present a retrospective study of a series of 46 patients who have benefited from a laparoscopic treatment for a distal tubal disease. The results have been expressed in terms of tubulars and adherentiels scores, of the type of plastic effected and of the sterility (pure tubular sterility or associated). The global pregnancy rate is 39, 1% of which 34,8% is IUP and 4,3% EP. We have observed: an average delay of 10,8 months to obtain a pregnancy; the superiority of the fimbrioplasties (rate of pregnancy 75%); the predicted value of tubular score (the cases scored I and II obtain pregnancy rates of 57,7%). The association of endometriosis or of light oligoasthenoteratospermia do not constitute a counter indication of the tuboplasty (in those cases, cumulative rate of pregnancy is 50% and 40% respectively). If no pregnancy is observed during the 18 months following the intervention we recommend that the couple be treated by IVF.
