[Relevance of gestational diabetes mellitus screening and comparison of selective with universal strategies]. / Intérêt du dépistage du diabète gestationnel et comparaison des stratégies ciblée et systématique.

OBJECTIVES: To assess the relevance of gestational diabetes mellitus (GDM) screening policy and to compare selective with universal screening. METHODS: Systematic review of all French and English languages publications in Medline and Cochrane Databases, published since 1990. RESULTS: Maternal hyperglycemia is associated with increased maternal and neonatal complications. The 75 g OGTT (Oral Glucose Tolerance Test) is a valid and reliable test for GDM diagnosis. Treatment of GDM reduces perinatal complications. Selective screening allows to limit false positive rate and to concentrate medical resources. Nevertheless, screening might be more difficult to perform and lead to miss up to 45% of GDM cases. Universal screening offers higher sensitivity but leads to more therapeutic interventions whose benefit and cost/efficiency ratio need to be estimated in low risk women. CONCLUSION: The benefits of GDM screening and treatment have only been proven for women with GDM risk factors. Their relevance in women without risk factor remains controversial.

Relevance of gestational diabetes mellitus screening and comparison of selective with universal strategies.

OBJECTIVES: To assess the relevance of gestational diabetes mellitus (GDM) screening policies and to compare selective with universal screening. METHODS: Systematic review of all French and English language publications in the Medline and Cochrane Databases, published since 1990. RESULTS: Maternal hyperglycaemia is associated with increased maternal and neonatal complications. The 75g OGTT (Oral Glucose Tolerance Test) is a valid and reliable test for GDM diagnosis. Treatment of GDM reduces perinatal complications. Selective screening helps limit false positive rates and concentrate medical resources. Nevertheless, screening could be more difficult and lead to missing up to 45% of GDM cases. Universal screening offers higher sensitivity but leads to more therapeutic interventions whose benefit and cost/effectiveness ratio need to be estimated in low risk women. CONCLUSION: The benefits of GDM screening and treatment have only been proven for women with GDM risk factors. Their relevance in women without risk factor remains controversial.

[Digestive endometriosis of the caecum and intussusception: about one case]. / Endométriose digestive de localisation caecale et invagination intestinale aiguë: à propos d'un cas.

We report the case of a 40-years-old woman who had a caeco-colic intussusception on a digestive endometriosis. Such exceptional association can be life-threatening, requiring urgent surgery.

[Primary ovarian abscess. Diagnosis and therapeutic approach]. / Abcès primaire de l'ovaire. Diagnostic et approche thérapeutique.

Primary ovarian abscess is a rare infection. A new case has led us to carry out a literature review in order to optimize the treatment. Exceptionally isolated, primary ovarian abscess usually belongs to the postoperative complications. Nevertheless, its etiopathogenies are numerous. The symptoms are often poor; therefore the diagnosis is difficult to establish. The curative treatment must associate surgery and antibiotherapy. Even if laparoscopic surgery is the first line treatment in many cases, laparotomy remains the choice procedure. Ultrasonographically-guided evacuation has to be further evaluated. Preventive treatment is of major importance.

[Early prophylactic cervical cerclage for hypoplastic cervix following exposure to DES in utero]. / Technique de cerclage prophylactique précoce des cols hypoplasiques après exposition au DES in utero.

AIM: Presentation of a prophylactic cerclage technique, placed in the beginning of second trimester of the pregnancy, derived from McDonald cerclage and adapted to hypoplastic cervix following exposure to DES in utero. MATERIALS AND METHODS: Prospective study including 20 pregnant patients exposed to DES in utero and presenting a hypoplastic cervix. Study of the location of the cerclage tape in the cervix and of changes in cervical length (before and after cerclage) assessed by physical examination of the cervix and by transvaginal ultrasonography. RESULTS: The cervix was longer after cerclage as shown by physical examination and by ultrasound. The tape was localized near the internal cervical os, its posterior portion nearer the internal cervical os than its anterior portion. CONCLUSION: This easy-to-perform technique of cerclage of hypoplastic cervix allows the tape to be localized near the internal cervical os without colpotomy and without use of the transabdominal approach, while allowing vaginal delivery.

[Anthropologic evolution of women's pelvis]. / Evolution anthropologique du bassin osseux des femmes.

The existence of dystocia in human presents a vexing problem for an evolutionary point of view. Dealing with the great apes and modern human's pelvis evolution, considering the bipedalism and the cerebral growth, the adaptative mechanisms and their obstetrical and social consequences are discussed.