Nonpuerperal uterine inversion caused by an adenosarcoma: A case report.

INTRODUCTION: Eighty-five per cent of uterine inversions are puerperal. Non-puerperal uterine inversion is usually caused by tumours that exert a traction force on the fundus of the uterus. This causes the uterus to be partially or completely inverted. It is commonly related to benign tumours like submucosal leiomyomas. Nevertheless, malignancies are an infrequent association. CASE PRESENTATION: We report a case of a 35-year-old female patient, medically and surgically free, gravida0 para0, complaining of menometrorrhagia associated with pelvic pain for 2 years. A suprapubic ultrasound scan showed an enlarged, globular uterus with a heterogeneous, undefined mass of 49 mm in size. MRI scan showed the appearance of a U-shaped uterine cavity and a thickened inverted uterine fundus with an endometrial infiltrating mass of 25 mm. Intraoperative exploration showed uterine inversion involving the ovaries; the fallopian tubes and the round ligaments and a necrotic intracavitary mass. The malignancy of the tumor was confirmed through anatomopathological examination as Adenosarcoma. CONCLUSIONS: Uterine inversion is rare outside the puerperal period, and malignant etiology must not be overlooked. Therefore, comprehensive care with meticulous etiological investigation is crucial.

Low back pain in pregnant women: A necessary or an avoidable evil?

OBJECTIVES: The aim of this study was to determine the prevalence, the main features and the potential risk factors of LBP in pregnant women. METHODS: This cross-sectional study included 173 pregnant women in the third trimester. Non-inclusion criteria were severe mental disability and known previous history of musculoskeletal diseases. The participants were categorised into two groups: women with pregnancy-related LBP and pain-free women. Demographic, socio-professional, clinical and obstetrical data were compared between the two groups using the appropriate statistical tests. RESULTS: The mean age was 32.2 ± 5.4 years [17-45]. Among them, 108 (62.4%) reported one or more episodes of LBP during at least 7 days, mostly in the third semester (n = 71). The presence of LBP was significantly associated with history of LBP in previous pregnancies and jobs requiring prolonged standing. Active jobs and the presence of gestational complications were significantly more common in pain-free women. In the multivariate analysis, LBP was independently predicted by the history of LBP in previous pregnancies and the absence of gestational complications. CONCLUSIONS: The association of LBP with gestational complications as a protective factor has not yet been reported in previous studies. These complications are a common cause of hospitalisation, which represents a period of relative rest during pregnancy. Our results revealed that history of LBP in previous pregnancies, sedentary lifestyle prior to pregnancy and prolonged standing are the main risk factors of LBP. In contrast, rest and avoidance of physical overstrain during pregnancy may be protective factors.

[Psychological impact of COVID-19 on women's wellbeing during pregnancy: about 2 cases]. / Impact psychologique des femmes enceintes atteintes du COVID-19: à propos de 2 cas cliniques.

This study is based on a psychoanalytically inspired psychological investigation of two pregnant women with COVID-19 at different stages of pregnancy in the Department of Obstetrics and Gynaecology A at the Charles Nicolle Hospital. Our study was conducted between 2020 and 2021, until deliveries. Two young Tunisian women aged 28 and 30 years were tested positive for COVID-19 during pregnancy. They suffered from emotional shock. In this study, we discuss the different points of collision between life and death by describing, in detail, the experiences of these two women during their confinement.

[A case of neonatal gastrointestinal duplication]. / Duplication digestive: à propos d´un cas néonatal.

Gastrointestinal duplications are defined as tubular or cystic malformations of a segment of the digestive tract, from the oral cavity to the anus. They are rare. Prenatal diagnosis ca be made in patients with a voluminous cyst. We here report the case of a 33-year-old primiparous woman with no previous medical-surgical history who was poorly screened. She just underwent ultrasound scan at 8 weeks of amenorrhea (WA). During the third trimester of pregnancy ultrasound showed anechoic nonvascularized cyst measuring 3cm located in the upper pelvis. It was anteriorly located; the kidneys and the bladder were not involved. Then magnetic resonance imaging (MRI) of the fetus was performed to better interpret ultrasound results. This showed well-defined cyst in contact with the small bowel loops along the mesenteric side. The diagnosis of gastrointestinal duplication was strongly suspected. C-section was done at 39 weeks' gestation because the woman had a history of primary infertility (7 years). Delivery proceeded without complications. Postnatal ultrasound results reinforced the hypothesis of gastrointestinal duplication, showing a cystic mass with a multi-bulkhead-like structure at the level of the left hypochondrium, measuring 45 mm x 19 mm, which could be consistent with gastrointestinal duplication. The new-born was referred to the Paediatric Surgery for better management and surgery in the first 6 months of life. The discovery of fetal anechoic cyst poses a challenge in etiology and diagnosis on the one hand and of follow-up and postnatal management on the other hand.

Contribution of ultrasound in the study of ovarian fibrothecomas: a series of 47 cases.

INTRODUCTION: Ovarian fibro-thecoma are rare presenting 1 to 4, 7%of ovarian organictumors. These tumors are of stromal origin and contain varied proportion of fusiform connective tissue cells and theca cells. They mainly affect menopausal or perimenopausal women. This tumor is benign in most cases and may be responsible for hormone secretion. OBJECTIVES: Study the epidemiological and clinical data of patients with ovarian fibro-thecoma, analyze ultrasonographic characteristics of these tumors,and evaluate the sensitivity and specificity of pelvic ultrasound in ovarian fibro-thecoma approach. METHODS: A retrospective study of 47 patients who underwent surgical treatment for ovarian fibro-thecoma was performed. Data were collected in our department of gynecologyand obstetrics A within Charles Nicole hospital in Tunis, over a period of 18 years between January 1994 and December 2012. For each of our observations, we analyzed the clinical and para-clinical data, including U.S. characteristics and available MRI data with confrontation to the final histological results. RESULTS: The average age of patients was 45.2 years. The average gravidity was 4 and the mean parity was 3. . Thirty-eight of our patients were postmenopausal (80.85%). Ovarian tumor was discovered incidentally in 11 cases and on the occasion of functional symptoms in 36 cases including pelvic pain in 18 cases. Physical examination revealed a pelvic mass in 17 patients and pelvic-abdominal in 14 patients. All patients underwent a pelvic ultrasound. . Ultrasound identified 49 tumors (2 cases of bilateral tumors). Average size of tumors was 10, 05 cm (4 to 30 cm). ) . Ovarian tumor was echogenic in 9 cases (18.36%), hypoechoic in 14 cases (28.47%), mixed in 14 cases (28.47%) and anechoic in 12 cases (24.49%). The tumor was found to be solid in 27 cases (55.1%); cystic in 8 cases (16.3%) and solido cystic in 14 cases (28.6%).It was compartmentalized in 10 cases. Extra cystic vegetations were found in 2 patients. The tumor was nonvascularized at color Doppler in 47 cases (95.9%) and slightly vascularized in 2 cases (4.1%). Intra peritoneal effusion was objectified in 15 cases. The diagnosis of ovarian fibro-thecoma was raised based on U.S in 25 cases (51.02%) before surgery .MRI was performed in four cases. All patients underwent surgery. We performed laparotomy in 36 cases and laparoscopy in 11 cases. By laparotomy were performed a total hysterectomy with bilateral oophorectomy in most cases (26 patients). By laparoscopy we did lumpectomy in all cases. . The final pathologic examination revealed 19 fibromas, 14cystadénofibromas and 14 fibrothecomas. CONCLUSION: The paraclinical exploration of ovarian fibro-thecoma isbased, as all ovarian tumors, on ultrasound examination. The most typical features are images of solid tumors with regular contours, echogenic or mixed with the presence of streakedshadows.

Cyto-colpo-histologic correlation: about an analytical study of 120 colposcopies.

PROBLEM: Cervical cancer is the second gynecological cancer Tunisian women after breast. This is a sexually transmitted disease including the role of HPV has been proven. Cervical cancer screening is possible due to the accessibility of the cervix with a speculum examination and implementation of cervical smear. AIM OF THE WORK: To study the epidemiological and clinical data of patients, analyze the results of the Pap test, colposcopy and cervical biopsy staging are the lesions observed in colposcopy, compare the results of smears, colposcopy and cervical biopsy. METHODS: A retrospective analytical study about 120 observations of patients who underwent colposcopy and biopsy of the cervix over a seven year period from January 2006 to December 2012. RESULTS: The mean age of patients was 46.6 years. The mean gravidity was 4.99. The mean parity was 4.07. The average age of first sexual intercourse was 24 years. 95.83% of the patients were married. Four patients had multiple partners, 3, 33%. Eighty-one patients 67.5% were genital activity. Two patients had a history of pelvic infection is 1.66%. A history of repeated low genital infection were found in 20 patients, or 16.66%. HPV testing was requested for two patients. The genotypes found were 16, 35 and 53. The most common reasons were essentially pathological smears, pelvic pain and exploration of bleeding. The FCU was performed in 98 patients either in 81.66% of cases. The smear was pathological in 83 patients or 84.69% of smears. He showed: a persistent inflammatory smears in 64 women, or 65.30% of the cases, 6 ASCUS or 6.12% of cases, 13 cervical dysplasia or 13.26% of cases: 8 CIN1 or 8.16% of event; 1 CIN2 or 1.02% and 4 CIN 3, or 4.08% of cases. Colposcopy was indicated before an abnormal smear: In 83 patients either in 69.16% of cases. Colposcopy was performed in front of an abnormal appearance of the cervix in 37 patients. Colposcopy has concluded that: normal cervix in 28 patients or 23.33% of the cases, cervicitis appearance in 15 patients or 12.5% of cases, ectropion in 23 patients or 19.2% of cases, with TAGI 47 patients or 39.2% of cases, a TAG2 in 6 patients either 5% of cases, ulceration in a patient or 0.83% of cases. Cervical biopsy objectified normal mucosa in 19 patients, or 15.8% of cases. She objectified cervical metaplasia in 11 patients, or 9.2% of cases, ectropion in a patient, or 0.8% of cases, cervicitis in 56 patients, or 46.7% of cases, condyloma in 2 patients, 1.7% of cases, CIN 1 in 6 patients, 5% of cases, CIN2 in 4 patients, soit3,3% of CIN3 and in 3 patients, 2.5% of cases. FCU had a sensitivity of 60%, a specificity of 95.18%, positive predictive value of 69% and a negative predictive value of 93%. The sensitivity of colposcopy was 66% and specificity of59%. Positive predictive value of 18% and a negative predictive value of 92%. For high-grade dysplasia, colposcopy had a sensitivity of 85%, specificity 58%, positive predictive value of 11.3% and a negative predictive value of 98%. Cervical biopsy finds carcinoma in situ in two cases and squamous micro-invasive carcinoma in one case. The treatments were performed essentially a cervical electrocoagulation in 8 patients, a cone biopsy in 7 patients and post conization hysterectomy in 2 patients. CONCLUSION: Colposcopy is a harmless and reliable examination to guide the cervical biopsy. Tracks smear, colposcopy and directed biopsy confirmed.

Cyto-colpo-histologic correlation: about an analytical study of 120 colposcopies.

PROBLEM: Cervical cancer is the second gynecological cancer Tunisian women after breast. This is a sexually transmitted disease including the role of HPV has been proven. Cervical cancer screening is possible due to the accessibility of the cervix with a speculum examination and implementation of cervical smear. AIM OF THE WORK: To study the epidemiological and clinical data of patients, analyze the results of the Pap test, colposcopy and cervical biopsy staging are the lesions observed in colposcopy, compare the results of smears, colposcopy and cervical biopsy. METHODS: A retrospective analytical study about 120 observations of patients who underwent colposcopy and biopsy of the cervix over a seven year period from January 2006 to December 2012. RESULTS: The mean age of patients was 46.6 years. The mean gravidity was 4.99. The mean parity was 4.07. The average age of first sexual intercourse was 24 years. 95.83% of the patients were married. Four patients had multiple partners, 3, 33%. Eighty-one patients 67.5% were genital activity. Two patients had a history of pelvic infection is 1.66%. A history of repeated low genital infection were found in 20 patients, or 16.66%. HPV testing was requested for two patients. The genotypes found were 16, 35 and 53. The most common reasons were essentially pathological smears, pelvic pain and exploration of bleeding. The FCU was performed in 98 patients either in 81.66% of cases. The smear was pathological in 83 patients or 84.69% of smears. He showed: a persistent inflammatory smears in 64 women, or 65.30% of the cases, 6 ASCUS or 6.12% of cases, 13 cervical dysplasia or 13.26% of cases: 8 CIN1 or 8.16% of event; 1 CIN2 or 1.02% and 4 CIN 3, or 4.08% of cases. Colposcopy was indicated before an abnormal smear: In 83 patients either in 69.16% of cases. Colposcopy was performed in front of an abnormal appearance of the cervix in 37 patients. Colposcopy has concluded that: normal cervix in 28 patients or 23.33% of the cases, cervicitis appearance in 15 patients or 12.5% of cases, ectropion in 23 patients or 19.2% of cases, with TAGI 47 patients or 39.2% of cases, a TAG2 in 6 patients either 5% of cases, ulceration in a patient or 0.83% of cases. Cervical biopsy objectified normal mucosa in 19 patients, or 15.8% of cases. She objectified cervical metaplasia in 11 patients, or 9.2% of cases, ectropion in a patient, or 0.8% of cases, cervicitis in 56 patients, or 46.7% of cases, condyloma in 2 patients, 1.7% of cases, CIN 1 in 6 patients, 5% of cases, CIN2 in 4 patients, soit3,3% of CIN3 and in 3 patients, 2.5% of cases. FCU had a sensitivity of 60%, a specificity of 95.18%, positive predictive value of 69% and a negative predictive value of 93%. The sensitivity of colposcopy was 66% and specificity of59%. Positive predictive value of 18% and a negative predictive value of 92%. For high-grade dysplasia, colposcopy had a sensitivity of 85%, specificity 58%, positive predictive value of 11.3% and a negative predictive value of 98%. Cervical biopsy finds carcinoma in situ in two cases and squamous micro-invasive carcinoma in one case. The treatments were performed essentially a cervical electrocoagulation in 8 patients, a cone biopsy in 7 patients and post conization hysterectomy in 2 patients. CONCLUSION: Colposcopy is a harmless and reliable examination to guide the cervical biopsy. Tracks smear, colposcopy and directed biopsy confirmed.

[Parauterine solitary fibrous tumor: about a case]. / Tumeur fibreuse solitaire parautérine: à propos d'un cas.

Solitary fibrous tumors of the female genital tract are extremely rare. We report the case of a 78-year old patient presenting with a pelvic mass. Surgical exploration showed parauterine tumor. Anatomo-pathological examination confirmed the diagnosis of malignant solitary fibrous tumor. The evolution was marked by the death of the patient. It is important to be able to detect these tumors whose evolution can be poor. Long-term follow-up of patients with resectable tumor should be recommended.

[Medical treatment of endometriosis]. / Traitement medical de l'endométriose.

PREREQUISITES: Pathogenesis and pathophysiology of endometriosis, pharmacodynamics of oral contraceptives, progestagens, antiprogestagens, danazol, GnRh agonist and non-steroidal antiinflammatory. PURPOSE OF REVIEW: The aim of this paper is to systematically review the literature evidence of medical treatments for endometriosis and to summarize recently published recommendations. METHODS: Literature and recently published recommendations review via bibliographic research using Pubmed/Medline, Google scholar and Cochrane database. RESULTS: Endometriosis is an estrogen-dependent gynecological disease. Medical treatement of endometriosis induce an estrogen deprivation situation. The Oral contraceptives reduce the rate of postoperative endometrioma recurrence and should be considered an essential part of long-term therapeutic strategies.New agents promise a distinct perspective in endometriosis treatment. CONCLUSIONS: The effectiveness of medical treatmentis well established in the management pelvic pain and infertility associated with endometriosis and constitutes an important alternative or complement to surgery.

[Medical treatment of ectopic pregnancy]. / Traitement médical de la grossesse extra-utérine.

BACKGROUND: The ectopic pregnancy (EP) is a public health problem and its frequency has doubled in most industrialized countries in 20 years. aim: To evaluate the effectiveness of medical treatment of ectopic pregnancy with methotrexate (MTX) intramuscularly (IM). METHODS: prospective study supported between October 2006 and December 2010. The selected patients received methotrexate IM (1 mg per kg). The monitoring was based on: the kinetics of plasma HCG, clinical examination and ultrasound. A second injection was performed if hCG on day 4 was increased by more than 25% or J7> the initial rate. Healing corresponded to obtain a zero rate of HCG in a stable manner. RESULTS: We used the first-line medical treatment in 122 patients. The average age of patients was 31.94 years. A haematosalpinx was found in 87.70% of cases. The initial rate of HCG plasma varied between 40 IU/ml and 4088 IU / ml, with an average of 805.88 m IU / ml. The primary success rate obtained after a single injection of intramuscular MTX was 67%. The high success rate obtained after two injections of MTX was 27%. The overall success rate after 1 or 2 injections of MTX was 82%. 17 patients underwent surgical treatment after a first injection of methotrexate. 5 patients underwent surgery after receiving two doses of methotrexate. The period of normalization of plasma levels of h CG was 24 days on average, with extremes ranging from 4 to 43 days for 67 patients cured after a single injection of MTX. This period was 33 days on average, with extremes ranging from 8 to 62 days for patients healed after two injections of MTX. CONCLUSION: Medical treatment applied to 38% of ectopic pregnancies diagnosed in our department is effective in 82% of cases if the inclusion criteria are strictly adhered to. Successful treatment is limited by patient compliance and demanding nature of monitoring.

[Prospective study of the relationship between heart rate fetal anomalies, pH umbilical cord at birth and Apgar]. / Etude prospective de la relation entre anomalie du rythme cardiaque fœtale, pH ombilical et Apgar à la naissance

BACKGROUND: The search for an acute fetal distress during labor remains one of the objectives of obstetrical surveillance. AIM: To find a relationship between different aspects of fetal heart rate (FHR) occurring during labor, Apgar score at first minute and the pH blood at birth. METHODS: A prospective study which involved 170 single-fetal pregnancies to term. RESULTS: In our population, by comparing the APGAR score in the first minute and umbilical pH, it was found that only 25.7% of newborns with Apgar at 1st minute less than 7 had an umbilical arterial pH <7.15. Thus in our study, the Apgar score did not predict umbilical acidosis and the difference was significant (p = 0.02). In the same population, by comparing the analysis of FCR and umbilical PH, we found that fetal bradycardia was associated with pH umbilical lowest with an average of 7008 and the difference was significant (p = 0.008). Other types of ERCF were also significantly associated with neonatal acidosis. CONCLUSION: Recording fetal heart rate is a limited review to assess the exact condition of the fetus. It has a good negative predictive value but there is little specific consideration. Combination with other techniques to better assess the fetal state.

[Sexuality and contraception: a prospective study of 85 cases]. / Impact de la pilule œstroprogestative sur la sexualité: Étude prospective à propos de 85 cas.

BACKGROUND: Contraception opposing procreation interferes with the primary purpose of sexuality. Few studies have yet been made on the actual interaction between contraception and sexuality. AIM: To study contraceptive practices ie non medicalized contraception and oral contraception, study aspects of women's sexuality and to study the physiological impact and psychological contraception on women's sexuality. METHODS: Prospective and analytical study conducted over a period spanning from October 2008 to February 2009. This study was based on a survey, carried out through an oral questionnaire to 85 women in reproductive age, married, with contraceptive-based pill or natural birth control for at least one cycle, having experienced during their personal background a sexuality contraception or at least one contraceptive method other than its current average. RESULTS: Comparison between the group of women using oral contraception and women not using contraception medicalized showed significant differences in outcomes relating to: the average frequency of intercourse / month (p = 0.01), sexual desire ( p = 0.01), sexual pleasure (p = 0.03). The comparison of the different parameters of sexuality among the group of women using intra uterine device and women using oral contraceptives showed no significant differences in the parameters of sexuality. CONCLUSION: The awareness of the big importance of the interaction between sexuality and contraception, in one way or another, could help us tailor our applications to contraceptive practices of each woman.

[Postmenopausal bleeding. Comparison between ultrasonography, hysteroscopy and histology results]. / Les métrorragies post ménopausiques. Confrontation des résultats échographiques, hystéroscopiques et histologiques.

BACKGROUND: Post-menopausal bleeding are frequently found in gynaecological consultations and requires the search of an organic cause AIM: To value the profit and the performances of the transvaginal ultrasonography and the hysteroscopy in the determination of the causes of post-menopausal bleeding. METHODS: 80 patients presenting abnormal uterine bleeding in post menopause period have been explored in our department with transvaginal ultrasonography and hysteroscopy. The findings have been evaluated on the basis of specimens obtained from either endometrial biopsy, hysterectomy or operative hysteroscopy. We have calculated in our study the sensitivity, the specificity, the positive and negative predictive values of transvaginal ultrasonography and hysteroscopy. RESULTS: The sensitivity, the specificity, the positive and negative values predictive of the transvaginal ultrasonography is respectively 93, 75%, 87, 5%, 83, 3% and 95, 45%. In the other part, hysteroscopy seems more performant in the diagnosis of intrauterine abnormalities with the respective values: 100%, 95, 83%, 94, 11% and 100%. CONCLUSION: The initial investigation in front of all mennorhagic patients must be the transvaginal ultrasonography but we also need the hysteroscopy because its highly accurate means in the diagnosis of the causes of excessive uterine bleeding in post menopausal period.

[Correlation between vital signs and hemoperitoneum in ruptured ectopic pregnancy]. / Corrélation entre signes vitaux et hémopéritoine au cours des grossesses extra-utérines rompues.

BACKGROUND: Ectopic pregnancy (EP) is a medical-surgical emergency. Rupture of an ectopic pregnancy is a serious complication and may develop severe life-threatening to the patient. AIM: To determine correlation between vital signs and hemoperitoneum in ruptured ectopic pregnancy and the association between abnormal vital signs and tubal rupture. METHODS: Via a retrospective study we have considered a sample of 32 patients of ruptured ectopic pregnancy. All patients were diagnosed at the Gynecology and Obstetrics Unit Aat Charles Nicole Hospital, Tunisia. RESULTS: Mean minimum systolic (SBP) 109 mmHg (range 70-150), mean maximum (HR) 81.5 beats/min (range 70-140). Mean volume of hemoperitoneum 693.75 mL (range 100 -2000 mL).Correlation between vital signs and volume of hemoperitoneum was poor (R 2 = 0.279 for HR, R 2= 0.267 for SBP). Hypotension was associated with blood loss of at least 1280 ml. Association of tachycardia with hypotension was observed in only 2 cases.Correlation between HR and SBP was not significant and poor (p=0.23, R 2= 0.05) CONCLUSION: Normal vital signs alone are poor predictors of ruptured ectopic pregnancy and do not correlate well with volumes of hemoperitonieum.

[Prospective study of 45 cases of disseminated intravascular coagulation]. / Etude prospective à propos de 45 cas de coagulation intra vasculaire disséminée.

BACKGROUND: Disseminated intravascular coagulation (DIC) in obstetric disorders is a severe complication. AIM: To study the frequency and means of diagnosis of DIC and the therapeutic care and maternal morbidity induced. METHODS: Monocentric, prospective and descriptive study about 45 cases of intravascular coagulation in an obstetrical service collected at the University Hospital of Obstetrics and Gynecology Hedi Chaker of Sfax over a period ranging from June 2007 to June 2010. All the pregnant patients who have given birth beyond 28 weeks and have presented a DIC were selected for this study. RESULTS: The mean age of patients was 31.4 years. The mean parity was 2.6. The main diseases during pregnancy were: severe preeclampsia (22.2%), diabetes (28.8%), intrauterine fetal death (17.7%), previa placenta (8.8%). The main causes of DIC were: uterine atony (44.4%), abruptio placenta (22.2%), Hellp syndrome (11.1%) and uterine rupture (6, 6%). The lowest rate of platelets was 21000/mm3. The fibrinogen level was <0.5 g in 40% of cases. Despite reanimation and transfusion with blood products, surgical treatment was necessary in 77.7% of cases. All the patients were transferred in intensive care unit with an average stay of about three days. No maternal death was reported. CONCLUSION: DIC is a frequent complication of many obstetrical diseases. The treatment is urgent. It requires first to the cause and the shock by massive transfusions of packed red blood cells, fresh frozen plasma, and platelets, associated with antifibrinolytic drugs, if necessary.