Menses, fertility and pregnancy after arterial embolization for the control of postpartum haemorrhage.

BACKGROUND: The long-term effects of uterine artery embolization for the control of postpartum haemorrhage on menses, fertility and future pregnancy evolution have not been assessed. METHODS: Between November 1993 and July 1999, 31 women with obstetric haemorrhage underwent arterial embolization. Four patients underwent a hysterectomy. Gynaecological information on 25 of the 27 patients who did not undergo hysterectomy was obtained by interview. RESULTS: All women had a return of normal menses. Nine of the 25 patients desired subsequent pregnancy and five patients became pregnant with normal delay of conception. Moreover, two other patients who did not plan another pregnancy became pregnant. A total of 10 pregnancies was studied, four ended during the first trimester. For the six others, the maternal evolution of the pregnancy was uneventful until term. No case of pre-eclampsia was observed. The ultrasonographic examinations revealed normal fetal growth and umbilical and uterine Doppler studies showed no anomaly. No repetition of obstetric haemorrhage was observed. All full-term, newborns were healthy, weighing from 3220 to 4100 g. CONCLUSION: Our results suggest that women who undergo arterial embolization for obstetric haemorrhage should expect to have a return of normal menses with preservation of future fertility and successful uneventful pregnancies.

[Acute vulval ulcer or Lipschutz's disease]. / Ulcère aigu de la vulve ou maladie de Lipschutz.

The case of a 16-year-old woman with typical clinical features of acute vulval ulcer, Lipschutz's disease, is reported. The main differential diagnoses are discussed. Isolated vulval ulcer can reveal a recurrent aphthous ulcer, Behçet's disease or Crohn's disease. In contrast, acute vulval ulcer spontaneously heals with no recurrence, that must be taken into account for diagnosis.

[Ovarian pregnancies: revaluation of diagnostic criteria]. / Grossesses ovariennes: réévaluation des critères diagnostiques.

OBJECTIVES: To clarify the clinical features of ovarian pregnancy and to show the incapacity of Spielberg's criteria to establish the diagnosis. MATERIAL AND METHOD: and method. Retrospective experience of ovarian pregnancies in a single maternity unit over seven years with comparison between new diagnostic criteria and those of Spiegelberg. RESULTS: Thirteen ovarian pregnancies identified (incidence=1 for 1400 deliveries). History of pelvic disease (one case), use of an IUCD (five cases), pelvic pain (all the cases), metrorrhagia (four cases), hemorrhagic shock (two cases). Diagnosis was evoked only once by ultrasound. Eleven patients were treated by laparoscopy. None of the ovarian pregnancies in the present series met the criteria of Spiegelberg's definition. CONCLUSION: Ovarian pregnancy is a rare form of ectopic pregnancy, but its incidence is certainly underestimated. Search for difficult to detect ultrasonographic features is essential. Criteria, other than those described by Spiegelberg, when present together confirm ovarian pregnancy: serum beta-hCG level > or = 1000 IU/l and uterine vacuity at vaginal ultrasonography; ovarian implication confirmed by surgical exploration, with bleeding, visualisation of chorionic villi or presence of an atypical cyst on the ovary; normal tubes; absence of serum beta-hCG after treatment of the ovary. Ovarian pregnancy does not compromise subsequent fertility of these patients. Recurrence is exceptional.

[Influence of the type of breech presentation on delivery in selected primiparous women at term]. / Influence du mode de la présentation dans l'accouchement du siège chez la primipare à terme sélectionnée.

OBJECTIVE: Study the effect of the type of breech presentation on the prognosis of delivery in selected primiparous women at term. PATIENTS AND METHODS: We reviewed retrospectively 146 breech presentations seen between January 1, 1993 and December 12, 1999 in our unit. We limited our study to primiparous mothers at term (> or = 37 weeks gestation) who had had a normal single fetus pregnancy and who had accepted a trial of labor. We analyzed the mode of labor termination, and maternal, fetal, ovular, obstetrical and neonatal features by type of breech presentation and by type of delivery. We collected data by manual search of the patients' registered files (AUDIPOG). The chi-squared and Fisher's tests were used as appropriate for statistical analysis. RESULTS: Spontaneous vaginal delivery was achieved in 10.3% of the cases and non-spontaneous vaginal delivery in 56.2%. Cesarean section during labor was required in 33.5%. There was no significant difference between frank breech presentation (27.4%) and incomplete breech presentation (72.6%). Maternal, fetal, ovular, obstetrical and neonatal features were not significantly different. CONCLUSIONS: Unlike data reported by others, our series did not demonstrate any significant feature predictive of obstetrical and neonatal prognosis irrespective of the type of breech presentation in selected primiparous women at term who had had a normal pregnancy.