[Early home abortion and immediate contraception with Evra® patch]. / IVG précoce à domicile et contraception immédiate post-IVG par le patch Evra®.

AIM: To propose a new home safe abortion protocol and effective immediate contraception. PATIENTS AND METHODS: Four hundred women undergoing home safe abortion with RU 486. Hundred accepted to start contraception with Evra® patch. RESULTS: Concerning home abortion, the failure rate of the protocol was only 3% (12 cases). Concerning contraception, the continuation rate was 50% (50 cases). CONCLUSION: Early home abortion is a promising method to propose an immediate contraception. The Evra® patch is well accepted and appears to be a first line contraceptive choice.

[Prepubic TVT: a prospective study of 164 female patients treated for stress urinary incontinence]. / TVT prépubien. Etude prospective longitudinale dans le traitement de l'incontinence urinaire d'effort de la femme: à propos de 164 cas.

OBJECTIVE: A prospective open study was conducted to evaluate the prepubic (TPP) route of TVT. PATIENTS AND METHODS: 164 patients suffering from stress or mixed urinary incontinence were operated by prepubic route mainly under spinal anaesthesia. The incision is more proximal and para-uretral dissection directed more lateral to reach ischiopubic bone. The tape is introduced while keeping the needle tip close to bone to perforate between bone and ischiocavernous muscle. Then the needle is brought forwards to get its tip in vertical position and pushed under vulva to supra pubic area. A cough test is done with more pulling than in TVT since in TPP the pulling forces will act more frontally and laterally. Evaluation included detailed clinical examination with stress test, pads, endoscopic and urodynamic assessments and questionnaires in order to detect prognostic factors and to have a global treatment policy for associated low urinary tract symptoms and prolapse. RESULTS: Mean follow-up time was 20 months (14-30). No significant intraoperative complications occurred. All patients urinated the first day. The mean postvoid residual urine was 45 ml. Objective cure rate was achieved in 135 (82.3%) patients and 7 (4.3%) patients were improved while failure was observed in 22 (13,4%) patients. From patients'point of view success and satisfaction rates were 85.4% and 86%. No significant modification of sexual activity occurred. DISCUSSION AND CONCLUSION: TPP is a simple technique with very low risks and the preliminary results are consonant with those of other published techniques.

[Systematic screening for Chlamydia trachomatis with the molecular biological AMP-CT test in urine samples from young women]. / Recherche systématique de Chlamydia trachomatis dans l'urine d'une population de femmes jeunes par biologie moléculaire AMP-CT.

OBJECTIVE: We report the results of a systematic direct detection screening protocol for Chlamydia trachomatis in urine samples from young women. MATERIAL AND METHOD: The study included 1026 patients aged 13 to 30 years. Urine samples were tested with a molecular biology assay: AMP-CT. RESULTS: Thirty-five patients (3.4%) were positive: 80% of the positive patients were aged less than 25 years, 48.6% less than 20 years. All these patients were treated and post treatment controls were negative. CONCLUSION: This study suggests that national screening programs for Chlamydia trachomatis could be beneficial for women aged between 15 and 25 years and that the "Calmat" law could be modified in consequence.

[Removal or conservation of ovaries during hysterectomy for benign lesions]. / Conservation ou ablation des ovaires lors des hystérectomies pour lésions bénignes.

At the time of hysterectomy, the aging ovary presents a dilemma. We conducted a prospective study to assess the feasibility of systematic oophorectomy in women 50 years or older and a retrospective study of hysterectomy history in patients who developed cancer of the ovary. Our finding and data in the literature point out the requirement for careful assessment of two aspects of the problem, one technical (feasibility of adnexectomy) and the other functional (ovary function and risk of cancer on the retained ovary).

[Role of misoprostol in the delivery outcome]. / Place du misoprostol dans la direction de la délivrance.

OBJECTIVES: Delivery-induced hemorrhage is defined as a blood loss greater than 500 ml within the first 24 hours after delivery. Loss of more than 1000 ml is a sign of gravity. For certain authors, 40% of these hemorrhages could be avoided with systematic preventive measures using uterotonic agents to control the third phase of labor. The aim of our work was to assess the preventive efficacy of active management measures during the third phase of labor and to determine which agents are most effective. PATIENTS AND METHODS: We compared two protocols for controlled deliver: a conventional method using ocytocin (2.5 IU i.v. bolus), and a more recent method using a prostaglandin E1 analog: misoprostol (Cytotec, 3 tablets per os). We compared the two methods with a control group where no preventive measures were used, the standard procedure in our maternity unit. RESULTS: Six hundred two women participated in the study. They were divided into 3 homogeneous groups (ocytocin group misoprostol group, control group). There was a 46% reduction in delivery-induced hemorrhage in the ocytocin group but only a minimal preventive effect against severe hemorrhage. Misoprostol did not demonstrate any efficacy in our study. DISCUSSION: It would appear appropriate to take preventive measures against delivery-induced hemorrhage for all deliveries. A bolus intravenous injection of ocytocin immediately after delivery should bed used. The dose should be greater than that used in this study in order to prevent the development of severe hemorrhage. The most satisfactory results can be obtained with 5 IU (1 ampoule of Syntocinon). It is important to obtain a precise quantification of excessive blood loss in order to institute appropriate care rapidly. Misoprostol should be assessed with other prospective studies because of its easy administration, its low cost and easy storage, important advantages in countries with limited resources.

[Impact of Chlamydia trachomatis on pregnant women in Gabon]. / Impacts de Chlamydia trachomatis sur les femmes enceintes au Gabon.

During two years 3,312 pregnant women has been screened for C. trachomatis. In spite of an improvement of the way of life and program of information on STD the rate of C. trachomatis have increased and reach a percentage of 22%. C. trachomatis is mostly found in women younger than 21 years and give no clinical sign in more than 55%. The consequence of this high degree of infection on the new born is difficult to assess but one cause, stress that 30% of the conjunctivitis are linked to C. trachomatis. Prevention has to be done to protect the newborn and to prevent the tubal infertility in young women.

[The levels of apolipoprotein A in liquor in normal and pathological pregnancies (author's transl)]. / Evolution du taux de l'apolipoprotéine A dans le liquide amniotique au cours de la grossesse normale et pathologique.

As liquor contains only HDL (High Density Lipoprotein) as a lipoprotein we have studied the changes in the levels of apolipoprotein A, which is the major component of HDL according to the duration of the pregnancy. The study has been carried out in normal and pathological pregnancies. It has been found that the level of apolipoprotein A rises from the 16th week of amenorrhoea of pregnancy to the 26th week and then gradually drops to term. The maximum level is approximately ten times greater than the level of apolipoprotein A at term (a level approximately of 1 mg per litre). This change parallels that of total proteins throughout pregnancy. We have limited our study in pathological pregnancies to the examination of the liquor at the end of pregnancy. The three pathological maternal conditions that have been most frequently found are:--diabetes,--Rhesus-immunisation,--vasculo-renal syndromes. There has been no significant change shown up in the period that we have studied, which was from the 30th to the 38th week of amenorrhoea.

[Application of a rapid serum beta-hCG assay in the early diagnosis of the ectopic pregnancies (author's transl)]. / Application d'un dosage rapide de la beta-hCG sérique à la détection précoce des grossesses extra-utérines.

We have assessed the clinical utility of a rapid serum beta chorionic gonadotropin ( beta-hCG) assay. The assay employed a commercial kit that we have modified to assure its validity. We reach a sensitivity of 10 mIU/ml, and inter assay precision of 8,1% and an intra assay precision of 6.4 and 4.7% for concentrations of 7.6 +/- 0.5 mIU/ml and 1 825 +/- 86.3 mIU/ml respectively. This work was carried out on 106 radioimmune determinations of beta-hCG during the first trimester of 56 normal pregnancies and on 168 levels estimed in 116 suspected ectopic pregnancies. In normal pregnancies, a trophoblastic secretion of beta-hCG is detected on the 10th day following the thermal nadir; the levels quickly rise to reach a peak between the 42th and the 52th post-ovulation day, and then gradually decrease. In the 116 suspected pregnancies, 40 of them were surgically proven ectopic gestations: there were no false positive or false negative results. This rapid and accurate assay may contribute to the early diagnosis of an ectopic pregnancy.

[Late prenatal diagnosis of fetal growth retardation: the diagnosis of a case of trisomy 18 (author's transl)]. / Le diagnostic prénatal tardif pour hypotrophie foetale: mise en évidence d'un cas de trisomie 18.

The authors were able to confirm when dealing with a case of severe intra-uterine growth retardation that they were dealing with a case of trisomy 18 when they suspected a positive sign of growth retardation and carried out a pre-natal diagnostic test at the 32nd week of the pregnancy. They point out that this new indication could avoid unnecessary Caesarean operations.

[Multiple pregnancies. Apropos of 37 cases]. / Grossesses plurigémellaires. A propos de 37 observations.

Induction with ovarian stimulators and especially HMG together with HCG are the principal causes of multiple pregnancies as has been revealed by the studies of 37 case histories of multiple pregnancies over and above twin pregnancies. It is important to be very careful and take strict precautions with these patients who often have psychological troubles that have to be treated first. It is useless to carry out cerclage (cervical stitching) after these triplet and quadruplet pregnancies have been diagnosed early by systematic echography, which should be used in every case where ovulation is induced. It is essential to supervise these patients in a special centre. The children tend to be small for datas and it is best to deliver them by cesarean section at 35 weeks onwards. It is important to avoid these very pathological pregnancies as far as possible. Echography of the ovary should be routine before induction of ovulation.

[Maternal mortality in the gynaecological and obstetrical clinic of the University Hospital in Rennes. A retrospective study over 10 years, from 1969 to 1979 (author's transl)]. / La mortalitématernelle à la clinique gynéco-obstétricale du C.H.U. de Rennes. Etude rétrospective sur 10 ans, de 1969 à 1979.

Maternal mortality in the C.H.U. of Rennes from the 1st January 1969 to the 1st January 1979 consisted of 8 deaths in 24.911 deliveries and 1.381 Caesarean sections, which gives a mortality of 32 per 100.000 deliveries. There was 1 death due to hyperemesis gravidarum, 1 due to toxaemia of pregnancy, 3 due to haemorrhage, 1 due to puerperal sepsis, 1 due to cerebral haemorrhage and lastly 1 due to cancer of the pancreas. 2 women died during Caesarean section, which works out at 1 death per 690 Caesareans. Of these 8 deaths, 4 were possibly avoidable, and 3 of their children survived. In spite of continual progress since the end of the second world war, maternal mortality should decrease still further and tend down to the figures for Scandinavia or England (10 deaths for 100.000 deliveries).

[A consideration of "avoidable deaths". A study on early neonatal mortality in Ille-et-Vilaine from 1972 to 1977 (author's transl)]. / A propos des "morts évitables". Une étude sur la mortalité néo-natale précoce en Ille-et-Vilaine, de 1972 à 1977.

The authors have made a study of 514 case notes of early neonatal deaths that occurred in Ille-et-Viliane from the 1st January 1972 to the 1st January 1977 among a total of 61,400 deliveries. They had 3 objects in mind: 1. To know what mechanisms had produced these deaths. In order to do this they divided their observations into 4 groups according to what seemed to them at the time to be the primary cause of the death, namely a lethal congenital malformation, a complication occurring in pregnancy, an accident that happened during the delivery, prematurity and dysmaturity. 2. To establish the importance of what is now called "avoidable deaths" and the conditions under which they were produced. 3. To show the means and methods that might eventually reduce this mortality after studying these results. On the conclusion of this study it seems to them that this improvement can here and now be obtained not so much by new procedures as by better monitoring of the state of pregnancy and the puerperium, and by more attention to the classical rules and more sensible use of the numerous techniques that already exist today.

[Alterations in the proteins found in the amniotic fluid in the course of normal pregnancy. A study carried out by immunoprecipitation tests on the amniotic fluid (author's transl)]. / Variations des protéines du liquide amniotique au cours de la grossesse normale. Etude par immunoprécipitation en milieu liquide.

A fluonephelometric technique was used to study the proteins in amniotic fluid. 113 samples taken between the 8th and the 44th week of amenorrhoea from pregnancies without any fetal abnormality were tested. The levels of 8 protein fractions were estimated: albumen, IgG, IgA, alpha 1 antitrypsin, transferrin, orosomucoid, alpha 2 macro-globulin and IgM. 6 of these fractions could be estimated in almost every sample of amniotic fluid, but alpha 2 macroglobulines and IgM could only be found in a few cases. Furthermore, the fractions of the proteins most clearly shown appeared in a parallel way more or less as the total levels of proteins as estimated by Lowry's method.

[Infectious complications of intrauterine devices]. / Complications infectieuses sous sterilet.

PIP: 5 descriptions of uterine infections caused by an IUD are given. The symptoms are leukorrhea and metroraghia. The antibiotic treatment must be accompanied by removal of the IUD. If symptoms are ignored, the infections become worse, with serious results. 2 of the cases needed drastic surgery and another became sterile. Close surveillance is necessary to avoid such infections and to provide careful treatment if they occur. Prevention should include avoiding IUD use in those who have never given birth, or at the time of curettage.^ieng

[Radio-anatomy of uterine malformations]. / Radio-anatomie des malformations utérines

33 cases of uterine anomalies were studied from the external morphological point of views as well as by hysterography. These cases were grouped according to R. Mussel's classification (1964) which is itself the synthesis of radiological and anatomical investigations.

[Letter: Cytologic study of amniotic fluid. A simple method of sex determination of the fetus in utero]. / L'étude cytologique du liquide amniotique. Une méthode simple de détermination du sexe du foetus in utero

PIP: 104 samples of amniotic fluid taken between the 20th and the 44th week of pregnancy were studied and the sex of the fetus was predicted with certainty in 103 cases. The method of taking the samples and conducting the analysis is briefly described. It was found that in the case of female festuses, the basophilic malpighian cell content was over 40% in all cases, while in male fetuses it was less that 33% in all cases except 1 (59%). The method is described as simple and very reliable toward the end of pregnancy after the 20th week, and current studies suggest that it may even be reliable at an earlier stage, because the appropriate cells are already present by approximately the 10th week of amenorrhea. Thus, it might be possible to determine the sex of the fetus with certainty at an early stage and know the risk of hereditary diseases related to sex.^ieng