Risk factors and symptoms associated with maternal and neonatal complications in women with uterine rupture. A 16 years multicentric experience.

OBJECTIVE: high maternal and fetal morbidity and mortality levels have been associated with uterine ruptures. The aims of our study were to determine risk factors and signs for maternal and fetal complications in patients with uterine rupture. STUDY DESIGN: retrospective, population-based study, in all Val d'Oise public obstetrics departments, France, between 2000 and 2015. All patients with uterine rupture were analyzed using medical records. To identify risk factors and signs for maternal and fetal complications, patients were divided into two groups according to adverse maternal and fetal outcomes or not, and compared. RESULTS: During the study period, 126 patients with complete uterine rupture were identified. In all, 74 (58.7%) had maternal and fetal complications, and these were more frequently observed in patients with unscarred uterus (N=18; p<0.001 and OR 5.52, 95% CI 2.09-14.55), lateral injured uterus (N=21; p<0.001), after labour induction (N=21, p=0.01 and OR 3.69, 95% CI 1.22-13.53), and when a sudden onset of abdominal pain, in patients with previous successful epidural analgesia, occurred (75.9% vs 39.2%, p<0.001 and OR 4.88, 95% CI 1.9-12.13). CONCLUSION: Unscarred and lateral ruptures of uterus were associated with maternal vascular injuries, and higher maternal and fetal complications. Sudden onset of abdominal pain in woman with previous successful epidural analgesia might be predictive of complicated uterine rupture.

Rosacea fulminans during pregnancy.

BACKGROUND: Rosacea fulminans (RF) is a severe form of facial dermatosis presenting with a sudden onset of numerous facial pustules, papules, and erythema. During pregnancy its treatment may be difficult and can have an impact on obstetrical outcomes. CASE: A 37-year-old woman during the 37th week of her fourth pregnancy presented RF that was associated with ocular manifestations. The usual treatment with isotretinoin was contraindicated during pregnancy and the patient started an alternative treatment with prednisone and azithromycin. After delivery at 38 weeks of gestational age, there was a significant improvement. CONCLUSION: RE is a severe dermatological disease with unknown etiology and with a rapid improvement in the immediate postpartum period.

Idiopathic spontaneous hemoperitoneum during pregnancy.

Spontaneous hemoperitoneum is defined as bleeding within the peritoneal cavity of non-traumatic and non-iatrogenic etiology. It is a rare and life-threatening condition during pregnancy. Spontaneous hemoperitoneum is considered idiopathic when the source of bleeding is not detected during the exploratory laparotomy. The authors report two cases of spontaneous hemoperitoneum during pregnancy with sudden onset of abdominal pain during the third trimester of their pregnancy. Cesarean section was performed for fetal distress. In both cases, hemoperitoneum with a large quantity of blood was found, but the source of bleeding could not be identified during surgical exploration.

[Ectopic decidua: variability of presentation in pregnancy and differential diagnoses]. / La déciduose ectopique: variabilités de présentation pendant la grossesse et diagnostics différentiels.

The ectopic decidua is a common occurrence during pregnancy, corresponding to the presence of decidual tissue outside the endometrium. The pathophysiology of these lesions is not yet fully elucidated. The phenomenon is most often benign, with a favourable outcome in the post-partum and without follow-up. Because of the wide range of clinical presentations, from localized peritoneal granulation to large pelvic mass, the clinical diagnosis of ectopic decidua is difficult. Furthermore, imaging is not specific. The discovery of such lesions should lead to the realization of systematic biopsies for histological examination and rule out other causes such as lesions of tuberculosis or carcinomatosis. Immunohistochemical studies are helpful in differentiating deciduosis from malignant deciduoid mesothelioma, its main differential diagnosis with a catastrophic prognosis.

[Uterine torsion in twin pregnancy]. / Torsion utérine au cours d'une grossesse gémellaire.

A case of uterine torsion in a 37-years-old woman during twin pregnancy is described. Diagnosis was made during caesarean section and the torsion successfully reduced through a standing laparotomy. Detorsion was accomplished by rotating the uterus to the left. A severe post-partum haemorrhage occurred and hysterectomy was required. The patient recovered and was discharged home with her baby. Uterine torsion at term is a rare obstetric event that occurs mainly in the third trimester with adverse maternal and neonatal consequences and raises several critical management considerations. We review possible diagnostic signs and management of this rare complication from literature.

Prenatal diagnosis of adrenal neuroblastoma by ultrasound: a report of two cases and review of the literature.

Prenatal diagnosis of neuroblastoma is a rare event. Two cases diagnosed at 32 and 34 weeks are reported together with a description of the various ultrasound appearances of this tumor. Both cases had a favorable outcome and surgery was necessary in only one case. The management options are discussed in the light of the current literature. The role of ultrasound in the detection and follow-up of this tumor in the third trimester of pregnancy is discussed.

[Ureteral endometriosis: three cases. Diagnostic and therapeutic management. Literature review]. / Endométriose urétérale: à propos de 3 cas. Conduite diagnostique et thérapeutique. Revue de la littérature.

Ureteral endometriosis is a rare but serious entity because of its insidious evolution which can lead to the loss of kidney function. Three cases are reported: two patients have received a medical and endoscopic management and the third one has undergone a surgical procedure. According to the literature, the authors suggest a diagnostic and therapeutic tree.

[Prolapse surgery through the vagina with the help of Endo Stitch. Technical note and preliminary study]. / Cure de prolapsus par voie basse exclusive à l'aide de l'Endo Stitch. Note technique et étude préliminaire.

OBJECTIVE: Vaginal cure of genitourinary prolapses is a reliable technique. We propose a technical simplification: the use of the laparoscopic suturing instrument Endo Stitch. Bladder neck suspension can be performed in this way without supra-pubic incision. Sacrospinous suspension is sometimes difficult with a risk of sciatic nerve, pudendal artery or rectum trauma. This is also performed more easily using Endo Stitch. SUBJECTS AND METHODS: Twenty patients with genitourinary prolapse were treated by one surgeon using the Endo Stitch. The patients were followed for 6 to 18 months. RESULTS: No per- or postoperative complications attributable to the use of Endo Stitch were encountered. With two recurrent genital prolapses and one persistent urinary stress incontinence, anatomic and functional results seem to be similar to reference series, but must be confirmed with more follow-up.

Complications of diagnostic ultrasound-guided percutaneous umbilical blood sampling: analysis of a series of 341 cases and review of the literature.

OBJECTIVE: To study the complications of percutaneous umbilical blood sampling (PUBS) conducted for purely diagnostic purposes, in a retrospective study of 341 personal cases and an analysis of 4922 cases from literature. SUBJECT: Analysis of the sampling procedure and complications seen in 341 punctures, including 12 failures. INTERVENTIONS: Freehand echo-guided percutaneous umbilical blood sampling. PARAMETERS STUDIED: Conditions in which the blood samples were taken (gestational age, indications, placental location, technique--including number of punctures, duration); total number of fetal deaths and number of fetal deaths related to the procedure; other complications (bradycardia, hematoma of the umbilical cord, hemorrhage, premature births). RESULTS: 20 fetal deaths (FDs) were recorded in 341 cases (5.87%) (figures for the literature: 189/4922 = 3.84%); 3 FDs appeared to be directly related to the procedure (0.88) (figures for the literature: 48/4922 = 0.98%). There were 32 cases of bradycardia (9.38%); this complication was seen more frequently after repeated and prolonged punctures. Hematomas of the cord (1.47%) were seen when punctures were attempted in a free loop of the cord. There was a marked increase in the number of complications (8.96% FDs and 20.73% of bradycardias) when the procedure lasted more than 10 min and/or when more than 3 punctures were attempted (33.33% FDs). These two occurrences are closely related to the gestational age at which the PUBS was conducted, the placental location, the experience of the operators and the condition for which the sample was being taken. Pathological pregnancies (fetal malformation, disease or hypotrophy of the fetus, diseases of the amniotic fluid) had a mortality rate of 11.24% (19/169), whereas fetuses that were presumed to be healthy had a lower risk of 0.58% (1/172). CONCLUSIONS: The overall mortality (including all fetal and neonatal deaths) appears to be around 5.0% (between 3.84 and 5.87%), but the mortality rate directly related to the procedure seems to be around 1% (between 0.88 and 0.98%). It seems that the fetal mortality rate is closely related to: (a) The state of the fetus and thus to the indication of the procedure. The higher overall mortality rate observed is related to the natural history of the conditions for which the procedure was conducted and the time taken to conduct the procedure and the number of punctures. This depends on the experience of the teams, on the observation of the rule that the attempt should not be prolonged beyond 10 min and no more than 2 punctures should be attempted in any one session.

[Value of initial chemotherapy in the treatment of advanced cancers of the uterine cervix]. / Intérêt d'une chimiothérapie première dans le traitement des cancers évolués du col utérin.

Eleven patients who had advanced cancer of the cervix were treated with combination chemotherapy containing Cisplatin as a primary treatment. The cases were: 3 stage II B N+, 2 stage III not involving the bladder, 3 stage III involving the bladder and 3 stage IV. The response rate was 40% with 6 patients responding. The response was better than 50% in 3 and there were 5 failures. In the 6 patients where the treatment was helpful, 2 could have extended surgery whereas the others had follow-up radiotherapy without developing urinary fistulae. Just as it to be found in the literature, it was not possible to pick out prognostic criteria for sensitivity to chemotherapy. A protocol for treatment is suggested, starting with a therapeutic test of chemotherapy. If this is successful it should be followed by extended surgery or radiotherapy. It if is not successful, conventional treatment with radiotherapy will be undertaken. It is essential to carry out multicentre studies in future to find out whether this attitude is going to be successful.

[Pneumococcal peritonitis. An unusual diagnosis in gynecology]. / La péritonite à pneumocoque. Un diagnostic inhabituel en gynécologie.

The authors, having had a case of primary pneumococcal peritonitis, review the features of this pathological condition which has become rare, and of gynaecological pneumococcal infections. Pneumococcal peritonitis presents as a very serious peritonitis and the usual diagnosis that is first made is peritonitis due to appendicitis. Pneumococcal peritonitis can be primary but it is possible that it is often secondary to genital pneumococcal infections. Treatment should always be by laparotomy to confirm the diagnosis, with a peritoneal toilet which is needed in order to stop a pelvic abscess developing. Antibiotics, which are usually of the penicillin group, should be given for at least 15 days. The treatment can be varied in those rare cases where cirrhotic ascites or serious nephrotic syndromes develop in children. Putting in drains and removing the appendix when it is normal are both useless.