[Obstetric vesicovaginal fistulas, about 131 cases]. / Les Fistules Vésico-Vaginales D'origine Obstétricale. A propos de 131 cas.

BACKGROUND: Vesicovaginal fistulas are the most frequent type of urogenital fistulas. Obstetrical cause remains the dominant etiology. They still represent a public health problem. Aim : to study epidemiological aspects of obstetric vesico-vaginal fistulas and their management. METHODS: a retrospective multicentric study among 19 hospital departments from February 1982 to January 2007. RESULTS: 131 VVF (92% of urogenital fistulas). The vaginal route for surgical repair was used in 2/3 cases. The mean diameter of the fistula was 11.35 mm. In 122 cases (86.5%), the fistula was unique. IVU findings were normal in 83% cases. All patients had normal renal function apart one who had acute renal failure. 177 interventions were performed (1.37 intervention per patient). CONCLUSION: Our findings suggest a regression in obstetrical VVF. However many efforts on institutional, socioeconomic and obstetrical levels have to be done in order to eradicate this pathology that is of major handicap for women regarding socioeconomic, functional and psychological effects.

[Imperforate hymen: a series of 13 cases]. / Imperforation hyménéale: A propos de 13 cas.

BACKGROUND: Imperforate hymen is a rare congenital malformation. Patients often remain asymptomatic until puberty and present in early adolescence with cyclic abdominal pain. Early diagnosis and treatment must be performed in order to prevent morbidity. THE AIM of this study was to asses management of this disease. METHODS: A retrospective study of 13 cases of imporforate hymen diagnosed in the department of obstetrics and gynecology "A" of Charles Nicolle hospital of Tunis from January 1980 to December 2008. The clinical features and the management are discussed. RESULTS: The mean age was 14 years. All patients were single and had primary amenorrhea. They presented with pelvic pain in 9 cases and bladder urinary retention in 4 cases. Secondary sexual characters were present and normal in all cases. Inspection of the vulva could establish the diagnosis in all cases. Pelvic ultrasounds showed the hematocolpos in all cases. The latter was associated to a hematometria and a Douglas pouch liquid in 2 cases. Hematocolpos was evacuated by hymeneotomy under oxytocin infusion in all cases. Eight patients were treated by cruciform incisions and five patients were treated by radial incisions of the hymen. The volume of hematocolpos varied from 250 ml to 2000 ml. One patient underwent surgery twice for restenosis of the imperforate hymen. CONCLUSION: Imperforate hymen is a rare anomaly. Its diagnosis is simple and could be established at birth by a systematic screening. More frequently, the diagnosis must be suspected in front of a primary amenorrhea associated to abdominal pain in order to prevent complications.

[First trimester ultrasound: an early screening tool for fetal structural and chromosomal abnormalities]. / Echographie du premier trimestre: un outil de dépistage précoce des malformations foetales et des anomalies chromosomiques.

BACKGROUND: Prenatal diagnosis has been greatly expanded in recent years. Many biological and sonographic criteria participated in the development of fetal medicine. AIM: Analyze the contribution of first trimester ultrasound in prenatal diagnosis of aneuploidy and early fetal malformations, and its impact on the strategy of prevention of disability. METHODS: A prospective longitudinal descriptive study including all women who did a first trimester ultrasound during their pregnancy. We evaluated the detection rate of malformations and chromosomal abnormalities of the morphological embryonary study and nuchal translucency. These tests were then confronted with the results of fetal samples and the outcome of pregnancy. RESULTS: 593 ultrasound examinations were performed. The average age of pregnant women was 32.7 years. The mini-morphological ultrasound study revealed 26 abnormalities (3 major lethal malformations, 5 cystic hygroma and 18 increased nuchal translucency). Chromosomal abnormalities were found in six cases. The first trimester ultrasound has ensured the detection of 2/3 of total aneuploidies of the study. CONCLUSION: The first trimester ultrasound allows early detection of a large number of aneuploidies and fetal malformations.