[Coelioscopy in gynecologic emergencies. About 239 cases]. / Place de la coelioscopie en cas d'urgence gynecologique. A propos de 239 cas.

OBJECTIVE: The goal of this study was to determine the efficiency of lapaorscopy as method of diagnosis and treatment of gynecologic emergencie. METHODS: A laparoscopy was performed in two hundred and thirty-nine patients who presented in emergency with signs like acute pelvic pain, uterine bleeding or fever. Diagnoses and treatments are presented in a retrospective study. RESULTS: The median patient age was 30.4 years and median parity was 14 sonography was performed in all patients and bHCG rate was positive in 101 patients. The most suspected diagnosis was ectopic pregnancy (42%) followed by complicated cysts (30%) and ligh genital infections (27%) At laparoscopy 92 cases of ectopic pregnancy, 66 cysts complicated or not and 47 high genital infections were found. Laparoscopy didn't show any evident pathology in 6.6% of patients. We didn't note any anesthesial or surgical complication. CONCLUSION: Laparoscopy for gynecologic emergencies can be satisfactorily performed in the majority of patients, regardingly to low fiability of usual diagnostic methods. II is useful for diagnosis and treatment. The rate of it's overall complications is relatively low.

Clinical and anatomic features of acardiac twins.

OBJECTIVE: To report 6 cases of acardiac twins, and to investigate prognostic factors that would lead to survival of the normal twin. SUBJECTS AND METHODS: During a 9-year period from 1993 to 2001, 6 cases of acardiac twins out of 109,000 deliveries at the Maternity Center, Tunis, Tunisia were studied. Detailed inspection, X-rays, ultrasound and autopsies were performed. RESULTS: Prenatal diagnosis was made in only 1 case at 33 weeks of gestation. Rudimentary cardiac tissue was observed in 2 of the 6 perfused twins, and the cephalic pole was less developed than other parts of the body. Severe agenesis or hypoplasia of the thoracoabdominal organs was commonly observed. Many limb malformations were observed, with arms the most affected. One of the pump twins was stillborn, 3 died between days 1 and 3 from respiratory distress, and 2 developed cardiac failure after birth and were treated with diuretics and digoxin, which led to a favorable outcome in only 1. The ratio of the weight of the acardiac to pump twin (TWR) ranged from 50 to 142%. CONCLUSION: The findings of this study indicate that acardia can be diagnosed by means of ultrasound in front of a monochorial twin pregnancy when one of the fetuses is deformed and has no cardiac activity. Heart failure and polyhydramnios, as well as a TWR greater than 50% are prognostic factors for the pump twin.