[Intraperitoneal hemorrhage from rupture of uterine varicose vein during pregnancy: case report and review of the literature]. / Hémopéritoine par rupture de varices utérines en cours de grossesse.

We report a case of spontaneous rupture of uterine varicose vein revealed by a massive peritoneal hemorrhage in a 34-year-old patient at 27th weeks of gestation. Laparotomy enabled diagnosis and treatment of this complication. The pregnancy was continued without any problem with a normal delivery at term of a healthy child.

[Bowel obstruction revealing post-traumatic diaphragmatic hernia in a pregnant woman]. / Syndrome occlusif chez une femme enceinte révélant une hernie diaphragmatique post-traumatique méconnue.

We describe a case of late post-traumatic diaphragmatic hernia revealed during pregnancy by bowel obstruction. The diagnosis was made during exploratory laparotomy at 29 weeks. After surgical repair of the hernia the pregnancy went to term uneventfully. A healthy baby was delivered at 39 weeks by elective cesarean section.

[Paraplegia and pregnancy: anaesthesic management]. / Paraplégie et grossesse: prise en charge anesthésique.

Pregnancy is a rare occurrence in patient suffering from spinal cord lesion. The authors report the case of labour and delivery in a paraplegic patient who was suffering from lesion located T6 level. In early labour epidural analgesia was maintained and the vaginal delivery was successful without associated fluctuation of blood pressure or other signs of autonomic hyperreflexia. The epidural catheter was maintained for 48 h post-partum. The main risks and anaesthesic management of pregnancy in paraplegic patients are discussed.

[Hemorrhaging during delivery]. / Les hemorragies de la delivrance.

PIP: Hemorrhage during delivery or postpartum occurs in around 2% of deliveries in France and is responsible for 8-15% of maternal deaths. The causes of obstetrical hemorrhage are well known, but the factors leading to serious hemorrhage are often multiple. Knowledge of etiologies should permit early diagnosis before major clinical problems develop. This work defines hemorrhage of delivery as loss of 500 ml or more of blood at the site of placental insertion during delivery or within 24 hours. The work begins by describing the three phases of normal delivery of the placenta: separation, expulsion, and hemostasis. The mechanisms by which they occur and possible problems in each phase are described. The compensating physiological mechanisms that limit bleeding during normal deliveries are described. The various etiologies of hemorrhage during delivery are next examined: placental retention, uterine atony, uterine inversion, lesions of the genital tract or uterine rupture. Indirect or preexisting causes are also described, including retroplacental hematoma, preeclampsia, retention of a dead embryo in utero, placenta previa, amniotic embolism, or pathology of hemostasis. Criteria for diagnosis of hemorrhage rely primarily on abnormal duration and intensity of bleeding. Treatment of hemorrhagic shock and of the obstetrical problems is then described, as are preventive measures and possible complications. A flow chart summarizes the main steps to be taken in case of hemorrhage.^ieng