[Perinatal risk at term and post-term revisited]. / Période du terme: le risque périnatal revisité.

The aim of this review was to revisit the evaluation of risk of foetal and neonatal mortality at term. We analyse the meaning of term period and difficulty to determine the normal duration of the pregnancy. Specific complications associated with post term and the statistic approach of the perinatal risk are analysed, together with various mortality rates and especially the prospective risk introducing foetal term as a new concept. We study various aspect and evolution of non specific morbidity of the term period. An optimal decision for term management should involve pregnant women and the analysed parameters should be taken into consideration.

[Trial of labor after previous cesarean delivery: review of the literature]. / Essai de travail en cas de césarienne antérieure: revue de la littérature.

OBJECTIVE: The aim of this review was to relate the evolution of obstetrical management of delivery in women who had previously undergone cesarean delivery and to search the studies supporting the choice of the mode of delivery. MATERIAL AND METHOD: We identified relevant studies through a computer search in the Medline database. RESULTS: After a period from 1980 to 2000 when the vaginal delivery had been increasingly recommended, a growth in the use of the planned cesarean delivery was observed. Recent studies report more evidence that uterine rupture is the result of trial of labor and that adverse perinatal outcomes are associated with uterine rupture. The risk of uterine rupture is increased with labor induction. The use of prostaglandins appears to be implicated in a significant increase of uterine rupture, and subsequently might be contraindicated in this situation. The use of oxytocin induced labor appears to increase the risk of uterine rupture. However, the level of adverse perinatal outcomes is low. The choice of the mode of delivery should take into account the likelihood of a further pregnancy, due to the increased risk of placental pathologic conditions depending on the number of repeated cesarean sections. CONCLUSION: An optimal decision for the mode of delivery should be shared with the pregnant women and all these factors should be taken into consideration.

The role of ultrasound and fetal fibronectin in predicting the length of induced labor when the cervix is unfavorable.

OBJECTIVE: To compare cervical clinical data, ultrasound parameters and fetal fibronectin assessment in the prediction of the duration of induced labor when the cervix is unfavorable. METHODS: This was a prospective study of 90 pregnant women with a Bishop score /= 27 mm (P = 0.002 and P = 0.005). CONCLUSION: Cervical dilatation as assessed by digital examination is the best predictor of the duration of the latent phase and of that of the whole of labor. Ultrasound measurement of cervical length is not more accurate at predicting the duration of labor than are clinical data.

Does ultrasound examination when the cervix is unfavorable improve the prediction of failed labor induction?

OBJECTIVE: To compare the Bishop score, ultrasound cervical parameters and fetal fibronectin assessment for predicting failed labor induction when the cervix is unfavorable. METHOD: A prospective observational study was performed in 106 consecutive pregnant women with a Bishop score < or =5 undergoing labor induction. Assessment of fetal fibronectin and ultrasound measurement of cervical length, cervical wedging and cervical lip areas were performed. The relationship between these parameters and failure of labor induction was determined. RESULTS: Failure of labor induction was defined as failure to reach a cervical dilatation of > or =5 cm, and it occurred in 16 patients (15.1%). Induction failure was associated with low Bishop scores before (P = 0.004) and 6 h after the start of induction (P = 0.007), increased clinical cervical length (P = 0.02) and increased ultrasound anterior cervical lip area (P = 0.04). The logistic regression model identified the Bishop score before induction (odds ratio = 2.25; 95% CI, 1.30-3.91; P = 0.003) and the clinical cervical length (odds ratio = 3.95; 95% CI, 1.3-11.7; P = 0.01) as being independent predictors of failed induction. To predict an induction failure, the best Bishop score cut-off value was 4, with a sensitivity of 87.5%, a specificity of 45.6%, a likelihood ratio of 1.58, a positive predictive value of 22.2% and a negative predictive value of 95.4%. CONCLUSION: Compared with the Bishop score, cervical length by ultrasound is not a better predictor for the outcome of labor induction in an unfavorable cervix. Nevertheless, the Bishop score appears to be of poor predictive value for failed induction of labor.

[Primary fibromatosis of the breast]. / Fibromatose primitive du sein.

Primary fibromatosis of the breast is a very rare pathology which looks like a malignant tumor, clinically and radiologically. Fibromatosis of the breast is characterised by a local invasion and a risk of recurrence. Positive diagnosis is provided by histology and its treatment is surgical. The aim of this study was to report one case and to emphasize the difficulties encountered in the diagnosis and the treatment.

[Hypoglossia, situs inversus and absence of the pituitary in a neonate: teratogenic effect of maternal hyperthermia?]. / Hypoglossie, situs inversus et absence d'hypophyse chez un nouveau-né: effect tératogène d'une hyperthermie maternelle?

UNLABELLED: Hypoglossia is a rare malformation that is not fatal, unlike otocephaly. CASE REPORT: A neonate, born at 39 weeks of GA and dead at 5th day showed hypoglossia, dextrocardia, situs inversus and pituitary aplasia. Maternal hyperthermia was observed at 4 weeks gestation. CONCLUSION: This case is reminiscent of a community of syndrome with agnathia-holoprosencephaly and situs inversus. The responsibility of maternal hyperthermia is raised.

[Uterine activity and premature delivery. Review of the literature]. / Activité utérine et accouchement prématuré. Revue de la littérature.

OBJECTIVE: This paper reviews the recent literature on uterine activity during gestation with term and preterm delivery. METHODS: A review of the literature on uterine activity during gestation with term and preterm delivery was conducted by searching Medline file from 1990 to the present, using the key terms "uterine activity", "uterine monitoring", "preterm delivery", "term delivery". Additional references were accessed by cross referencing the bibliographie of the articles obtained through this search. RESULTS AND CONCLUSIONS: Contractions are infrequent in normal pregnancy. The mean 24-hour frequency of uterine contractions increase progressively with advancing gestational age. A strong diurnal rhythm is present from 24 weeks to the term with surge of contractions at night. These uterine activity noctural surges precede term delivery. These surges are lost in women who deliver prematurely. These studies suggest that early identification of increase in uterine activity is not the most appropriate intervention for prediction of preterm delivery. The reason lies in a flawed contraction-based theory of the pathogenesis of prematurity.

[O'Gilvie's syndrome in obstetrics. Review of the literature, apropos of a case]. / Le syndrome d'O'Gilvie en obstétrique. Revue de la littérature, à propos d'un cas.

The authors report one case of idiopathic dilatation of the colon (O'Gilvie's syndrome) which was complicated by perforation of the caecum following a caesarean operation. They study the cases associated with pregnancy from 1913 to 1984. They discuss pathogenesis, diagnosis and therapy. They insist on the usefulness of colonoscopy.