ABSTRACT
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The ectopic pregnancy (EP) could be treated by spontaneous resolution, or medical treatment or laparoscopic treatment. Spontaneous resolution of EP with beta hCG < 1,000 mUl/ml, plasmatic progesterone < 5 ng/ml had 74% success rate.... more
The ectopic pregnancy (EP) could be treated by spontaneous resolution, or medical treatment or laparoscopic treatment. Spontaneous resolution of EP with beta hCG < 1,000 mUl/ml, plasmatic progesterone < 5 ng/ml had 74% success rate. Methotrexate (MTX) injection is the common Medical treatment of EP with beta hCG < or = 5,000 mUl/ml and mean diameter of EP < or = 3 cm: a single dose of 50 mg/m2 or 1 mg/kg intramuscular injection had 93.4% success rate; local injection under sonographic control (1 mg/kg) had 80.2% success rate. The surgical conservative treatment by laparoscopy had 94% success rate.
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Cervical pregnancy is a rare form of ectopic pregnancy defined by the implantation of the blastocyst in the cervical canal. Most of the cervical pregnancies have been reported in patients with a history of vacuum curettage or caesarean... more
Cervical pregnancy is a rare form of ectopic pregnancy defined by the implantation of the blastocyst in the cervical canal. Most of the cervical pregnancies have been reported in patients with a history of vacuum curettage or caesarean section. The authors report a case of cervical pregnancy occurred after a failure of medical abortion. A literature review discusses the possibility of a cervical secondary implantation and describes the management of such pregnancies.
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Since the 1990s, governmental plans in France have imposed the regionalization of perinatal care to improve both safety and quality of care. The Eastern Paris Perinatal Network is under construction in health area 75-2, which includes the... more
Since the 1990s, governmental plans in France have imposed the regionalization of perinatal care to improve both safety and quality of care. The Eastern Paris Perinatal Network is under construction in health area 75-2, which includes the 11th, 12th, 13th and 20th arrondissements of Paris. A major issue is ensuring that the network can meet the needs of its target population. The objective is to define the network's target population of mothers and newborns. We designed a matrix to help assess these needs and identify the data required to define the network's population. Four principal data sources were analyzed: the National Statistics and Economic Studies Institute (Insee) data, annual health facility activity data, national medical informatics program data, and 8th-day health certificates. The network's target population varies according to the precise perinatal period and the planning stage. For the conception period, it includes the general population and specifical...
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In the early 1960s, it became apparent that oral contraception (OC) with oestroprogestogens increased the cardiovascular, venous thromboembolic (VTE), myocardial infarction (MI) and cerebrovascular accident (CVA) risk. The change in... more
In the early 1960s, it became apparent that oral contraception (OC) with oestroprogestogens increased the cardiovascular, venous thromboembolic (VTE), myocardial infarction (MI) and cerebrovascular accident (CVA) risk. The change in medical prescribing patterns, the reduction in ethinyloestradiol dosage and the use of less androgenic progestogens made prescribers confident that the risks would subsequently decrease. At the end of 1995 and early 1996, four publications called into question that optimism by showing that third-generation pills induced a two-fold increase in VTE risk compared with second-generation pills. A biological rationale was due to be announced later. Since then, re-analysis of the data has shown that the thrombotic risk factors are increased in third-generation OC users but, more importantly, that those users (unlike those using second-generation pills) are the women who have not had the opportunity of revealing a latent thrombophilia and are, therefore, at a gr...
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The purpose of this study of 109 myomectomies is to evaluate the feasibility, limits and results in term of fertility of the laparoscopic myomectomy. Retrospective study from January 1990 to December 1993, including 109 patients having... more
The purpose of this study of 109 myomectomies is to evaluate the feasibility, limits and results in term of fertility of the laparoscopic myomectomy. Retrospective study from January 1990 to December 1993, including 109 patients having had a myomectomy, 39 by laparotomy (35,7%) and 70 by laparoscopy. The average number of myomas extracted by laparoscopy and by laparotomy were 1.5 and 6.7 respectively. The diameter of the major myoma was 7 cm in the laparotomic group versus 6.2 cm in the laparoscopic group. Among 70 myomectomies approached by laparoscopy, 29 (41,4%) have necessitated a laparoconversion. The reason of this conversion was mainly the size of the myoma (superior 5 cm) in 21 cases, the number of myomas (superior 5) in 6 cases, the interstitiel location of the myoma in 1 case and a per-operative hemorrhage in 1 case. Among 109 patients having had a myomectomy, 60 (55%) desired a pregnancy including 22 patients having laparoscopy myomectomy. Among these 22 patients, 8 have ...
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Objective – To study the perinatal management of fetal macrosomia (FM) and the obstetrical and neonatal results related to FM in the Île de France area.Materials and methods – Case-control study from the fifteenth of July to the fifteenth... more
Objective – To study the perinatal management of fetal macrosomia (FM) and the obstetrical and neonatal results related to FM in the Île de France area.Materials and methods – Case-control study from the fifteenth of July to the fifteenth of September 1999 in fifteen maternity in Paris and the Île de France area. All singletons, without malformation, weighing more than 4,000 grammes,
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In the past few years hysteroscopy has become a useful method, improving the specificity of the diagnosis of intrauterine lesions. Today, operative hysteroscopy is commonly performed for the evaluation and treatment of benign intrauterine... more
In the past few years hysteroscopy has become a useful method, improving the specificity of the diagnosis of intrauterine lesions. Today, operative hysteroscopy is commonly performed for the evaluation and treatment of benign intrauterine lesions, including postmenopausal ...
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Using a newly-developed technique, a severe acquired plasma resistance to activated protein C has been described in women using third-generation (rather than second-generation) oral contraceptives. The following items are discussed: (i)... more
Using a newly-developed technique, a severe acquired plasma resistance to activated protein C has been described in women using third-generation (rather than second-generation) oral contraceptives. The following items are discussed: (i) the technical parameters used to appreciate the effect of activated protein C induce a bias of interpretation, the mean intrinsic effect of activated protein C, in plasmas from women on second or third-generation oral contraceptives being strictly identical; (ii) there are no data available to show that this assay can indicate a thromboembolic risk in asymptomatic women on oral contraceptives; and (iii) this assay is a global and non-specific test, basically sensitive to the plasma concentrations of many coagulation factors which are increased or decreased by oestrogens and progestogens. For instance protein S, in which oral contraceptive-induced modifications account for the differential effect of oral contraceptives on Rosing&#39;s assay, but which modifications are not related to the thromboembolic risk of oral contraceptives. The androgenic potential of the progestogen may counteract the effect of oestrogens in the test. More generally, in such a complex situation in which there is a &#39;modification of the modification&#39;, there is no haemostasis-related test which provides a risk indicator for thrombosis. Based on testing of the plasma response to activated protein C, it is impossible to state that third-generation oral contraceptives induce a more important thromboembolic risk than oral contraceptives containing a more androgenic progestogen.
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We report the limits, complications, subsequent fertility and outcome of pregnancies after laparoscopic myomectomy. From January 1990 to October 1995, 143 patients underwent a first laparoscopic approach to myomectomy. A total of 41... more
We report the limits, complications, subsequent fertility and outcome of pregnancies after laparoscopic myomectomy. From January 1990 to October 1995, 143 patients underwent a first laparoscopic approach to myomectomy. A total of 41 patients (28.7%) had a laparoconversion (12 cases for a number of myomata &gt;5, 15 cases for myoma diameter &gt;7 cm, 12 cases for peroperative haemorrhage and two cases for adenomyosis). Seventy patients (49%) wished to conceive: 26 had undergone laparoconversion and 44 laparoscopic myomectomy. A total of 19 pregnancies were obtained in 17 patients after laparoscopic myomectomy (38.6%): eight vaginal deliveries, three Caesarean sections, four miscarriages, two abortions, one ectopic pregnancy and one therapeutic abortion. The pregnancy rate in patients with unexplained infertility and with multifactorial infertility was 48.2% and 20% respectively. The mean delay to conception was 11.3 months. No uterine rupture was noted. Pelvic adhesions were found in the four patients who underwent second-look procedure. Our preliminary results indicate that laparoscopic myomectomy is a useful technique.
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To evaluate safety and efficacy of intrasaccular methotrexate (MTX) for treatment of ectopic pregnancy (EP). Longitudinal nonrandomized trial of MTX treatment of EP. Department of Obstetrics and Gynecology (A. Béclère Public Hospital,... more
To evaluate safety and efficacy of intrasaccular methotrexate (MTX) for treatment of ectopic pregnancy (EP). Longitudinal nonrandomized trial of MTX treatment of EP. Department of Obstetrics and Gynecology (A. Béclère Public Hospital, Clamart, France Paris-Sud University). One hundred patients with an EP visualized by sonography. Patients were 31.4 +/- 4.8 years old, para 0 to 4, and gravida 0 to 7. Twelve patients had a past history of EP, and 18 had previously undergone tubal surgery. Inclusion score for proposed medical treatment used six criteria graded from 1 to 3: gestational age, initial hCG level, P level, existence of abdominal pain, size of hemoperitoneum, and diameter of hematosalpinx. Eleven patients had an EP with cardiac activity. Treatment consisted of MTX, 1 mg/kg, given locally under transvaginal sonographic control. Eighty-three of 100 patients were considered to be completely cured (return of hCG to &lt; 10 mIU/mL). The success rate was 92.8% with an initial hCG level &lt; 5,000 mIU/mL and 87% when the score was &lt; or = 12. Seven of the 11 patients with an EP with cardiac activity were treated successfully, including 5 of 7 when the initial score was &lt; or = 12, and all failures concerned cases with an initial score &gt; 12. Twenty-eight of 83 patients treated successfully required more than one injection of MTX (additional doses being given intramuscularly) because of nonresolution of hCG levels. Follow-up hysterosalpingography was performed in 80 patients showing 90% tubal patency on the side of the treated EP. Of 58 patients wishing pregnancy, 34 pregnancies occurred, including 25 ongoing or delivered. We observed a low recurrence rate of EP (3 with 1 on the same side). Treatment by initial transvaginal injection of MTX under sonographic control appears to be simple and effective, with no demonstrable untoward effects. The tubal patency and subsequent fertility obtained appear satisfactory. The highest success rate is observed when hCG level is under 5,000 mIU/mL and/or a pretherapeutic score &lt; or = 12 when EP is visualized by sonography.
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Damage to the anal sphincter has been considered as the cause of anal incontinence after childbirth. The aims of the present study were to determine prospectively the incidence of anal incontinence and anal sphincter damage after... more
Damage to the anal sphincter has been considered as the cause of anal incontinence after childbirth. The aims of the present study were to determine prospectively the incidence of anal incontinence and anal sphincter damage after childbirth, and their relationship with obstetric parameters in France. We studied 259 consecutive women six weeks before and eight weeks after delivery. They were asked to fill out a questionnaire dealing with faecal and urinary incontinence. Anal endosonography (B&amp;K 7-10 MHz) was then performed. Two independent observers analyzed internal and external anal sphincters. Two hundred and thirty-three women (90%) were assessed, among whom 31 had had a caesarean section. De novo sphincter defects were observed in 19.3% (39 patients) in the postpartum period only after vaginal delivery (202 patients). These disruptions occurred with the same incidence after the first and second childbirth. Independent risk factors (odds ratio; 95% confidence interval) for sphincter defect were forceps (odds ratio 11.9; 4.8-33.3), perineal tears (odds ratio 16.1; 4.4-83.9), episiotomy (odds ratio 6.6; 1.7-34.2), and pauciparity &lt; or = 2 (odds ratio 8.8; 1-78.3), as revealed by multivariate analyses. The overall rate of de novo anal incontinence was 9% (20 patients), and independent risk factors involved forceps (odds ratio 4.5; 1.5-13), perineal tears (odds ratio 3.9; 1.4-10.9), de novo sphincter defect (odds ratio 5.5; 5-15) and prolonged labor (odds ratio 3.4; 1-11). Among the 20 women who had de novo anal incontinence, only 45% (9 patients) had sphincter defects. De novo anal incontinence after delivery is multifactorial and anal sphincter defects account only for 50% of them. Primiparous and secundiparous women have the same high-risk factor for sphincter disruption and anal incontinence. Since external anal sphincter disruptions are more frequent than internal anal sphincter damage, surgical repair should be discussed.
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Résumé L’incontinence urinaire, notamment à l’effort, est un problème fréquent, quel que soit l’âge des patientes, notamment pour certaines patientes toujours en âge de procréer. Un certain nombre de ces patientes vont bénéficier d’une... more
Résumé L’incontinence urinaire, notamment à l’effort, est un problème fréquent, quel que soit l’âge des patientes, notamment pour certaines patientes toujours en âge de procréer. Un certain nombre de ces patientes vont bénéficier d’une cure chirurgicale d’incontinence urinaire à l’effort (IUE) avant d’avoir terminé leur désir de maternité. Depuis environ dix ans, la chirurgie « mini-invasive » de l’IUE est devenue
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The prenatal diagnosis of ambiguous genitalia requires a complete examination of the fetal anatomy to rule out any other congenital defects and the analysis of the fetal genotype. In addition any additional information on the anatomy of... more
The prenatal diagnosis of ambiguous genitalia requires a complete examination of the fetal anatomy to rule out any other congenital defects and the analysis of the fetal genotype. In addition any additional information on the anatomy of the internal genitalia, i.e. the presence or absence of fetal uterus, may be relevant to the prenatal evaluation of female pseudo-hermaphroditism. The recent development of 3D and 4D ultrasound technology may be relevant to a more clearly identification of the fetal uterus. Volume contrast imaging (VCI) provides high contrast images by the realization of thick slices of the region of interest (ROI) thereby providing a clearer picture of the fetal uterus. The multiplanar mode may also facilitate the differentiation of the fetal uterus from the other intra-pelvic organs by offering images in three perpendicular planes. Finally, the tomographic ultrasound imaging (TUI) mode offers the ability to display on a single panel numerous 2-dimensional sections,...
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During in vitro fertilization (IVF) morphological criteria are the only means usable today to select embryos before their uterine transfer in order to obtain pregnancy with the best chances of success. Since several years many attempts... more
During in vitro fertilization (IVF) morphological criteria are the only means usable today to select embryos before their uterine transfer in order to obtain pregnancy with the best chances of success. Since several years many attempts have been made to find more functional means. Quantification of apoptosis of granulosa cells has been proposed for this purpose. The aim of this review is to take stock of our knowledge on apoptosis and its mechanisms in granulosa cells and to analyse how quantification of these apoptotic cells could be a reliable and predictive marker of success for an attempt of an IVF in terms of pregnancy.
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The expulsive forces of childbirth can be included among the many potential risk factors implicated in the subsequent development of perineal disorders. The objective of this study was to devise a non-invasive way to measure abdominal... more
The expulsive forces of childbirth can be included among the many potential risk factors implicated in the subsequent development of perineal disorders. The objective of this study was to devise a non-invasive way to measure abdominal pushing that would accurately represent the expulsive forces during childbirth. By means of intravesical and intrauterine manometry, and electromyography (EMG) of intercostal muscles, we quantified these forces in 21 women during vaginal delivery. A mixed Ancova model showed the integral of intravesical pressure to be significantly associated (P<0.001) with the integral of intercostal muscle electrical activity during the first 6 uterine contractions during the phase of fetal expulsion. Electromyography is a non-invasive measurement that can replace intravesical determinations to quantify these forces as it reflects the real intra-abdominal pressure.
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To describe medical and obstetrical prenatal care of pregnant women infected by HIV-1 emphasizing the role of cesarean section. A retrospective study of 202 pregnancies followed between 1990 and 1998 in a french hospital in Paris. 56.9%... more
To describe medical and obstetrical prenatal care of pregnant women infected by HIV-1 emphasizing the role of cesarean section. A retrospective study of 202 pregnancies followed between 1990 and 1998 in a french hospital in Paris. 56.9% of the women were born in subsaharian Africa; 80.2% were infected by sexual intercourse and the seropositivity was discovered during the pregnancy in 51% of the cases. Viral coinfections by hepatitis B virus, hepatitis C virus and Human papillomavirus were found respectively in 14.7%, 16.5% and 13% of the pregnancies. Prematurity occurred in 15% of the deliveries. Efficacy of antiretroviral therapy was confirmed in this study: 5.7% of the children were infected despite the antiretrovial treatment versus 19.3% without treatment (p < 0.03). Prophylactic cesarean section was proposed to the patients since 1994; the morbidity of cesarean was 8.8% (69 cesarean sections). The policy of the association of prophylactic cesarean section and monotherapy by ...
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Damage to the anal sphincter has been considered as the cause of anal incontinence after childbirth. The aims of the present study were to determine prospectively the incidence of anal incontinence and anal sphincter damage after... more
Damage to the anal sphincter has been considered as the cause of anal incontinence after childbirth. The aims of the present study were to determine prospectively the incidence of anal incontinence and anal sphincter damage after childbirth, and their relationship with obstetric parameters in France. We studied 259 consecutive women six weeks before and eight weeks after delivery. They were asked to fill out a questionnaire dealing with faecal and urinary incontinence. Anal endosonography (B&K 7-10 MHz) was then performed. Two independent observers analyzed internal and external anal sphincters. Two hundred and thirty-three women (90%) were assessed, among whom 31 had had a caesarean section. De novo sphincter defects were observed in 19.3% (39 patients) in the postpartum period only after vaginal delivery (202 patients). These disruptions occurred with the same incidence after the first and second childbirth. Independent risk factors (odds ratio; 95% confidence interval) for sphinc...
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In France, prescription of micronized progesterone at high doses of 900 to 1200 mg/day is common practice in the case of preterm delivery, even though this is neither an indication nor a posology given for marketing authorisation. A few... more
In France, prescription of micronized progesterone at high doses of 900 to 1200 mg/day is common practice in the case of preterm delivery, even though this is neither an indication nor a posology given for marketing authorisation. A few cases of gestational pruritus have been reported during such use, associated with cholestasic and/or cytolytic hepatic disorders. We report here the results of a controlled, double-blind study versus a placebo, aimed at assessing the effects on the liver of micronized progesterone administered orally at high doses (900-1200 mg/day), conducted in a population of 201 women presenting moderate menace of preterm delivery during the third trimester of pregnancy. 85 patients received micronized progesterone and 116 the placebo. The increase above normal levels of total biliary acids (TBA) and aminotransferases (ASAT, ALAT), was significantly more frequent in the micronized progesterone than in the placebo group. Among the 26 patients (14%) with a level of ...
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HELLP syndrome is characterized by association of haemolysis (H), elevated liver enzymes (EL), and low platelets (LP). From 1989 to 1991, we studied retrospectively 12 cases of HELLP syndrome cases that occurred during the third trimester... more
HELLP syndrome is characterized by association of haemolysis (H), elevated liver enzymes (EL), and low platelets (LP). From 1989 to 1991, we studied retrospectively 12 cases of HELLP syndrome cases that occurred during the third trimester for 7 cases and during post-partum for 5 cases. 83% of patients (10/12) were black people (African or Creole). The most frequent sign of HELLP syndrome during pre- and post-partum was epigastric or dorsal pain, present in 91% of the cases (11/12) and in all cases of preeclampsia. Aggressive treatment was always performed, leading to 12 births: 7 of the 12 children were hypotrophic for gestational age. There were no maternal or neonatal deaths. Post-partum HELLP syndrome occurred 28.8 hours (mean) after delivery. Whether HELLP syndrome occurred during pre- or post-partum, laboratory findings returned to normal levels after equivalent delays: platelets 57 hours, ASAT 68 hours and ALAT 65 hours.
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Transabdominal amnioinfusion can be used to facilitate external cephalic version. Our technique involves filling the uterine cavity with 700 or 900 mL of 37C saline under continuous echographic monitoring. External cephalic version is... more
Transabdominal amnioinfusion can be used to facilitate external cephalic version. Our technique involves filling the uterine cavity with 700 or 900 mL of 37C saline under continuous echographic monitoring. External cephalic version is done the next morning. We have used this procedure in six women, all of whom had previous unsuccessful attempts at external cephalic version. After amnioinfusion, all six patients were converted to cephalic presentation and delivered normally, without obstetric or neonatal complications.
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We report a case of fetal immobility following antenatal corticosteroid therapy administered to women in thirty weeks at risk of preterm labor. The short-term side effect of corticosteroid, a decrease in fetal heart rate variation are... more
We report a case of fetal immobility following antenatal corticosteroid therapy administered to women in thirty weeks at risk of preterm labor. The short-term side effect of corticosteroid, a decrease in fetal heart rate variation are well known. This case report presents the difficulty of therapy choice in front of fetal immobility and acute fetal distress. We chose a medical surpervision. A review of the literature suggests other criteria, such as Doppler of umbilical artery, which could help therapeutical choice.
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The objective of this study was to evaluate the variation over 5 years of functional discomfort associated with pelvic organ prolapse (POP) repaired by sacrospinous ligament fixation (SLF). A total of 178 women who had undergone SLF from... more
The objective of this study was to evaluate the variation over 5 years of functional discomfort associated with pelvic organ prolapse (POP) repaired by sacrospinous ligament fixation (SLF). A total of 178 women who had undergone SLF from 1992 to 2001. In 2002 and 2008, patients were sent a questionnaire including the pelvic floor distress inventory (PFDI-20); 79 responded and comparison of those data served to evaluate subjective signs at 5 years. This population was divided into two groups: ≤60 and &gt;60 years old, and their 2002-2008 differences were compared. The outcomes were satisfaction, functional results and sexuality. Mean follow-up was 115 (72-173) months. Our results showed the long-term stability of SLF functional outcomes for women &gt;60 years. However, for those≤60 years, functional outcomes and satisfaction had declined at 5 years.