RESUMEN
PURPOSE: Fetal growth restriction (FGR) management and delivery planning is based on a multimodal approach. This meta-analysis aimed to evaluate the prognostic accuracies of the aortic isthmus Doppler to predict adverse perinatal outcomes in singleton pregnancies with FGR. METHODS: PubMed, EMBASE, the Cochrane Library, ClinicalTrials.gov and Google scholar were searched from inception to May 2021, for studies on the prognostic accuracy of anterograde aortic isthmus flow compared with retrograde aortic isthmus flow in singleton pregnancy with FGR. The meta-analysis was registered on PROSPERO and was assessed according to PRISMA and Newcastle-Ottawa Scale. DerSimonian and Laird's random-effect model was used for relative risks, Freeman-Tukey Double Arcsine for pooled estimates and exact method to stabilize variances and CIs. Heterogeneity was quantified using I2 statistics. RESULTS: A total of 2933 articles were identified through the electronic search, of which 6 studies (involving 240 women) were included. The quality evaluation of studies revealed an overall acceptable score for study group selection and comparability and substantial heterogeneity. The risk of perinatal death was significantly greater in fetuses with retrograde Aortic Isthmus blood flow, with a RR of 5.17 (p value 0.00001). Similarly, the stillbirth rate was found to have a RR of 5.39 (p value 0.00001). Respiratory distress syndrome had a RR of 2.64 (p value = 0.03) in the group of fetuses with retrograde Aortic Isthmus blood flow. CONCLUSION: Aortic Isthmus Doppler study may add information for FGR management. However, additional clinical trial are required to assess its applicability in clinical practice.
Asunto(s)
Aorta Torácica , Retardo del Crecimiento Fetal , Resultado del Embarazo , Ultrasonografía Prenatal , Femenino , Humanos , Embarazo , Aorta Torácica/diagnóstico por imagen , Retardo del Crecimiento Fetal/diagnóstico por imagen , Feto/irrigación sanguínea , Mortinato , Ultrasonografía Doppler/métodos , Ultrasonografía Prenatal/métodos , Muerte FetalRESUMEN
OBJECTIVE: To investigate whether abdominal scar characteristics could predict the incidence and severity of intra-abdominal adhesions found at repeat cesarean delivery. PATIENTS AND METHODS: Prospective cohort study including 151pregnant women with at least one previous cesarean delivery and who delivered abdominally in the department of obstetrics and gynaecology of Farhat Hached teaching hospital-Sousse-Tunisia, during 6 months. Abdominal scar characteristics were studied. The main outcome measure(s) were the incidence and severity of intra-abdominal adhesions. Statistical analysis was performed using SPSS 18.0. RESULTS: Of 151 women enrolled into this trial, 111 (73.5%) had adhesions, 57 (37.8%) had dense adhesions. Of all the abdominal scar characteristics studied, a depressed scar was associated with an increased incidence of both dense and filmy intra-abdominal adhesions and frozen pelvis if compared of women who did not have a depressed scar (P<10(-4) ; RR=7.6; IC=2.98-19.45). A number of previous cesarean section equal or more than 2 was also correlated with an increased incidence of severe intra-abdominal adhesions and frozen pelvis if compared with women who had only one previous cesarean section (P=0.002; RR=2.53; IC=1.16-5.56). DISCUSSION AND CONCLUSION: A depressed abdominal scar of a previous cesarean delivery and a number of previous cesarean sections are significantly correlated with the incidence and severity of intra-abdominal adhesions.
Asunto(s)
Abdomen/cirugía , Cesárea Repetida/efectos adversos , Cicatriz/patología , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Pelvis/patología , Complicaciones Posoperatorias/patología , Adherencias Tisulares/patología , Adulto , Cesárea Repetida/estadística & datos numéricos , Femenino , Humanos , Incidencia , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Adherencias Tisulares/epidemiología , Adherencias Tisulares/etiología , Túnez/epidemiologíaRESUMEN
OBJECTIVES: The diagnostic laparoscopy has long been the key consideration in the export of female infertility. This place is being reconsidered, especially in the case of normal hysterosalpingogrophy (HSG), because of the advent of assisted reproductive technologies which are more efficient, and because of the improvement of medical imaging techniques which are more sensitive and specific. We wanted to clarify the place of the diagnostic laparoscopy in the balance of female infertility in normal HSG. PATIENTS AND METHODS: It is a retrospective study on a series of 100 observations of infertile patients with a normal HSG and having a diagnostic laparoscopy in the department of Gynecology and Obstetrics at Farhat Hached hospital in Sousse (Tunisia) from 1st January 1993 to 1st March 2003. RESULTS: The mean age was 32.3years; the mean duration of infertility was 70.47months. Laparoscopy revealed pelvic abnormalities in 45% of cases, dominated by disease tubo-adhesions (23%), endometriosis was found in 6% of cases. These anomalies are considered major in 23% of cases and minor in 22% of cases. Conducting a surgical procedure in the same operating time (adhesiolysis, tubal plastic surgery, electrocoagulation of endometriosis implants) could improve the prognosis of fertility. Only 20 patients were followed among the 45 with pelvic abnormalities, seven pregnancies have been completed (35% of cases). DISCUSSION AND CONCLUSION: Laparoscopy has improved the prognosis for the fertility of our patients by treating abnormalities involved in infertility. It is estimated that the prognosis can be improved by selecting patients with risk factors for pelvic abnormalities.
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Histerosalpingografía , Infertilidad Femenina/diagnóstico , Infertilidad Femenina/cirugía , Laparoscopía , Adulto , Endometriosis/complicaciones , Endometriosis/diagnóstico , Endometriosis/cirugía , Enfermedades de las Trompas Uterinas/complicaciones , Enfermedades de las Trompas Uterinas/diagnóstico , Enfermedades de las Trompas Uterinas/cirugía , Femenino , Humanos , Infertilidad Femenina/etiología , Persona de Mediana Edad , Embarazo , Estudios Retrospectivos , Adherencias Tisulares/diagnóstico , Adherencias Tisulares/cirugía , Resultado del Tratamiento , Túnez , Adulto JovenRESUMEN
Holoprosencephaly is a rare brain abnormality resulting from an incomplete cleavage of the primitive prosencephalon of forebrain during early embryogenesis. It includes a series of rare complex and heterogenosis disorders. Alobar form is associated with an extremely poor fetal prognosis. Here we report three cases of alobar holoprosencephaly and one case of semilobar holoprosencephaly diagnosed at the third trimester. Causes, diagnosis and management of holoprosencephaly are discussed referring to literature.
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Holoprosencefalia , Aborto Eugénico , Adulto , Amniocentesis , Encéfalo/anomalías , Encéfalo/embriología , Encéfalo/patología , Consanguinidad , Diabetes Gestacional , Cara/anomalías , Cara/diagnóstico por imagen , Cara/embriología , Cara/patología , Femenino , Cabeza/diagnóstico por imagen , Cabeza/embriología , Cabeza/patología , Holoprosencefalia/diagnóstico por imagen , Holoprosencefalia/embriología , Holoprosencefalia/etiología , Holoprosencefalia/patología , Humanos , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Microcefalia/diagnóstico por imagen , Microcefalia/embriología , Microcefalia/etiología , Microcefalia/patología , Embarazo , Rubéola (Sarampión Alemán) , Toxoplasmosis , Ultrasonografía PrenatalRESUMEN
The aim of the study is to evaluate seroprevalence of rubella virus (RV), cytomegalovirus (CMV), varicella zoster virus (VZV), and parvovirus B19 (PB19) in 404 Tunisian pregnant women, and to determine reliability of maternal past history of eruption. Sociodemographic characteristics, risk factors, and past history of eruption were collected through a questionnaire. Serologic tests were performed using enzyme immunoassays. Risk factors were analyzed using univariate and multivariate logistic regression models. Seroprevalences were 79.7% for rubella, 96.3% for CMV, 80.9% for VZV, and 76.2% for PB19. In multivariate analysis, the number of persons per room (> 2) in the house during childhood was associated with CMV infection (P = 0.004), irregular professional husband's activity was correlated with VZV infection (P = 0.04), and an age of more than 30 years was associated with PB19 infection (P = 0.02). History of rubella, varicella, and PB19 infection was unknown for, respectively, 55.8%, 20%, and 100% of women. False history of rubella and varicella were found for 7.4% and 15% of women, respectively. The positive and negative predictive values (PPV and NPV) of rubella history were, respectively, 92.6% and 17.2%, and were, respectively, 84.9% and 20.9% for varicella history. Susceptibility to RV, VZV, and PB19 infection remains high in pregnancy in our population. Preventive strategies against congenital rubella must be reinforced. Vaccination against VZV should be considered in seronegative women. Systemic CMV screening is not warranted in our country where high immunity is acquired probably in childhood. Since maternal history of eruption is not reliable, we recommend serologic testing to determine immune status of women.
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Anticuerpos Antivirales/sangre , Infecciones por Citomegalovirus/epidemiología , Citomegalovirus/inmunología , Herpes Zóster/epidemiología , Herpesvirus Humano 3/inmunología , Infecciones por Parvoviridae/epidemiología , Parvovirus B19 Humano/inmunología , Complicaciones Infecciosas del Embarazo/epidemiología , Virus de la Rubéola/inmunología , Rubéola (Sarampión Alemán)/epidemiología , Adulto , Femenino , Maternidades/estadística & datos numéricos , Hospitales Universitarios/estadística & datos numéricos , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Valor Predictivo de las Pruebas , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Estudios Prospectivos , Factores de Riesgo , Estudios Seroepidemiológicos , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Diabetic mastopathy is a recently described pathological entity. Little is known about this benign condition. It usually occurs in young patients with type 1 diabetes, or having an autoimmune disorders. Clinically, this mastopathy simulates a breast cancer. Graphic tests are not very informative. The diagnosis is histological. Through a case of diabetic mastopathy occurring in a patient with diabetes on insulin for 16 years and carries multiple degenerative complications, we recall the clinical, radiological and outcome of this disease.
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Enfermedades de la Mama/patología , Diabetes Mellitus Tipo 1/complicaciones , Adulto , Biopsia , Enfermedades de la Mama/etiología , Neoplasias de la Mama , Diagnóstico Diferencial , Femenino , Enfermedad Fibroquística de la Mama , Humanos , Mamografía , Mastitis , Ultrasonografía MamariaRESUMEN
OBJECTIVES: The study was conducted to investigate the prevalence and risk factors for hepatitis E virus (HEV) infection in Tunisian pregnant women. METHODS: A total of 404 pregnant women were enrolled. Data were collected through a standard questionnaire which covered sociodemographic characteristics and risk factors. Blood samples were collected and were tested for HEV IgM and IgG antibodies, IgG against hepatitis A (anti-HAV IgG), hepatitis B virus surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV). Risk factors were analyzed using univariate and multivariate logistic regression models. RESULTS: Prevalence of anti-HEV IgG, anti-HEV IgM, anti-HAV IgG, HBs Ag and anti-HCV was 12.1 %, 0 %, 97 %, 3 % and 0,5 %, respectively. In multivariate analysis age (>30 years) and the number of persons per room (>2) in the house were independent factors predicting HEV infection. History of agricultural work, kind of water, sewage treatment, use detergent to wash vegetables, contact with animals and parenteral risk factors were not correlated with the presence of anti-HEV IgG. CONCLUSION: The important seropositive rate among pregnant women is compatible with endemicity of HEV in Tunisia. Hepatitis E should be considered in the diagnosis of acute hepatitis during pregnancy. Our result suggests that infection occurs sporadically by person-to-person transmission route but further investigations are needed to determine the natural reservoir of infection.
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Hepatitis E/diagnóstico , Hepatitis E/epidemiología , Complicaciones Infecciosas del Embarazo/virología , Adulto , Anticuerpos Antivirales/sangre , Femenino , Anticuerpos de Hepatitis A/sangre , Antígenos de Superficie de la Hepatitis B/sangre , Anticuerpos contra la Hepatitis C/sangre , Virus de la Hepatitis E/inmunología , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Análisis Multivariante , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Factores de Riesgo , Túnez/epidemiologíaRESUMEN
OBJECTIVE: To assess the effects of ambulation during the first stage of labor on the duration of labor and other maternal and infant outcomes. PATIENTS AND METHODS: A prospective randomized trial conducted from 1st November 2008 to 31st March 2009 at the department of obstetrics and gynecology, CHU Farhat Hached, Sousse, Tunisia. Two hundred mothers with uncomplicated term pregnancies were randomly assigned to one of two groups: first group (100 parturients) authorized to ambulate until 6cm of cervical dilation and a second group (100 parturients) confined to bed in dorsal or lateral recumbence. RESULTS: Upright position reduces significantly (for about 34%) the duration of the first stage of labor (P<0.0001), the pain intensity, the oxytocin consumption (P=0.001), the rate of delivery by cesarean section and of instrumental deliveries. Upright position leads also to a net improvement of the maternal outcome (7% side effects versus 13%) and the fetal outcome (net improvement of the Apgar's score at first and fifth minute, and reduction of a factor 5 of the rate of transfer to the neonatology clinical care unit. CONCLUSION: Our study allowed to confirm the benefits of ambulation on labor progress as well as on the maternal comfort and the maternofetal outcome.
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Primer Periodo del Trabajo de Parto/fisiología , Trabajo de Parto/fisiología , Resultado del Embarazo , Caminata , Adulto , Puntaje de Apgar , Cesárea/estadística & datos numéricos , Parto Obstétrico/métodos , Femenino , Humanos , Cuidado Intensivo Neonatal/estadística & datos numéricos , Oxitocina/administración & dosificación , Dolor/epidemiología , Embarazo , Estudios Prospectivos , Factores de TiempoRESUMEN
OBJECTIVES: The aim of the present study was to characterize women with premature ovarian failure (POF) by their ovarian ultrasonographic appearances using transabdominal technique to establish the relationship to clinical, hormonal status, and genetic analysis. PATIENTS AND METHODS: We studied a cohort of 80 patients suffering from POF. The surface of the ovary was calculated and we identified the detection or not of follicles. RESULTS: The detection of the two ovaries by ultrasound was positive in 33 patients; only one ovary was identified in seven patients; none was noted in 40 patients. The surface of the ovaries ranged between 0.74 et 5.92 cm(2) (2.2+/-1.13 cm(2)). Ultrasonography identified follicles in 23 patients (28.75%). The presence of follicles suggested at ultrasonography was detected in 14 cases (70%) in normal-sized ovaries (> or =2 cm(2)) and in nine cases (45%) in small-sized ovaries (p=0.1). No significative statistical difference was found between the ultrasonographic appearances and the type of amenorrhea, pubertal development, hormonal status (estradiol, testosterone and delta-4-androstendione) and the chromosomal analysis. CONCLUSION: The clinical and hormonal status and the genetic analysis can't predict the presence or not of follicles in the ovaries of patients with POF.
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Folículo Ovárico/diagnóstico por imagen , Pelvis/diagnóstico por imagen , Insuficiencia Ovárica Primaria/diagnóstico por imagen , Adolescente , Adulto , Amenorrea/diagnóstico por imagen , Androstenodiona/sangre , Aberraciones Cromosómicas , Estudios de Cohortes , Estradiol/sangre , Femenino , Hormona Folículo Estimulante/sangre , Humanos , Hormona Luteinizante/sangre , Estudios Prospectivos , Pubertad , Testosterona/sangre , Ultrasonografía , Adulto JovenRESUMEN
Cephalopagus are a rare variant of conjoined twins resulting from an incomplete late division of the embryonic disk and associated with an extremely poor fetal prognosis. Here, we report a rare case of a male cepahalopagus conjoined twins diagnosed during the 23rd week of gestation. Delivery was vaginal showing twins fused from the top of the head to the umbilicus. The fused skull showed a cephalocele with agenetic brain. Esophagus, stomach and duodenum are common for the two twins. Causes, diagnosis and management of cephalopagus are discussed referring to literature.
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Gemelos Siameses , Humanos , Masculino , MortinatoRESUMEN
Radiation-induced breast sarcoma is a late complication of radiation treatment. We report a case of an undifferentiated sarcoma occurring 8 years after breast conserving treatment, which required mastectomy taking pectoralis major.
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Neoplasias de la Mama/radioterapia , Neoplasias Inducidas por Radiación/diagnóstico , Radioterapia/efectos adversos , Sarcoma/radioterapia , Adulto , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , División Celular , Femenino , Humanos , Resultado del TratamientoRESUMEN
Axillary lymph node tuberculosis is rare and often poses problems of differential, diagnosis, especially with breast carcinoma. We report the case of a tuberculous axillary lymphadenitis discovered at the time of the exploration of a supposedly metastatic liver and, initially, taken for metastases of an occult breast carcinoma. Tuberculous axillary lymphadenitis remains a rare condition which must be considered in patients living in country with endemic tuberculosis.
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Tuberculosis Ganglionar/diagnóstico , Axila , Neoplasias de la Mama/secundario , Carcinoma/secundario , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Hepáticas/secundario , Persona de Mediana Edad , Neoplasias Primarias Desconocidas/diagnósticoRESUMEN
To determine if blunt or sharp expansion of the uterus at caesarean delivery is associated with increased maternal peripartum haemorrhage as estimated by the drop in hematocrit. Prospective randomised intention to treat clinical trial of women undergoing elective or urgent caesarean delivery at at least 36 weeks gestation. Two study groups were formed; after an initial hysterotomy which consisted in a transverse uterine incision of the lower segment, in the blunt group, the surgeon's indexes expanded the initial incision bilaterally and cephalad; in the sharp group, expansion of the initial incision was made using scissors. The primary outcome measure was the mean drop in hematocrit and p < 0.05 was considered significant. Three hundred women were randomised: 153 to the sharp group and 147 to the blunt group. The demographic and clinical characteristics of the two populations were similar. There were no statistically significant differences between the groups in estimated blood loss as assessed by the mean drop in hematocrit (%) (respectively 1.71 +/- 3.18 versus blunt group 1.91 +/- 3.28 p = 0.58 non significant). Our findings support that sharp or blunt expansion of hysterotomy during caesarean section equally affect blood loss as estimated by drop in hematocrit.
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Pérdida de Sangre Quirúrgica , Cesárea/métodos , Histerotomía/métodos , Hemorragia Posoperatoria/etiología , Adulto , Cesárea/instrumentación , Cesárea Repetida , Procedimientos Quirúrgicos Electivos , Urgencias Médicas , Femenino , Hematócrito , Hemoglobinas/análisis , Humanos , Histerotomía/instrumentación , Embarazo , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Peritoneal tuberculosis can mimic advanced stage ovarian cancer and can lead to the performance of an unnecessary extended surgery. Clinical discrimination between peritoneal tuberculosis and ovarian carcinoma may sometimes be extremely difficult. We report 2 cases of peritoneal tuberculosis mimicking ovarian carcinoma. Diagnosis was made on perioneal biopsy.
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Neoplasias Ováricas/diagnóstico , Peritonitis Tuberculosa/diagnóstico , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Laparoscopía , Laparotomía , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Tuberculoma/diagnósticoRESUMEN
OBJECTIVE: To determine the rate and risk factors for group B streptococcus (GBS) colonization in term pregnancies. PATIENTS AND METHODS: Vaginal and anal cultures were prospectively conducted in 294 parturient on admission for term vaginal delivery. RESULTS: Thirty-eight (12.92%) parturient had positive GBS cultures. None of the studied risk factors (age, education status, nulliparity, previous obstetric problem, twin pregnancy and diabetes) was statistically predictive of maternal colonization. All the isolated GBS were sensitive to the penicillin G. DISCUSSION AND CONCLUSION: Systematic screening strategy of GBS close to the delivery on all pregnant women is desirable.
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Antibacterianos/uso terapéutico , Portador Sano/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Infecciones Estreptocócicas/epidemiología , Streptococcus agalactiae , Adulto , Canal Anal/microbiología , Portador Sano/diagnóstico , Portador Sano/tratamiento farmacológico , Femenino , Francia , Humanos , Tamizaje Masivo , Penicilinas/uso terapéutico , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Estudios Prospectivos , Factores de Riesgo , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológico , Vagina/microbiologíaRESUMEN
Anti-phospholipid antibodies (APA) are heterogeneous group of autoantibodies that target phospholipid or phospholipid-binding proteins. APAs were previously shown to induce several thrombotic states, including idiopathic recurrent spontaneous abortion (RSA). Unlike the contribution of the classical lupus anticoagulant (LAC) and anticardiolipin antibodies (ACA), the contribution of anti-beta2 glycoprotein 1 (beta2GPI) and anti-annexin V antibodies to RSA risk remain poorly understood. We assessed anti-beta2GPI and anti-annexin V IgM and IgG antibodies as RSA risk factors for RSA in 172 Tunisian women with >3 consecutive idiopathic pregnancy losses, together with 173 matched control women. The prevalence of anti-beta2GPI IgG (P=0.41, OR=1.64) and IgM (P=0.50, OR=1.70) were comparable between cases and controls. Higher anti-annexin V IgG (P=0.02, OR=5.28), but not IgM (P=0.25, OR=1.78), levels were seen in cases. Regression analysis showed that anti-beta2GPI IgM (OR=8.90; 95% CI=1.23-64.63) was associated with early RSA, while anti-annexin V IgG (OR=9.35, 95% CI=1.44-60.86) was associated with late RSA. For combined early + late RSA, the only variable selected was BMI (OR=0.93; 95% CI=0.87-0.99), and neither anti-annexin V nor anti-beta2GPI IgM and IgG were associated with early + late RSA. Anti-annexin V and anti-beta2GPI appear to be independent risk markers of RSA.