Fetal aortic isthmus Doppler assessment to predict the adverse perinatal outcomes associated with fetal growth restriction: systematic review and meta-analysis.

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.

[Seroprevalence and risk factors of hepatitis E among pregnant women in central Tunisia]. / Séroprévalence et facteurs de risque de l'hépatite virale E chez la femme enceinte dans le centre tunisien.

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.

[Seroprevalence of rubella virus, varicella zoster virus, cytomegalovirus and parvovirus B19 among pregnant women in the Sousse region, Tunisia]. / Séroépidémiologie de la rubéole, de la varicelle et des infections par le cytomégalovirus et le parvovirus B19 chez les femmes enceintes dans la région de Sousse, Tunisie.

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.

[Holoprosencephaly: pathogenesis, phenotypic characteristics. About four cases]. / L'holoprosencéphalie : étiopathogénies et caractéristiques phénotypiques. À propos de quatre observations.

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.

[Cephalopagus conjoined twins: case report and review of literature]. / Les jumeaux conjoints céphalopages: à propos d'une observation avec revue de la littérature.

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.

[Radiation induced breast sarcoma: a case report]. / Sarcome radio-induit du sein: à propos d'un cas.

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.

[Risk factors for group B streptococcal colonization in pregnant women at term: prospective study of 294 cases]. / Facteurs de risque du portage du streptocoque du groupe B chez la femme enceinte à terme: étude prospective à propos de 294 cas.

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.

[The effect of uterine incision expansion at caesarean delivery on perioperative haemorrhage: a prospective randomised clinical trial]. / Impact de la technique d'hystérotomie au cours de la césarienne sur le saignement périopératoire: un essai prospectif randomise.

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.

[Clinical case of the month. Peritoneal tuberculosis mimicking ovarian carcinoma]. / Le cas clinique du mois. Tuberculose péritonéale simulant un cancer ovarien.

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.

[Tuberculous axillary lymphadenitis: an unusual presentation]. / Le cas clinique du mois. Tuberculose ganglionnaire axillaire une présentation inhabituelle.

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.

[Clinical and sonographic diagnosis of occiput posterior position: a prospective study of 350 deliveries]. / Diagnostic clinico-échographique et devenir des variétés postérieures dans la présentation du sommet: étude prospective longitudinale de 350 parturientes.

OBJECTIVE: To evaluate clinical reliability compared to intrapartum ultrasound as a tool to diagnose occiput posterior position and to investigate the proportion of rotations occurring during labour. PATIENTS AND METHODS: 350 women in labor with a singleton fetus in a vertex position were prospectively studied using ultrasound and obstetrical examination. Outcome of labor was also monitored. RESULTS: Reliability of clinical examination is 85,7%, initial occiput posterior position represented 40,2% and most rotated in an anterior position (84, 8%) while only 0,6% of initial anterior positions delivered in occiput posterior position. Logistic regression did not allow to find significant predictor of occiput posterior position rotation. DISCUSSION AND CONCLUSION: Clinical examination is relatively reliable for posterior position diagnosis and in most cases, initially occipitoposterior positions rotate anteriorly.

[Rupture of rudimentary horn pregnancy at the 18th week of gestation: a case report]. / Rupture d'une corne rudimentaire sur une grossesse de 18 semaines d'aménorrhée: à propos d'un cas.

We report a case of pregnancy in a rudimentary horn that ruptured at 18 weeks. An emergency laparotomy was taken for acute abdomen and ruptured right rudimentary horn pregnancy was diagnosed. Excision of the rudimentary horn and ipsilateral salpingectomy were carried out. The patient's postoperative course was uneventful, and she left the hospital 6 days later.

[Cavernous hemangioma of the breast: a case report]. / Hémangiome caverneux du sein: à propos d'un cas.

Cavernous hemangiomas of the breast are uncommon. Clinical diagnosis is rather difficult. Generally there are coincidental microscopic findings. We present a case of a 67-year-old woman which commenced as a 6 cm palpable mass of the right breast. The use of mammography, ultrasound and MRI facilitate diagnosis. Large surgical excision of the lesion was performed and histology allowed to find a cavernous hemangioma without cellular atypia.

[Mifepristone 100 mg for early medical abortion]. / Mifépristone à la dose de 100 mg dans les avortements médicamenteux.

OBJECTIVES: To assess the clinical efficacy of mifepristone 100 mg followed two days later by misoprostol 400 microg orally in women undergoing medical termination of pregnancy up to 56 days gestational age. MATERIALS AND METHODS: Retrospective study over 8.5 months of 762 cases early medical abortion. 100 mg mifepristone was used on day 1 after clinic visit and vaginal ultrasonography. Misoprostol 400 microg was administered orally on day 3. Following administration of prostaglandin, women were observed in the ward for 4 hours. A control visit on day 15 was systematic. Success was defined as a complete uterine evacuation without the need for surgical intervention. RESULTS: Medical terminations accounted for 42% of all abortions. 16% of women were pregnant for < 42 days, 76% for 43 to 49 days and 8% for 50 to 56 days. Termination occurred within 4 hours after administration of misoprostol in 80.2% of the women. Only one woman aborted within 48 hours of mifepristone administration only. The success rate in this study was 94.4% and the failure rate increased with the gestational age. Pain was the predominant side effect. Six cases of bleeding required a surgical intervention. No patient required transfusion. 96% of patients attended a control visit on day 15. The acceptability rate of the method has been 94%. CONCLUSION: Mifepristone 100 mg followed two days later by misoprostol 400 microg orally is safe and effective for early termination of pregnancy.

[Post-cesarean parietal scar characteristics are predictive of pelvic adhesions. A prospective cohort study]. / Les caractéristiques de la cicatrice pariétale de césarienne sont des facteurs prédictifs des adhérences pelviennes. Étude de cohorte prospective.

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.

[Prognostic value of fetal aortic isthmus Doppler waveform in intrauterine growth retardation: prospective longitudinal study]. / Apport pronostique du Doppler de l'isthme aortique foetal dans la prise en charge du retard de croissance intra-utérin.

OBJECTIVE: Our purpose was to determine whether the use of aortic isthmus Doppler waveform analysis in growth restricted fetuses delivered at 28 to 38 weeks predicts perinatal outcomes. MATERIAL AND METHODS: Prospective longitudinal study including singleton non-malformed euploid fetuses with accurate dating and diagnosed as growth restricted (abdominal circumference<10th percentile) and who were followed up at our institution and delivered<10 days after the last Doppler. Timing of delivery was collegial. Perinatal mortality and morbidity outcomes were compared in cases with anterograde blood flow versus retrograde net blood flow in aortic isthmus. Relative risk (RR) were calculated with 95% CI and P<0,05 was considered significant. RESULTS: Thirty-two cases were considered for analysis: growth-restricted foetuses with anterograde blood flow (n=26) versus retrograde net blood (n=6). Maternal demographic characteristics in the two groups were similar and exceptions made of femur length average values for fetal biometrics were not significantly different. Doppler velocimetry results at the uterine, umbilical and cerebral arteries were similar in the two groups. Gestational age at delivery and birth weight were similar in both groups (respectively (239.65 20.1 vs. 247.3 16.4 (days) (p=0.349) and 1748.8 gr 468.7 vs. 1933.3 gr 468.7 (p=0.408)). There was a statistically significant increase in perinatal mortality in retrograde net blood flow group: 8.66 [IC 95% 2.03 - 36.84]. An interesting finding was that neonates with aortic isthmus retrograde net blood flow were more frequently born by cesarean delivery because of a suspected fetal compromise RR=3.22 CI 95% [1.29-8]. CONCLUSION: In our study Doppler identification of aortic isthmus retrograde net blood flow in growth-restricted fetuses was associated with an increase of perinatal death.

[Oxytocin and misoprostol administered intravaginally for termination of pregnancy at 13 to 29 weeks of amenorrhea. A prospective randomized trial]. / Apport de l'association d'ocytocine au misoprostol administré en intravaginal au cours des interruptions de grossesses entre 13 et 29 semaines d'aménorrhée. Essai clinique prospectif randomisé.

OBJECTIVE: To compare the effectiveness of misoprostol administrated intravaginally alone versus misoprostol with oxytocin infusion for termination of pregnancy at 13 to 29 weeks. Subjects and methods. Ninety women at 13-29 weeks requesting pregnancy termination were randomized to receive 200 microgram of misoprotol intravaginally every 12 hours either with oxytocin infusion or alone for up to 48 hours. RESULTS: The mean induction to abortion interval was significantly shorter in the misoprostol-oxytocin group than in the misoprostol alone group (22+/-10.8 hours versus 27+/-14.1 hours respectively p<0.05). The 48 hours successful abortion rates were 95% and 90% respectively. Abortion was complete in 79.1% and 62.5% respectively. Side effects were similar between groups. CONCLUSION: Vaginal misoprostol associated with oxytocin infusion is more effective than misoprostol alone in termination of second-trimester pregnancy.

[Post-prandial plasma glucose test as screening tool for gestational diabetes: A prospective randomized trial]. / Apport de la mesure de la glycémie post-prandiale dans le dépistage du diabète gestationnel.

OBJECTIVE: To compare one hour postprandial glucose measurements with the one hour 50gm plasma glucose test as predictors of gestational diabetes. SUBJECTS AND METHODS: One hundred women at 24-28 weeks' gestation were prospectively randomized for both screening methods: one hour postprandial and one hour 50gm plasma glucose test with a one-week-interval between tests. A week later a formal 2-hour 75gm glucose tolerance test was done in each case. RESULTS: Of the 95 patients who completed the study 13 had gestational diabetes (13.6%). For a threshold of 7.1mmol/l the sensitivity of 1-hour postprandial plasma glucose screening test was 84.6% with a specificity of 87.8%. These values were respectively 84.6% and 81.7% for 1-hour 50 gm plasma glucose test screening test. A threshold of 7.7mmol/l yielded a sensitivity of 60.5% with a specificity of 91.4% for the 1-hour postprandial plasma glucose screening test (69.2% and 86.5% for 1-hour 50gm plasma glucose test) CONCLUSION: In our study the 1-hour postprandial plasma glucose screening test was as effective as the 1-hour 50 gm plasma glucose test screening test for gestational diabetes.

[Contribution of intracervical PGE2 administration in premature rupture of the membranes at term. Prospective randomised clinical trial]. / Apport de l'administration intracervicale de PGE2 dans les ruptures prématurées des membranes à terme. Essai clinique prospectif randomisé.

OBJECTIVE: To compare the clinical effectiveness and safety of intracervical dinoprostone versus conservative management of term prelabor rupture of membranes. SUBJECTS AND METHODS: 88 women with term prelabor rupture of membranes were assigned randomly to one of two groups RESULTS: 44 women were allocated in each group. The means (+/- S. D) intervals from PROM to delivery and from inclusion to start of labour were significantly shorter in the dinoprostone group (19.5+/-6.2 vs 25.5+/-7.7 hours p<0.01 and 8.7+/-5.5 hours vs 14+/-6. 8; p=0.32 respectively). No significant differences were observed in the mean duration of labour (4.5+/-1.6 hours vs. 4.9+/-1.67 p=0.32). The rates of clinical amniotits were 15.9% in the dinoprostone group and 6.8% in the control group; difference is not statistically significant (p=0.17). The mode of delivery and Apgar score were similar in the two groups. Uterine tachysystole occurred more frequently in the dinoprostone group (6.8 vs 0%) but did not reach statistical significance. CONCLUSION: Intracervical administration of dinoprostone with prelabor rupture of membrane at term and unripened cervix shortens the interval to delivery without a significant increase of maternal or neonatal morbidity.

[Pseudoaneurysm of the uterine artery: apropos of 1 case]. / Pseudoanévrisme de l'artère utérine. A propos d'un cas.

Pseudoaneurism of the uterine artery is uncommon and is usually associated with pregnancy or surgical trauma. Diagnosis is based on both Doppler sonography and arteriography. We report a case of pseudoaneurysm of the uterine artery associated with a leiomyoma without prior surgery or pregnancy. Treatment, which consisted on laparotomy, allowed avoiding rupture and confirmed diagnosis.