Antepartum detection of macrosomic fetus: the effect of misdiagnosis.

AIM: To determine the effect of misdiagnosis of macrosomia on maternal and perinatal outcomes. METHODS: We conducted a retrospective study ,between January 2007 and December 2008 of women (n = 464) who delivered singleton neonates with actual birth weight over 4000g and in whom fetal weight was estimated, by both methods :sonographic and clinical, up to 3 days before delivery.Statistical comparisons were made between patients in whom fetal macrosomia was predicted : «prediction ¼ group (n=336)and those in whom it was not « non prediction ¼group (n=128) for outcome variables. RESULTS: The cesarean delivery was performed in 35.9% in « non predicted ¼ group, and in 35.7% in the « predicted ¼ group.The difference was not statistically significant. Failure to detect macrosomia was associated with higher rates of maternal and fetal complications in the group « non predicted ¼ compared with the group « predicted ¼ :perineal trauma,post partum hemorrhage, 5- minute Apgar scores less than 7, and shoulder dystocia, mostly related to the higher rate of surgical vaginal deliveries. CONCLUSIONS: The misdiagnosis of fetal macrosomia substantially did not modify the cesarean section rate but leads to increase the maternal and neonatal complications.

Interest of speckle tracking in the detection of cardiac involvement in pregnant women with hypertensive disorder.

INTRODUCTION: Pre-eclampsia is associated with many cardiovascular disorders present even in asymptomatic women. Several echocardiographic parameters are used to identify them. However, these parameters may be normal until late in the course of the disease process. Which justifies using new and more sensitive techniques. PURPOSE: We sought to test the hypothesis of subclinical cardiac involvement in such patients, based on speckle tracking, and to check its sensitivity compared to the usual methods. METHODS: We conducted a comparative case-control study, which included thirty pregnant women with hypertensive disorder and thirty healthy ones. The filling pressure of the left ventricle (LV) and strain peaks are measured for all women. RESULTS: Usual parameters were in favour of diastolic dysfunction in patients. Eighteen patients with high LV filling pressure were recorded, eight of them had at least one complication, which corresponded to a specificity of 77% and a sensitivity of 47%. However, global longitudinal strain (GLS) was severely altered in patients (p < .001). Moreover, there was a strong correlation of GLS with the usual parameters. Thus, for a threshold value of -18%, GLS had the best sensitivity of 87% and a specificity of 42% to predict complications. There was no significant difference for the radial and circumferential strain. CONCLUSION: GLS is more sensitive than other usual echocardiographic parameters in the detection of subclinical cardiac dysfunction in pregnant women with hypertensive disorder. It is strongly correlated with complications. Future larger studies could validate the integration of 2D-strain in the management of such patients.

[Pyogenic abscess of the breast: clinical and therapeutic aspects]. / Abcès du sein à pyogènes: aspects cliniques et thérapeutiques.

OBJECTIVE: The goal of this retrospective work was to study the clinical aspects and the principles of management of the abscess of the breast in order to determine a convenient and recent therapeutic attitude. PATIENTS AND METHODS: Our retrospective survey concerns 114 cases of breast abscess collected in a surgery department over a period of 14 years, from 1990 to 2003. All patients have been operated and the diagnosis confirmed through the operation. The puerperal abscesses have been noted in 31 cases. RESULTS: One hundred and four women and ten men were concerned, with a sex-ratio of 0.1. The medium age was 33 years old for the women and 42 years for the men. The diagnosis was based on the clinical criteria, confirmed by the ultrasonography in 11 cases out of 16 and by the mammary puncture in 15 cases out of 22. Two non-puerperal abscesses have revealed an infiltrating canal carcinoma. The Staphylococcus aureus was the germ the most frequently met, concerning 8 cases out of 16. The surgical biopsies carried out in 52 cases revealed a fibrocystic mastopathy in six cases, a canalar ectasia in two cases and an infiltrating canalar carcinoma in two cases. The surgical treatment, performed in any case, was associated to an anti-staphylococcus antibiotherapy. The recurrence of the abscess has been observed in four cases. DISCUSSION AND CONCLUSION: The frequency of pyogenic abscess of the breast, particularly the puerperal abscesses, has considerably decreased. The non-puerperal abscesses often pose a differential diagnosis problem with the very aggressive inflammatory cancers. The percutaneous ultrasonography guided drainage must be proposed in first intention to treat the abscesses of the breast. However, surgical treatment is still valid with an abscess either relapsing or chronic, or else the failure of the non-operative processes.

[Sexuality of the couple during pregnancy stemming from a medically assisted procreation]. / Sexualité du couple lors de grossesse issue d'une procréation médicalement assistée.

OBJECTIVE: We studied the impact of pregnancy stemming from a medically assisted procreation on the sexuality of the couple. PATIENTS AND METHODS: Our study was forward-looking realized in the maternity of Sfax on duration of nine months. Its methodology is based on a questionnaire distributed to 40 women and on a review of the literature. RESULTS: Our patients continued to have a sexual activity during their pregnancy in the majority of the cases (at least 65% of the cases) but with a decrease of libido in 80% of the cases as well as a net decrease of the frequency of the sexual intercourse. DISCUSSION AND CONCLUSION: In front of these difficulties of the consequent sexual life noticed also in the literature, a psychological support of these couples is so recommended that a sexologic care adapted to the particular context of the medically assisted procreation countered justified.