Self-administered multi-level pregnancy tests in simplified follow-up of medical abortion in Tunisia.

BACKGROUND: This study was conducted to assess the efficacy and acceptability of using a multi-level pregnancy test (MLPT) combined with telephone follow-up for medical abortion in Tunisia, where the majority of providers are midwives. METHODS: Four hundred and four women with gestational age ≤ 70 days' LMP seeking medical abortion at six study sites were enrolled in this open-label trial. Participants administered a baseline MLPT at the clinic prior to mifepristone administration and were asked to take a second MLPT at home and to call in its results before returning the day of their scheduled follow-up visit 10-14 days later. RESULTS: Almost all women with follow-up (97.1 %, n = 332/342) had successful abortions without the need for surgical intervention. The MLPT worked extremely well among women ≤63 days' LMP in ruling out ongoing pregnancy (negative predictive value (NPV) =100 % (n = 298/298)) and also detecting women with ongoing pregnancies (sensitivity = 100 %; 2/2) as needing follow-up due to non-declining hCG. Among women 64-70 days' LMP, the test also worked well in ruling out ongoing pregnancy (NPV = 96.9 % (n = 31/32) but not as well in terms of sensitivity (50 %), with only one of two ongoing pregnancies detected by MLPT as needing follow-up. Most women (95.1 %) found the MLPT to be very easy or easy to use and would consider using the MLPT again (97.4 %) if needed. CONCLUSIONS: Self-administered pre and post MLPT are very easy for women to use and accurate in assessing medical abortion success up to 63 days' LMP. MLPT use for medical abortion follow-up has the potential to facilitate task sharing services and eliminate the burden of routine in-person follow-up visits for the large majority of women. Additional research is warranted to explore the accuracy of the MLPT in identifying ongoing pregnancy among women with gestational ages > 63 days. TRIAL REGISTRATION: This study was registered on May 13, 2010, on clinicaltrials.gov as NCT01150279 .

Fetal sex assignment by first trimester ultrasound: a Tunisian experience.

OBJECTIVE: To assess the feasibility and accuracy of fetal sex identification during the first trimester ultrasound exam. METHODS: A prospective study was carried out on 312 fetuses at 11-14 weeks' gestation. The genital region was examined by transabdominal ultrasound. The angle of the genital tubercle to a horizontal line through the lumbosacral skin was measured. Fetal gender was assigned as male if this angle was > 30 degrees and female when it was < 10 degrees . RESULTS: Sex assignment was feasible in 89.7% and accurate in 85.7% of fetuses. Accuracy was similar in males as in females (87.9% vs 83.3%; NS). However, accuracy increased significantly during the gestational age period in male (Chi-square for trend P = 0.03) but not in female (P = 0.41) fetuses. Compared with singletons, presence of multiple fetuses (n = 12) did not influence feasibility or accuracy (89.2% vs 96% and 85.6% vs 86.4% respectively). In male fetuses, there was a significant increase in the angle of the genital tubercle with increasing crown-rump length(CRL) (r = 0.667; p = 0.025), while in females the angle did not significantly change with increasing gestation. CONCLUSION: Sonographic first trimester sex assignment is highly feasible and accurate.

[Eclampsia: epidemiological aspects and management of 28 patients]. / Eclampsie: profil épidémiologique et prise en charge a propos de 28 cas.

AIM: To ascertain the characteristics, clinical features, and maternal fetal outcome in eclampsia in a tertiary referral center (Service A, CMNT). METHODS: 28 case notes were retrieved retrospectively and data was analyzed descriptively. RESULTS: Twenty eight pregnancies complicated by eclampsia were identified. 14.8% of the women were nulliparous and 50% were primiparous. The mean age was 32.5 years. Mean gestational age at the time of seizures was 33.4 weeks' gestation. Twenty-two women had antepartum seizures (78.57%); 8 of the 22 had seizures at home. 6 women had postpartum seizures (21.42%). Headache preceded seizures in 17 cases (60%) hyperreflexia preceded seizures in 16 cases. 50% of women presented with systolic blood pressure (SBP) > 160 mmHg and 42.85% presented with diastolic blood pressure (DBP) > 110 mmHg. One case of maternal mortality are noted. There were 12 perinatal deaths. Three patients had intrauterine fetal deaths. CONCLUSION: Eclampsia increased maternal and perinatal morbidity and mortality. She was not found to be a progression from severe preeclampsia. There is a need to develop new methods to identify this group of patients in an effort to further reduce the prevalence of this dangerous condition.

[Place of the sulprostone in therapeutic interruptions of the pregnancy]. / Place du sulprostone dans les interruptions therapeutiques de la grossesse.

BACKGROUND: Therapeutic interruption of the pregnancies of the 2nd and 3-rd quarter is often badly accepted by the patients and it is original that his realization is easy, effective and the less traumatic possible. In this indication, the sulprostone (Nalador) is a big contribution. AIM: The purpose of our study is to review this product, to describe our experience concerning its use in the therapeutic interruptions of pregnancies and to study alternatives in case of failure or of against indication in its use. METHODS: It is about a forward-looking study opened from the 01-07-02 led in the service "A" of the CMNT. We brought together 30 women where a therapeutic interruption of the pregnancy was put and who did'nt present of against indications to the sulprostone. RESULTS: The average age was of 27 years with extremes from 18 to 39 years 50% of our patients were nullipares. The terms of pregnancy varied from 16 to 28 LIMITED COMPANIES with an average of 20 LIMITED COMPANIES. The indications of these terminations of pregnancy were maternal in 33.33% of cases and foetal in 66.66% of cases. The average number of light bulbs of Nalador used by the women was of 2.25 with extremes going from 1 to 4. The delay of eviction from the beginning of the induction was on average of 21 hours, with a rate of success of 90%. We did not regret any break uterine Delivery was incomplete requiring a uterine revision under general anesthetic in 5 cases. Tolerance was good in general In case of failure alternatives were: the misoprostol (cytotec *), the Probe extra amniotic dries and the wet Probe. CONCLUSION: The sulprostone by intravenous way constitutes an effective method of medical interruption of the pregnancy in the 2-nd and 3-rd quarter with a satisfactory tolerance and a rate of success of 90 %.

[Endometrial actinomycosis. Two case reports]. / Actinomycose endometriale. A propos de deux cas.

Actinomyces is an aerobic, Gram positive bacteria saprophyte of the genital tract. The endometrial involvement is extremely rare. The authors report two cases of pelvic actinomycosis in a 58 and 55 year old women, the second using intrauterine device for 11 years.

[Subcapsular liver hematoma, severe complication of pregnancy toxemia. A case report]. / L'hematome sous capsulaire du foie, complication severe de la toxemie gravidique. A propos d'un cas.

Subcapsular liver hematoma is a rare and severe complication of pregnancy. This event is already known to have a poor maternal and foetal prognosis. The authors report a case of spontaneous rupture of subcapsular hematoma of the liver in 40 year old multiparous. Confirmation of diagnosis is obtained by abdominal echotomography or TOM. The surgical treatment of this hematoma joints the traumatic surgery of the liver. In every case foetal extraction by cesarean section constitutes the first therapeutic procedure.