[Lactational breast abscesses: Do we still need surgery?]. / Abcès du sein lactant : et si on ne les opérait plus ?

AIM: To show the effectiveness of ultrasound-guided puncture in the treatment of lactational breast abscess and identify its risk factors. MATERIALS AND METHODS: Retrospective descriptive study at the CHU of Lyon-Sud from December 2007 to December 2013, including patients with lactational breast abscess confirmed on ultrasound and treated with antibiotics and analgesics. Realisation of ultrasound-guided needle under local anesthesia by the radiologist and washing the cavity with physiological serum. RESULTS: Forty patients had lactational abscesses at an average of 10 weeks post-partum. Thirty-four patients were treated by needle aspiration, of which 2 had first surgical drainage. The average size of the abscess was 41.2mm. The success rate of needle aspiration was 91.2%. No cases of recurrence were observed, however, there were 5 fistulisations. In all, 91.2% were treated on an outpatient basis. In 87.8% of cases, breastfeeding was continued on the healthy side and in 48.5% of cases on the affected side. The major risk factor for abscess was mastitis in 91.1% of cases. CONCLUSION: Ultrasound guidance of needle aspiration should be gold standard for the treatment of lactational breast abscesses to continue breastfeeding including the affected side.

[To evaluate the role of fetal movement counting and amnioscopy in the management of prolonged pregnancies]. / Place du compte des mouvements actifs fœtaux et de l'amnioscopie dans la surveillance des grossesses prolongées.

OBJECTIVES: To evaluate the role of fetal movement counting and amnioscopy in the management of prolonged pregnancies. MATERIALS AND METHODS: PubMed and the Cochrane library were searched using terms: fetal movement counting, decreased fetal movement, post-term pregnancy, late pregnancy, prolonged pregnancy, postdate pregnancy, amnioscopy, meconium amniotic fluid, surveillance of the fetus. RESULTS: Decreased fetal mouvements (DFM) in prolonged pregnancies is a frequent cause of unplanned visits. For many authors, the best criterion is the self-perception of reduced maternal or any change of fetal movement. Current data is insufficient to show a link between DFM and increased fetal morbidity and mortality. It is reasonable to recommend to the patient to consult in case of DFM and make an assessment of fetal vitality (experts' opinion). Current data are insufficient to show a potential benefit of the establishment of an information given to patients on DFM in prolonged pregnancy (experts' opinion). No fetal movement counting was assessed in the prolonged pregnancy. High negative predictive value of amnioscopy explains it is reassuring only if the amniotic fluid is clear. Amnioscopy showed no neonatal benefit in the survey of prolonged pregnancies (NP4). CONCLUSION: In the prolonged pregnancies, no fetal movement counting can reduce the perinatal morbidity and mortality rate. The interest of amnioscopy in the survey of prolonged pregnancies has never been showed. It is not recommended to use it.