[Balloon catheter for cervical ripening on scarred uterus with unfavorable cervix: multicenter retrospective study of 151 patients]. / Maturation du col utérin défavorable par ballonnet supra-cervical sur utérus cicatriciel : étude rétrospective multicentrique de 151 patientes.

OBJECTIVES: To evaluate safety and efficacy of balloon catheter for labor induction in women with previous cesarean section. MATERIAL AND METHODS: In a multicenter retrospective cohort study, 151 patients were included with the following criteria: pregnancy over 37 weeks, singleton, vertex presentation, previous caesarean section with unique transversal segmentary incision, medical indication for induction of labor, unfavorable cervix with Bishop score inferior to 7, no premature rupture of membranes. Balloon catheter used for cervix ripening, is inflated from 30 to 80 mL of sterile of NaCl and is left until 24 hours. RESULTS: Overall rate of vaginal delivery was 53.7% (81/151). Labor began before balloon catheter removal for 58 out of 151 (38.4%) with vaginal delivery for 75% (42/58). Best prognosis factors for vaginal delivery were spontaneous labor after balloon removal (P=0.004) and anterior vaginal delivery (P=0.03). Side effects were rare bleeding or PROM, but didn't prevent continuing ripening labor. Other morbidity consisted in two uterus ruptures (1.2%) without maternofetal incidence. CONCLUSION: Supracervical balloon is a safe and efficiency method for inducing labor on scarred uterus with unfavorable cervix with low side effects.

[Mastocytosis and pregnancy]. / Mastocytoses et grossesse.

Mastocytosis is a rare disorder characterized by an accumulation of mastocytes in cutaneous and visceral tissues. In the presence of stimuli such as stress, pain, drug administration and cutaneous compression, it can ultimately lead to cardiovascular collapse. In women with mastocytosis, pregnancy monitoring and pain management in the peripartum period can be challenging and should involve a multidisciplinary approach. In this article, we discuss our ante partum care and intra partum management, as illustrated by three recent cases.

[Contribution of robot-assisted surgery in the management of female infertility]. / Apport de la chirurgie robot-assistée dans la prise en charge de l'infertilité féminine.

Although considerable progresses were made in the field of medically assisted procreation, surgery keeps its place in the therapeutic armamentarium of female infertility. Indeed, its results are very interesting, both in its tubal, myometrial and endometriosis indications. Laparotomy is the first step in the development of any surgical technique. Laparoscopy brings benefits concerning recovery, but also in terms of fertility because of the reduction of postoperative adhesions. Nevertheless, comfort of the surgeon, so the ease of skills, are often altered, especially for complex operations such as those implicated in infertility treatment. Robot-assistance takes here all its interest. It allows indeed a quality in the realization of precise and complex skills, and results at least as interesting as standard laparoscopy can be provided. An overview of robot-assistance in surgery of female infertility is here presented. A review of world literature furnished multiple studies evaluating the tubal robotic surgery, and demonstrating its interesting results. Other indications could, according to us, emerge and be evaluated in this area, such as myomectomy and endometriosis surgery.

Radiofrequency ablation of retained placenta accreta after conservative management: preliminary evaluation in the pregnant ewe and in normal human placenta in vitro.

OBJECTIVE: To evaluate radiofrequency (RF) efficiency and safety for the ablation of retained placenta in humans, using a pregnant sheep model. DESIGN: Experimental study. SETTING: Laboratory of Surgery School, Nancy, France. POPULATION/SAMPLE: Three pregnant ewes/ten human placentas. METHODS: Various RF procedures were tested in pregnant ewes on 50 placentomes (individual placental units). Reproducibility of the best procedure was then evaluated in a further 20 placentomes and on ten human term placentas in vitro after delivery. MAIN OUTCOME MEASURES: Placental tissues destruction, lesions' size, myometrial lesions. RESULTS: Low power (100 W) and low target temperatures (60 degrees C) lead to homogenous tissue destruction, without myometrial lesion. No significant difference was observed in terms of lesion size and procedure duration for in the placentomes of pregnant ewe in vivo and in human placentas in vitro. The diameter of the ablation could be correlated with the tines deployment. CONCLUSION: The placental tissue structure is very permissive to RF energy, which suggests that RF could be used for the ablation of retained placenta, providing optimal control of tissue destruction. These results call for further experimental evaluations.