[Embryo vitrification: First Tunisian live birth following embryo vitrification and literature review]. / Vitrication embroyonnaire: Présentation de la première naissance Tunisienne d'embryon vitriflé et de la literature.

Embryo cryopreservation is an essential tool in assisted reproduction. The option to freeze gametes and embryos provides unique possibilities for patients with various indications. After a review on some of the technical details of embryo freezing the idea of vitrification compared to slow freezing is discussed. It is recognized that the slow freezing technique is still overwhelmingly applied in most human in vitro fertilization (IVF) centers, but there is mounting evidence demonstrating the benefit of vitrification. Theoretical and practical examples are now sufficient to convince the embryologist that the time has arrived to switch to the vitrification technique. We report our experience that is the first Tunisian live birth following embryo vitrification at the blastocyst stage, collected at the military hospital of Tunis-Tunisia. A 29-year-old woman presented a primary infertility of 3 years of male origin. IVF with intra-cytoplasmic spermatozoid injection ICSI has been indicated. 7 blastocysts were obtained at fifth day. Two of them were replaced and ended in terminated pregnancy at 6AW. Vitrification method is a procedure which is to immerse the embryos directly into liquid nitrogen at -196 ° C. thereby achieving descents temperature of about -2000 ° C per minute within a secure glitter. The kit used in our laboratory is "irvine scientific" with glitter cryobiocystem. Six months later 2 blastocysts were devitrified in February 2012 and after replacement provided a normal progress pregnancy, delivery by caesarean section of a newborn male in good health.

Pregnancy in kidney transplanted women: what are the optimal conditions for a better pregnancy outcome?

BACKGROUND: Motherhood has long been not recommended for kidney transplanted women for fear of adverse effects on the graft and the risks to the fetus. AIMS: This article aimed to provide evidence based answer to the following questions regarding pregnancy in kidney transplanted women: 1. what are the nephrologic and obstetrical parameters that can influence the pregnancy outcome? 2. What is the impact of pregnancy on graft? 3. What are the optimal conditions for pregnancy planning in kidney transplanted women? METHODS: A literature search was conducted using as key words "pregnancy", "renal transplant", "renal graft survival" in the PubMed database over the period from January 1994 to December 2011. RESULTS: Recovery of renal function in kidney transplanted patients is followed by restoration of endocrine function. Knowledge of the initial nephropathy assesses the risk of recurrence after transplantation, which may affect the graft. Chronic glomerular nephropathies are the most frequent from 32 to 76.1%. Duration of hemodialysis (over 2 years) is associated with a risk of preterm delivery and growth retardation. A period of 1 year between renal transplantation and conception seems reasonable to stabilize renal function and reduce the doses of immunosuppressants. The number of unintended pregnancies remains high (50%). The incidence of pregnancy after renal transplantation varies between 3 and 21.2%. Graft survival in patients who carried a pregnancy is equivalent to that of patients who were not pregnant. CONCLUSIONS: Pregnancy in kidney transplanted patients is a highrisk pregnancy, but it does not seem to affect graft function through certain conditions.

Lower incidence of hypotension following spinal anesthesia with 6% hydroxyethyl starch preload compared to 9 ‰ saline solution in caesarean delivery.

BACKGROUND: Hypotension is a common complication following spinal anesthesia for cesarean delivery. Techniques to prevent hypotension include preloading intravenous fluid. AIM: To compare the effect of two preloading regimens: 6% hydroxyethyl starch (HES) and 9‰ saline solution, to prevent hypotension after spinal anesthesia in cesarean delivery. METHODS: 105 patients undergoing intrathecal anesthesia for elective cesarean delivery were randomized and allocated to receive a preload of 500 ml HES 130/0.4 (HES Group) or a preload of 1500 ml 9‰ saline solution (CR group). Blood pressure and heart rate were recorded at baseline and after spinal anesthesia (every minute for the first 10 min, every 3 min for the next 10 min, and then every 5 min for the last 20 min). The primary outcome was to compare the incidence of hypotension (defined as a 20% reduction in systolic arterial pressure from baseline) between the two preloading regimens. Vasopressor requirements (i.v. bolus of 6 mg ephedrine) were also compared. RESULTS: The incidence of hypotension was 87% in the CR group and 69% in the HES group (p= 0.028). Ephedrine requirement, incidence of nausea, and/or vomiting and neonatal outcome did not significantly differ between the two groups. CONCLUSION: The incidence of hypotension was lower after preloading of 500 mL of HES 130/0.4 than preloading with 1500 mL of 9‰ saline solution.

Does cryopreservation of testicular sperm affect ICSI outcomes in azoospermia ?

OBJECTIVE: To evaluate the outcomes of intracytoplasmic sperm injection (ICSI) cycles when using fresh versus frozen testicular testicular sperm extraction (TESE) samples in non obstructive and obstructive azoospermia in terms of fertilization, cleavage, embryo quality, implantation and clinical pregnancy rates. STUDY DESIGN: A total of one hundred and forty consecutive testicular sperm extraction ICSI cycles were performed at our centre between 2012 and 2018 involving infertile men with obstructive and non-obstructive azoospermia.  Fresh TESE samples were used in 56 consecutive ICSI cycles (group 1) and frozen-thawed TESE sperm samples were used in 84 ICSI cycles (group 2). RESULTS: Our two groups were comparable concerning epidemiologic characteristics. There were no significant differences between the fresh TESE group and the frozen TESE group in the rates of fertilization, embryo cleavage rate, average number of, rate of tops embryos, blastocyst formation rate, implantation rate  and clinical pregnancy rate (32.1% vs. 35.7%; p = 0 ,62). Correlation between clinical pregnancy rate and the type of the injected sperm (motile/ immotile) was not significant (46, 3% vs. 66, 7%; p = 0, 59). CONCLUSIONS: Cryopreservation of testicular sperm seems not to influence ICSI outcomes. Thereby, this alternative is rather efficient in ICSI cycles in azoospermic patients since it may avoid iterative ovarian puncture, especially with non-obstructive azoospermia.

A computer-aided method based on geometrical texture features for a precocious detection of fetal Hydrocephalus in ultrasound images.

BACKGROUD: Hydrocephalus is the most common anomaly of the fetal head characterized by an excessive accumulation of fluid in the brain processing. The diagnostic process of fetal heads using traditional evaluation techniques are generally time consuming and error prone. Usually, fetal head size is computed using an ultrasound (US) image around 20-22 weeks, which is the gestational age (GA). Biometrical measurements are extracted and compared with ground truth charts to identify normal or abnormal growth. METHODS: In this paper, an attempt has been made to enhance the Hydrocephalus characterization process by extracting other geometrical and textural features to design an efficient recognition system. The superiority of this work consists of the reduced time processing and the complexity of standard automatic approaches for routine examination. This proposed method requires practical insidiousness of the precocious discovery of fetuses' malformation to alert the experts about the existence of abnormal outcome. The first task is devoted to a proposed pre-processing model using a standard filtering and a segmentation scheme using a modified Hough transform (MHT) to detect the region of interest. Indeed, the obtained clinical parameters are presented to the principal component analysis (PCA) model in order to obtain a reduced number of measures which are employed in the classification stage. RESULTS: Thanks to the combination of geometrical and statistical features, the classification process provided an important ability and an interesting performance achieving more than 96% of accuracy to detect pathological subjects in premature ages. CONCLUSIONS: The experimental results illustrate the success and the accuracy of the proposed classification method for a factual diagnostic of fetal head malformation.

Supervised classification approach of biometric measures for automatic fetal defect screening in head ultrasound images.

This paper presents an advanced approach for foetal brain abnormalities diagnostic by integrating significant biometric features in the identification process. In foetal anomaly diagnosis, manual evaluation of foetal behaviour in ultrasound images is a subjective, slow and error-prone task, especially in the preliminary treatment phases. The effectiveness of this appearance is strictly subject to the attention and the experience of gynaecologists. In this case, automatic methods of image analysis offer the possibility of obtaining a homogeneous, objective and above all fast diagnosis of the foetal head in order to identify pregnancy behaviour. Indeed, we propose a computerised diagnostic method based on morphological characteristics and a supervised classification method to categorise subjects into two groups: normal and affected cases. The presented method is validated on a real integrated microcephaly and dolichocephaly cases. The studied database contains the same gestational age of both normal and abnormal foetuses. The results show that the use of a support vector machine (SVM) classifier is an effective way to enhance recognition and detection for rapid and accurate foetal head diagnostic.

[Lower urinary trauma complicating gyneacologic and obstetrical surgery]. / Les lésions urologiques provoquées par des interventions chirurgicales gynécologiques et obstétricales.

INTRODUCTION: The trauma of the lower urinary tract in gynecologic and obstetrics surgery is rare. AIM: Discover the circonstances of their happening, their symptoms, and their methods of diagnostic and their treatment. METHODS: Authors report 24 cases observed over a 12 years period. RESULTS: These lesions consisted on 20 bladder lesions and 4 ureteric lesions. The frequency of these urological complications was 0.21% among the 12000 surgical operations performed between 1992 and 2003. The most causal operation was caesarean and abdominal hysterectomy. Urinary trauma was more frequent in patients with history of abdominal surgery. Post operative course was uneventful in most cases. CONCLUSION: Trauma of the lower urinary tract in gynecologic and obstetrics surgery is rare but their ignorance may seriously affect the functional urinary prognostics.

Risk Assessment and Management of Venous Thromboembolism in Women during Pregnancy and Puerperium (SAVE): An International, Cross-sectional Study.

The clinical burden of obstetric venous thromboembolism (VTE) risk is inadequately established. This study assessed the prevalence and management of VTE risk during pregnancy and postpartum outside the Western world. This international, noninterventional study enrolled adult women with objectively confirmed pregnancy attending prenatal care/obstetric centers across 18 countries in Africa, Eurasia, Middle-East, and South Asia. Evaluations included proportions of at-risk women, prophylaxis as per international guidelines, prophylaxis type, factors determining prophylaxis, and physicians' awareness about VTE risk management guidelines and its impact on treatment decision. Data were analyzed globally and regionally. Physicians ( N = 181) screened 4,978 women, and 4,010 were eligible. Of these, 51.4% were at risk (Eurasia, 90%; South Asia, 19.9%), mostly mild in intensity; >90% received prophylaxis as per the guidelines (except South Asia, 77%). Women in Eurasia and South Asia received both pharmacological and mechanical prophylaxes (>55%), while pharmacological prophylaxis (>50%) predominated in Africa and the Middle-East. Low-molecular-weight heparin was the pharmacological agent of choice. Prophylaxis decision was influenced by ethnicity, assisted reproductive techniques, caesarean section, and persistent moderate/high titer of anticardiolipin antibodies, though variable across regions. Prophylaxis decision in at-risk women was similar, irrespective of physicians' awareness of guidelines (except South Asia). A majority (>80%) of the physicians claimed to follow the guidelines. More than 50% of women during pregnancy and postpartum were at risk of VTE, and >90% received prophylaxis as per the guidelines. Physicians are generally aware of VTE risk and comply with guidelines while prescribing prophylaxis, although regional variations necessitate efforts to improve implementation of the guidelines.

[Cesarean deliveries in the maternity of military hospital of Tunis. Indication and prognosis: about 5008 cases]. / Les césariennes à la maternité de l'hôpital militaire de Tunis indication et pronostic: à propos de 5008 cas.

BACKGROUND: The rates of cesareans increased in many countries, these last years. AIM: we propose to evaluate the indications, and the maternal and foetal prognosis. METHODS: it's a retrospective study of 5008 cesareans during 10 years period, collected in the maternity of the military hospital of Tunis. RESULTS: Cesarean section rate is 21.59%. The cicatricial uterus constitutes the dominant indication (34%). In the event of noncicatricial uterus, the fetal suffering (24.7%), the failure of the trial of labour (14.2%), and the breech presentation (12.7%) are the principal indications. The hemorrhage constitutes the major complication into peroperational (2%). The post-operative complications are noted in 15.5%. Maternal mortality is 0.13%; perinatal mortality is 1.06%; perinatal morbidity is 9.68%. CONCLUSION: The increase of cesarean rate improves fetal and neonatal prognosis however it was associated to an increase of maternal.

[The approach diagnoses of ovarian tumors by echography]. / L'approche diagnostique des masses ovariennes par l'echographie.

In more of positive diagnosis, echography makes it possible to approach the histological nature of ovarian tumors. From a series of 106 cases of ovarian tumours, we propose to evaluate this approach by analysing the various echographic signs according to histological types'. The serous cysts are anechogen in 77,7% of the cases. The mucinous cysts are anechogen in 71,4% and finely echogen in 28,5% of the cases. The dermoid cysts are echogen in 47,3% and heterogeneous in 26,3%. The endometriosic cysts can be finely echogen (45%), heterogeneous (25%) or echogen (20%). The malignant tumors are of mixed aspect in 54,55% of the cases. The sensitivity of echography for the malignant tumors is 81,82% whereas specificity is 75,79%. The negative predictive value is 97,3%, and the positive predictive value is 28,13%. The size of the tumor, the vegetations and the partitions are also studied: a size lower than 5 cm and the absence of partition and vegetation are synonymous with benignity in all the cases.

[Maternal and foetal prognostic during severe toxemia]. / Pronostic maternel et foetal au cours de la toxemie gravidique severe.

Severe gravidic toxemia gives heavy maternal and foetal morbidity and mortality. The purpose of our study is to loosen the factors of bad maternal and foetal prognostic. It's a retrospective study about 100 cases of severe and complicated gravidic toxemia repertorieted in the maternity of Military Hospital of Tunis. Maternal morbidity is dominated by the complications of hypertension and a blood disorders. We raised 4 cases of eclampsia, 9 cases of retro placental hematome and 5 cases of HELLP syndrome. We don't deplore any maternal death. Perinatal mortality is 28.8%. The rate of delay intra-uterine growth was 43.8% and the prematurity 65.9%. More toxemia appears early during pregnancy more maternal and foetal prognostic is compromised.

Soft-tissue tumor of the perineum: an exceptional case of bilateral perineal myoma.

Perineal myomas in female are exceptional. We report the second case in literature of perineal myomas. It is a case of bilateral perineal myomas lifting the skin occurring in a female patient of 49 years old. She was operated by perineal incisions. Histopathology confirmed the fibromatous nature without signs of malignancy.

Frequency and spectrum of hemochromatosis mutations in Tunisia.

The occurrence of the C282Y and H63D mutations of the HFE gene, responsible for toxic iron overload in the liver (hereditary hemochromatosis), was still unknown in Tunisia. We report the screening of 194 chromosomes from 97 randomly collected cord blood samples. The mutations were analyzed by PCR followed by DNA sequencing. The mild H63D and the severe C282Y mutations were found in 17.5+/-5.34% and 0.5+/-0.97% of the alleles, respectively. The allele frequency of the IVS 2+4 T --> C polymorphism is high (46.4+/-7.01%) in this population. Risk for homozygosity for the severe C282Y mutation is present in the Tunisian population at a low theoretical incidence. However, due to the relatively high rate of consanguinity in the country, liver pathology due to HH is not to be disregarded.

[Management of urogenital prolapse in the maternity service of the Tunis military hospital. 82 cases]. / Prise en charge des prolapsus urogenitaux à la maternité de l'hôpital militaire de Tunis. A propos de 82 cas.

This survey has for goal to specify the epidemiological and of the prolapse of our patient, as well as our therapeutic attitude. It is about a retrospective survey that concerned 82 cases of prolapse, structural on a period of 5 years. The average of age of our patient is of 59 years. 73.17% of women are multiparous. 78% of women gave birth less once at home. The main motive of consultation is the vaginal ball sensation, in agreement with the total character of the prolapse that is the third degree in 46.34% of cases. The urinary incontinence is associated to the prolapse in 50% of cases. We achieved a vaginal surgery in 82.93 of cases. The hysterectomy has been achieved at 86.76% of operated then by vaginal surgery whereas for operated them by abdominal surgery, the uterus is preserved in the half of cases.

[Potter's reno-facial syndrome]. / Syndrome de Potter. Etude analytique a propos de 4 cas.

Potter's reno-facial syndrome is a rare innate abnormality. We bring 4 observations repertoried at the maternity of military hospital of Tunis over a period of 6 years (1997 - 2002). The purpose of our work is to determine after a review of the literature the echographic and foetopathologic characteristics, and the forecast of this syndrome. The frequency of the bilateral renale agenesis is of 0.27 per thousand. Positive diagnosis bases essentially on the ultrasound of the 2th, or the 3-th trimester. The signs of appeal are essentially the oligoamnios associated to an hypotrophy. The caryotype is systematic to eliminate an associeted chromosomic abnormality. Foetopathologic exam is usefull for the diagnosis. Main abnormality except the urinary pathology is the lung hypoplasia. Therapeutic interruption of the pregnancy in this situation not compatible with the extra-uterine life., only type IV authorize the development of the pregnancy according to echographic data and of foetal urinaire biochemistry. We insist on the early practice of the morphological ultrasound between 20 - 22 weeks for the diagnosis of foetal abnormalities and the place of the genetic advice in association with the geneticist in the coverage of the couple.

[Umbilical endometriosis: apropos of 3 cases]. / Endométriose ombilicale: à propos de trois cas.

Umbilical endometriosis is a rare localisation of the disease. The authors report three cases of umbilical endometriosis. The symptomatology is not usually typic. The only effective treatment remains the surgical exercise thus allowing the confirmation histological.

[Surgical laparoscopy in the management of women infertility]. / Apport de la coelioscopie operatoire dans la sterilite feminine.

The authors report their experience about surgical laparoscopy in the management of women infertility. Based on a series of 87 patients (median age: 31 years), 61% have primary infertility. The surgical procedures were distal tuboplasty in 26 cases, endometriosis cure in 19 cases, ovarian driling for polycystic ovarian syndrome in 18 cases and adhesiolysis in 24 cases. The rate of intra uterine pregnancy of the 81 followed patients is 40.7% with 23 newborn (28.39%), 5 abortions (6.17%) and 5 current pregnancies (6.17%). The rate of ectopic pregnancies is 3.7%.

[Role of uterine curettage in endometrial pathology. Report of 200 cases]. / Intérêt du curetage biopsique dans l'exploration de l'endomètre. A propos de 200 cas.

UNLABELLED: The aim of this study is to evaluate the reliability of the uterine curettage in endometrial pathology. It is a retrospective analysis of 200 uterine curettages carried out in the military hospital of Tunis over 4 years (1994-1998). The reasons of consultation were genital hemorrhage, sterility and amenorrhea. Histological lesions were classified as follows: 40.8% hyperplasia, 8.4% atrophy, 1.34% endometrite, and 1.34% adenocarcinoma. CONCLUSION: Uterine curettage associated to hysteroscopy is far the best technique for the diagnosis of intrauterine lesions.