[Sexuality and contraception: a prospective study about 85 cases]

Contraception opposing procreation interferes with the primary purpose of sexuality. Few studies have yet been made on the actual interaction between contraception and sexuality. To study contraceptive practices is non medicalized contraception and oral contraception, study aspects of women's sexuality and to study the physiological impact and psychological contraception on women's sexuality. Prospective and analytical study conducted over a period spanning from October 2008 to February 2009. This study was based on a survey, carried out through an oral questionnaire to 85 women in reproductive age, married, with contraceptive-based pill or natural birth control for at least one cycle, having experienced during their personal background a sexuality contraception or at least one contraceptive method other than its current average. Comparison between the group of women using oral contraception and women not using contraception medicalized showed significant differences in outcomes relating to: the average frequency of intercourse / month [p = 0.01], sexual desire [p = 0.01], sexual pleasure [p = 0.03]. The comparison of the different parameters of sexuality among the group of women using intra uterine device and women using oral contraceptives showed no significant differences in the parameters of sexuality. The awareness of the big importance of the interaction between sexuality and contraception, in one way or another, could help us tailor our applications to contraceptive practices of each woman

[Prospective study about 45 cases of disseminated intravascular coagulation]

Disseminated intravascular coagulation [DIC] in obstetric disorders is a severe complication. To study the frequency and means of diagnosis of DIC and the therapeutic care and maternal morbidity induced. Monocentric, prospective and descriptive study about 45 cases of intravascular coagulation in an obstetrical service collected at the University Hospital of Obstetrics and Gynecology Hedi Chaker of Sfax over a period ranging from June 2007 to June 2010. All the pregnant patients who have given birth beyond 28 weeks and have presented a DIC were selected for this study. The mean age of patients was 31.4 years. The mean parity was 2.6. The main diseases during pregnancy were: severe preeclampsia [22.2%], diabetes [28.8%], intrauterine fetal death [17.7%], previa placenta [8.8%]. The main causes of DIC were: uterine atony [44.4%], abruptio placenta [22.2%], Hellp syndrome [11.1%] and uterine rupture [6, 6%]. The lowest rate of platelets was 21000/mm3. The fibrinogen level was <0.5 g in 40% of cases. Despite reanimation and transfusion with blood products, surgical treatment was necessary in 77.7% of cases. All the patients were transferred in intensive care unit with an average stay of about three days. No maternal death was reported. DIC is a frequent complication of many obstetrical diseases. The treatment is urgent. It requires first to the cause and the shock by massive transfusions of packed red blood cells, fresh frozen plasma, and platelets, associated with antifibrinolytic drugs, if necessary

[Cervical ripening at term. a randomized and prospective study: Misoprotol versus dinoprostone]

To compare the efficacy and safety of cervical ripening at term by vaginal Misoprostol and Dinoprostone. We performed a prospective randomized study on cervical ripening with misoprostol and dinoprostone in the third trimester of pregnancy. 300 patients have been divided into two groups: one consisted by 150 patients who received Misoprostol [Cytotec registered] and the second consisted by 150 patients who received Dinoprostone [Pr‚pidil registered]. Analysis of our results allowed to reveal: a significant decrease in the time of entry into work for the Misoprostol group [9.08 hours versus 12.51 hours, p = 0.007], a significant reduction delivery time [14.48 hours versus 19.30 hours, p = 0.001]. Moreover, the birth rate in the first 24 hours after the first dose was significantly higher in the Misoprostol group [86.7% versus 72.7%, p = 0.003]. The use of oxytocin was significantly reduced with Misoprostol [44% versus 58.7%, p = 0.01]. The mode of delivery was not influenced by membership in one or other of the two groups. Misoprostol seems an interesting molecule for cervical ripening and labor induction

[Ligation of internal iliac arteries for sever hemorrhage in obstetric]

To assess the efficiency of arteries ligation in intractable obstetrical hemorrhage. Prospective study which concerned 53 patients who underwent internal iliac arteries ligation for persistent and severe obstetrical hemorrhage from January 2007 to June 2010. The average age of patients was 29.3 years. The mean parity was 2.2. Main etiology of hemorrhage were: uterine atony [62.2%], abruptio placentae [15.1%]. Coagulation disorders and hypovolemic shock were observed respectively in 20.7% and 37.7%. Blood transfusion was performed in all cases. Internal iliac arteries ligation allowed hemorrhage control in 90.5% of cases. In five cases a hysterectomy was necessary to control bleeding.. No peroperative complication were observed. Internal iliac arteries ligation is a prerequisite treatment of severe postpartum hemorrhage. It is a good alternative to arterial embolization

[Emergency peripartum hysterectomy: indications and prognosis]

Detect the risk factors, indications and maternel morbidity of haemostatic hysterectomy. A retrospective study of 46 women who had haemostatic hysterectomy between 2005 and 2009. The mean age was 33.3 years. The mean parity was 3.5. 35% of patients had a previous cesarean section. The mode of delivery was: vaginal delivery [47.8%], cesarean delivery [52.2%]. The hysterectomy was subtotal in 39 cases [85%]. The indications of haemostatic hysterectomy was: uterine inertia [44%], disseminated intravascular coagulation [26%], placenta accreta [8.7%], Placenta praevia [13%], uterine rupture [8.7%]. Three patients were dead. Five patients had a depression. Six patients had a dyspareunia. Five patients had a decrease of sexual desire. Haemostatic hysterectomy is a multilating surgery giving an irreversible infertility. The development of arterial embolization avoid the appeal to this surgery

[Genital prolapse in young women: a study of risk factors]

To determine the risk factors for genital prolapse in a group of 33 young women less than 45 years old. We studied 33 young women who had been operated for genital prolapse, whereas the control group consisted of women operated for benign gynaecologic disorders. In the study group the number of pregnancies and deliveries, the babies'weight, the positive family history of prolapse were heavier than in the control group. The women with prolapse had more often chronic pulmonary diseases, asthma, as well as operations for abdominal hernias. The mode of delivery, be it a cesarean section or the use of forceps, and the active second stage of labor had no effect whatever on the occurring of genital prolapse in young women. Our data support the suggestion that multiparity, babies weight and congenital factors are responsible for a higher rate of genital prolapse in young women

[Confrontation ultrasonography-cal25-histology in the managment of ovarian cysts: a prospective study about 77 cases]

To study the correlation between ultrasound, Doppler,measurement of CA 125 and histology in the preoperative diagnosis of ovarian cysts. Prospective and analytical study about 77 patients in whom we analyzed the contribution of ultrasound, the assay of CA125, the couple CA125 ultrasonography and laparoscopy in the diagnosis and management of cysts the ovary. The value of CA125 was considered pathological like the one adopted by our biochemistry laboratory of the CHU Habib Bourguiba, Sfax [> 35 UI / ml]. The mean age was 35.6 years. On the whole, ultrasound has a sensitivity of 71.41% and a specificity of 80%. The positive predictive value was 35.71% and negative predictive value was 96.55%. The sensitivity of CA125 to detect malignant lesions among ovarian cysts was 85.71% and a specificity of 85.93%. The PPV was low [42.85%]. The combination Ultrasound-CA125 had a sensitivity of 85.7%, a specificity of 82.8%, a PPV and NPV respectively 35.3% and 98.1%. The concordance between the macroscopic perlaparoscopic and histological diagnosis of different tumors was 83.3% for functional cysts, 77.7% for serous cysts, and 100% for dermoid cysts, endometriosis and bleeding. The contribution of Doppler ultrasound and tumor markers is essential in the diagnosis of ovarian cysts

[Obstetrical prognosis following ligation of hypogastric arteries]

Ligation of hypogastric arteries is a conservative surgical treatment in cases of postpartum hemorrhage. To study the fertility and pregnancies outcome in women who required hypogastric artery ligation for severe post-partum haemorrhage in our hospital. The fertility and pregnancy outcome parameters were retrieved from medical files and telephone interviews. 34 patients required hypogastric ligation on this period. 39 pregnancies were observed with 30 term deliveries, 1 ectopic pregnancies and 8 miscarriages. Two patients had infertility and pregnancy was obtained in less than 10 months most once desired.Pregnancy outcome was normal. 73, 3% of deliveries were by caesarean. Hypogastric artery ligation for post-partum haemorrhage is not responsible for secondary infertility. Following pregnancies do not suffer complications from the ligation

[Anatomic and functional results after surgical treatment of uro genital prolapse: prospedtive study about 93 cases]

Genital polapse is a frequent olisease several techniques were described. To evaluate the anatomical and functional results of surgery for genital prolapse by vaginal and abdominal approach. Prospective study on 93 patients operated for urogenital prolapse [50 by high and 43 vaginal approach] in the department of obstetrics and gynecology of Sfax. Anatomic results and postoperative patient satisfaction was assessed. Quality of life was assessed using the French versions of the questionnaires Pelvic Floor Distress Inventory [PFDI 20], Pelvic Floor Impact Questionnaire [PISQ 7]. The mean age of patients was 59 years. 85.9% of our population consisted of postmenopausal women. The results of the postoperative visit, after a mean of 28.7 months, showed about the anatomical level, a success rate for the treatment of prolapse by high 82% against 72.1% for vaginal delivery, but the difference is not significant [P = 0.45]. For prolapse of grades 1 and 2, surgical treatment by high and low has corrected all the elements of prolapse. For prolapse of grades 3 and 4, high surgery has resulted in a satisfactory anatomical result in 86%, while the lower channel yielded a significant result in 76.5%, and recurrence were interested mainly the anterior stage. The questionneer PFDI 20, showed an improvement in the quality of life after surgery significantly in both groups [p<0.003]. The improvement was more significant PFDI 20 after surgery by high versus vaginal surgery [p <0.002]. Regarding PFIQ 7, improved quality of life was observed after surgery without significant differences between the two groups. The treatment of urogenital prolapse is mainly based on surgical and reconstructive surgery to restore anatomical and functional surgery also in order to improve the quality of life of patients

[Nicardipine versus salbutamol in the treatment of premature labor: comparison of their efficacy and side effects]

The objective of this study is to compare the tocolytic action and the side effects of nicardipine to those of salbutamol in patients presenting premature labor in order to propose nicardipine as a promising alternative to salbutamol in the treatment of premature labor. Forty eight patients admitted for premature labor were included in this prospective randomized study comparing nicardipine and salbutamol, administered with intra venous drip. The nicardipine group included 25 patients and the salbutamol group included 23 patients. The epidemiologic characteristics of the 2 groups are similar. No significant difference between the 2 groups was noted in the average time of disappearance of the uterine contractions. In nicardipine group, the pregnancy was prolonged more than 48 hours in 87.5% of the cases against 85.8% in salbutamol group [P: NS]. Adverse effects linked to tocolysis were recorded. In nicardipine group, 8% of the patients presented an intolerance of the molecule, against 47% of salbutamol group, the difference is significant [P=0.02]. The term of delivery was similar in both groups. The neonatal status of the infants was identical in the two groups. In the group of new born hospitalized, we did not note biological disorders concerning the glycemia and the calcemy. Nicardipine is at least as effective as salbutamol in tocolysis; but it has less secondary effects. Thus, nicardipine is proposed as the tocolytic of first intention instead of the salbutamol which is considered as reference molecule