[Splenic cyst during pregnancy: a rare disease with difficult management]. / Kyste splénique et grossesse : une pathologie rare de prise en charge difficile.

Maternal splenic cyst during pregnancy seems to be a rare disease whose treatment is not codified. The most feared complication of these cysts is the rupture. In case of rupture, 60% of cases occur during the third trimester of pregnancy and result in a significant maternal and fetal morbidity and mortality. We examine the two main modes of treatment used nowadays: surgical splenectomy or radiological drainage.

[Follow-up and counselling after pelvic inflammatory disease]. / Suivi et conseils après infections génitales hautes.

Pelvic inflammatory disease (PID) can be responsible for infertility and chronic pelvic pain. Treatment of acute PID is very important as it can reduce the risk of sequelae. However, follow-up, partner treatment and counselling are also useful to reduce the reinfection rate. Few weeks after PID, clinical evaluation as well as transvaginal and transabdominal sonography must be performed. The interest of systematic bacteriological tests is not proved. Hysterosalpingography and second-look laparoscopy should be considered only for women with infertility and severe infection. Use of condom is advisable in this population in order to prevent sexually transmitted diseases (STD) including HIV and to decrease rate of recurrence, associated to contraceptive pill, which is also a good option. In selected cases, intrauterine devices can be used in patients with history of PID if the infection is resolved and no significant risk factors for STD exist. Infertility and chronic pelvic pain are the most common sequelae in the population of young women with severe and recurrent infection. The risk of ectopic pregnancy is higher for these women and must be kept in mind. Counselling and risk-reduction interventions decreased significatively the rate of recurrence and sequelae in PID.

[Myoma and pregnancy: when medical treatment is not sufficient]. / Fibrome et grossesse: quand le traitement médical ne suffit pas.

The leiomyoma is the most common benign uterine tumor in population of childbearing age women. We report a patient case with uterine myomas threatening the pregnancy continuation and causing a real problem of maternal tolerance. In presence of a 22 cm subserosal fibroma which is responsible of a severe abdominal pain syndrome resistant to level 3 analgesics, the use of surgical treatment was considered, even if current recommendations are for an optimal medical management. Myomectomy by laparotomy has been performed after 13 weeks of gestation.

[How did I contract human Papillomavirus (HPV)?]. / Papillomavirus humain (HPV) : comment ai-je attrapé ça ?

More than 120 genotypes have been identified among the Papillomavirus (HPV) family. These viruses are ubiquitary with skin or mucous membrane tropism and cause various pathologies from wart to neoplasia. HPV family is classified according to their tropism. Genital HPV infection is considered as the most frequent sexually transmitted disease in the world. Seventy-five percent of women will be in contact with HPV at least one time in their life. HPV is usually transmitted through direct skin-to-skin contact, more often during penetrative genital contact. Other types of genital contact in the absence of penetration can lead to HPV infection, but those routes of transmission are much less common than sexual intercourse. However, virgins (<2 % of cases) and young children can present HPV infection, suggesting other routes of transmission than sexual intercourse. HPV infection could occur during delivery; vaginal deliveries appear to promote this transmission in comparison with cesarean section. But cesarean section do not completely protect against contamination risk. In utero, vertical transmission has been suggested by different studies but with lack of evidence. HPV infection can be detected on inanimate objects, such as clothing or environmental surfaces. However, transmission is not known to occur by this route. More detailed knowledges of the transmission route of HPV infection will enable to get prevention more effective.

[Maturity-onset-diabetes-of-the young-5 and genital malformations diagnostic management: case report]. / Diabète MODY-5 et malformations génitales: prise en charge diagnostique. A propos d'un cas.

With an incidence of 5% in the female population, genital malformations are a frequent clinical occurrence presented by Oppelt et al. (2007) [1]. First, we have to diagnostic them and search for extra genital malformation when it is necessary. Think about maturity-onset-diabetes-of-the young 5 (MODY-5) when there's a personnel or family story of diabetes. This is often within the competence of the diabetologist and our speciality can be put in contribution in the research for the associated genital malformation. We report on the case of a young woman age of 19 with diabetes diagnosed during her adolescence, a nephropathy with polycystic kidneys, biological cytolysis, a bicornuate unicervical uterus while this may be a clinical diabetes MODY-5 confirmed by the discovery of the complete deletion of the gene coding for HNF-1 beta in the heterozygous state.

[Pregnancy after uterine-artery embolization for symptomatic fibroids: a case of placenta accreta with uterine rupture]. / Un cas de rupture utérine sur placenta invasif compliquant une grossesse après embolisation des artères utérines pour fibromes.

The evolution of pregnancies following uterine-artery embolisation (UAE) for symptomatic fibroids remains uncertain. We report a case of pregnancy after UAE, complicated of adherent placenta with uterine rupture, in a context of uterine leiomyomata with a prior cesarean delivery. Through a recent review of the literature, we discuss the main obstetrical complications following UAE. Appropriate management of these high-risk pregnancies, notably in case of risk of adherent placenta, seems to be necessary.

[Medical treatment of idiopathic menorrhagia]. / Hémorragies utérines fonctionnelles ou ménorragies idiopathiques Traitement médical : modalités, efficacité, complications.

Heavy menstrual bleeding is frequent, and can be caused by particular uterine abnormalities such as fibroids or adenomyosis but there is often no recognisable pathology. Surgery such as hysterectomy has proven its efficacy in treating these conditions, but alternatives techniques have been developed since many years and give interesting results. New medical treatments have also emerged, and in particular a new intrauterine levonorgestrel-releasing system (IUD-LNG). In case of dysfunctional uterine bleeding, the use of medical treatment should be considered in first line. Progestogens are often used in this condition even if it has been proven that they are less effective than antifibrinolytics, non steroid anti-inflammatory drugs or IUD-LNG. Appropriate treatment should be considered according to clinical conditions and based on efficacy, tolerance, cost and should also take into account the patient's wishes as observance in case of medical therapy is of particular importance. In case of DUB, medical therapy when correctly prescribed is effective.

[Short interpregnancy intervals: risk factors and perinatal outcomes]. / Grossesses rapprochées: facteurs de risque et conséquences périnatales.

OBJECTIVES: To study risk factors and perinatal outcomes in short interpregnancy intervals. MATERIALS AND METHODS: Retrospective study, between 1995 and 2001, comparing women with short interpregnancy intervals (<6 months, n = 192) and women controls (interpregnancy intervals between 18 and 23 months, n = 210). The analysis included demographical and social factors, maternal medical histories and perinatal outcomes for the 2(nd) pregnancy. RESULTS: Risk factors of short interpregnancy intervals were: young age, no anterior contraception, celibacy, medical history of intrauterine fetal death or medical pregnancy termination and high parity and gestity. The patients at risks of short interpregnancy intervals often belong to little supported social background, are generally without profession and often leave against medical opinion. The short interval between pregnancies is associated to a high score of prematurity (19% vs 8%, OR = 2.8, p < 0.001). CONCLUSION: These data suggest that obstetricians and other care providers need to be alert to these identifiable risk factors and then direct preventive strategies during and after pregnancy.