[Sexuality and contraception: a prospective study of 85 cases]. / Impact de la pilule œstroprogestative sur la sexualité: Étude prospective à propos de 85 cas.

BACKGROUND: Contraception opposing procreation interferes with the primary purpose of sexuality. Few studies have yet been made on the actual interaction between contraception and sexuality. AIM: To study contraceptive practices ie 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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 of 45 cases of disseminated intravascular coagulation]. / Etude prospective à propos de 45 cas de coagulation intra vasculaire disséminée.

BACKGROUND: Disseminated intravascular coagulation (DIC) in obstetric disorders is a severe complication. AIM: To study the frequency and means of diagnosis of DIC and the therapeutic care and maternal morbidity induced. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

[Emergency peripartum hysterectomy: indications and prognosis]. / Hystérectomie d'hémostase : Indications et pronostic

AIM: Detect the risk factors, indications and maternal morbidity of haemostatic hysterectomy. METHODS: A retrospective study of 46 women who had haemostatic hysterectomy between 2005 and 2009. RESULTS: 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. CONCLUSION: Haemostatic hysterectomy is a mutilating surgery giving an irreversible infertility. The development of arterial embolization avoid the appeal to this surgery.

Mullerian adenosaroma of the cervix with sarcomatous overgrowth and heterologous elements presenting as a recurrent cervical polyp.

Mullerian adenosarcoma of the cervix is a rare tumor composed of benign epithelial and malignant stromal components. Sarcomatous overgrowth and heterologous elements in cervical adenosarcoma are extremely infrequent. We report the case of a 26-year-old woman admitted at the gynaecology department for a painless mass protruding from her vagina. The initial pathological exam concluded to endocervical polyp. Six months later, the patient was readmitted with a recurrence of the polyp. The pathological exam demonstrated interlacing fascicles of elongated spindle cells with few mitotic activity and no glandular formation. After reviewing of the initial polyp the diagnosis of mullerian adenosarcoma was suggested. A second recurrence of the polyp was noted one month later. Histopathological exam of the recurrent polyp confirmed the diagnosis of adenosarcoma with sarcomatous overgrowth and heterologous elements. The patient was lost for follow-up. Cervical adenosarcoma with sarcomatous overgrowth and heterologous element is a rare tumor that occurs in younger age in contrast to endometrium/corpus uterin mullerian adenosarcoma. In young women with recurrent cervical polyp, mullerian adenosarcoma must be considered and should be excluded by careful histopathological exam. Sarcomatous overgrowth and myometrial invasion are the most important prognostic factors. Treatment strategy is still unclear.

[Cervical ripening at term. A randomized and prospective study: Misoprotol versus dinoprostone]. / Maturation cervicale à terme. Étude prospective randomisée: misoprostol versus dinoprostone.

AIM: To compare the efficacy and safety of cervical ripening at term by vaginal Misoprostol and Dinoprostone. METHODS: 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 ®) and the second consisted by 150 patients who received Dinoprostone (Prépidil ®). RESULTS: 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. CONCLUSION: Misoprostol seems an interesting molecule for cervical ripening and labor induction.

[Ligation of internal iliac arteries for severe hemorrhage in obstetric]. / Ligature des artéres iliaques internes dans la prise en charge des hémorragies du post partum.

AIM: To assess the efficiency of arteries ligation in intractable obstetrical hemorrhage. METHODS: Prospective study which concerned 53 patients who underwent internal iliac arteries ligation for persistent and severe obstetrical hemorrhage from January 2007 to June 2010. RESULTS: 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. CONCLUSION: Internal iliac arteries ligation is a prerequisite treatment of severe postpartum hemorrhage. It is a good alternative to arterial embolization.

[Anatomic and functional results after surgical treatment of uro genital prolapse: prospective study about 93 cases]. / Résultats anatomiques et fonctionnels après cure chirurgicale de prolapsus uro-génital : étude prospective. A propos de 93 cas.

BACKGROUND: genital polapse is a frequent olisease several techniques were described. AIM: To evaluate the anatomical and functional results of surgery for genital prolapse by vaginal and abdominal approach. METHODS: 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). RESULTS: 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 questionnaire 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. CONCLUSION: 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.

[Obstetrical prognosis following ligation of hypogastric arteries]. / Pronostic obstétrical après ligature des artères hypogastriques.

BACKGROUND: Ligation of hypogastric arteries is a conservative surgical treatment in cases of postpartum hemorrhage. AIM: To study the fertility and pregnancies outcome in women who required hypogastric artery ligation for severe post-partum haemorrhage in our hospital. METHODS: The fertility and pregnancy outcome parameters were retrieved from medical files and telephone interviews RESULTS: 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. CONCLUSION: Hypogastric artery ligation for post-partum haemorrhage is not responsible for secondary infertility. Following pregnancies do not suffer complications from the ligation.

[Prospective study of the correlation of ultrasonography and CA125 in the management of ovarian cysts: a study of 77 cases]. / Confrontation échographie - CA125 - histologie dans la prise en charge des kystes de l'ovaire : Etude prospective à propos de 77 cas

AIM: To study the correlation between ultrasound, Doppler,measurement of CA 125 and histology in the preoperative diagnosis of ovarian cysts. METHODS: 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). RESULTS: 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. CONCLUSION: The contribution of Doppler ultrasound and tumor markers is essential in the diagnosis of ovarian cysts.

[Genital prolapse in young women: a study of risk factors]. / Etude des facteurs de risque du prolapsus genital chez les femmes jeunes.

AIM: To determine the risk factors for genital prolapse in a group of 33 young women less than 45 years old. METHODS: We studied 33 young women who had been operated for genital prolapse, whereas the control group consisted of women operated for benign gynaecologic disorders. RESULTS: 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. CONCLUSION: Our data support the suggestion that multiparity, babies weight and congenital factors are responsible for a higher rate of genital prolapse in young women.

[Maternal mortality trends in the Sfax region from 1979 to 2000]. / L'évolution de la mortalité maternelle dans le région de Sfax de 1979 à 2000.

We report a retrospective study about maternal mortality in Sfax (Tunisia) between 1979 and 2000. Maternal mortality rate has fallen strikingly from 76.8 per 100,000 mortality cases in 1979 to 40.1 per 100,000 mortality cases in 20,000. However deaths from unavoidable causes have fallen much more slowly than avoidable causes.