Acute fatal group A Streptococcal primary peritonitis following vaginal delivery.

Acute primary peritonitis due to group A streptococci (GAS) is a rare but life-threatening disease most often seen in case of liver cirrhosis or nephrotic syndrome. The specific mechanism of this infection remains unknown and according to the literature hematogenous, lymphatic, retrograde inoculation from the genitourinary tract and translocation of intestinal tract flora have all been proposed. We report a case of a 37-year-old previously healthy patient who presented to the emergency, four days after vaginal delivery, with abdominal pain and septic shock. Acute peritonitis was diagnosed and peritoneal and blood culture revealed group A streptococci. Unfortunately, the patient died within 12 h despite adequate resuscitation and antimicrobials. The present case report highlights the importance of an early diagnosis with an adequate therapy in case of GAS peritonitis after vaginal delivery.

[Induction of labour at term with misoprostol: the experience of a Tunisian maternity ward]. / Déclenchement du travail à terme par le misoprostol: expérience d'une maternité tunisienne.

To evaluate the efficacy and safety of vaginal misoprostol for term labour induction. A prospective study conducted at the Department of Obstetrics and Gynecology B of hospital Charles Nicolle, Tunis, over a period of 4 months. The group of subjects, selected to represent the population of interest, were pregnant patients at term undergoing cervical ripening. Patients received 50 mcg vaginal misoprostol every 12 hours. The parameters studied were: contractile abnormalities, abnormalities of fetal heart rate (FHR), mode of delivery, delayed delivery and neonatal status. 44 patients underwent cervical ripening with misoprostol. The average term was 40 WA. Nulliparous rate was 23/44 (52%). Vaginal birth rate was 31/44 (70.4%). 84% of patients received a single dose of misoprostol. FHR abnormalities were observed in 14/44 (32%). The rates of meconium-stained amniotic fluid was 12/44 (27%). Apgar score of less than 7 at 5 minutes was found in 7/44 (16%). A case of uterine rupture occurred in a primipara after a single dose of misoprostol. Our results are disappointing due to the occurrence of 1 uterine rupture and of 1 significant neonatal morbidity. Other multicentre prospective studies will be useful to better ensure the effectiveness but primarily the safety of low-dose misoprostol for induction of labour at term.

Prevalence of vitamin D deficiency in mothers and their newborns in a Tunisian population.

OBJECTIVE: To assess vitamin D status in mothers and their newborns and identify predictive factors of vitamin D deficiency. METHODS: A cross-sectional study was undertaken of healthy women and their full-term newborns delivered at the Charles Nicolle Hospital, Tunis, Tunisia, between October and November 2012. Maternal and neonatal serum 25-hydroxy vitamin D (25(OH)D) concentrations were measured. Correlations were tested. RESULTS: Overall, 87 mothers and their newborns were enrolled. No mother or neonate had an adequate vitamin D status. Mean maternal and neonatal serum 25(OH)D concentrations were 6.82±5.14ng/mL (range 3.60-23.77) and 5.92±4.15ng/mL (range 3.60-22.28), respectively. Vitamin D deficiency (serum 25(OH)D<20ng/mL) was found in 84 (97%) mothers and 85 (98%) neonates, of whom 76 (87%) and 78 (90%), respectively, had severe deficiency (serum 25(OH)D<12ng/mL). Maternal serum 25(OH)D showed a strong positive correlation with neonatal serum 25(OH)D (r=0.69, P<0.001). Maternal dietary vitamin D intake was the only factor shown to be associated with serum 25(OH)D concentrations (P<0.05). CONCLUSION: Vitamin D deficiency is prevalent among Tunisian mothers and their neonates.

[Efficacy of misoprostol for medical termination of pregnancy in second trimester : Prospective study]. / Efficacité du misoprostol pour l'interruption médicale de grossesse au 2éme trimestre: Etude prospective.

AIM: To investigate the efficacy of misoprostol used alone, and the time of fetal expulsion for medical termination of pregnancy in the second trimester. PATIENTS AND METHODS: 50 patients were enrolled in a prospective study over two years and in whom termination of pregnancy was indicated between 14 and 28 weeks of amenorrhea. Misoprostol was reported in a well-defined protocol: group 1: 2 tablets every 3 hours as intra vaginal, group 2: half dose for women bull 4th or more or carrying a scarred uterus for terms greater than or equal to 22 weeks of amenorrhea. RESULTS: 48 patients expelled misoprostol alone and we have used an aspiration in two cases. The period of expulsion for 24 hours was 97% for the first group and 90% for the second. CONCLUSION: using misoprostol within this protocol is effective and reduce the time required for the fetal expulsion of the second trimester pregnancy.

[Epidemiological profile, etiological diagnosis and prognosis of uterine synechias: report of 86 cases]. / Epidemiological profile, etiological diagnosis and prognosis of uterine synechias: report of 86 cases

BACKGROUND: Uterine synechias may pose real problems for fertility prognosis. It depends mainly on its etiology. AIM: To study the epidemiological profile of patients, describe the circumstances of discovery of uterine synechias, specify the diagnostic procedures for pelvic ultrasound, hysterography and hysteroscopy and estimate the benefits on fertility. METHODS: A retrospective study over a period of 10 years from 1 January 2000 to December 31, 2009 in the department of obstetrics gynecology B Charles Nicolle's Hospital in Tunis. RESULTS: We collected 86 patients. The age average was 35.42 years, gestit average of 1.36 with 37.2% of nulligeste and an average parity of 0.67. The uterine revision was the main etiology (55.8%). The main circumstance of discovery was the exploration of infertility (60%). Hysterosalpingography showed a luminal filling defect in 79% of patients mostly fundic location (37.3%). Faced with data from the hysteroscopy sensitivity of HSG was 78% and positive predictive value was 100%. For the seat of the synechia its sensitivity is only 40%. The surgical procedure took place in one time in 74 cases. Our complication rate is 8.14%: 2 uterine perforations, 2 falseroads and 3 cases of hemorrhage stopping surgery. CONCLUSION: The main etiology is a history of uterus revision. The main circumstance of discovery is the exploration of infertility. Anatomic results were generally good as testified hysteroscopy control.

Conservative management of cervical pregnancy. A case-report.

BACKGROUND: cervical pregnancy is one of the rarest ectopic locations. It can be responsible of spontaneous haemorrhage enquiring hysterectomy. Ultrasonography technical improvements allow early diagnosis and conservative treatment. AIM: This study aims to report a new case of cervical pregnancy treated conservatively. CASE REPORT: patient with cervical pregnancy diagnosed on ultrasonography and treated by one dose systemic methotrexate requiring a second injection because of no decreasing of serum beta human chorionic gonadotrophin level leading to expulsion of the pregnancy one month later. CONCLUSION: methotrexate is the standard treatment of early diagnosed cervical pregnancy. When haemorrhage occurs, many therapeutic methods allow conservative treatment in order to preserve fertility.

[Neonatal prognosis of second twin]. / Pronostic neonatal du deuxieme jumeau.

BACKGROUND: Twin pregnancy is associated to high neonatal morbidity particularly for the second twin. AIM: To assess twin delivery practice in our department and prognosis of second twin. METHODS: Retrospective study of medical files of parturition women with twin pregnancy between January 2003 and December 2006. Were excluded women delivered before 28 weeks gestation, twin pregnancies with death or malformation of one of twins. Descriptive and comparative analyses were realised. RESULTS: One hundred forty six twin pregnancies were counted. Vaginal delivery was attempted with 90 parturition women with 85.5% of success. Caesarean section delivery rate was 47.2%. Overall there's no difference between twins considering neonatal complication. In case of vaginal delivery, the second twin's 5 minutes Apgar score was statistically under the one of the 1st twin if compared to the caesarean section delivery. This difference was no more significant if regarding the Apgar score under 7 at 5 minutes. Apgar score of the second twin was also under the one of the first twin in non cephalic presentation. CONCLUSION: Vaginal delivery of twin pregnancy was noot associated to high risk for twins. Obstetrical manoeuvres should be well controlled to reduce obstetrical trauma.

[Adenomyosis at hysterectomy]. / L'adenomyose a l'hysterectomie.

BACKGROUND: adenomyosis is a frequent gynecologic pathology which affects women particularly in the fifth decade. It is responsible of abnormal uterine bleeding and pelvic pain. The diagnosis can be difficult especially when it's associated to other gynaecologic pathologies. Contribution of transvaginal sonography and magnetic resonance imaging made preoperative diagnosis possible. THE AIM of this study is to report frequency, epidemiologic profile, clinical signs and diagnostic and therapeutic methods of adenomyosis. METHODS: this is a retrospective study about 52 cases of adenomyosis diagnosed upon 336 hysterectomies for benign pathologies. Descriptive analysis of epidemiologic, clinical, diagnosis and therapeutic data was performed. RESULTS: prevalence of adenomyosis was 15% and multiparity observed for 90% of women was the main risk factor. CONCLUSION: women desirous of pregnancy and affected by adenomyosis can benefit from conservative treatment, but hysterectomy remains the reference treatment.