[Third- and fourth-degree post-delivery perineal tears : retrospective analysis and management adaptation]. / Les déchirures périnéales des 3ème et 4ème degrés post-accouchement : analyse rétrospective et adaptation de la prise en charge.

Third- and fourth-degree perineal tears are injuries involving the anal sphincter that occur during vaginal delivery. Their prevalence is between 0.25 and 6 %, which highlights the variability of obstetrical practice among different countries. This type of tear can lead to short- and long-term complications for the mothers, affecting their quality of life. Therefore, it seems essential that their management should be optimal. In this study, we analyzed the records of all women who suffered from an obstetric anal sphincter injury between January 2015 and January 2021. During this period, out of 11222 vaginal deliveries, 61 records (0.54%) were retained. Maternal, fetal, and delivery-related risk factors were studied and were mostly similar to those found in the literature. However, the treatment of these lesions was very heterogeneous among patients and lacked standardization. A better management of these tears through the establishment of a decision algorithm would potentially reduce the long-term morbidity.

Les déchirures périnéales des troisième et quatrième degrés sont des lésions entreprenant le sphincter anal et survenant lors de l'accouchement par voie vaginale. Leur prévalence est comprise entre 0,25 et 6 %, ce qui souligne la variabilité de la pratique obstétricale selon les pays. Ce type de lésion peut entraîner des complications à court et long termes pour les patientes, affectant leur qualité de vie. Dès lors, il semble essentiel que leur prise en charge soit optimale. Dans cette étude rétrospective monocentrique, les dossiers des femmes ayant présenté une lésion obstétricale du sphincter anal entre janvier 2015 et janvier 2021 ont été analysés. Durant cette période, sur 11.222 accouchements par voie basse, 61 dossiers (0,54 %) ont été retenus. Les facteurs de risque maternels, fœtaux et liés à l'accouchement ont été étudiés et sont majoritairement similaires à ceux retrouvés dans la littérature. En revanche, la prise en charge de ces lésions était très hétérogène parmi les patientes, avec un manque de standardisation. Une meilleure gestion de ces déchirures via l'instauration d'un algorithme décisionnel permettrait potentiellement d'en diminuer la morbidité à long terme.

[Belgian register and reference centers for gestational trophoblastic diseases]. / REGISTRE BELGE ET CENTRES DE RÉFÉRENCE POUR LES MALADIES TROPHOBLASTIQUES GESTATIONNELLES.

Gestational trophoblastic diseases include placental pathologies comprising fertilization abnormalities (hydatidiform moles) and malignant lesions (choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor). Due to their low incidence and heterogeneity, their diagnosis, management and treatment are not always optimal. Following the example of other European countries, a national registration system with two reference centers has been set up to guide physicians and patients and to propose individualized management. The centers offer their expertise through a systematic centralised pathology review by a panel of experts. HCG values are plotted in regression curves. In case of gestational trophoblastic neoplasia, an imaging work-up is proposed, from which the FIGO score and stage are derived and will guide the choice of treatment. Belgian centers offer a multidisciplinary approach, in partnership with the referent physician. More information for practitioners and patients is available on a web site: www.mole-chorio-bgog.eu, which also harbours a forum of discussion.

[Female sexual dysfunction and postmenopausal androgen therapy]. / Dysfonction sexuelle féminine et androgénothérapie a la ménopause.

Female sexual dysfunction is essentially multifactorial and its therapeutic management is accordingly diversified. However, after natural menopause or, even more, surgical menopause, age, climacteric syndrome, progressive loss of endogenous androgens, all facilitate the occurrence of the Hypoactive Sexual Desire Disorder (HSDD), defined by loss of libido and sexual responsiveness leading to sexually related personal distress. In that prospect, administration of varied medications with androgenic properties has been tried in addition to postmenopausal hormone therapy. Type, dosages, routes of administration of androgens are adapted toward minimizing side effects inasmuch as long-term safety of androgens is not yet clearly established. Recent randomized controlled studies appear very promising in terms of efficacy and safety, at least when androgen therapy is limited to 6-12 months in case of HSDD.