Sexuality and quality of life of patients operated for Rokitansky syndrome Mayer Kuster Hauser.

INTRODUCTION: Rokitansky syndrome or Mayer Rokitansky Kuster Hauser (SRKMH) is a rare congenital malformation defined by uterovaginal aplasia. The aim of the treatment is to create a neovagina and restore sexual life. However, postoperative results in terms of sexual and overall quality of life of patients remain controversial. AIM: To evaluate the quality of life and sexuality of patients operated on for Rokitansky syndrome. METHODS: This was a retrospective and comparative study between two groups of patients. The first group consisted of patients who had undergone vaginoplasty as part of SRKMH. The second group was that of the controls. Control in terms of sexual function by the Ar FSFI (Arab FemaleSexualFunction Index) and quality of life by the SF36 (Short Forms Health Survey) were used in both groups. RESULTS: The average age of patients operated on for SRKMH was 22.53 years. Eighteen of these patients (60%) were sexually active at the time of the study. Patients operated on for SRKMH had a significantly lower Ar FSFI score compared to the control group. The two areas most affected were lubrication and pain. Likewise, patients who underwent vaginoplasty had a significantly lower SF 36 score compared to the control group. The psychological component was the most affected of the different components of quality of life. CONCLUSION: Sexual function and quality of life after vaginoplasty in the context of Rokitansky syndrome remains unsatisfactory despite the anatomical result.

Decreased fetal movement: Maternal characteristics and pregnancy outcome.

INTRODUCTION: Decreased fetal movement is a common reason for consultation. It can reveal an intrauterine death or fetal distress. AIM: To evaluate the epidemiological profile of decreased fetal movement and to identify the predictive factors of poor pregnancy outcome. METHODS: We performed a retrospective and descriptive study in the department of Maternity between January 2015 and December 2019 including patients hospitalized for decreased fetal movements. RESULTS: The study included 150 patients with a mean age of 30.7±5.8 years. The patients were primiparous in 45.3% of cases. The mean term of pregnancy was 37.17±2.97 weeks. Cardiotocography was pathological in 22.7% of patients. The delivery rate during the hospitalization was 87.3% with a mean term of 37.9±2.5 SA. Poor pregnancy outcome was noted in 22.1% of cases. The identified predictive factors of poor pregnancy outcome were: gestational term less than 37 weeks (ORa=9.42), insufficient prenatal care (ORa=2.85), delayed maternal reporting of decreased fetal movement (ORa=1.29), complications during pregnancy (ORa=3.01), small symphysiofundal height for gestational age (ORa=6.17), pathological cardiotocography (ORa=1.66), fetal growth restriction (ORa=6.17), abnormal Umbilical Artery Doppler (ORa=6.51). CONCLUSION: Decreased fetal movement can be a false alarm but it is important to identify predictive factors of poor pregnancy outcome to recognize patients at increased risk and optimize their management.

Performance of ultrasound fetal weight estimation in twins.

BACKGROUND: Ultrasonography is an essential tool in the management of twin pregnancies. Fetal weight estimation is useful to anticipate neonatal care in case of weight restriction or growth discordance. AIMS: To assess the accuracy of estimated fetal weight (EFW) in twins and to assess the accuracy of sonographic examination to predict birth weight discordance (BWD) and small birth weight (SBW).    Methods : This was  a longitudinal prospective study over a period of one year. We have included 50 twin pregnancies with a first trimester ultrasound calculated term and specified chorionicity. An ultrasound EFW was scheduled for all patients within an interval of 4 days before delivery. We calculated the differences between EFW and BW in terms of absolute difference and percentage error. We studied the correlation and the agreement between EFW and BW. Finally we calculated the sensitivity, the specificity, PPV and NPV of ultrasound in the diagnosis of BWD and SBW. RESULTS: Absolute differences between BWF and BW were similar for the two twins. The relative difference was 7.7% [0-32] for T1 and 8.2% [0-27] for T2. The margin of error was greater than 10% in 38% of the cases for T1 and in 34% of cases for T2. Furthermore, correlation coefficients R1 and R2 for T1 and T2 were close to 1; R 1 =0.87 and  R 2 = 0.89. Linear regression analysis allowed us to calculate the birth weight based on the estimated weight and this according to the following equations: For the first twin BW T1 = 0.846 * EFW 415,57+ T1 For the second twin BW T2 = 65.68 + 0.963 * EFW T2 in 34% of cases for T2. Chorionicity, presentation and gestational age did not affect the estimations. Ultrasonography in the diagnosis of SBW had a sensitivity of 90.32%, a specificity of 76.82%, a (PPV) of 80% and a (VPN) of 87%. The performance of ultrasound in the diagnosis of BWD varied according to the adopted threshold. CONCLUSION: Ultrasound is an effective examination to estimate twins weight. Regarding prenatal diagnosis of birth weight discordance, the relevance of this examination increases with the adopted threshold.