[Catamenial hemothorax: Results of 11 operated cases]. / Hémothorax cataménial : résultats de 11 cas opérés.

OBJECTIVE: To report our therapeutic approach toward catamenial hemothorax. PATIENTS AND METHODS: This retrospective study from January 1994 to November 2018 concerned patients operated under general anesthesia for catamenial hemothorax. A posterolateral thoracotomy approach was implemented either directly or after primary videothoracoscopy. Six-month hormone therapy was systematically prescribed postoperatively. The result was assessed in terms of occurrence or non-occurrence of hemothorax upon resumption of menses after discontinuation of hormone therapy. RESULTS: Eleven patients were selected, with an average age was 32years (25-41). Catamenial hemothorax was associated with hemorrhagic ascites in 5 cases. Endometriotic plaques in the form of diaphragmatic fenestrations were found nine times and were resected (1 case) or covered by a synthetic non-absorbable patch (8 cases). Pleural symphysis completed the surgical procedures. The one hormone used was triptorelin. Mortality was zero. Mean postoperative hospital stay was 10.24days and mean follow-up was 3.5years. One patient was lost to follow-up at 3months. One hemothorax recurrence was observed after discontinuation of hormone therapy at 4months [1], and repeated pleural punctures were carried out while awaiting revision surgery. The five cases of ascites recurred and the patients were monitored in the gynecology unit. CONCLUSION: In patients suffering from catamenial hemothorax with diaphragmatic fenestrations, we recommend phrenoplasty using synthetic patches associated with pleural talcage and 6-month complementary concomitant hormone therapy.

[Frequency of cord prolapse: etiological factors and fetal prognosis in 47 cases in a health center]. / La procidence du cordon: facteurs etiologiques et pronostic foetal a propos de 47 cas colliges dans un centre de sante de reference.

UNLABELLED: Cord prolapse constitute an imprevisible accident of the period of labor and an important cause of perinatal mortality. The aim of our study was to determine the frequency of cord prolapse, its etiological factors and to evaluate fetal prognosis. MATERIAL AND METHODS: Our study was done in the department of obstetric and gynecology of the Treichville university teaching hospital. It is a descriptive prospective study that covers 4 years period, from January 1st 1997 to December 31st 2000. RESULTS: We did record 16.924 deliveries with 47 cases of cord prolapse representing a frequency of 0.28% The influencial factors for occurrence of cord prolapse were: prematurity, multiple pregnancy, dystocic presentations and spontaneous rupture of membranes. 28% of our patients had pregnancy not at term. Twin pregnancies represented 23.4% and in 91% of the cases, prolapsed concerned the second twin. Our rate of cord prolapse associated with vertex presentation was 23.4%; 42.5% in breech and 12.8% in the case of shoulder presentation. Spontaneous rupture of membranes was the most frequent type. In 61.7% of the cases, the delivery was done by caesarian section. Cord prolapse was greatly lethal for the fetus with 36.2% of death occurring before the 5th minute of life. CONCLUSION: Umbilical cord prolapse is a grave obstetrical complication that compromises fetal prognosis.

Uterine torsion with maternal death: our experience and literature review.

Torsion of the gravid uterus around its cervical junction is a rare event especially in humans. In 1992, a literature review by Jensen, mentioned by Carbonne, showed 212 cases with different etiologies. Uterine torsion is more frequently dextrorotatory (2/3 of cases). The diagnosis is difficult and generally done during cesarean section because it is frequently not symptomatic. Uterine torsion signs, when present, are not specifics. Pain, nausea and vomiting may present without any sign of shock, as in our patient. Sometimes ultrasonography can lead to a correct diagnosis, showing a modification of the placenta site during pregnancy, or an abnormal positioning of the ovarian vessels which pass in front of the lower uterine segment. Some authors report cardiotocographic abnormalities probably due to the reduction of blood flow caused by the torsion. Quickness of surgical treatment is fundamental for the reduction of fetal mortality which is very frequent in a large number of cases, while maternal mortality is not so frequent but possible. A diligent anamnesis and ultrasonographic examination are surely useful to single out the rare cases of uterine torsion in pregnancy.