[Use of misoprostol in gynecology and obstetrics]. / Utilisation du misoprostol en gynécologie-obstétrique.

Although misoprostol is a widely used medication in gynecology and obstetrics, it is an off label drug that is not officially approved and used in an illegal way. This literature review shows its efficacy and safety in most of its indications in gynecology and obstetrics. Misoprostol is effective in cervical priming before curettage or operative hysteroscopy. Medical abortion using a combination of mifepristone followed 36 to 48 h by misoprostol seems efficient. The induction of abortion after 17 weeks gestation can be achieved also by using misoprostol. The cervical ripening and induction at term by misoprostol cannot be a first line therapy because of its sides effects on uterine contractility and fetal heart rate. After failure of other methods, it could be proposed. The use of misoprostol in prevention and management of postpartal hemorrhage seems efficient but more studies are needed particularly randomised contre sulfoprostone.

[Isolated antenatal pyelic dilatation: postnatal follow-up and care for vesico-ureteral reflux]. / Dilatations pyéliques isolées: diagnostic prénatal, suivi postnatal et prise en charge des reflux vésico-urétéraux.

OBJECTIVE: To assess the risk of aneuploidia in case of isolated antenatal pyelic dilatation and to detail urological care for these children. METHODS: Prenatal and postnatal follow-up was analyzed in 350 cases. RESULTS: The overall rate of chromosome anomalies was 1.3%. Trisomy 21 was found alone in one case (0.3%). The sex ratio was 26% girls and 74% boys. Vesico-ureteral reflux was similar in both sexes (13%). CONCLUSION: The question of proposing karyotyping in case of isolated pyelic dilatation remains unsolved because minimal subjective signs such as slightly excessive amniotic fluid can completely change the assessment of the risk of aneuploidia. The frequency of postnatal vesico-ureteral reflux associated with prenatal pyelic dilatation warrants complete prenatal ultrasound screening.

Prenatal diagnosis of a subdural hematoma associated with reverse flow in the middle cerebral artery: case report and literature review.

To our knowledge this is the first reported case of a subdural hematoma, related to fetal autoimmune thrombocytopenia, diagnosed prenatally by ultrasound. The underlying etiology was hidden maternal autoimmune thrombocytopenia. This disease, which is as serious as alloimmune thrombocytopenia, causes severe fetal thrombocytopenia, which carries with it a high risk of intracranial hemorrhage and recurrence in subsequent pregnancies. Only 14 cases of fetal subdural hematomas have been reported in the literature. The etiologies of these cases were principally traumatic, or due to disorders of hemostasis. Their prognoses were generally poor, with 50% resulting in fetal death in utero and the remaining 50% demonstrating post-natal sequelae. The presence of reverse flow in the middle cerebral artery is rare and its association with a subdural hematoma unusual. Abnormalities found on cerebral Doppler studies indicate an adaptive response to a fetal condition for which the prognosis is then very poor. Monitoring fetuses at risk for hemorrhage by ultrasound imaging and Doppler studies enables us to detect indicators of a worsening prognosis before the ultrasound appearance of morphological hemorrhage. The development of intracranial hemorrhage raises difficult management issues during the index pregnancy and in subsequent pregnancies.

External cephalic version with epidural anaesthesia after failure of a first trial with beta-mimetics.

OBJECTIVE: To assess the efficacy, tolerance, and cost of external version under epidural anaesthesia and beta-mimetic tocolysis after the failure of an initial attempt with tocolysis alone. DESIGN: Prospective open study. PARTICIPANTS: Sixty-eight women with breech presentation at around 36 weeks of gestation and an attempted external cephalic version under salbutamol that failed, who consented to try a second attempt under epidural anaesthesia. RESULTS: The overall success rate under epidural anaesthesia was 39.7% (27/68), and complications occurred in two cases. The total cost of attempting external version was higher than the cost of expectant management. CONCLUSIONS: The efficacy of external cephalic version under epidural reduces the rate of caesarean sections associated with breech presentation, but its relative safety remains in question. Moreover, our economic analysis discourages the hope of lowered costs suggested by earlier reports that this technique is more expensive than expectant management, except in institutions with a policy of systematic caesarean sections when version fails.