[Termination of pregnancy and placenta previa, interest of performing feticide before the labor induction?]. / Interruption médicale de grossesse et placenta praevia, intérêt d'un fœticide précoce?

OBJECTIVES: Study of maternal morbidity when termination of pregnancy (TOP) is associated with placenta previa and study of the interest of performing feticide before labor induction. PATIENTS AND METHODS: This is a retrospective case control study with two groups of matched women: the case group (women with placenta previa) and the control group (women without placenta previa). Maternal morbidity have been studied and compared between the two groups and in the case group, between women who had feticide between labor induction and women who did not have feticide. RESULTS: Between 1996 and 2009, we identified 15 cases of TOP with placenta previa (seven complete placentas previa and eight low lying placenta including partial and marginal placenta previa) who have been matched with 29 women. In the case group, eight women had feticide before labor induction, six women had no feticide and one woman had feticide the same day of labor induction. Maternal morbidity was increased in this group but without major complications (four hemorrhages during labor, two postpartum hemorrhages, four transfused patients and mean difference of hemoglobin level was 1.5 g/dl in the case group versus no hemorrhage during labor, no postpartum hemorrhage, no transfusion and mean difference of hemoglobin level was 0.5 g/dl in the control group; P<0.005). Performing feticide before labor induction allowed a non-significant reduction of mean loss of hemoglobin and of the number of women who needed transfusions. CONCLUSION: A vaginal delivery in cases of TOP with placenta previa and even totally recovering seems a reasonable solution; performing feticide before labor induction could decrease loss of blood but further studies are needed.

[Aneurysm of the pancreatico-duodenal artery]. / Anévrisme des artères pancréatico-duodénales.

The mean age is 50. Symptoms include acute abdominal pain, hypotensive shock, GI bleeding, biliary colic, jaundice, and/or acute anemia. Less often, pancreatico-duodenal aneurysms may be fortuitously diagnosed by abdominal imaging. Rupture of a PDAA is a grave complication with high mortality and demands urgent intervention. Arterial embolization is the treatment of choice; surgical intervention should be reserved for failures of embolization. We report a case of PDAA successfully treated by arterial embolization but which posed problems in both diagnosis and treatment.