[X-ray pelvimetry practice survey in Northeast French maternities]. / Enquête sur la pratique de la radiopelvimétrie dans les maternités de l'inter-région Nord-Est.

OBJECTIVE: To describe and compare the indications and modalities of X-ray pelvimetry in obstetrical practice in the Northeast French maternities. MATERIALS AND METHODS: An anonymous questionnaire was sent to the heads of obstetric departments in the Northeast French maternities. The questionnaire was built around four issues: description of the hospital characteristics, assessment of the obstetrical prognosis (modalities of delivery), indications and modalities of X-ray pelvimetry. RESULTS: The response rate was 47%. The evaluation of the obstetrical prognosis was performed in 77% of maternities. Indications were: breech presentation (86%), suspicion of fetal-pelvic disproportion (78%), mother size lesser than 150cm (64%) and previous caesarean section (42%). Pelvic computed tomography was performed in the majority of the maternities (94%), between 35 and 37 weeks of amenorrhea (47%). Level III maternities and maternities with more than 2000 deliveries per year seemed to observe fewer indications than other maternities, but these indications were still globally excessive, comparing with the Collège national des gynécologues et obstétriciens français' recommendations. CONCLUSION: These results should lead professionals to develop an assessment of their practices about the indications of X-ray pelvimetry.

[Materno-fetal morbidity of instrumental deliveries: forceps versus spatulas. About a series of 77 cases]. / Morbidité materno-fœtale des extractions instrumentales : forceps versus spatules. À propos d'une série de 77 cas.

OBJECTIVE: To compare the early feto-maternal morbidity after assisted vaginal delivery using forceps versus spatulas. PATIENTS AND METHODS: It is a retrospective comparative study conducted in a third level maternity carrying on cephalic instrumental non premature deliveries by forceps or spatulas, on singleton pregnancies. Forty assisted vaginal deliveries using forceps and 40 others using spatulas were registered, over a period of 4.5 months. Feto-maternal lesions were analyzed. RESULTS: Characteristics of the population of forceps and spatulas groups were alike (Body Mass Index: 25.9 versus 26.7kg/m(2), P=0.79; parity: 0.6 versus 0.4, P=0.20; fetal weight: 3306g versus 3295g, P=0.91). The characteristics of labor were also similar, except for the left transverse fetal position more important in spatulas group (10.8% - 4/37 - versus 0%; P=0.03). More fetus had no lesion in the spatulas group (85.7% - 30/35 - versus 60.5% - 23/38), P=0.02). The episiotomy rate was higher in the forceps group: 32/40 (80.0%) versus 13/37 (35.1%); P=0.0001. DISCUSSION AND CONCLUSION: These results are similar to those from the literature, which evoke a fetal protection by spatulas. However, this is biased by the fact that the two instruments are not always used in the same conditions. Besides, spatulas do not appear to be more deleterious to maternal perinea. Therefore, perpetuation and teaching the use of these two instruments seem essential.

[Post-rape pregnancy]. / La grossesse après viol.

A rape is a traumatizing circumstance for the victim. This aggression often has, regrettably, immediate repercussions, and then medium and long-term ones. Its complications are psychological, but also sometimes somatic, like pregnancy. Through an international literature review, and the study of the national legislation, we will summarize the main essential elements of the medical and forensic care of a pregnancy arising after a rape.

[Mastocytosis and pregnancy]. / Mastocytoses et grossesse.

Mastocytosis is a rare disorder characterized by an accumulation of mastocytes in cutaneous and visceral tissues. In the presence of stimuli such as stress, pain, drug administration and cutaneous compression, it can ultimately lead to cardiovascular collapse. In women with mastocytosis, pregnancy monitoring and pain management in the peripartum period can be challenging and should involve a multidisciplinary approach. In this article, we discuss our ante partum care and intra partum management, as illustrated by three recent cases.

[Conservative management of a percreta placenta involving the omentum]. / Prise en charge conservatrice d'un placenta percreta impliquant l'épiploon.

We present the case of a percreta placenta involving the omentum, occurring in a patient with two uterine scars, diagnosed by chance during a scheduled caesarian. A conservative management of the uterus but radical for the placenta was made possible because of the invasion of the free edge of the omentum, not described in the literature until then. The postoperative course was uneventful. The question of the antanatal diagnosis and of the management of this potentially serious pathology is discussed in front of the international literature.

[Contribution of robot-assisted surgery in the management of female infertility]. / Apport de la chirurgie robot-assistée dans la prise en charge de l'infertilité féminine.

Although considerable progresses were made in the field of medically assisted procreation, surgery keeps its place in the therapeutic armamentarium of female infertility. Indeed, its results are very interesting, both in its tubal, myometrial and endometriosis indications. Laparotomy is the first step in the development of any surgical technique. Laparoscopy brings benefits concerning recovery, but also in terms of fertility because of the reduction of postoperative adhesions. Nevertheless, comfort of the surgeon, so the ease of skills, are often altered, especially for complex operations such as those implicated in infertility treatment. Robot-assistance takes here all its interest. It allows indeed a quality in the realization of precise and complex skills, and results at least as interesting as standard laparoscopy can be provided. An overview of robot-assistance in surgery of female infertility is here presented. A review of world literature furnished multiple studies evaluating the tubal robotic surgery, and demonstrating its interesting results. Other indications could, according to us, emerge and be evaluated in this area, such as myomectomy and endometriosis surgery.

Pelvic arterial ligations for severe post-partum hemorrhage. Indications and techniques.

In cases of serious bleeding postpartum, resuscitation and surgical techniques are complementary and should be adapted to both the etiology and severity of bleeding. In extremely severe cases, the performance of a hysterectomy should not be delayed. For women with stable hemodynamic status, so-called "conservative" surgical techniques can instead be used. In this study, we describe and discuss the indications and feasibility of various techniques of vascular ligation. Uterine mattress suture compression techniques and abdomino-pelvic packing are also described. When conservative management is feasible, the first line approach should be bilateral distal ligation of the uterine arteries: this simple and low-risk technique is immediately effective in 80% of cases. If bleeding persists, uterine devascularization can be completed by a triple ligation as described by Tsirulnikov, with or without supplemental proximal ligation of the uterine arteries. This procedure should be performed in preference to the so-called "stepwise ligation sequence", which involves ligation of the ovarian pedicles and poses a risk of subsequent ovarian failure. Bilateral hypogastric artery ligation is also an effective and widely used first-line technique for experienced surgeons. This approach is technically challenging for less-experienced surgeons and is reserved for cases of failed triple ligation.

[Review: Repetitive hydatidiform moles]. / Review : les môles hydatiformes à répétition.

Repetitive moles are rare. They are either sporadic or familial, with or without consanguinity. Some of them can be explained by a NLRP7 mutation, which causes genomic parental imprinting alteration, with a preferential paternal phenotypic expression. Currently, no effective therapeutic solution has been developed. Among the 1687 patients declared to the French Trophoblastic Disease Reference Center, 13 presented at least two hydatidiform moles, thus less than 1% of the patients. A mutation of the NLRP7 gene was shown in six of 12 tested patients (50%) among whom three presented a homozygous mutation and three a heterozygous mutation. For an affected patient, type of mole can indifferently be a complete hydatidiform mole or a partial hydatidiform mole. We describe these cases and compare them to those already published.

[Anticholinergic drugs in overactive bladder]. / Anticholinergiques et syndrome d'hyperactivité vésicale.

The overactive bladder syndrome (OAB) associates urgency, frequency, nycturia, more or less associated with urinary incontinence. Its frequency is between 16 to 45 %, in the general population; the number of affected people in the USA being estimated at 34 million. Symptomatology is primarily marked by the abrupt, irrepressible need to urinate, impossible to defer, but also by a diurnal and night high mictional frequency. This OAB is more frequent when patients age increases, and affects indifferently men and women. The OAB induces a known negative impact on the quality of life and can lead to depression, sexual disorders, sleep disorders and a professional absenteism. The OAB medical treatment is actively concerned by the research since the discovery of oxybutinine. Tolterodin, solifenacin, darifenacin, trospium chloride supplement the therapeutic arsenal. New formulations (immediate and extended releases), new administration mediums (intravesical, transdermic, vaginal, rectal), new active ingredients (botulinic toxin, capsaicine, resiniferatoxine) are currently tested. The therapeutic options multiply, aiming at reducing to the maximum symptomatology, as well as the induced side effects.