[Fatal amniotic fluid embolism. Extraction by Caesarean section of a living child without neurological after-effects]. / Embolie de liquide amniotique rapidement fatale. Extraction par césarienne d'un enfant vivant sans séquelles neurologiques.

The authors report on the case of an amniotic fluid embolism, proven by post mortem, which was the result of an inaugural and irreversible cardiac arrest in a 37-year-old woman at 39 weeks of normal pregnancy. The Caesarean section was carried out as an extreme emergency in the labour room, while efforts were being made to resuscitate the mother, so as to deliver a living newborn without any neurological after-effects. The haemostatic consequences were showed up only on blood tests.

[Simultaneous pregnancy in each cavity of a bicornuate bicervical uterus with a double vagina]. / Grossesse simultanée dans chaque cavité d'un utérus bicorne bicervical avec vagin double.

A case of twin pregnancy in a bicervical uterus with double vagina is reported. The malformation was known before conception. Caesarean section was performed for premature rupture of the membranes at 34 weeks. This enabled the extraction of two low-birth-weight premature infants free of any particular pathology. The possibility of twin pregnancy in a bicervical bicornuate uterus is 1/1,000,000 and implies the maturation of at least two oocytes. This is a high risk pregnancy. Spontaneous abortions, prematurity (40%), low-birth-weight (25%) are the most notable complications. Although the probability of dynamic dystocia is multiplied by 7, vaginal delivery is not excluded when the obstetric past history is satisfactory and the presentation of both twins cephalic. Caesarean involves hysterotomy of each horn and raises no special technical problems. Double delivery increases the risk of hemorrhage.

[Another case of Sertoli-Leydig cell ovarian tumor (arrhenoblastoma). Review of the literature]. / Un nouveau cas de tumeur ovarienne à cellules de Sertoli-Leydig (arrhénoblastome). Revue de la littérature.

In reporting another case of Sertoli-Leydig cell tumor (SLCT) treated by conservative management, the principal characteristics of these tumors are reviewed and a general review is made: SLCT (arrhenoblastomas) are rare endocrine tumors (1 p. cent of tumors of the ovary). They most frequently occur in young women, are unilateral in 98 p cent of cases, and are manifest after a long period by endocrine signs (75 p. cent of cases) whose most frequent combination is: amenorrhea-hirsutism-hoarse voice. They are classified in four histological types which have different prognoses. Their potential development varies and is variously assessed: these are tumors with a low incidence of malignancy (mean 18 p. cent). Under certain conditions, this permits the institution of conservative therapy conserving future fertility. Malignant types of tumors are treated in the same way as other malignant ovarian tumors: surgery is the main tool; radiotherapy is often insufficient and chemotherapy often provides remission more frequently than cure (80 p. cent 5 year survival).

[Positive HIV (human immunodeficiency virus) serology in the pregnant woman: current data on its management. Apropos of a continuous series of 56 cases]. / Sérologie VIH (virus immunodéficient humain) positive chez la femme enceinte: données actuelles sur la conduite à tenir. A propos d'une série continue de 56 cas.

56 cases of pregnant women with a positive HIV serology were reported in 20 months at the Maternity of the Nice Hospital Center. In 10 cases, there were clinical signs of the disease (9 ARC-Syndrome, one case of AIDS). The predisposing factor was most of the time drug addiction, 53 cases (94.5%) and one case occurred after a blood transfusion. In the majority of the cases (52%) the pregnancy was pursued because of the late term or the patient's decision. A therapeutic abortion was performed in 12 instances (25%) and an interruption before 12 weeks of amenorrhea in 15 cases. 24 women delivered. The obstetrical complications were frequent with especially a fetal death in utero, five premature deliveries and fifteen hypotrophies. A severe infectious complication (septicemia, pneumopathy secondary to Pneumocystis carinii) was observed in 9 cases, a marked thrombopenia causing profuse post-partum haemorrhages in one case. Finally, one woman died 35 days after delivery. The study of the consequences on the child is incomplete because of insufficient follow-up: all children were sero-positive at birth and among thirteen children aged between 12 to 20 months, there were one death, one AIDS syndrome, 4 ARC-syndrome, 4 sero-positive and 3 sero-negative. The notion of HIV sero-positivity in a pregnant woman presents serious problems for the obstetrician. Decompensation of the disease during the pregnancy is uncertain but it is now confirmed that the child is affected, and this is a well established fact. These important consequences lead to propose, at this time a therapeutic interruption of pregnancy when possible, depending on the term, and when accepted by the patient.

[Value of ultrasonics in acute pelvic infections]. / Intérêt de l'échographie dans les infections pelviennes aiguës.

Sonograms performed in 228 women admitted for acute pelvic infection has enabled to find a normal image in 39.9% of the cases. In order of frequency, the abnormalities include: endometrial alterations (31.1%), one (or several) pelvic masses (25.9%) and a collection in the Douglas cul-de-sac (22.8%). The main advantage of the examination in the acute phase is the diagnosis and the study of the mass structure: most of the time, it concerns a "mixed" or heterogeneous aspect, for all of the images of a mass, as well as for images corresponding to a tubo-adnexal collection. The major critic of this examination is the lack of specificity of the images which are very diversified. The risk of confusion with another pathology (gynecological or, exceptionally gastro-intestinal) must be decreased with an examination of good quality and comparison with the clinical context. The presumption of a tubo-adnexal collection cannot, in most cases, be established with certainty. However, the Echography guides the diagnosis by showing an anechogenous image or a particular aspect (Douglas abscess, huge septated images of sequelae) and remains more reliable than clinic to detect the mass (44% of false negative, clinically) and follow the evolution of the disease. The therapeutic advantage is also mentioned, but the tap of an abscess under sonogram guidance is seldom performed.

[Human immunodeficiency virus (HIV), thrombopenia and pregnancy]. / Virus de l'immunodéficience humaine (V.I.H.), thrombopénie et grossesse.

Three cases of thrombocytopenia in pregnant women are described. Two of these patients had an AIDS-like illness and the third one had AIDS. This HIV-associated change occurred in 8% of the complications of a consecutive series of 38 pregnant women who were positive for the HIV antibody test in the course of one year. A link with HIV was established after eliminating idiopathic pregnancy thrombocytopenic purpura and after eliminating every other viral cause for the thrombocytopenia. The normal myelogram speaks in favour of a peripheral origin for the platelet destruction. Treatment consisted in administering immunoglobulins intravenously in a continuous transfusion in doses of 0.04 g/kg per day. The method was effective in two cases. Three cesareans were carried out. In two cases the recovery was uncomplicated and in the third case the haemorrhagic syndrome developed immediately after delivery. This patient died 35 days after delivery. Fetal scalp blood or fetal cord blood could not be taken in any of these three cases. The newborn did not have thrombocytopenia at birth, but they did have anti-IVF antibodies and one of them developed and AIDS-like syndrome. The time interval has not been long enough to assess the further development in the two other cases. The survivors are being followed up with a threefold assessment of the blood picture, the immunological state and the virology. This is being done on the two surviving mothers and the three infants.