[Persistence and recurrence of in situ cervical adenocarcinoma after primary treatment. About 121 cases]. / Persistance et récidive des adénocarcinomes in situ après traitement: à propos d'une série rétrospective multicentrique de 121 cas.

OBJECTIVE: The aim of this study is to assess the results of conservative management of adenocarcinoma in situ (AIS) of the uterine cervix. PATIENTS AND METHODS: Retrospective multicentric study with 121 cases. Patients with cervical invasive lesions were excluded. General characteristics of population, diagnosis circumstances, treatment, histology and evolution were studied. RESULTS: Conservative treatment was performed in 98.3% of cases with 64% of negative margins. In the positive margins group, 80% of conservative treatments were performed by electrosurgical loop. Length of cone resection is significantly higher for conization with negative margins (p<0.001). The rate of residual lesion was 18% in negative margins group and 46% in positive margins group. Two noninvasive and one invasive recurrence were deplored. DISCUSSION AND CONCLUSION: Conservative surgery for patients with AIS could be considered in young patients but several conditions should be respected: careful follow-up after conservative treatment; cold knife conization; length of cone specimen greater than 25 mm and negative margins.

[Management of in situ cervical adenocarcinoma]. / Prise en charge de l'adénocarcinome in situ du col utérin.

The management of adenocarcinoma in situ of the cervix (ACIS) is difficult because it is often diagnosed in younger women who may wish to preserve their potential of fertility. Conservative treatment has been accepted as an appropriate strategy but interrogations persist as to carcinological safety. We report a complete review of the literature on this subject where conservative attitude appears possible but is associated with recurrence risk (5 to 10%) and invasive disease (2%). Conditions to perform conservative management are: cold knife cone biopsy, negative margins, cone resection of at least 25 mm, realization of endocervical curettage and total patient compliance. In all cases, regular cytological and histological monitoring must be performed. If maintaining reproductive capacity is not desired, hysterectomy is systematically proposed to patient.

Linear association between maternal pre-pregnancy body mass index and risk of caesarean section in term deliveries.

OBJECTIVE: Maternal obesity is a well-known risk factor for caesarean delivery. The aim of this study is to determine whether all the spectrum of pre-pregnancy maternal corpulence (body mass index [BMI]) is associated with the risk of caesarean delivery. DESIGN: Observational study over 4.5 years (2001-05). SETTING: Groupe Hospitalier Sud-Réunion's maternity (island of La Réunion, French overseas department, Indian Ocean). POPULATION: All consecutive singleton live births having delivered at the maternity. METHODS: Data have been analysed according to different risk factors. Maternal corpulence has been defined as the maternal pre-pregnancy weight. BMIs have been studied by multiples of 5 kg/m2 from 10-14.9 kg/m2 to 40-44.9 kg/m2. MAIN OUTCOME MEASURE: Rate of caesarean section. RESULTS: There were 17 462 singleton live births during the period, of which 16 952 (97.1% of the total) pre-pregnancy BMIs have been determined. There is a linear association (chi 2 for linear trend, P < 0.001) between maternal corpulence and risk of caesarean deliveries, the leanest mothers having the best rate of vaginal delivery. This linear association exists in a model controlling for diagnosis of gestational diabetes, term deliveries (> or =37 weeks), very short maternal height (<1.50 m), primiparity and maternal age > or = 35 years (adjusted chi 2, P < 0.001). CONCLUSION: There is a significant linear association between pre-pregnancy maternal corpulence and risk of caesarean deliveries in pregnancies at term. The authors discuss several interpretations including the adaptability of fetal birthweights to maternal corpulence and the concept of soft-tissue dystocia.

[Hematocolpos due to obstructed hemivagina. About three cases]. / Hématocolpos par hémivagin borgne. A propos de trois cas.

Abnormalities of the reproductive tract interest a little more than 1% of the women. The symptoms are not specific: abdominal pain seems like appendicitis, invalidating dysmenorrheas in the girl, urinary manifestations. They should be discovered and treated because they could bring about obstetric complications later. We present three observations, illustrated with a recent review of the literature, and describe the diagnostic difficulties and their surgical treatments.

[Short interpregnancy intervals: risk factors and perinatal outcomes]. / Grossesses rapprochées: facteurs de risque et conséquences périnatales.

OBJECTIVES: To study risk factors and perinatal outcomes in short interpregnancy intervals. MATERIALS AND METHODS: Retrospective study, between 1995 and 2001, comparing women with short interpregnancy intervals (<6 months, n = 192) and women controls (interpregnancy intervals between 18 and 23 months, n = 210). The analysis included demographical and social factors, maternal medical histories and perinatal outcomes for the 2(nd) pregnancy. RESULTS: Risk factors of short interpregnancy intervals were: young age, no anterior contraception, celibacy, medical history of intrauterine fetal death or medical pregnancy termination and high parity and gestity. The patients at risks of short interpregnancy intervals often belong to little supported social background, are generally without profession and often leave against medical opinion. The short interval between pregnancies is associated to a high score of prematurity (19% vs 8%, OR = 2.8, p < 0.001). CONCLUSION: These data suggest that obstetricians and other care providers need to be alert to these identifiable risk factors and then direct preventive strategies during and after pregnancy.

[Acute fatty liver of pregnancy: a rare pathology of the third trimester]. / Stéatose hépatique aiguë gravidique: une pathologie rare du troisième trimestre de grossesse.

Acute fatty liver of pregnancy is a rare clinical syndrome of pregnancy that occurs during the third trimester. Clinicians must have a high index of suspicion for this condition when a woman has nausea or vomiting during the last trimester. Early diagnosis and prompt delivery improve foetal and maternal prognosis. We report a case of a previously healthy 23-year-old woman who presented an acute fatty liver of pregnancy with intrauterine fetal death. Based on this experience as well as on medical literature, characteristics of this uncommon pathology are discussed.

[Obstetrical risk factors of 365 primiparous adolescent pregnancies in Reunion Island]. / Etude des facteurs de risques obstétricaux dans le suivi de 365 grossesses primipares adolescentes à l'île de la Réunion.

OBJECTIVES: Analysis of obstetrical risk factors in teenage primiparous pregnancies in Reunion Island (4% of total births). MATERIALS AND METHODS: Retrospective study, between 2001 and 2002, comparing primiparous adolescents (13-17 years, n = 365), with primiparous controls (18-29 years, n = 2050). The analysis included demographical factors, maternal medical histories, prenatal follow-up, obstetrical risk factors, delivery modes and neonatal characteristics. RESULTS: Adolescents attended on average 8 prenatal consultations, however 4% had poor prenatal care (less than 3 visits, OR 4.2, P < 0.001 vs controls). They presented less gestational diabetes, but there were no differences concerning pre-existing hypertension, hypertensive disorders of pregnancy, medical reasons of hospitalisation between the two groups. Mode of delivery was more favorable in adolescents (half rate of caesarean sections, shorter duration of membrane ruptures). Nevertheless, adolescents presented a higher risk of severe prematurity (<32 Weeks gestation, incidence 3.6% vs 1.6%, OR 2.3, p = 0.008). CONCLUSION: With optimal prenatal care (more than 90% of our cohort), primiparous adolescents present globally a favorable course of their pregnancies and have better deliveries than their young (18-29 years) counterparts. However, there is a significant risk of severe prematurity requiring special care for these pregnancies.

[Endometriosis with ascites and pleural effusion: a case report]. / Endométriose avec ascite et épanchement pleural: à propos d'un cas.

Massive ascites associated with pelvic endometriosis is an uncommon combination. Pleural effusion may rarely occur. Fourteen cases are reported in the literature. We report the case of a black nulligravida woman followed for a primary infertility. Endometriosis was suspected in presence of increasing dysmenorrhea, cystic adnexal masse, umbilical nodes and ascites. The diagnosis was confirmed at exploratory laparoscopy. The patient had been followed for assisted procreation for six years and had undergone a conservative laparoscopic surgery never described. After several ascites recurrences, the pathology was resolved by Gonadotropin-releasing hormone agonist therapy. But a right pleural effusion with ascites occurred following a bad therapeutic observance. This complication reveals an early pregnancy never reported for this exceptional pathology. A conservative management allowed this unique case of well outcoming pregnancy. The possible pathogenesis of ascites and pleural effusion are explored and recommendations for diagnosis and treatment options are discussed.

[Sacrococcygeal teratomas: is there a place for in utero treatment of complicated forms? About three cases]. / Y a-t-il une place pour le traitement in utero des formes compliquées? A propos de trois cas.

The majority of sacrococcygeal teratomas diagnosed before birth can be managed by planned delivery and postnatal surgery. However, large tumors early in gestation may result in placentomegaly, hydrops and fetal death and a preeclampsia-like syndrome in the mother. This is due to high output cardiac failure in the fetus caused by arteriovenous shunting through the tumor. In these cases, in utero treatment may offer improved chances of survival, and emerging technologies should lower fetal and maternal morbidity. Nevertheless, these therapeutics need to be correctly evaluated.

[Isolated torsion of the Fallopian tube in a 15-year old adolescent. About one case]. / Torsion tubaire isolée chez une adolescente de 15 ans. A propos d'un cas.

Isolated torsion of the Fallopian tube is an uncommon event. Surgery is often necessary to establish the diagnosis. This report focuses on a 15-year old female who presented with acute pelvic pain. Pelvic ultrasound showed an adnexal mass. The laparoscopy performed confirmed the diagnosis of isolated tubal torsion. Based on this experience as well as on other similar reported cases, characteristics of isolated torsion of the Fallopian tube are discussed. This pathology should be considered in the differential diagnosis of acute pelvic pain in the female patient. Prompt surgical intervention may allow for preservation of the tube.