[Obstetric vesicovaginal fistulas, about 131 cases]. / Les Fistules Vésico-Vaginales D'origine Obstétricale. A propos de 131 cas.

BACKGROUND: Vesicovaginal fistulas are the most frequent type of urogenital fistulas. Obstetrical cause remains the dominant etiology. They still represent a public health problem. Aim : to study epidemiological aspects of obstetric vesico-vaginal fistulas and their management. METHODS: a retrospective multicentric study among 19 hospital departments from February 1982 to January 2007. RESULTS: 131 VVF (92% of urogenital fistulas). The vaginal route for surgical repair was used in 2/3 cases. The mean diameter of the fistula was 11.35 mm. In 122 cases (86.5%), the fistula was unique. IVU findings were normal in 83% cases. All patients had normal renal function apart one who had acute renal failure. 177 interventions were performed (1.37 intervention per patient). CONCLUSION: Our findings suggest a regression in obstetrical VVF. However many efforts on institutional, socioeconomic and obstetrical levels have to be done in order to eradicate this pathology that is of major handicap for women regarding socioeconomic, functional and psychological effects.

[Tubo-ovarian actinomycosis. A report of two cases and literature review]. / L'actinomycose tubo-ovarienne. A propos de deux cas et revue de la littérature.

Actinomycosis is an infection due to an anaerobic Gram-positive bacilus bacteria: Actinomyces. Tubo-ovarian locallisation is rare. It more often appears clinically as a pseudo-tumoral and feverish syndrom, evoking wrongly a malignant tumoral pathology, and often leads to a mutilating surgical treatment. Intra-uterine device appears as the principal favorable factor of this pathology. Basing on two cases reported by the authors, and after literature review, physiopathology, clinical and paraclinical expression, and treatment of this affection are discussed. A set up is made.

[Prune belly syndrome: early prenatal diagnosis and management]. / Le syndrome de prune belly. Diagnostic anténatal précoce et prise en charge.

Prune Belly syndrome is characterized by a combination of megacystis, anterior abdominal wall distension with deficiency of the abdominal wall musculature, and bilateral cryptorchidism. Diagnosis is easy after 15 weeks of gestation, but may be difficult at the end of the first term. Authors report 2 cases of Prune Belly syndrome diagnosed at 11 and 14 weeks of gestation respectively. After literature review, diagnosis and prognosis particularities of this syndrome are discussed.

[Indicators for successful vaginal delivery after cesarean section: a proposal of a predictive score]. / Les indicateurs de succes de l'accouchement par voie basse sur uterus cicatriciel: proposition d'un score predictif.

The purpose of this study is to determine predictive factors of successful vaginal delivery after cesarean section, and to estimate the risks of this trial of labor (TOL). A retrospective study about 352 women undergoing a TOL after cesarean section was carried out. Different variables stratified by the termination of the TOL were analysed with statistic tests. TOL success rate was 76.1%. Parity > or = 3. prior vaginal delivery following cesarean section, body mass index < 30, fundal height < 34 cm, and low fetal head level at the beginning of labor increased significantly the probability of success. Uterine rupture rate is 1.1%. Failure of TOL was associated with a higher risk of uterine scar dehiscence and rupture, and higher fetal morbidity. A predictive score of successful vaginal delivery after cesarean section is proposed.

[Blind hemivagina: diagnostic method and problems of treatment]. / L'hemivagin borgne: methode diagnostique et problemes therapeutiques.

Blind hemivagina with duplex uterus and agenesis of the homolateral urinary tract is a rare malformation. For this reason, diagnosis may be not found. We report one case of duplex uterus with blind hemivagina in a fourteen-year-old adolescent girl. From this case, clinical signs, principal diagnosis criteria, complications and treatment are discussed, transvaginal resection of the hemivaginal septus is the best method of treatment but resulting hymeneal rupture may constitute a real problem of treatment in some social environments. So we propose to evaluate endoscopic septotomy.

[The delivery of macrosomic infants weighing 4500 g and more. A report of 61 cases]. / L'accouchement du macrosome de 4500 g et plus. A propos de 61 cas.

UNLABELLED: The objective of this study is to review the difficulties in prediction of great macrosomia, to assess trial of labor results, and to confirm the increased risk of perinatal complications. MATERIAL AND METHOD: in this retrospective study we analyzed 61 deliveries of infants with birth weights > 4500 g in one year period. This group was compared with a group of infants weighing between 4000 and 4500 g (339 cases) born during the same period. Elective cesarean delivery was performed for 3 cases of the second group because of overestimation of fetal weight. 38 cases of the first group (62.3%) were delivered vaginally after underestimation of fetal weight. Incidence of shoulder dystocia in vaginal delivery was 13.5% in the first group and 5.32% in the second one, but difference was not statistically significant (p = 0.07). Difference between incidence of hypoglycemia in the first group (18.03%) and in the second one (2.06%) was highly significant (p = 0.00006) There is no reliable method for prediction of fetal weight > than 4500 g. With literature review, we confirm the increased risk of shoulder dystocia, birth asphyxia and hypoglycemia for these infants. So, we believe that cesarean delivery is justified in all cases of fetal weight estimation > 4500g.

[Sonographic estimation of fetal weight at term: a proposal of a predictive score of a weight more than 4500 g]. / L'estimation echographique du poids foetal a terme: proposition d'un score predictif d'un poids supérieur à 4500 g.

UNLABELLED: Estimation of fetal weight at term is essential because of risks of macrosomic infant delivery. The purpose of this study is to assess sonographic prediction of macrosomia and especially in fetal weight (o) > 4500 g. MATERIAL AND METHOD: In a retrospective study on one year period, we analyzed sonography of 214 pregnant women at term having delivered macrosomic infants. From sensitivity, specificity and VPP found for each fetal measurement (abdominal transverse diameter: ATD, femur length: FL, and biparietal diameter :BPD) we tried to determine the best thresholds values that permit to suspect fetal weight more than 4500 g. RESULTS: Sensitivity of ATD (o) > 100 mm, FL (o) > 76 mm and BPD (o) > 94 mm in prediction of macrosomia were: 70.5%, 56% and 58.9% respectively. The most reliable and predictive thresholds for macrosomia more than 4500 g were: 105 mm, 78 mm and 98 mm respectively for ATD, FL and BPD. In an other study, we have found that fundal height (o) > 37 cm is also predictive of such a macrosomia. So we have proposed a predictive score of fetal weight more than 4500 g, based on the best thresholds found for fundal height, ATD, FL and BPD.

[Clinical fetal weight estimation and prediction of macrosomia]. / Estimation clinique du poids foetal: interet dans la prediction de la macrosomie.

The purpose of this study is to assess symphysis fundal height measurement in prediction of fetal macrosomia and to search for the error causes. A retrospective study concerning 400 macrosomic newborns was performed. For each pregnant woman before delivery, we have reviewed fundal height, weight, height and newborn weight. Influence of obesity and maternal height were especially studied. Fundal height measurement is not reliable in prediction of fetal macrosomia. Patient body mass and height may be error causes.

[Peripartum pubic symphysis separation. A report of three cases and review of the literature]. / La disjonction symphysaire du peripartum. A propos de trois cas et revue de la littérature.

Peripartum pubic symphysis separation is a rare complication of delivery, but the incidence seems to be under-estimated. We report three cases of pubic syphysis separation identified in a two-year period. All cases occurred following spontaneous non operative vaginal deliveries. The underlying etiology and pathophysiology has not been fully elucidated. Thus, prevention is difficult. Conservative therapy usually results in a complete recovery within many weeks.

[Ovarian pregnancy: the situation in 2003. A report of four cases and literature review]. / La grossesse ovarienne: le point en 2003. A propos de 4 cas et revue de la littérature.

Ovarian pregnancy remains a rare form of extracitérine pregnancy. It's incidence is estimated at 1 to 6% of ectopic pregnancies. We report 4 cases of ovarian pregnancies diagnosed at the obstetric and gynecology department of Nabeul Hôspital (Tunisia) during a 4 year period. An update on ovarian pregnancy based on these 4 cases and a literature review is provided. In contrast to tubal pregnancy, ovarian pregnancy occurs as a single event in an otherwise healthy woman. There is no specific clinical, laboratory test or ultrasonographic signs for differentiating ovarian from tubal pregnancy. At laparoscopy, it frequently suggest haemorrhage from the corpus luteum or a rupture of ovarian cyst. Histology is the only means of establishing the diagnosés. Ovarian pregnancy rupture is often more dangerous than tubal pregnancy, but conservative treatment is often possible. Recurrency is exceptional and future fertility usually is unmodified.

Molecular spectrum of alpha-thalassemia in Tunisia: epidemiology and detection at birth.

We present the characterization of the molecular spectrum and frequency data of alpha-thal (thal) defects in Tunisia, and an evaluation of the efficacy and limitations of Hb Bart's (gamma4) measurement for the screening of alpha-thal at birth. Cord blood samples were collected from two different areas: the northeast of the country, an area where Hb H (beta4) disease frequently occurs, and Tunis, the capital city, representative of the average Tunisian population. From the first group, 110 samples with Hb Bart's and/or microcytosis at birth were selected from 1270 randomly collected samples. Two additional population samples, one from the same northeastern region (n = 90), the other from Tunis (n = 104) were collected randomly. Nine common deletional alpha-thal defects and nondeletional mutations were screened. In the northeastern samples, selected for the presence of Hb Bart's and microcytosis, the -alpha3.7 deletion was the most common defect (4.5% allele frequency) followed by a polyadenylation (poly A) signal mutation (1.8%), the five nucleotide (nt) deletion and the -alpha4.2 deletion (both 0.9%). The African polymorphism (G-->TCGGCCC at position 7238 and T-->G at 7174) was found with an allele frequency of 11% in the selected northeastern samples. In the random population samples, the overall alpha-thal allele frequency was 4% in the northeast region, against 2% in the average Tunisian population. The +14 (G-->C) polymorphism in the 5'UTR (untranslated region) of the alpha2 gene and the African polymorphism in the second intron of the same gene, were found in 3.5% of the alleles. No alpha0-thal alleles were found among the 304 blood samples studied at the DNA level during this survey.