[Diagnosis and management of uterine perforations after intrauterine device insertion: a report of 11 cases]. / Diagnostic et prise en charge des perforations utérines par dispositif intra-utérin: à partir de 11 cas.

OBJECTIVE: Intrauterine device insertion is common. It is however not harmless and uterine perforation can be serious. PATIENTS AND METHODS: Eleven cases of uterine perforation after intrauterine device insertion were listed at Tourcoing hospital between 2005 and 2009. They were analyzed to identify risk factors of uterine perforation and specify management. RESULTS: The main symptom was pelvic pain (4 cases), pregnancy occurrence (3 cases) or inability to remove the IUD (2 cases). The intrauterine device was set during the first 9 months of post-partum in 7 cases, 2 patients were still breastfeeding. Seven patients underwent laparoscopy, 2 needed switch for laparotomy, one was treated by laparotomy only and one was lost of follow-up. DISCUSSION AND CONCLUSION: Incidence of uterine perforation after IUD insertion ranges from 0,1 to 3/1000. Pelvic pain is the most revealing symptom. Fifteen percent of perforations complicate with adjacent organ lesion. Perforation incidence seems greater if the intrauterine device is set during the 6 first weeks of post-partum and breastfeeding, but non influenced by operator practical experience. Ultrasound follow-up of patients carrying intrauterine device is controversial. Facing a suspicion of ectopic intrauterine device, pelvic ultrasound examination is the first step imaging modality and using 3D could be useful. If it fails to localize the intrauterine device, an abdominal X-ray must be performed. Ectopic intrauterine device removal is recommended.

[Contribution of ultrasonography to the diagnosis of non-hormonal acquired clitoromegalia: a case report]. / Place de l'échographie dans le diagnostic des clitoromégalies acquises non hormonales: à partir d'un cas.

We report the case of a 30-year-old woman, consulting for a painful clitoromegaly which developed progressively and rapidly. The gyneco-endocrinological assessment ruled out hyperandrogenism. Ultrasound examination of the clitoris revealed the presence of a clitoral cyst. Acquired clitoromegaly is a symptom which occurs in severe hyperandrogenism. Other organic etiologies include clitoral cysts of various nature and solid tumors. An ultrasonographic examination should be included in the diagnostic work-up for acquired clitoromegaly.

Pregnancy induced hypertension in women with gestational carbohydrate intolerance: the diagest study.

OBJECTIVE: To determine the relationship between pregnancy induced hypertension (PIH) and gestational glucose intolerance. METHODS: A 50g, 1h glucose loading test was offered to all pregnant women between 24 and 28 weeks of gestation in 15 centres in northern France during 8 months in 1992. If the test was positive (> or =7.2 mmol/l), the woman underwent a 3h oral glucose tolerance test (OGTT) as soon as possible. Using the criteria of Carpenter and Coustan, gestational diabetes mellitus (GDM) was defined by two abnormal values (n=218) and gestational mild hyperglycemia (GMH) by one abnormal value (n=130). Each control group was defined by a 50g, 1h loading test result of <7.2 mmol/l (n=108).PIH included gestational hypertension (GH) and preeclampsia (PE). GH was defined as a diastolic pressure of more than 85 mmHg on at least two occasions arising during pregnancy. PE was defined as GH with proteinuria > or =500 mg/24h. RESULTS: The rate of PIH in the three groups (GDM; GMH and control group, C) was, respectively 17.0, 10.8, and 4.6%. All the six PE occurred in the GDM group. Univariate analysis showed significantly higher rate of hypertension in women with a history of PE, increasing body mass index before pregnancy (BMI) and glucose intolerance. In multivariate analysis with adjustment for primiparity, independent risk factors for PIH were a history of PE, BMI>27 and GDM, contrary to GMH and maternal age. CONCLUSIONS: PIH appears to be linked to the level of glucose intolerance during pregnancy, independently of other known factors of hypertension.

Gestational diabetes mellitus and HLA class II (-DQ, -DR) association: The Digest Study.

Gestational diabetes mellitus (GDM) and impaired glucose tolerance during pregnancy (IGT) are associated with an increased risk of perinatal morbidity and then further development of diabetes among 30-50% of affected women. This is a real public health problem that deserves investigation of phenotypic and genotypic predisposing markers. However, the involvement of genetic background in GDM and IGT remains unclear. In particular, association with HLA class II polymorphism has been poorly studied and has produced conflicting results. In attempt to clarify these discrepancies, we investigated HLA class II polymorphism in 95 GDM and 95 IGT women from the north of France using DNA amplification followed by restriction enzyme digestion (PCR-RFLP). Ninety-five pregnant women with normal glucose tolerance (NGT) were chosen as a control reference group. The distribution of HLA class II polymorphism was not found to be significantly different between GDM, IGT and NGT samples. In particular, we did not find any significant variation of DRB1*03 and DRB1*04 allele frequencies between these three groups. These data provide further evidence that insulin-dependent diabetes mellitus (IDDM) HLA class II susceptibility alleles cannot serve as genetic markers for susceptibility to glucose intolerance during pregnancy. However, GDM and IGT were not equivalent to the NGT control group and presented particular HLA patterns. In particular, we observed an increase of the DRB1*0701-DQA1*0201-DQB1*02 haplotype in GDM women (P = 0.02; Pc not significant) and an increase of DRB1*0101-DQA1*0101-DQB1*0501 and DRB1*1302-DQA1*0102-DQB1*0604 haplotypes in the IGT group (P = 0.02 and 8 x 10(-3), respectively; Pc not significant). In contrast, we found a decrease in the DRB1*1101 allele in IGT samples (P = 0.03; Pc not significant) and a decrease of DRB1*1103-*1104 alleles in the GDM group (P = 9 x 10(-3); Pc not significant). Although these findings are only descriptive, it points out the genetic heterogeneity of glucose intolerance during pregnancy.

[Malaria and pregnancy. Therapeutic problems, a case report]. / Paludisme et grossesse. Problèmes thérapeutiques, à propos d'un cas.

Malaria is an old but still current parasitosis. Transmitted by the bite of the female anopheles, it can be revealed by more or less serious symptoms according to the species of Plasmodium. Plasmodium falciparum is responsible for the serious forms. It is the most frequent species, resistant to 4 amino-quinolein and sulfamides in some areas. P. vivax and P. ovale, usually harmless, are not so widely geographically spread as P. falciparum; and apparently are not drug resistant but they expose patients to the risk of relapses. During pregnancy, the choice of a curative and prophylactic therapy must take into account the supposed or confirmed species, the place of the stay and the duration of the exposure. On this case the authors call to mind the epidemiological criteria necessary for early diagnosis, the antimalarial drugs that can be used in pregnant women and draw attention to immuno-allergic and the classical secondary effects of quinine, which can also occur with chloroquine.

[Problem in echographic diagnosis: intrauterine pseudo-sac]. / Une difficulté de diagnostic échographique: le pseudo-sac intra-utérin.

The authors report eight cases of an intra-uterine pseudo-sac giving a wrong diagnosis of intra-uterine pregnancy. In two cases there was hypertrophy of the uterine mucosa and in six cases there was decidual change. The pseudo-sac corresponds to: either a blood clot held by the uterine mucosa; or a marked hypertrophy of the endometrium with intense decidualization and massive oedema. Certain characteristic criteria suggest that a pseudo-sac may be in the uterus; the oblong shape, dimensions which do not accord with the period of amenorrhoea, absence of peripheral and linear thickening, the variety of sites in which the picture is seen and in particular its disappearance, which makes it difficult to localise it in all sections. On the other hand it is not possible to diagnose between an intra-uterine pseudo-gestational sac and an early intra-uterine pregnancy which is not growing, in our present state of knowledge.

[A case of cylindroma of the cervix (author's transl)]. / A propos d'un cas de cylindrome du col utérin.

The authors, in this article, report on a case of the relatively rare condition of cylindroma of the cervix (adenoid cystic carcinoma). The typical features as seen under the optical and electron microscope are broadly as well as the different techniques available to treat this rare lesion, which is more fulminating in its evolution than the similar condition when it occurs in the skin or the breast.

[The level of glycohaemoglobin (Hb A1c) in connection with diabetes and pregnancy (author's transl)]. / Dosage de l'hémoglobine glycosylée (Hb A1c) dans l'association "diabète et grossesse".

The authors worked out a normal curve using 379 levels obtained over 9 months in 180 normal pregnancies. 6% (with a confidence level between 4.4% and 7.6%) was usual for haemoglobin A1c. Then they compared 42 levels of glycohaemoglobin obtained from 14 pregnant diabetic patients where the mean value was 8.34%. Glycohaemoglobin A1c therefore is a good indicator or the level of stabilisation in diabetic pregnancies in the two months before the estimation is taken. It is therefore possible to think that it does indicate chronic hyperglycaemia and does seem to have a future in screening diabetic pregnancies. On the other hand it does not seem to be of any supplementary value in monitoring the fetus of the diabetic mother in the third trimester of pregnancy because of the small variations in the levels that are obtained as compared with the suddenness of fetal complications.

[The diagnosis of adnexal masses of a gynaecological nature using ultrasound: an analysis of the specificity and reliability of the examination (author's transl)]. / Diagnostic des masses gynécologiques annexielles par l'ultrasonographie: analyse de la spécificité et de la fiabilité de l'examen.

A retrospective analysis has been carried out on 118 cases of gynaecological tumours of the adnexae. The reliability of ultrasound examination is about 90% for evaluating the existence, the size, the localisation and the structure of these masses. The principal mistakes occurred when the technique was poor, when the interpretation of the picture was faulty and when loops on intestine were in the way. It is possible to diagnose accurately simple ovarian cysts, dermoid cysts and adenocarcinomatous cysts. It is difficult to be specific as far as tubal pathology is concerned, and particularly in infections and ectopic pregnancies. Echotomography of the pelvis has become accepted among the battery of paraclinical gynaecological examinations. It has become of greatest importance in these examinations and particularly when exploring adnexal gynaecological masses. The purpose of this retrospective work has been to evaluate the reliability of ultrasound diagnosis of the nature and origin of masses.

[The value of estimating the levels of amniotic insulin which come from the fetus in looking after diabetic pregnancies in the last trimester (author's transl)]. / Intérêt du dosage de l'insuline amniotique d'origine foetale dans la surveillance des grossesses de diabétique au dernier trimestre.

The authors carried out 49 estimations of amniotic fluid levels of insulin in 41 patients. 25 of these patients were non-diabetic and they were a control group, and 16 patients were diabetic (24 estimations). The liquor was collected by amniocentesis between the 32nd and the 42nd week of amenorrhoea. The mean of the control levels was 3.17 micro-units per ml. The mean of the values in diabetic pregnancies was 9.97 micro-units per ml. The difference between the two groups is statistically significant. We have studied this insulinaemia in relationship to the duration of the diabetes, the maternal weight increase, the levels of insulin used therapeutically, the blood glucose level, the rise in arterial blood pressure, the weight of the infant, the date of delivery, the presence of fetal distress and the control of blood sugar. There is a statistically significant difference between the insulinaemia of patients in whom the diabetes is well controlled (mean level of 7.08 micro-units per ml) and the patients in whom the diabetes is badly controlled (31.7 micro-units per ml). This new parameter for supervision of the third trimester of pregnancy in diabetics gives rise to the possibilities of a better approach to materno-fetal blood sugar regulation and to an adjustment of the therapeutic doses of insulin that are given which will result in lengthening of the duration of pregnancy, with the aim of achieving a spontaneous vaginal delivery at term.

[Ultrasonic size of fetal crump-rump length in first trimester of pregnancy. Accuracy of gestational age assessment (author's transl)]. / La mesure échographique de l'embryon. Une détermination précise de l'âge gestationnel.

The fetal crown rump length was measureed by means of pulsed ultrasound. The normal values between 49 and 94 days from the onset of the last menstrual period were determined in 72 patients. Statistical analysis showed a good correlation between gestationnal age and fetal crown rump length. The usefulness of this measure is so demonstrated: assessment of gestational age, within few days.