[Reorganization of a third-level maternity ward during the COVID-19 pandemic: maternity ward experience at the University Hospital of Marrakech]. / Expérience de réorganisation d'une maternité de troisième niveau face à la pandémie de la COVID-19: étude du cas de la maternité de l´hôpital universitaire de Marrakech.

Introduction: COVID-19 pandemic has put unprecedented pressures on obstetrics and gynecology care services. Maternity hospitals have needed to rapidly prepare to provide quality care while preventing the transmission of the infection. The purpose of this study is to describe the key elements of the response to COVID-19 within the maternity ward of the Mohammed VI University Hospital in Marrakech. Methods: a case study was conducted. Data were collected using various administrative documents related to activities in the maternity ward of the Mohammed VI University Hospital during the COVID-19 pandemic. We also conducted semi-structured interviews with professionals at the maternity ward. Qualitative thematic analysis approach was used for the analysis of transcribed data and triangulation, with the analysis of documentary data. Results: the study highlighted phases of design and organization of two maternity ward access circuits. A new circuit for suspicious or confirmed cases of COVID-19 ensured access to quality care for patients, by guaranteeing isolation measures. The access circuit that was commonly used remained functional to consolidate the right of access to tertiary obstetrics and gynecology care while applying protective measures against COVID-19. Conclusion: this study highlights the necessity to draw on the experience of other health facilities, to contextualize local activities and to anticipate work organization in the face of health crises.

Benign adenomyoepithelioma of the breast: a case report.

The diagnosis of adenomyoepitheliomas is difficult and relies on the presence of a double component of epithelial and myoepithelial cells belonging to the breast lobules and ducts. The clinical and imaging characteristics are not specific; thus, the diagnosis is histological. In this article, we present a case of a young female who presented with a 2 cm lump in the breast without other clinical symptoms, which revealed a benign adenomyoepithelioma (AME). We performed a large excisional lumpectomy, and the patient recovered well with no complication or recurrence within two years follow-up. When it comes to adenomyoepitheliomas, the published literature is mainly composed of case reports, so much so that there are no evidence-based guidelines. Our case shows that an excisional lumpectomy is often enough when facing a small size tumor with no signs of malignancy, which contributes to the limited data on the subject.

[Severe neonatal thrombocytopenia due to maternal alloimmunization: case report and literature review]. / Allo-immunisation fœto-maternelle sévère: à propos d´un cas et revue de la littérature.

Prior to 1970, maternal alloimmunization was the leading cause of perinatal death. Currently, it has become rarer thanks to screening and monitoring in high-risk pregnancies. The advent of transcranial doppler has been a turning point in the monitoring of these pregnancies, as it is a reliable, non-invasive method for the diagnosis of fetal anemia. This helps clinicians decide whether or not to perform intrauterine transfusion. Anti-D immunoprophylaxis has also played an important role in preventing fetal and neonatal hemolytic anemia and its administration is currently well codified. Adequate management helps to avoid the effects of alloimmunization on the fetus and newborn as well as to reduce the risks of alloimmunization in subsequent pregnancies. We here report a case of severe fetomaternal rhesus (Rh) alloimmunization during unmonitored pregnancy complicated by fetoplacental anasarca.

Endometriosis of the vesico-vaginal septum: a rare and unusual localization (case report).

BACKGROUND: We report a rare and unusual case of endometriosis in the vesico-vaginal septum. The location of this disease at this site is so uncommon that the literature about is very rare. CASE PRESENTATION: A 41-year-old female was presented with urinary symptoms. There was history of caesarean section. Physical examination revealed an anterior vaginal wall mass. Pelvic MRI showed an inter vesico-vaginal mass, suggesting a leiomyoma. Surgical excision was performed by the vaginal route. There were no postoperative complications. Histopathology examination showed focal endometriosis. CONCLUSION: Endometriosis of the anterior compartment remains relatively rare; its localization to the vesico-vaginal septum (VVS) is very rare. With the occurrence of nonspecific cyclic urinary signs in women during periods of genital activity, endometriosis should be mentioned, especially in the presence of an antecedent of pelvic surgery.

Management of Severe COVID-19 in Pregnancy.

The scarcity of data concerning pregnant patients gravely infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) makes their management difficult, as most of the reported cases in the literature present mild pneumonia symptoms. The core problem is laying out evidence on coronavirus's implications on pregnancy and delivery, as well as vertical transmission and neonatal mortality. A healthy 30-year-old pregnant woman, gravida 6, para 4, at 31 weeks of gestation, presented severe pneumonia symptoms promptly complicated with premature rupture of membranes (PROM). A nasopharyngeal swab returned positive for SARS-CoV-2 using reverse transcription polymerase chain reactions (RT-PCR). The parturient underwent a cesarean delivery. This paper is an attempt to outline management of the critical condition of COVID-19 during pregnancy.

[Antenatal diagnosis and management of ileal atresia]. / Atrésie intestinale iléale: diagnostic anténatale et prise en charge.

Ileal atresia is a rare congenital malformation which affects a small percentage of the population, with an incidence of 1 in 5000 cases. It may be suspected and diagnosed by ultrasound at the end of the second and third trimester. Obstetrical and surgical consultation is the key to success here. Eliminating a systemic disease with poor prognosis, fighting to reduce premature births and immediately entrusting the child to the surgeon are the main objectives to achieve. During surgery, the surgeon will determine the type of atresia, its location, single or multiple areas of occlusion and its length; thus surgery depends on etiology. Our study reports an interesting clinical case of ileal atresia diagnosed antenatall.

[Postcoital bleeding: 68 case-reports and review of the literature]. / Les hémorragies post coïtales: à propos de 68 cas et revue de literature.

Consensual or imposed sexual act can cause traumas. Post coital bleeding is a common gynecological symptom. It can reveal serious problems. The aim of our study is to analyze the epidemiological, diagnostic and therapeutic profile as well as preventive measures in case of post coital tear. This is a prospective study, over two years, conducted in the Department of Obstetrics and Gynecology at the Center Hospital University Mohammad VI (CHU) in Marrakech. We collected 68 patients. The average age was 27 years. Most of the patients were nulliparous (89.7% of the cases). Half of the patients had traditional wedding. Sexual intercourse was consensual in 74% of the cases. Vaginal bleeding was the most frequent reason for consultation (98% of the cases). Hymenal lesions were found in 39% of the cases and the lesion involved the posterior fornix of the vagina in 35% of the cases. Therapeutic management consisted of a surgical suture in 97% of the cases, associated with blood transfusion in two patients and sexual abstinence of all patients for at least two weeks. The social context as well as the lack of sex education were often highlighted, hence the importance of psychological support to prevent both the impact of traumas on sexuality and the recurrences.

[Vaginal colonization by group B streptococcus among pregnant women in the region of Marrakech]. / Portage vaginal du streptocoque du groupe B chez la femme enceinte au niveau de la région de Marrakech.

INTRODUCTION: Group B streptococcus is the main etiological agent of maternal and fetal infections, sepsis and meningitis in the term newborns. The objective is to determine group B streptococcal (GBS) carriage rate in vagina of term pregnant women. METHODS: Vaginal swab was performed prospectively in 275 pregnant women in labor, prior to entering the delivery room over a period of 6 months. RESULTS: Colonization rate was 20.2%. The bearing was variable according to the gestational age, it constitutes 57.5% between 37 and 38 weeks of amenorrhoea. None of the risk factors was statistically predictive for maternal GBS colonization. CONCLUSION: Screening should be performed from 37 weeks of amenorrhoea and, as colonization is intermittent, a negative swab result does not ensure that GBS colonization is eradicate at birth.

[Neonatal genital prolapse: an exceptional entity (about a case)]. / Le prolapsus génital néonatal: entité exceptionnelle (à propos d'un cas).

Neonatal genital prolapse is an uncommon entity. It is usually associated with birth defects of the central nervous system. We here report the case of a full term newborn with a genital prolapse not associated with central nervous system abnormalities in order to highlight the diagnostic and therapeutic particularity of this very rare disease.

A Rare Localization of Ectopic Pregnancy: Intramyometrial Pregnancy in Twin Pregnancy following IVF.

Intramyometrial pregnancy is a rare form of ectopic pregnancy. It makes a diagnostic and therapeutic challenge. If misdiagnosed the intramyometrial pregnancy can cause a uterine rupture and become life-threatening condition. We report a case of intramyometrial pregnancy in twin pregnancy following IVF with spontaneous abortion of the first twin At 9 weeks of gestation. The 10 weeks scan showed a normal fetus which was described to be highly localized in the uterus but the diagnosis of intramyometrial pregnancy was not suspected. The patient was admitted at 14 weeks of gestation with pelvic pain, hemorrhage, and shock. She was operated and the diagnosis of ruptured intramyometrial pregnancy was done and managed conservatively. This case illustrates the diagnostic difficulties of intramyometrial pregnancy. We discuss pathophysiology, diagnosis, and treatment of this exceptional form of ectopic pregnancy.

A new removable uterine compression by a brace suture in the management of severe postpartum hemorrhage.

Postpartum hemorrhage (PPH) is a life-threatening complication of delivery. It is the leading cause of maternal mortality. During the last 15 years, several total uterine compressive sutures were described in literature. They have proven their effectiveness and safety in the management of severe PPH as an alternative to hysterectomy. We present in this paper a new technique of uterine compressive sutures based on removable uterine brace compressive sutures with compression of the uterus against the pubis. This technique may be more effective by using two mechanisms of uterine bleeding control and also may prevent uterine synechia by respecting the uterine cavity and the removal of the suture 1 or 2 days later. We also present the results of a 15 patients' series using this new suture.

Paget's Disease of the Vulva in Premenopausal Woman Treated with Only Surgery: A Case Report.

Paget's disease of the vulva remains a rare condition with only a limited number of cases reported in the literature. It is an uncommon neoplasm usually of postmenopausal white women characterized by controversies in its prevalence, clinical features, treatment strategies, and prognostic. We here report a case of a primary Paget's disease of the vulva in premenopausal woman treated by only surgery with a favorable issue.