Hysteroscopic diagnosis of ectopic pregnancy.

Although vaginal ultrasonography combined with plasma beta-hCG determination can provide a reliable diagnosis and location of ectopic pregnancy, the results can be difficult to interpret in the early stages when hCG levels are low. Hysteroscopy can be used in such cases to differentiate between ectopic pregnancy and non-viable uterine pregnancy when viable uterine pregnancy has been ruled out. General anaesthesia and laparoscopy are avoided. We performed 60 hysteroscopic procedures between January 1989 and December 1990 in patients with suspected ectopic pregnancies. The pregnancy had been located by means of vaginal ultrasonography in every case in which the hCG was above 1500 IU/ml and in 36% of cases in which the beta-hCG was below this level. Hysteroscopy was hindered by metrorrhagia in three cases and was inconclusive in one, necessitating laparoscopy. Diagnosis was possible in all the remaining cases, as follows: ectopic pregnancy in 41 cases, with an empty uterus and occasional bleeding from an ostium; non-viable uterine pregnancy in 18 cases, with the presence of material within the cavity. Hysteroscopy therefore confirmed the diagnosis in 55% of the cases and was itself diagnostic in a further 43% of cases. Its sensitivity for the diagnosis of ectopic pregnancy was 100% and its specificity 95%. We propose a diagnostic decision tree.

[Local and long-term systemic risks of silicone breast implants]. / Risques locaux et généraux au long cours des implants mammaires en silicone.

A woman of 59 years of age, who had bilateral breast implants, 20 years earlier, presented with both breasts hard, inflamed and ulcerated, which suggested bilateral siliconomas. Bilateral mastectomy was carried out in two stages because she developed disseminated intravascular coagulation during the first operation.

[Major sickle cell anemia and pregnancy. Systematic prophylactic transfusions. 13 case reports]. / Drépanocytose majeure et grossesse. Transfusions prophylactiques systématiques. A propos de 13 cas.

The seriousness of sickle cell disease together with pregnancy has led doctors to look for therapies which have yet scarcely shown their worth. Systematic blood transfusions in pregnancy did seem to improve the prognosis for both mother and fetus. Prophylactic transfusion has made it possible for us to carry thirteen pregnancies to term. There was no mortality either of fetus or mother while the morbidity either of fetus or mother while the morbidity was significantly cut down to new pathologies which were easily treated. The absence of any side effects from the transfusions encourages us to contribute this treatment working together with a highly competent blood transfusion bank.

[The role of pelvic arterial embolization in the treatment of severe postpartum hemorrhages]. / Place de l'embolisation artérielle pelvienne dans le traitement des hémorragies graves de la délivrance.

Two cases of severe post-partum haemorrhage were treated successfully with pelvic arterial embolisation. The authors explain the place for this technique to be used. They have come to the conclusion that it is possible to carry out this therapy which is very valuable and which can avoid dangerous surgery or be added to it when the surgery itself is insufficient.

[A uterus with two scars: can we allow vaginal delivery?]. / Utérus bicicatriciel: peut-on autoriser la voie basse?

This study gives the results of a year in which the active conduct of a trial of labour was carried out on uteruses that had scars in them. This approach allowed 22% of women to deliver vaginally out of a total of 41 patients. Of 17 patients (41.4%) that were put down for a tentative trial delivery, 9 (53%) did deliver vaginally. This approach seems to have been reasonable and beneficial so long as proper precautions were taken. The prognosis is better if there has been a previous vaginal delivery.

[The anatomo-clinical characteristics of granulosa tumors observed at the maternity unit of Rabta-Tunisia. Review of the literature]. / Caractéristiques anatomo-cliniques des tumeurs de la granulosa observées à la Maternité de la Rabta-Tunis. Revue de la littérature.

We have found eight granulosa tumours in nine years out of 280 ovarian tumours which were collected in the maternity and neonatology unit in Rabta. The mean age of the patients was 53, the mean parity was 8. Signs of oestrogen excretion were found in all cases and metrorrhagia was the principal reason for consulting doctors in 75% of cases. There was always a palpable mass on clinical examination. Histology was usually only microfollicular. Radical surgical treatment was carried out in all cases and consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy.

Pregnancy-associated idiopathic intrahepatic cholestasis. Hypotheses of physiopathology: a therapeutic case report.

By modification of the circulating pool of biliary acids, the administration of ursodesoxycholic acid has permitted the restoration of normal maternal hepatic function during a triple pregnancy complicated by the precocious onset of an intrahepatic cholestasis. The marked regression in clinical and biological markers of the disease confirms the role of biliary acids in the aggravation of hepatic abnormalities.