RESUMEN
OBJECTIVES: To investigate the immediate fetal-maternal morbidity related to Thierry's spatula for first instrumental vaginal delivery. PATIENTS AND METHODS: We conducted a prospective observational study in Toulouse university hospital, including primiparas who vaginally delivered a live singleton cephalic infant>36 WG, between December 2005 and June 2006. Instrumental deliveries were performed using short spatulas in all cases. Outcome measures were: perineal complications (episiotomy, laceration and associated lesions, urinary retention, pain at H48), neonatal morbidity (cutaneous injuries, neonatal transfer, cord pH, Apgar score). Instrumental deliveries were compared with spontaneous vaginal deliveries (SVD). RESULTS: Six hundred and eight primiparas were included, distributed in 195 extractions (32%) and 413 SVD (68%). Spatulas allowed fetal extraction in all cases. Main differences between the two groups were: length of labour, occiput posterior position (12.8% for spatulas vs 1.7% for SVD; p<0.0001), episiotomy rate (97.9% vs 51.3%; p<0.0001), severe perineal lacerations (3.6% vs 0.2%; p=0.0007), post-partum morbidity (pain, hematoma, and urinary retention). No case of early severe neonatal complication was related to the use of the spatulas. DISCUSSION AND CONCLUSIONS: Perineal complications (severe lacerations) associated with spatulas are increased with regard to SVD, but comparable to that reported with forceps. The main disadvantage is the high frequency of episiotomy, which should not be systematic. Neonatal morbidity is reduced. Comparative studies (spatulas vs. other procedures) are needed to confirm these data, but spatulas remain a multipurpose instrument which should continue to be taught.
Asunto(s)
Extracción Obstétrica/instrumentación , Adolescente , Adulto , Episiotomía , Femenino , Humanos , Laceraciones , Perineo/lesiones , Embarazo , Estudios ProspectivosRESUMEN
OBJECTIVES: To study immediate perineal and neonatal outcomes after instrumental rotational performed with Thierry's spatula among primiparous, and compare subsequent perineal tear with occiput posterior position delivery. MATERIALS AND METHODS: The study was performed from December 2005 to June 2006 at Paule-de-Viguier hospital (Toulouse university hospital) including all persistent occiput posterior vaginal deliveries among primiparous (49 patients). Mode of delivery was: 1) seven patients with spontaneous occiput anterior vaginal delivery (14.3%); 2) seven patients with rotational extraction using spatula with occiput anterior delivery (30.6%); 3) twenty-seven patients with instrumental extraction and occiput posterior delivery (55.1%). Maternal and fetal parameters were studied prospectively. RESULTS: Spatula was performed for failure of progress in 71.4% of cases (n=30) and for no reassuring fetal status in 28.6% of cases (n=12). In "rotational group", only one perineal tear was observed (Third degree) (6.6%) versus seven in "occiput posterior extraction group" (26%) with three severe perineal lacerations. Neonatal superficial lesions are frequent (26,6% after rotation versus 11.6% after occiput posterior extraction). None severe traumatic tears were observed. CONCLUSION: Instrumental rotation using Thierry's spatula seems to be less deleterious for maternal perineum than occiput posterior extraction, without increasing neonatal complications. Theses preliminary results have to be confirmed by more important prospective works.
Asunto(s)
Versión Fetal/instrumentación , Adolescente , Adulto , Peso al Nacer , Extracción Obstétrica/instrumentación , Extracción Obstétrica/métodos , Femenino , Edad Gestacional , Humanos , Presentación en Trabajo de Parto , Embarazo , Estudios Prospectivos , Versión Fetal/métodosRESUMEN
OBJECTIVE: To assess the frequency of deprivation in pregnant women and estimate the associated medical risks. MATERIAL: and methods. A retrospective study of the hospital's computerised data (6149 women) and two prospective studies with health staff (n=534) and social workers (n=85) in two maternity hospitals. RESULTS: In the retrospective study, 17.5% of mothers were deprived. Deprivation was associated both with more difficulties during pregnancy and the perinatal period and with longer hospital stays. The prospective studies confirmed the prevalence of deprivation and gave a more detailed idea of the associated social and demographic characteristics. Deprivation was related with a combination of risk factors with a particularly important influence of economic risk. A quarter of deprived mothers had unwanted pregnancies and according to the social workers approximately 10% of them were not in a position to take care of their baby. CONCLUSION: This study emphasizes the importance of deprivation as a perinatal medical risk factor. Screening should take place in early pregnancy in order to find the best way to help such families.
Asunto(s)
Enfermedades Fetales/epidemiología , Complicaciones del Embarazo/epidemiología , Adolescente , Adulto , Femenino , Humanos , Embarazo , Estudios Prospectivos , Carencia Psicosocial , Estudios Retrospectivos , Factores de Riesgo , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To determine the relative effects of abdominal, vaginal or laparoscopic approaches for hysterectomy on female sexuality. STUDY DESIGN: One hundred and seventy women who underwent abdominal (n=68), vaginal (n=67), and laparoscopic (n=35) hysterectomy for benign disease were studied. Pre- and postoperative sexuality was assessed by questionnaire. RESULTS: Overall, sexuality after hysterectomy remained unchanged in 60.4% of cases, and improved or deteriorated in 21.3 and 18.3%, respectively. Postoperative delay in resuming sexual activity was shorter after vaginal (45.2+/-6.7 days) hysterectomy than after abdominal hysterectomy (62.4+/-9.3 days). Deterioration of sexual function occurred more frequently after abdominal hysterectomy (24%) than after vaginal (13.5%) or laparoscopic (8.5%) hysterectomy. CONCLUSION: These results indicate that the impact of vaginal and laparoscopic hysterectomy on women's sexuality may be milder than that of abdominal hysterectomy.
Asunto(s)
Histerectomía Vaginal/efectos adversos , Histerectomía/efectos adversos , Histerectomía/métodos , Laparoscopía/efectos adversos , Sexualidad/fisiología , Femenino , Humanos , Matrimonio , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Autoimagen , Sexualidad/psicología , Enfermedades Uterinas/cirugíaRESUMEN
OBJECTIVE: To identify risk factors related to maternal ethnic origin. METHODS: Retrospective review of 5808 cases of French, Maghrebian and Black African women who delivered between 1988 and 1994 at the Maternity of La Grave Hospital in Toulouse. RESULTS: Pathological pregnancies were more frequent (60% vs 45%), specifically anemia OR = 10.2[6.3-16.7] and OR = 5.7[4.0-8.3]) and genital infections (OR = 1.7[1.2-2.6] and OR = 1.7[1.4-2.1]) in African and Maghrebian respectively. than in French women. These differences cannot be referred to any classical risk factors but only to the mother's ethnic origin. Moreover, cesarean delivery occurred almost twice as much in African women 34% vs 19%) and no specific medical indication was found to explain this increase. CONCLUSION: Our data concluded that important risk factors were related to the mother's ethnic origin. This finding demonstrates that management of perinatal care and epidemiologic studies should take maternal ethnic origin into account.
Asunto(s)
Población Negra , Parto Obstétrico , Etnicidad , Trabajo de Parto , Embarazo , Adulto , África/etnología , Femenino , Francia , Maternidades , Humanos , Estudios Retrospectivos , Factores de RiesgoRESUMEN
We report an exceptional case of para-cervical pregnancy. Ultrasonography enabled accurate diagnosis after explorative laparoscopy. Treatment was conservative involving methotrexate and surgical ablation of the pregnancy by vaginal approach with a successful outcome.
Asunto(s)
Cuello del Útero/diagnóstico por imagen , Embarazo Ectópico/terapia , Adulto , Terapia Combinada , Femenino , Humanos , Metotrexato/uso terapéutico , Embarazo , Embarazo Ectópico/diagnóstico por imagen , Embarazo Ectópico/cirugía , Ultrasonografía PrenatalRESUMEN
The authors present a series of 962 hysterectomies for fibroma carried out between January 1981 and December 1995 in the Department of Gynecology and Obstetrics of CHU Toulouse-La Grave. They carried out 453 vaginal hysterectomies and 509 abdominal hysterectomies. They compared the largest series reported in the literature, between vaginal and abdominal technique. The vaginal route has the obvious advantages of speed of operation, less operative trauma, lower risk of thrombo-embolic disease and the hospital stay is shorter. Laparoscopic assistance allows to extend indications of vaginal route.
Asunto(s)
Histerectomía Vaginal , Histerectomía , Leiomioma/cirugía , Neoplasias Uterinas/cirugía , Adulto , Estudios de Evaluación como Asunto , Femenino , Humanos , Histerectomía/efectos adversos , Histerectomía Vaginal/efectos adversos , Persona de Mediana Edad , Paridad , Complicaciones PosoperatoriasRESUMEN
Vaginal sacro-spino-fixation or Richter's procedure is valuable for the treatment of posthysterectomy vaginal prolapse. Although technically difficult, this procedure is associated with minimal trauma and is effective in correcting pelvic static disorders. There seem to be few complications. Results are very promising. The functional and anatomic improvements induced by the operation persist over the long term. Although the main indication is treatment of prolapse of the vaginal vault, Richter's procedure is also useful for the prevention of prolapse. Based on the experience acquired by a surgical team, the technique, indications, complications, and results of Richter's procedure are discussed.
Asunto(s)
Histerectomía/efectos adversos , Ligamentos/cirugía , Prolapso Uterino/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Técnicas de Sutura , Resultado del Tratamiento , Prolapso Uterino/etiologíaRESUMEN
The authors report 6 cases of carcinoma of the ovary presenting during pregnancy in the Department of Gynecology and Obstetrics of La Grave University Hospital, Toulouse, between 1972 and 1994. Analysis of this series is followed by a review of the literature which reveals that carcinoma of the ovary fortunately remains a rare event during pregnancy. All reported series conclude that the diagnosis is made at an early stage. Management depends in great part on the age of the pregnancy and stage of malignancy. During the first 6 months, immediate surgery is essential, with sacrifice of the pregnancy, except at stage IA1. During the final 3 months, surgery is delayed until fetal maturity. This classical attitude is currently being questioned. This classical attitude is currently being questioned. Some teams feel that conservative treatment followed by chemotherapy is possible, thereby preserving the pregnancy. The choice of the couple must always be taken into account when making these management decisions.
Asunto(s)
Carcinoma Embrionario , Cistadenocarcinoma Mucinoso , Cistadenocarcinoma Seroso , Neoplasias Ováricas , Complicaciones Neoplásicas del Embarazo , Tumor de Células de Sertoli-Leydig , Adulto , Antineoplásicos/uso terapéutico , Carcinoma Embrionario/tratamiento farmacológico , Carcinoma Embrionario/cirugía , Cesárea , Cisplatino/uso terapéutico , Terapia Combinada , Cistadenocarcinoma Mucinoso/tratamiento farmacológico , Cistadenocarcinoma Mucinoso/cirugía , Cistadenocarcinoma Seroso/tratamiento farmacológico , Cistadenocarcinoma Seroso/cirugía , Femenino , Humanos , Histerectomía , Recién Nacido , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/cirugía , Ovariectomía , Embarazo , Complicaciones Neoplásicas del Embarazo/tratamiento farmacológico , Complicaciones Neoplásicas del Embarazo/cirugía , Pronóstico , Tumor de Células de Sertoli-Leydig/tratamiento farmacológico , Tumor de Células de Sertoli-Leydig/cirugíaRESUMEN
Severe obstetric bleeding is the primary cause of maternal morbidity and mortality. While classical causes such as uterine inertia or retained placenta are well known, inversion of the uterus is a rare cause which should not be missed. Only very rapid diagnosis and management can avoid serious and irreversible consequences. A case of inversion of the uterus is reported. The circumstances of onset and treatment possibilities are also discussed.
Asunto(s)
Hemorragia Posparto/etiología , Enfermedades Uterinas/complicaciones , Adulto , Femenino , Humanos , Recién Nacido , Masculino , Embarazo , Pronóstico , Enfermedades Uterinas/diagnóstico , Enfermedades Uterinas/cirugíaRESUMEN
OBJECTIVE: To examine the factors accounting for the increase in rate of cesarean section, between 1983 and 1993 (from 13.0% to 19.5%) in Toulouse University Hospital, a tertiary level center. DESIGN: Retrospective study of all single deliveries, excluding deaths in utero, between 1983 and 1993. RESULTS: Half the increase in overall rate was due to the numerical increase in women with a cesarean section history. The percentage of cesarean sections in these patients remained constant at 79% over this period. For the other patients, the increase in rate was due partly to an increase in risk factors, but mainly to a change in obstetric practice with a marked increase in elective cesarean section (70% of all cesarean sections in 1993). Major complications in the mothers were relatively rare, albeit significantly more frequent in the cesarean cases. Over the study period the percentage of infants requiring intensive care remained constant for the vaginal deliveries but declined for the cesarean sections. CONCLUSION: The increased rate of cesarean sections has not led to any increase in maternal complications, and appears to have had a small favorable influence on infant morbidity.
Asunto(s)
Cesárea/tendencias , Hospitales Universitarios , Pautas de la Práctica en Medicina/tendencias , Adulto , Cesárea/efectos adversos , Cesárea/estadística & datos numéricos , Femenino , Francia , Humanos , Modelos Logísticos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Embarazo , Resultado del Embarazo , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The impact of tamoxifen on the genital tract was assessed by cervico-vaginal cytology. Fifty two post-menopausal patients treated with tamoxifen for breast cancer were regularly monitored, with a pre-treatment reference smear showing a profoundly menopausal status, followed by an anual smear. Smears returned to a functional status in 44% of patients after 2 to 5 years treatment. The agonist effect of tamoxifen appears to be beyond any doubt, and responsible for certain adverse reactions. This should not bring into question the usefulness of the drug, but indicates the need for regular monitoring and, in the presence of a functional smear, further investigation by vaginal ultrasonography is essential in order to evaluate the status of the endometrium.
Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Monitoreo de Drogas/métodos , Posmenopausia/efectos de los fármacos , Tamoxifeno/uso terapéutico , Frotis Vaginal , Anciano , Femenino , Humanos , Persona de Mediana Edad , Factores de TiempoRESUMEN
OBJECTIVE: To determine if ovarian cysts are associated with a particular basal endocrine profile and impair follicular growth. DESIGN: Retrospective study. SETTING: In Vitro Fertilization (IVF) Center. PATIENTS: Nine hundred fourteen stimulation cycles stimulated with a combination of luteinizing hormone-releasing hormone analogues (LH-RH-a) and human menopausal gonadotropins (hMG) in a long protocol in an IVF program. RESULTS: After 15 days of LH-RH-a therapy, ovarian cysts (> or = 20 mm) were observed in 8% of cases. These cysts were not related to a particular basal endocrine profile and did not impair follicular growth and IVF results. However, puncturing these cysts enhanced the quality of subsequent follicular growth. On the contrary, cysts appearing during hMG treatment (> or = 25 mm) were related with a lower LH:follicle-stimulating hormone ratio (0.79 +/- 0.52 versus 0.92 +/- 0.74 in absence of cyst) and to a lower ovarian response as assessed by the maximal estradiol level to the total number of hMG ampules ratio (51.6 +/- 36.5 versus 65.9 +/- 47.9 in absence of cyst). However, this difference had no influence on the pregnancy per stimulation rate (18% versus 16% in absence of cyst; not significant). CONCLUSIONS: Results show that the pathogens of ovarian cysts appearing during the blockage phase and during the stimulation phase are different. However, they do not impair the results of IVF, and thus it is not necessary to cancel the attempt in case of ovarian cyst.
Asunto(s)
Fertilización In Vitro , Quistes Ováricos/fisiopatología , Buserelina/uso terapéutico , Estradiol/sangre , Femenino , Hormona Folículo Estimulante/sangre , Humanos , Leuprolida/uso terapéutico , Hormona Luteinizante/sangre , Menotropinas/uso terapéutico , Folículo Ovárico/fisiopatología , Embarazo , Estudios Retrospectivos , Pamoato de Triptorelina/uso terapéuticoRESUMEN
In the case of in vitro fertilization, LHRH analogs are used to induce an hypophysary blockage, before the phase of stimulation, via administration of exogenous gonadotropin. During in vitro fertilization attempts using LHRH analogs, the blockage is controlled after 14 days of treatment through measurement of the plasmatic estradiol and pelvic ultra-sonography. In this retrospective study, which concerned 1075 in vitro fertilization cycles, a paradoxical ovarian stimulation with LHRH analogs was observed in 93 cases (8.7%), with high estradiol levels and follicular growth (detected by ultra-sonography), in spite of low FSH and LH levels. In 4 cases, a follicular puncture was performed, which allowed to collect oocytes from which embryos were obtained, thus confirming the observed follicular growth and maturation. The most probable hypothesis explaining this phenomenon seems to be a direct ovarian stimulation, effectuated in vivo by LHRH analogs. This stimulation is only observed in certain patients, and apparently more frequently, with certain LHRH analogs, probably through a variation in the expression of ovarian LHRH receptors.
Asunto(s)
Fertilización In Vitro , Hormona Liberadora de Gonadotropina/análogos & derivados , Ovario/efectos de los fármacos , Estradiol/sangre , Femenino , Hormona Folículo Estimulante/sangre , Humanos , Hormona Luteinizante/sangre , Folículo Ovárico/efectos de los fármacos , Folículo Ovárico/fisiología , Ovario/fisiología , Inducción de la Ovulación , Estudios Retrospectivos , Pamoato de Triptorelina/administración & dosificación , Pamoato de Triptorelina/farmacología , Pamoato de Triptorelina/uso terapéuticoRESUMEN
In the case of in vitro fertilization, LHRH analogs are used to induce a hypophysial blockage before the phase of stimulation, via administration of exogenous gonadotropin. During in vitro fertilization attempts using LHRH analogs, the blockage is controlled after 14 days of treatment by measuring plasmatic estradiol and by pelvic ultrasonography. In this retrospective study, which concerned 1075 in vitro fertilization cycles, a paradoxical ovarian stimulation with LHRH analogs was observed in 93 cases (8.7%) with high estradiol levels and follicular growth (detected by ultrasonography), in spite of low FSH and LH levels. In 4 cases, a follicular puncture was performed, which made it possible to collect oocytes from which embryos were obtained, thus confirming the observed follicular growth and maturation. The most probable hypothesis explaining this phenomenon seems to be direct ovarian stimulation effectuated in vivo by LHRH analogs. This stimulation is only observed in certain patients, and, more frequently it seems, with certain LHRH analogs, which is probably due to a variation in the expression of ovarian LHRH receptors.
Asunto(s)
Fertilización In Vitro , Hormona Liberadora de Gonadotropina/análogos & derivados , Folículo Ovárico/efectos de los fármacos , Folículo Ovárico/fisiología , Protocolos Clínicos , Estradiol/sangre , Femenino , Hormona Folículo Estimulante/sangre , Humanos , Hormona Luteinizante/sangre , Estudios RetrospectivosRESUMEN
OBJECTIVE: To determine if biochemical differences in luteinizing hormone-releasing hormone analogues (LH-RH-a) have a clinical influence, we studied three of these molecules: buserelin acetate (group B), triptorelin (group T), and leuprorelin (group L). DESIGN: Clinical trial. SETTING: In Vitro Fertilization (IVF) Center. PATIENTS: Two hundred forty-six patients, undergoing their first IVF attempt, were randomly allocated to one group. The analogues were used in a long protocol for ovarian stimulation in an IVF program. RESULTS: After 15 days of LH-RH-a therapy, the follicle-stimulating hormone level was lower in group B (2.9 +/- 1, 4.3 +/- 1.7, 4.8 +/- 2.1 UI/L for B, T, and L groups, respectively; P less than 0.001), although no difference was found in LH and estradiol (E2) levels. After follicular growth stimulation by human menopausal gonadotropins (hMG), E2 level was significantly lower in B group (1,799 +/- 1,101, 2,440 +/- 1,298, 2,137 +/- 1,044 pg/mL for B, T, and L groups, respectively; P less than 0.01), as well as the E2 level per hMG ampule (67 +/- 51, 97 +/- 61, 82 +/- 49 for B, T, and L groups respectively; P less than 0.01). The pregnancy per stimulated cycle rate was not significantly different among the groups. CONCLUSIONS: These results suggest that LH-RH-a could act not only on the pituitary but also on the ovaries. Moreover, these data suggest that buserelin acetate could be preferentially used for high responders and triptorelin for poor responders.