¿Puede la ecografía tridimensional cambiar la exploración ecográfica ginecológica en nuestro medio?

Objective

To verify whether 3D transvaginal ultrasonography is as accurate as 2D conventional ultrasonography and whether it provides additional advantages in gynecologic diagnosis.

Material and methods

We performed a prospective study in 46 women who underwent 2D and 3D transvaginal scans successively. Three 3D volumes (uterus and each ovary) were acquired and evaluated 4 months later on a personal computer. We compared 2D and 3D scans in relation to sonographic diagnosis and biometry and the time spent.

Results

There was complete agreement between 2D and 3D techniques for sonographic diagnosis (31 normal exams, 16 adnexal cysts and seven myomas), except for the visualization and measurement of the uterine cervix. The mean time for 2D scans was 3.29 ± 1.32 minutes and was 2.96 ± 0.58 minutes for 3D examination (P=.076). The time required to acquire 3D volumes was only 1 hour, freeing 1 hour and 32 minutes for the performance of new scans.

Conclusions

Transvaginal 3D ultrasonography can be more efficient than conventional 2D ultrasonography in gynecologic diagnosis.     

Projets de naissance en soins palliatifs : un domaine de la périnatalité à construire

Some couples may choose to continue the pregnancy unable to decide for termination of pregnancy. Such situations recently occurred in neonatology units and may lead to neonatal palliative care. Faced with all uncertainties inherent to medicine and the future of the baby, medical teams must inform parents of different possible outcome step by step. Consistency in the reflection and intentionality of the care is essential among all different stakeholders within the same health team to facilitate support of parents up to a possible fatal outcome. This issue in perinatal medicine seems to be to explore how caregivers can contribute in the construction of parenthood in a context of a palliative care birth plan.     

Suture péritonéale ou non au cours de la césarienne en 2008 ?

Non closure of the peritoneum at cesarean is still debatable, despite the national and international guidelines. This review aims at exposing risks and benefits of non closure of the peritoneum, focusing on the peritoneum adhesions. Many studies demonstrated no benefits at peritoneum closure in the duration of surgery, the immediate postoperative period and the short-term complications. Data about pelvic adhesion risk are more inconsistent. Different criteria were considered in the studies: adhesions incidence and density during subsequent cesareans or pelvic surgeries, duration of surgery and the delay between incision and birth during the subsequent cesarean and fertility known to be impaired by thick-pelvic adhesions. Most of the studies are exhibiting serious bias, leading to weak conclusions. However, two randomised controlled trials compared pelvic adhesion in the subsequent c-section, in step with closure or non closure of the parietal and visceral peritoneum at first caesarean. The results showed that non closure of the peritoneum does not increase or even reduce the adhesions risk. These results are consistent with results from three studies reporting no modification of patient fertility. As a conclusion, current data are supporting the national and international medical society recommendations about the benefits of the non closure of the peritoneum at caesarean section.     

Accueil d’embryon : pourquoi tant de retard à la mise en place en France ? Difficultés pratiques, éthiques et psychologiques

Since 1999, French legislation has stipulated that embryo donation is one of the possibilities afforded to couples who have a surplus of cryopreserved embryos. Donation of embryos with no foreseeable future use by the genetic couple can therefore be given to infertile couples. In practice however, since the authorization of this novel Medically Assisted Reproduction technique, embryo donation is not widely performed in France even though it is not technically difficult. Why then is there reluctance towards the implementation of embryo donation in France? The aim of this article is to analyze the grounds for the delay in the realization of embryo donation in France. Our findings propose that a myriad of factors including organizational, ethical and psychological determinants have deterred the implementation of embryo donation in France.     

Tratamiento inmunodepresor en la gestación

Today there are many patients with immunosupressor therapy. In women, the need to mantain it to preserve the graft and its function, adds a factor to think about it during pregnancy, because pathologycal situation can start or get worse and theratogenic or toxic effects can occurr in the fetusThis article is a review of the several immunosupressor drugs and its relation with pregnancyGenerally, those pregnancies are associated with prematurity and low birth weight. It is necessary a special surveillance for two aspects: first a closer monitorization of blood drug concentrations, on the other hand, it is important to watch out for glucemia and blood pressure to rule out for preeclampsiaImmunosurpressor therapy should not be stopped because of the graft rejection is a high risk     

L’observation en continu du développement embryonnaire en FIV (time lapse) à l’aide de l’Embryoscope® : un outil d’aide à la décision ?

Among all the strategies available in order to improve success rates in IVF cycles, a lot of work has been done on embryo culture conditions and embryo quality evaluation. Most IVF centres use conventional incubators and select embryo according to punctual morphological evaluation, but this strategy has several limitations. Recently developed commercial devices associating more stable culture conditions and time lapse observation of embryo development provide new insights into early embryo development in IVF cycles. Among them, the Embryoscope^® appears to be the most user-friendly, performing and suited for routine daily practice. The first Embryoscope^® for France was installed in the University Hospital of Nantes in 2011. In our experience, it takes relatively a short time to get used to this system. Moreover, its integration in routine process yielded several advantages, such as better embryo selection according to kinetic parameters and observation of abnormal cleavage events, continuing education and training, quality control and flexibility. This leaded to an overall increase in success rates in IVF cycles.