Responsabilité médicale en gynécologie

One hundred and twenty cases of medical responsibility in gynaecology from January 1973 to September 1996 are reviewed. Close to 50 percent of these cases were related to recto-vaginal fistulae, pregnancy following tubal ligation, vesico-vaginal fistulae, abnormal cervical smears and salpingitis after tubal ligation. Of these cases, 31 were assessed as avoidable (25,8%). Those cases with increased rates of being avoidable included forgotten surgical swabs (75,0%), abnormal cervical smears (57,1 %), undetected ectopic pregnancies (50,0%), pregnancies following tubal ligation (40,0%), medications errors (36,4%), uterine perforation (28,6%) and those cases related to informed consent (28,6%). These avoidable accidents must be closely monitored and eventually prevented by risk management strategies including comprehensive patient information and better informed consent, documentation on the patient file and enhancement of quality assurance of the gynaecological interventions.     

La décision médicale partagée en gynécologie

When two options or more can be chosen in medical care, the final decision implies two steps: facts analysis, and patient evaluation of preferences. Shared Medical Decison-Making is a rational conceptual frame that can be used in such cases. In this paper, we describe the concept, its practical modalities, and the questions raised by its use. In gynaecology, many medical situations involve “sensitive preferences choice”: for example, contraceptive choice, menorragia treatment, and approach of menopause. Some tools from the “Shared Medical Decision Making” concept are useful to structure medical consultations, to convey information, and to reveal patients preferences. Decision aid are used in clinical research settings, but some of them may also be easily used in usual practice, and help physicians to improve both quality and traceability of the decisional process.     

Hypnose en anesthésie et analgésie en obstétrique et en gynécologie

Hypnosis is an altered state of consciousness, spontaneous or induced, different from the sleep and waking state. Hypnosis increases the thresholds of pain sensation by reducing its cognitive and affective components. The conversational hypnosis, based on the positive language, is commonly used by the caregivers. The formal hypnosis is the basis of the hypnosedation and the hypnoanalgesia. This technique complete our therapeutic and clinical tools in obstetric anesthesia and analgesia: analgesia for childbirth or antenatal diagnosis, anesthesia for cesarean section, especially emergency CS, and assistance to the management of pregnancy associated pathologies such as preeclampsia, premature rupture of membranes and post-partum hemorrhage; but also assisted procreation, oncology, breast surgery and gynecology.