The mammalian oviduct revisited

The oviducts, or uterine tubes, support the transport and final maturation of gametes, and harbour fertilization and early embryo development. The oviduct environment is finely regulated by ovarian steroids as well as by gametes and embryos that interact with it. Previously regarded as a simple transit zone, the oviduct is now regarded as a complex organ with multiple functions in these various processes. The tubal fluid, now better characterized, is to be regarded as the first interface between the mother and the embryo. It may play a major role in the quality of the conceptus.     

Epidemiology, characterization of genotypes of human papillomavirus in a population of women in Ouagadougou

Objectives

This work was carried out in order to determine the prevalence of different HPV genotypes in a population of women attending gynecological consultation.

Material and methods

From May to June 2010, cervical samples were obtained from 300 women attending gynecological consultation in two health centers in Ouagadougou. The strains of HPV genotyping was done using the technique of polymerase chain reaction (PCR) followed by reverse hybridization on nitrocellulose strips.

Results

Among the 73 women(24.3%) infected with HPV, only 27.4% (20/73) of them were infected with a HPV low risk (BR), the 72.6% (53/73). Other women were infected with at least one high risk HPV (HR). By combining the HPV genotypes found without taking into account the number of infected women, we found a total of 84 HPV among whom we have high-risk HPV : HPV-50'S(26/84 or 31.0%), HPV-18 (12/84 or 14.3%), HPV-16 (9/84 or 10.7%), HPV-30'S (5/84 or 5.9%), HPV-HR (5/84 or 5.9%) and HPV-45 (3/84 or 3.6%) and low-risk HPV: HPV-6 (15/84 or 17.9%) and HPV-BR (9/84 or 10.7%). We have found no HPV-11.

Discussion and conclusion

The prevalence of HPV found in our series is comparable to that found in the world. To complete this study, it would be necessary to investigate the prevalence of HPV found in cervical lesions in Burkina Faso.     

Management of pregnant women with advanced cervical cancer: About five cases observed in Lille from 2002 till 2009. Evaluation of practices referring to the new French recommendations of 2008

Purpose

An update on the management of invasive cervical cancer (from stage IB) diagnosed during pregnancy with reference to the recent French guidelines.

Patients and methods

We retrospectively analyzed patients for whom invasive cervical cancer was diagnosed during pregnancy and managed jointly by Jeanne-de-Flandres and Roubaix maternity and by Oscar-Lambret cancer center between 2002 and 2009.

Results

Five patients were included: four stage IB1, and one stage IB2. Five pregnancies resulted in the birth of six alive children. Three patients received neoadjuvant chemotherapy during pregnancy. One patient had a laparoscopic pelvic lymphadenectomy in first trimester. Two laparoscopic extraperitoneal paraortic lymphadenectomy have been made. The mean time of survey is 47.5 months (12–94 months). One patient died of her cancer.

Conclusion

The diagnosis of cervical cancer during pregnancy involves the same therapeutic guidelines in the absence of pregnancy. The laparoscopic pelvic lymphadenectomy (up to 20 to 24 weeks of gestation) is crucial in the therapeutic treatment for tumors less than 4 cm. Neoadjuvant chemotherapy is used during pregnancy for patients refusing medical termination of pregnancy.     

Quantitative assessment of medical students' clinical practical learning in department of obstetrics and gynecology of Brest Hospital University

Objective

The main objective of this study was to describe how medical students got progressively trained to perform the most frequent medical procedures in obstetrics and gynecology. The secondary objective was to rationalize and plan the training.

Methods

The medical students in our University Hospital were contacted either directly or by e-mail. They were given an anonymous simple choice questionnaire relating to eight most important acts in the specialty.

Results

Three hundred and eighty-two medical students have been consulted. We got 173 answers which means a participation rate of 45.3%. The survey showed up that the considered procedures were progressively put into practice with the exception of two: the insertion of an intrauterine contraceptive device (coil) and of an implant.

Conclusion

The study showed off some insufficiency in the training in two of the considered procedures. An amendment was proposed with simulated performances of the acts and the setting up of a training course booklet.     

Umbilical endometriosis in women free of abdominal surgical antecedents

Primary umbilical endometriosis represents a very rare localization of the disease and is represented by blue, papular, nodular or cystic lesions whose symptoms are related to ovarian cycle. We report the management of three women, free of surgical antecedents presenting with primary umbilical endometriosis. In each woman, abdominal laparoscopy revealed peritoneal pelvic endometriosis. The excision of umbilical lesions was performed with satisfactory esthetical outcomes. In our experience, umbilical endometriosis responsible for highly characteristic features appears playing the role of clinical marker for pelvic endometriosis.     

Adoption: an alternative to assisted reproductive techniques?

Information on adoption must be given to couples who seek treatment for medically-assisted procreation. But is adoption a real alternative? What are the chances for a couple who consults to see its desire for adoption be achieved according to its own situation, the characteristics of the child he wants, and the general situation of adoption? Can adoption, just like assisted procreation, often described by the couples as a “obstacle course”, go parallel? Or should one try adoption once assisted reproduction failed? Is the couple willing to suffer the social and legal control of adoption after having supported the medical control of the ART? In all cases, the reality is that two out of three couples engaged in assisted reproduction will have a child whereas scarcely more than one candidate to adoption will be offered to adopt a child after three or four-years procedure.     

Klinefelter syndrome: spermatogenesis and quality of gametes

Klinefelter syndrome is defined by the presence of a supernumerary X chromosome in a phenotypic male. It is the most frequent gonosomic anomaly in infertile men with an incidence of 0.1 to 0.2% in newborn males. The presence of an additional X chromosome induces spermatogenic failure but when gametes are present, they are usually normal. The risk of transmission of the chromosomal anomaly remains low. In the literature, only one 47,XXY foetus resulting from more than a hundred births from fathers with Klinefelter syndrome, has been reported. One can estimate, that a TESE performed in half of the patients with non-mosaic 47,XXY will be positive and may enable IVF/ICSI to be achieved.     

Infertility treatment in Klinefelter syndrome

Until few years ago, Klinefelter syndrome with a homogenous 47.XXY caryotype was considered a model of absolute male sterility. In this review, we will discuss the fertility issue following TEsticular Sperm Extraction-IntraCytoplasmic Sperm Injection (TESE-ICSI) and the potential advantage of searching for and cryopreserving spermatozoa in adolescent instead of adult patients.     

Induction of labour and breech presentation: experience of a French maternity ward

Introduction

For a few years, we can notice a progressive increase in the practice of systematic caesarean delivery as far as breech delivery is concerned. This is true notably since the publication of Hannah's “Term Breech Trial” in 2000 which recommends systematic caesarean delivery in the case of breech presentation. But the conclusions of this North-American study are questionable, knowing that French practice is often quite different from Hannah's study.

Objective

In the maternity ward of the French hospital Robert-Debré, Paris, vaginal delivery may be authorized as far as breech presentation is concerned if defined obstetrical criteria are met. Labour can be induced when a maternal or fetal indication exists. In the following study, we tried to assess our practice.

Study design

Our retrospective study included 624 patients with a breech presentation, of which 501 within the group of spontaneous labour (group 1) and 123 within the group of cervical preparation and induced labour (group 2), for the period going from 1 January 2000 to 31 December 2008.

Results

The results do comfort our attitude since they show equivalent results in terms of delivery mode and neonatal issues between breech presentations with spontaneous labour on one hand, and with labour induced by cervical maturation on the other hand.

Conclusion

The primary objective of this study was to evaluate an unusual operating practice in a well-trained level 3 obstetrical team. The results do comfort our attitude since they show equivalent results in terms of delivery mode and neonatal issues between breech presentations with spontaneous labour on one hand, and with labour induced by cervical maturation on the other hand. It seems however difficult to extrapolate our results and apply them to usual practice due to the lack of power of a retrospective and non-randomized study. Setting up a randomized and prospective study seems however difficult because of the medical and ethical problems it would raise.     

Anthropometric analysis of obstetrical pelvis from Neolithic area: obstetrical consequences. Preliminary study

Objectives

To study female pelves from Neolithic area (5000 years AD) in order to better understand the evolution of obstetrical mecanisms.

Materials and methods

The fossil material comprised 73 Homo sapiens pelves: we reconstructed all the 20 adult female bony pelves. We realised the shape and morphometric analysis of the pelvic cavity. Changes in pelvic neolithic morphology were compared with pelvic modern morphology.

Results

The pelves of prehistoric female were similar in shape with modern female. However, they differ in relative dimensions (transversal diameter of the pelvis inlet: respectively 118 mm vs 125 mm, p = 0.02).

Discussion and conclusion

Reconstructions based on Neolithic hominin fossils suggest that obstetrical mechanisms were probably common to Neolithic and modern humans: childbirth would probably require social adaptations and risks of perinatal and obstetric complications were undoubtedly high. However, the differences in morphometric analysis could suggest a change of human pelvis and raise the question of the evolution in obstetrical mechanisms in the future.     

Study of factors favouring the occurrence of Plasmodium falciparum in pregnant women in the health district of Bogodogo

Objective

The behaviour of pregnant women live in towards prevention, attitude health workers, access measures prejudices and inadequate in urban design contribute to course the persistence of malaria. Objective analyse the factors leading to occurrence of malaria in women speakers in the health district Bogodogo.

Patients and methods

He acts sectional study was place in the rainy season period high malaria transmission. The test rapid diagnosis (TDR) using soluble antigens (HRPII) of Plasmodium falciparum was the diagnostic method used in this work and carried on 810 pregnant women in the health area District Bogodogo in Ouagadougou, Burkina Faso.Results The overall prevalence of antigen HRPII P. falciparum was 18.6% with a CI [16.1–21.5] to 95%. It follows from this work that the risk of infection malaria was significantly higher among pregnant women: that were not educated, lived in outlying areas called “zones not off” of the town and villages nearby, who were not using net. For various reasons, the administration of sulfadoxine/pyrimethamine was not supervised and less than 50% of women regularly slept under a mosquito net.

Conclusion

The fight against malaria in pregnant women should focus on communication for change of behaviour of pregnant women and also of health professionals. The fight antivector must be considered in rural areas.     

Favourable outcome after fetoscopic laser surgery for twin-twin transfusion syndrome: experience of an emerging centre

Objectives

Our objective was to report perinatal outcome during the first three years of an emerging centre for laser photocoagulation in twin-twin transfusion syndrome (TTTS) and to compare with outcome observed earlier in the same centre when management consisted in recurrent amniodrainage.

Patients and methods

We conducted a single centre retrospective study. We compared perinatal outcome of 19 consecutive cases of mid trimester TTTS managed by amniodrainage over a 10-year period with 49 cases of TTTS managed by laser photocoagulation over a 3-year period.

Results

Laser photocoagulation increased survival rate at birth (P = 0.02) and at postnatal day 28 (P = 0.01). Neurologic and cardiologic complications did not differ significantly (P = 0.5 and P = 0.3 respectively). We observed a significant increase in survival of the donor after laser coagulation at birth (P = 0.04).

Discussion and conclusion

Our study demonstrated better outcome after laser photocoagulation. Early results of an emerging centre appeared comparable to those of more experienced centres.     

Chlamydia trachomatis: The enemy of the Fallopian tube

The female prevalence of the genital infections due to Chlamydia trachomatis (Ct) is considered at 1.6%, but reached 3.6% among women from 18 to 24 years. Ct is one of the most implied bacteria in PID, even if it is not possible to quantify exactly the prevalence of chlamydial salpingitis because of the frequency of the asymptomatic forms. The physiopathology of these complications is not completely elucidated. The natural clearance of Ct at the cervical level has been demonstrated but it varies with the bacterial serovar. The period between cervical infection and salpingitis is also vague. However, we know that the risk of salpingitis increases with the time of start-up treatment. In addition, the risk of PID and sequelae increases with the number of cervical infections. The diagnosis can be evocated on a rise in the rate of anti-Ct IgG correlated with a rise in CRP. The diagnosis of certitude rests on the coelioscopy, but endo-vaginal echography or the MRI can direct the diagnosis. The prevention of these complications remains the targeted screening of chlamydial infections in at-risk populations, teenagers in particular. The recent techniques of self-administrated vaginal swabs are, in this respect, a real progress.     

Preimplantation diagnosis with HLA typing: birth of the first double hope child in France

Preimplantation genetic diagnosis (PGD) is authorized in France since 1999. After 10 years, technical results are encouraging. With the development of new technologies, our team is able to diagnosis the large majority of chromosome translocations and 75 monogenic diseases. However, PGD remains limited because of the growing augmentation of demands causing an increasing delay for the first procedure of more than 18 months. Since 2006, 19 couples asked for a PGD with HLA typing. In January 2011, 11 couples have already been included in our PGD program. The birth of the first child after PGD with HLA typing offers new perspectives of treatment for these couples.     

Anti-TNFα therapy and its implication in gynecology and obstetrics

Anti-TNFα treatments have modified the medical care, the course and the quality of life of the patients with autoimmune rheumatic, cutaneous or bowel inflammatory diseases. On the other hand, these treatments may have potential severe side effects during pregnancy (congenital malformations, fetal infections). Actually, many pregnancies have been reported during anti-TNFα exposures, with good maternal and neonatal outcomes. The introduction or the discontinuation of these treatments will always have to be discussed with the specialist of the chronic disease and, ideally, during a preconceptional counselling. In gynecology, anti-TNFα drugs may offer a new safe and effective approach to treating patients with recurrent miscarriages or unexplained or failed in vitro fertilization cycles. On the other hand, these treatments significantly increase the risk for serious infections or viral reactivations and may promote gynaecological malignancies. An adapted gynaecological survey is necessary.     

Vers une simplification de la technique de césarienne : suture péritonéale ou non ?

Objectives

To assess the postoperative morbidity of a technique for caesarean section without closing the visceral and parietal peritoneum.

Patients and methods

We conducted a prospective cohort study randomized 252 patients over a period of four months (from March 1 to June 30, 2009). We studied the early postoperative morbidity.

Results

Among the 252 patients, 137 were included in the group “with peritonisation” and 115 in the group “without peritonisation”. Clinical and hematology maternal characteristics were comparable in both groups. The duration of intervention was reduced significantly in the absence of peritonisation (31.1 instead of 41.4 minutes; P < 0.001). The postoperative pain was less but not significant between h0 and h12, however it is significant at h18, h24and h30 in the absence of peritonisation (respectively 2.37 versus 2.81; P = 0.030; 1.98 versus 2.37; P < 0.001 and 1.38 versus 1.72; P = 0.018). Resumption of transit was significantly faster “without peritonisation” (24.3 versus 24.7 hours; P < 0.001). However, there is no significant difference between the two groups as regards the immediate postoperative complications.

Conclusion

The absence of visceral and parietal peritoneum shortens the operative time and favors an earlier resumption of transit. It also decreases pain symptoms. We therefore recommend not to suture the parietal and visceral peritoneum during cesarean section.     

Medical abortion from 12 through 14 weeks' gestation: a retrospective study with 126 patients

Objective

To assess the efficacy of medical abortion performed according to a single protocol from 12 through 14 weeks.

Study design

Retrospective observational study of medical abortions from 12 through 14 weeks performed from January 2007 through March 2009. The protocol combined 600 mg de mifepristone orally, followed 48 h later by 400 μg of misoprostol, administered orally, and repeated after 3 h, four times a day (during two days), if patient did not begin to abort. Outcome measures were the abortion rate, the rate of complication, the rate of manual uterine revision or vacuum aspiration, the time of expulsion and the misoprostol dose.

Results

The study included 126 medical abortions. The abortion rate was 98% and the secondary manual revision or vacuum aspiration rate was 41%. The mean time to expulsion was 10.4 (± 8.8) h, and the mean misoprostol dose 1040 (± 420) μg. Higher parity was significantly correlated with shorter time to expulsion (P = 0.02).

Conclusion

Medical abortion was consistently effective from 12 through 14 weeks but with high rate of secondary manual revision or vacuum aspiration.