Inversion utérine non puerpérale aiguë du 3e degré

The uterine inversion is a rare gynecologic complication. Usually, it is extremely serious obstetric complication exposing the young mother at the risk of postpartum haemorrhage. We report the case of a 57-year-old woman, hemodynamically unstable at admission, with an acute uterine inversion a complete fundic submucosal myoma. The surgical management was done by a double approach: laparoscopic and vaginal. Although rare and difficult diagnosis, the acute non-puerperal uterine inversion is a medical-surgical emergency caused by an intracavitary expansive process.     

Rupture utérine bilatérale sur utérus gravide non cicatriciel en dehors du travail

We report a case of bilateral spontaneous uterine rupture of an unscarred uterus occured in a primigravida at 32 weeks to take care in our department after in utero transfert. Uterine rupture occurs mainly on scarred uterus during labor. This is an unfrequent but serious complication involving fetal–maternal prognosis in the absence of immediate care. We are conducting a review about spontaneous uterine rupture of unscarred uterus, before and during labor.     

Prise pondérale maternelle pendant la grossesse et poids des nouveau-nés. Données marocaines

Patients and methods

Study including all patients who delivered in the maternity of the Benslimane provincial hospital between October 1st 2010 and October 1st 2011. Three groups of patients have been formed according to weight gain: less than 8 kg, between 8 and 16 kg and over 16 kg. The epidemiological characteristics and neonatal outcomes were analyzed. The survey was conducted on the basis of a questionnaire for parturient and obstetric records analysis.

Results

The average birth weight was higher in the group “weight gain ≥ 16 kg ” (3782.9 ± 595 g; p < 0.05) as well as the rate of newborns weighing more than 3 800 g (45.5%; p < 0.05), unlike those weighing less than 2 600 g (hypotrophy) whose percentage was higher in the group “weight gain < 8 kg” (6.2%; p < 0.05). Weight gain greater than 16 kg represented an increased risk of dystocia (34.7%).

Conclusion

An excessive weight gain during pregnancy has deleterious effects on neonatal trophicity. It promotes macrosomia. These data point out the interest to follow the recommendations of weight gain during pregnancy.     

Gigantomastie unilatérale gravidique : à propos d’un cas d’hamartome géant

Breast hamartoma is a benign tumour consisting of fat, fibrous and glandular tissue. A young woman in her 19th week of pregnancy underwent exceptional surgery for a unilateral gigantomastia secondary to a rapid-growth giant hamartoma during her second pregnancy. Rigourous clinical and ultrasonographic examinations were performed followed by multiple biopsies. The decision to perform surgery was guided by the risk to skin integrity and of tumour infarct. Our report provides detailed information on gestational benign breast tumours, on the specificities of medical imaging and breast surgery in pregnant patients.     

Salpingectomie bilatérale aux fins de contraception permanente : série de cas et facteurs limitant le changement de pratique

ObjectiveThe Society of Obstetricians and Gynaecologists of Canada (SOGC) and the Society of Gynaecologic Oncology of Canada (GOC) recommend complete removal of the fallopian tubes as a permanent contraceptive method because of its association with a reduced risk of ovarian cancer. Currently, many women are not offered bilateral salpingectomy as an alternative to tubal ligation for permanent contraception.MethodAs part of a quality improvement initiative, we reviewed all cases of sterilization performed at our university centre between 1 January and 31 December 2018. A literature review of the clinical and ethical considerations that prevent clinicians from offering bilateral salpingectomy as permanent contraception is also presented.ResultsThe records of 111 women who underwent tubal sterilization were reviewed. Of these, 31.5% underwent bilateral salpingectomy; 46.8% underwent tubal fulguration; 12.6% underwent clip ligation; and 9.1% underwent tubal implant ligation (Essure). According to the information on file, only 36.3% of women were offered bilateral salpingectomy, and of these, 83.8% chose this method.ConclusionBilateral salpingectomy should be offered to all women seeking permanent contraception. The benefits and very low risks associated with this procedure should make it a first choice option.     

Diastématomyélie: difficultés du diagnostic anténatal

Diastematomyelia is a rare spinal malformation characterized by a cleft in the spinal cord caused by a sagittal osseous or fibrocartilaginous spur. We report a case of prenatal diagnosis of diastematomyelia on a routine second-trimester sonography. Postnatal MRI confirmed the diagnosis, whereas fetal MRI detected a lumbosacral lipoma. Diastematomyelia can be diagnosed antenatally with highly specific sonographic signs. We discuss the interest of antenatal MRI, made in second intention, to specify the diagnosis and the prognosis of this malformation.     

Environnement,génétique et épigénétique

Beginning in the 1960s, the idea that the vast majority of human diseases are neither the result of isolated environmental exposures nor that of the mutation of a single gene was imposed: genetic and environmental risks often are combined. A few years later, experiments have shown that acquired cell changes can lead to persistent changes in gene expression and can be transmitted from one generation to another: the field of epigenetics was born. This article attempts to explain these mechanisms and to give examples. At risk pollutants in the environment include, for example, air pollutants, heavy metals (lead and mercury), flame retardants, and certain pesticides. The critical effects examined are fetal growth and prematurity, neurological and cognitive development, respiratory and immunological health, child growth, and obesity. Among the congenital abnormalities, those that are best known as a result of a gene–environment interaction are neural tube defects, facial clefts, and heart diseases. The recent concept of epigenetics and transgenerational heredity indicates that diet, breathed air, and even emotions might influence not only the expression of an individual’s genes but that of his children and grandchildren. Thus, undernutrition, overeating, or stress is likely to induce in the next generations pathologies as varied as obesity, diabetes, allergies, or cardiovascular diseases. Results of the quoted studies could have important consequences for the knowledge of risk factors, prevention, or even therapy of many diseases.     

Réhabilitation précoce postopératoire après césarienne

Caesarean delivery is more and more becoming a minor surgical procedure as present surgical techniques are associated with reduced trauma and because it is possible to return to normal life soon after surgery. Moreover, this surgical procedure is performed in numerous patients and institutions. More than in any other surgical procedure, rapid postoperative rehabilitation is essential to facilitate maternal and neonatal bonding. Improvement of present practice should be implemented rapidly in all institutions and may be obtained by modifying some simple but important strategies. Reducing invasiveness of care (postpartum avoidance of urinary catheter and of intravenous infusion) is the primary goal to achieve and is associated with rapid allowance of drinking in the post-anaesthesia care unit and oral feeding in the first hours after surgery. Adequate pain relief may be obtained by using multimodal strategies which allow a reduced use of opioids and their accompanying their side effects. Patient controlled oral analgesia can be combined with this strategy. Preventing postpartum haemorrhage by administration of an oxytocic drug, and choosing whenever possible carbetocin which is administered as a single injection also reduces the use of postoperative intravenous fluids. These simple and easy to implement recommendations should now be undertaken in every maternity unit by using multidisciplinary clinical pathways.     

Décidualisation ectopique géante du péritoine et de l’épiploon mimant une carcinose péritonéale

Ectopic decidual reaction of the peritoneum and the omentum is rare. It is usually an incidental finding during caesarean section and it could mimick macroscopically peritoneal carcinomatosis or tuberculosis. Histology is very important to make diagnosis. Ectopic decidual reaction is physiological, with an excellent prognosis and spontaneous resolution. We report one case of ectopic peritoneal and omental deciduosis of the peritoneum and discovered incidently during caesarian section. Definitive diagnosis was done by immunohistological examination. A laparoscopy four months later showed complete and spontaneous regression of all lesions.