Trauma périnéal à l'accouchement,intimité, ajustement dyadique et fonction sexuelle de nouveaux couples parentaux

Objective

This study focuses on perineal trauma during childbirth and its relationship to postnatal marital and sexual issues as expressed by the sexual function and perceived intimacy of new parent couples in Ontario.

Myomectomies : prévention de l'hémorragie

Myomectomy is a surgical procedure that allows preservation of the uterus in case of myomatous disease. Various surgical approaches may be considered. However, abundant peroperative haemorrhage may occur, resulting in complications such as incomplete surgery, modification of the surgical access, hypovolaemic shock, blood transfusion, and severe postoperative anaemia, necessitating aggressive treatment and transfusion, and delaying activity recovery. Such observations justify in seeking for means able to prevent peroperative haemorrhage. Several medical preoperative means have been strictly evaluated. The preoperative usage of gonadotrophin releasing hormone (Gn-RH) agonists seems to result, after a reduction of the uterine volume by myometrium vascular re-arrangements, in a reduction of peroperative haemorrhage; the results are still debated. Administrations of Gn-RH, misoprostol or antiprogesterone seem promising but further studies are necessary to confirmation. Preoperative embolization of the myoma could reduce peroperative blood loss but the use of this procedure in childbearing women is under evaluation. Peroperative means are available: chemical means such as vasoconstrictive or oxytocic agents, and mechanical means which temporarily interrupt the myometrial blood flow. Some have shown efficacy. As alternatives to surgery, techniques such myolysis – which induces in situ myoma destruction – necessitate further research, particularly regarding young childbearing women.     

Réunion de concertation pluridisciplinaire de l’endométriose pelvienne profonde : intérêts et modalités de fonctionnement

Deep endometriosis is a frequent disease that affects reproductive age women. This disease is characterized by the presence of functional endometrium-like tissue outside the uterus. The common sites of extragenital endometriosis are the bowel and the urinary tract. This disease is also associated with infertility. Furthermore, this disease can cause physical and psychological damage. Therefore, it is really important to develop a multidisciplinary approach in the aim to offer the appropriate treatment. The multidisciplinary team approach for endometriosis is developing to improve the understanding of endometriosis and a multidiciplinary committee for endometriosis was developed in our center. During this meeting, gynecologic, digestive surgeons, urologist, radiologist, procreative medical assistance physicians analyse the case. The role of surgery, before, after or as an alternative to in vitro fertilization (IVF) must be defined. The role of the medical treatment before or after the surgery, before the IVF shall be discussed in order to propose the optimal treatment. In fact, radical surgery is no more recommanded and minimaly invasive conservative surgery is encouraged in order to preserve the fertility. The multidisciplinary appraoach permits an appropriate optimal and personalised management of this multifocal disease. The multidisciplinary team approach helps in the developpement of evidence-based guidelines for the diagnosis and management of endometriosis.