[Obstetric vesicovaginal fistulas, about 131 cases].

Background: Vesicovaginal fistulas are the most frequent type of urogenital fistulas. Obstetrical cause remains the dominant etiology. They still represent a public health problem.

[Placenta praevia percreta with bladder invasion: a life-threatening pregnancy complication].

Placenta percreta is characterized by the penetration of trophoblast through the myometrium and peritoneum. This invasion may also involve adjacent structures. This condition is the most serious of placental implantation anomalies.

[Tubo-ovarian actinomycosis. A report of two cases and literature review].

Actinomycosis is an infection due to an anaerobic Gram-positive bacilus bacteria: Actinomyces. Tubo-ovarian locallisation is rare. It more often appears clinically as a pseudo-tumoral and feverish syndrom, evoking wrongly a malignant tumoral pathology, and often leads to a mutilating surgical treatment.

[Prune belly syndrome: early prenatal diagnosis and management].

Prune Belly syndrome is characterized by a combination of megacystis, anterior abdominal wall distension with deficiency of the abdominal wall musculature, and bilateral cryptorchidism. Diagnosis is easy after 15 weeks of gestation, but may be difficult at the end of the first term. Authors report 2 cases of Prune Belly syndrome diagnosed at 11 and 14 weeks of gestation respectively.

[Indicators for successful vaginal delivery after cesarean section: a proposal of a predictive score].

The purpose of this study is to determine predictive factors of successful vaginal delivery after cesarean section, and to estimate the risks of this trial of labor (TOL). A retrospective study about 352 women undergoing a TOL after cesarean section was carried out. Different variables stratified by the termination of the TOL were analysed with statistic tests.

[Blind hemivagina: diagnostic method and problems of treatment].

Blind hemivagina with duplex uterus and agenesis of the homolateral urinary tract is a rare malformation. For this reason, diagnosis may be not found. We report one case of duplex uterus with blind hemivagina in a fourteen-year-old adolescent girl.

[Peripartum pubic symphysis separation. A report of three cases and review of the literature].

Peripartum pubic symphysis separation is a rare complication of delivery, but the incidence seems to be under-estimated. We report three cases of pubic syphysis separation identified in a two-year period. All cases occurred following spontaneous non operative vaginal deliveries.

[Ovarian pregnancy: the situation in 2003. A report of four cases and literature review].

Ovarian pregnancy remains a rare form of extracitérine pregnancy. It's incidence is estimated at 1 to 6% of ectopic pregnancies. We report 4 cases of ovarian pregnancies diagnosed at the obstetric and gynecology department of Nabeul Hôspital (Tunisia) during a 4 year period.

[The delivery of macrosomic infants weighing 4500 g and more. A report of 61 cases].

Unlabelled: The objective of this study is to review the difficulties in prediction of great macrosomia, to assess trial of labor results, and to confirm the increased risk of perinatal complications.

Material And Method: in this retrospective study we analyzed 61 deliveries of infants with birth weights > 4500 g in one year period. This group was compared with a group of infants weighing between 4000 and 4500 g (339 cases) born during the same period.

[Sonographic estimation of fetal weight at term: a proposal of a predictive score of a weight more than 4500 g].

Unlabelled: Estimation of fetal weight at term is essential because of risks of macrosomic infant delivery. The purpose of this study is to assess sonographic prediction of macrosomia and especially in fetal weight (o) > 4500 g.

Material And Method: In a retrospective study on one year period, we analyzed sonography of 214 pregnant women at term having delivered macrosomic infants.

[Clinical fetal weight estimation and prediction of macrosomia].

The purpose of this study is to assess symphysis fundal height measurement in prediction of fetal macrosomia and to search for the error causes. A retrospective study concerning 400 macrosomic newborns was performed. For each pregnant woman before delivery, we have reviewed fundal height, weight, height and newborn weight.

[Tubo-ovarian actinomycosis ruptured in the sigmoid colon].

Actinomyces is an anaerobic, gram-positive bacteria saprophyte of the oral cavity, lungs, genital and gastro-intestinal tracts. Tubo-ovarian infection is rare. The authors report a case of tubo-ovarian abscess, due to actinomyces ruptured in the sigmoid and diagnosed in a 30-year-old woman using an intra-uterine device for more than 5 years.

Molecular spectrum of alpha-thalassemia in Tunisia: epidemiology and detection at birth.

We present the characterization of the molecular spectrum and frequency data of alpha-thal (thal) defects in Tunisia, and an evaluation of the efficacy and limitations of Hb Bart's (gamma4) measurement for the screening of alpha-thal at birth. Cord blood samples were collected from two different areas: the northeast of the country, an area where Hb H (beta4) disease frequently occurs, and Tunis, the capital city, representative of the average Tunisian population. From the first group, 110 samples with Hb Bart's and/or microcytosis at birth were selected from 1270 randomly collected samples.

[Voluntary surgical sterilization by laparoscopy in cases of cardiovascular diseases. Prospective study of 19 cases].

Nineteen women with cardiovascular disease underwent voluntary per-celioscopic sterilisation under local anesthesia at the La Rabta Maternity and Neonatology Centre, Tunis, Tunisia, between 1 July 1988 and 31 March 1989. There were 8 cases of hypertension, 1 of mitral insufficiency and 10 cases of surgically treated valve disease (6 cases of commissurotomy for mitral stenosis and 4 valve replacements). Mean parity of the women was 5 and mean age 35.

[Induction of labor in fetal death in utero using a Foley catheter and extra-amniotic perfusion of physiologic serum].

Nineteen cases of induction of labour by Foley catheter and extra-amniotic perfusion of normal saline for fetal death in utero occurring more than 24 weeks after the LMP were collected in the La Rabta Maternity and Neonatology Centre, Tunis, during the final 6 months of 1987. The mean age of the women was 27.8 and their mean parity 2.

[Voluntary surgical sterilization by laparoscopy in the immediate post partum period. Prospective study in 55 cases].

Fifty five voluntary sterilisations were carried out during the immediate post-partum period via celioscopy and under local anesthesia at the La Rabta maternity and neonatology centre, Tunis, between 1 July 1988 and 31 March 1989. The women had a mean age of 34.6, mean parity of 6 and living children of both sexes.

[Pregnancy following female surgical sterilization. A study apropos of 38 cases].

A study of 38 cases of pregnancy that occurred after sterilisation between 1st January 1981 and the 30th September 1987 at the Maternity and Neonatology Department of La Rabta, Tunis. This complication is rare because the overall global figure for failure is 7.1/1000.

[Maternal mortality at the Maternity and Neonatology Center in Rabta of Tunis from 1986 to 1989].

We studied 29 cases of maternal death occurring over a period of 3 years in the "Centre de Maternité et de Néonatologie de La Rabta-Tunis"; managed by the same staff. 42,028 live births occurred during the study years with 43,220 total births from April 24th 1986 to April 23rd 1989. The maternal mortality rate was 69 per 100,000 live births.

[Intramural pregnancy: a case report].

Implantation into the muscle wall is one of the rarer forms of ectopic pregnancy. We report an uncomplicated case which was discovered during therapeutic termination of pregnancy at 10 weeks. We point out how valuable the use of ultrasound during the operation is for making the diagnosis when suction does not provide adequate quantities of products.

[The role of culdocentesis in the diagnosis of ectopic pregnancy. Prospective study of 478 cases].

Four hundred and seventy height Culdocenteses were carried out in cases of possible ectopic pregnancy between the 20th September 1986 and 31st December 1987. Culdocentesis was considered to be positive if 2 cm3 or more of dark non-coagulated blood was removed, and negative if only a yellow liquid or blood stained serum was removed. It was not conclusive if nothing could be aspirated or if the blood was coagulated.

[Wegener's granulomatosis and pregnancy. A case].

Pregnancy concomitant with Wegener's granulomatosis is extremely rare: so far, only four cases have been published. The authors report a fifth case where the disease appeared during the post-partum period, a situation which has already been noted in two of the published cases. Interruption of a subsequent pregnancy was followed by a flare-up of the disease resulting in the patient's death.