[Missed diagnosis of postpartum hemorrhage].

Objective: The purpose of this work was to search for the reasons why the diagnosis of post-partum hemorrhage may be missed.

Patients And Methods: We reviewed retrospectively the files 5,517 vaginal delivery patients cared for in our Gynecology and Obstetrics Unit at the Rouen University Hospital between January 1, 1997 and September 30, 1999. Among these patients, 90 (1.

Thrombophilia and immunological disorders in pregnancies as risk factors for small for gestational age infants.

Objectives: To determine if inherited thrombophilia and immunological disorders represent risk factors for small for gestational age infants, and to assess their relationship with neonatal status.

Design: Case-control study.

Population: Ninety-seven consecutive women who had pregnancies complicated by unexplained small for gestational age infants, defined as a birthweight below the third centile and 97 women as controls who delivered infants with a birthweight > or = 10th centile.

Intravenous chemotherapy, early debulking surgery, and consolidation intraperitoneal chemotherapy in advanced ovarian carcinoma.

Objective: The efficacy of a cisplatin-anthracycline combination, early debulking surgery, and intraperitoneal chemotherapy has been demonstrated through separate studies. We evaluated a multimodal treatment strategy integrating these therapeutic options.

Methods: Women with stage III or IV ovarian carcinoma received six cycles of cisplatin/epirubicin alternating with leucovorin and 5-fluorouracil.

Abnormal placentation and selective embolization of the uterine arteries.

Objective: Abnormal placentation accounts for more than 50% of uterine artery embolization failure. The authors report their experience in this situation.

Study Design: Seven women presented with abnormal placentation.

Adnexal torsion: a report on forty-five cases.

Objectives: To evaluate the clinical findings, evolution of treatment and ovarian function following conservative therapy.

Study Design: A case series of 45 patients presenting with adnexal torsion between January 1989 and June 1999. All patients were surgically treated, either conservatively or radically.

Isolated mild fetal cerebral ventriculomegaly: a retrospective analysis of 26 cases.

We retrospectively studied 26 fetuses with isolated mild cerebral ventriculomegaly diagnosed between 1992 and 1998 and defined by a lateral ventricular atrial diameter of 10-15 mm without any other cerebral anomaly. Our objectives were to determine maternal risk factors, to evaluate complementary investigations, to assess developmental prognosis and to propose possible management. During pregnancy 10/26 patients had regressive ventriculomegalies, ten remained borderline at birth and six were confirmed postnatally.

[Primary fibromatosis of the breast].

Primary fibromatosis of the breast is a very rare pathology which looks like a malignant tumor, clinically and radiologically. Fibromatosis of the breast is characterised by a local invasion and a risk of recurrence. Positive diagnosis is provided by histology and its treatment is surgical.

Plasma progesterone kinetics following surgical treatment of ectopic pregnancies.

Objectives: Comparative study of plasma progesterone and betaHCG kinetics following surgical treatment of ectopic pregnancy.

Study Design: Prospective study involving 62 patients with tubal ectopic pregnancies. Study of the kinetics of plasma progesterone and betaHCG, and the correlation coefficient between plasma progesterone and betaHCG levels during post-operative follow-up.

False aneurysm of the uterine pedicle: an uncommon cause of post-partum haemorrhage after caesarean section treated with selective arterial embolization.

We report three cases of post-partum haemorrhage following caesarean delivery attributed to a false aneurysm of the uterine pedicle and treated with artery embolization. These lesion were probably post-traumatic in origin related to hysterotomy. Angiographic study of the anterior division of hypogastric arteries confirmed the diagnosis and embolization of the false aneurysm was successful in controlling the haemorrhage.

[Evaluation of clinical competence in gynecology obstetrics: an innovative approach using the Objective Structured Clinical Examination].

Objective: The evaluation of medical student clinical competence in Obstetrics and Gynaecology using Objective Structured Clinical Examination (OSCE).

Material And Methods: Development of OSCE with definition of an assessment of subject, choice of clinical stations sampling, identification of components of clinical competence to be evaluated, the level of performance required, development of specification table, editing of OSCE presentation page and assessment of praticability and results exploitation.

Results: Eleven station stimuli with simulated patient participation were carried out, 2 stations with a mannequin model and 1 questionnaire station.

[Which initial tests should be performed to evaluate meno-metrorrhagias? A comparison of hysterography, transvaginal sonohysterography and hysteroscopy].

Objective: Evaluate the feasibility and the value of hysterography, sonohysterography and hysteroscopy for investigation of abnormal uterine bleeding. Method. Longitudinal blind study of thirty-eight patients consulting for abnormal uterine bleeding during pre- and post menopause.

[Endometrial imaging].

The diagnostic value of endovaginal sonography in benign or malignant endometrial pathology is high, increased by sonohysterography. Sonohysterography is useful in the diagnosis of endometrial thickness and to determine further investigations. MRI is accurate in the uterine adenomyosis diagnosis and is the imaging modality of choice for the preoperative endometrial cancer staging.

[Sonographic findings of acardiac twin in the first trimester of pregnancy].

Twin Reversed Arterial Perfusion (TRAP) sequence, or the acardiac anomaly, is a rare complication of monozygotic twins, that occurs in approximately 1 in 35,000 births. In the first trimester, once the diagnosis of monochorionic twins is made, particularly if one embryo shows abnormal development or generalized edema, the TRAP sequence must be considered. Moreover, malformations reported in the perfused twin are often severe.

[Waldmann disease and pregnancy].

Waldman disease, also called intestinal lymphangiectasis, is a protein-loosing enteropathy caused by anomalous intestinal lymphatic canals. The condition is transmitted by autosomal dominant inheritance. Diet therapy including medium chain triglycerides improves the disease course.

[Grand prematurity, risk of neuropsychic handicaps and neuroprotection].

Increased survival of very preterm infants and extremely preterm infants does not imply an increase in neurodevelopmental sequelae. However, preterm infants remain at high risk of severe cerebral palsy with neuromotor dysfunction and mental retardation. Necrotic or hemorrhagic lesions occurring in the periventricular ring of telencephalic white matter are the most threatening events for the developing brain of these infants.

[Inherited thrombophilia and pregnancy].

Inherited thrombophilia include deficiences of antithrombin III, protein C and protein S, and the factor V Leiden mutation, the prothrombin gene variant, and homozygosity for the thermolabile variant of methylenetetrahydrofolate reductase (MTHFR). The incidence of thromboembolism events during pregnancy and postpartum period among women with thrombophilia is not well known and depends on the prethrombotic state resulting from the interaction of the underlying thrombophilic defect(s), history of congenital thrombophilia, and additional risk factors. In that way, many patients with congenital thrombophilia will require antenatal thromboprophylaxis, the timing of which will depend on the patient's history and thrombophilic disorders.

[Newborn shoulder width: physiological variations and predictive value for shoulder dystocia].

Objectives: The purpose of this study was to determine maternal and infant characteristics affecting newborn shoulder width (NSW) and to evaluate the predictive value of NSW measurement in cases of shoulder dystocia.

Design: NSW was systematically measured at birth during a period of 18 months.

Setting: Department of Obstetrics and Gynaecology of Saint-Antoine University Hospital (Paris-France).

Leuprorelin depot 3.75 mg versus lynestrenol in the preoperative treatment of symptomatic uterine myomas: a multicentre randomised trial.

Objectives: To compare the effect of the gonadotrophin-releasing hormone agonist leuprorelin and progestin lynestrenol, given prior to surgical treatment of symptomatic uterine myomas, on the pre-operative symptoms, tolerance, and operative blood loss.

Study Design: Fifty-six women were randomly selected to receive, during 16 weeks, either monthly subcutaneous injections of leuprorelin 3.75 mg sustained release (n=33) or lynestrenol 5 mg two tabs per day (5th to the 25th menstrual cycle) (n=23).

[Management of cholestasis in pregnancy].

Diagnosis: Pruritus in a pregnant women with healthy skin is suggestive of gravid cholestasis. The diagnosis can only be retained after ruling out viral or drug-induced hepatitis or gallbladder disease. The best markers are maternal serum transaminase and bile acid levels.