[Off-label drug use of the misoprostol in gynecology & obstetrics: From a medico-economics benefit to a potential legal risk].

The scandal of the Mediator® case led the legislature to take measures in order to regulate off-label drugs prescriptions. Indeed the law issued in December 29th, 2011 on strengthening the safety of drugs and all derivative health products came to pave the way for an "over-cautious" practice of medicine in line with the precautionary principle erected as a constitutional principle. The supervision of off-label prescribing has had a direct impact on the exercise of the medical profession and has resurrected the issues related to the freedom of prescription, the obligation to provide information to patients and in general their whole responsibility.

Feasibility and safety study of a new device (Odón device) for assisted vaginal deliveries: study protocol.

Background: Intrapartum complications are responsible for approximately half of all maternal deaths, and two million stillbirth and neonatal deaths per year. Prolonged second stage of labour is associated with potentially fatal maternal complications such as haemorrhage and infection and it is a major cause of stillbirth and newborn morbidity and mortality. Currently, the three main options for managing prolonged second stage of labour are forceps, vacuum extractor and caesarean section.

[Peritoneal serous borderline tumor discovered during a cesarean section. A case report].

During a caesarean section performed in a 36-year-old woman, we discovered small granulations on the pelvic peritoneum. Biopsies were performed. The diagnosis of primitive borderline serous tumor was confirmed by pathologists.

Utilization of carbetocin for prevention of postpartum hemorrhage after cesarean section: a randomized clinical trial.

Purpose: A randomized study involving pregnant women was conducted to compare the effectiveness of a single intravenous (IV) injection of carbetocin with that of a standard 2-h oxytocin IV infusion with respect to intraoperative blood loss in the prevention of uterine atony after cesarean section (CS). The two treatments also were compared for safety and ability to maintain adequate uterine tone and to reduce the incidence and severity of postpartum hemorrhage (PPH) in women at risk for this condition.

Methods: Between 1 September 2007 and 5 January 2008, we enrolled 104 patients with at least one risk factor for PPH undergoing CS in a randomized, controlled clinical trial.

Pregnancy and post-partum breast cancer: a prospective study.

Background: The concomitant occurrence of breast cancer and pregnancy remains a challenging clinical situation combining ethical and medical problems. There are few prospective data on pregnancy-associated breast cancer (PABC) whose incidence continuously increases.

Patients And Methods: Forty patients with PABC were compared with 61 non-pregnant, age-matched patients with infiltrative breast carcinomas (BC) diagnosed and followed since 1982.

Prevention of cerebral palsy during labour: role of foetal lactate.

Objectives: Intrapartum foetal monitoring goal is to prevent foetal asphyxia and its most severe consequence: cerebral palsy (CP). In this paper we describe the detection methods and the criteria needed to assess asphyxia during labour for preventing CP. Foetal cerebral damage assessment is considered from the medical-legal point of view.

Screening of foetal distress by assessment of umbilical cord lactate.

Purpose Of Investigation: Studies on umbilical cord blood for determination of lactate indicate that high levels seem to be correlated to foetal metabolism for anaerobic glycolysis taking place in oxygen-deprived tissues of the foetus. These findings may be of particular-deprived clinical importance when foetal distress or foetal hypoxemia is caused by perinatal events.

Methods: The maternal and foetal heart rates, acid-base values measured and the outcome of 94 pregnancies complicated by intrapartum foetal asphyxia have been reviewed, and the maternal and foetal acid-base and lactate levels during the course of labour and at delivery were studied in patients with evidence of metabolic acidosis.

[Management of ovarian cysts].

Ovarian cysts occur frequently in women of reproductive age. These are usually functional cysts which resolve spontaneously and whose evolution can be followed with ultrasound. Non-functional cysts have diverse histologic origins.

The complex relationship between smoking in pregnancy and very preterm delivery. Results of the Epipage study.

Objective: To assess the relationship between cigarette smoking during pregnancy and very preterm births, according to the main mechanisms of preterm birth.

Design: Case-control study (the French Epipage study).

Setting: Regionally defined population of births in France.

[Femoral neuropathy after transversal suspubic laparotomies. Etiopathological explanation on the basis of an anatomical study].

Objectives: Based on a case of transient troncular femoral neuropathy after the surgical treatment of a genital prolapse in a 46-year-old woman, a study was designed to better understand the mechanism of this postoperative complication.

Methods: The consequences of different varieties of transversal laparotomies were investigated in human cadavers.

Results: On the basis of the data from the anatomical evaluation, the most probable etiopathogenic explanation for the complication we observed is the compression of the femoral nerve, inside the psoas muscle, by the retractor lower edge.

[Multidisciplinary management of aortic dissection complicating pregnancy].

Background: Most cases of aortic dissection observed in women under 40 years of age occur as a complication of pregnancy in patients with other risk factors. Case report. We report a case of dissection of the ascending aorta in a young primigravida at 35 weeks gestation.

Antiphospholipid antibodies and preeclampsia: a case-control study.

Objective: To assess the association between the occurrence first of preeclampsia and antiphospholipid antibodies.

Methods: We conducted a prospective case-control study of 180 pregnant women with their first incidents of preeclampsia and no histories of thrombosis or systemic autoimmune diseases. Preeclampsia (n = 180) was defined as blood pressure (BP) at least 140/90 mmHg after 20 weeks' gestation and proteinuria at least 0.

[Massive feto-maternal transfusion. Report of 3 cases with review of the literature].

Massive feto maternal hemorrhage is rare. Early diagnosis is important because massive feto-maternal hemorrhage has a poor prognosis. The clinical manifestations of transplacental hemorrhage are related not only to the size of the hemorrhage but also to the time at which the hemorrhage occurs.

[Ursodeoxycholic acid: prospect for treatment of gravidic cholestasis? Report of 3 cases].

Ursodeoxycholic acid, employed in treatment of intrahepatic cholestasis as seen in primary biliary cirrhosis, primary sclerosing cholangitis, and chronic hepatitis; does not have marketing approval for prescription during pregnancy because of lack of data. In 3 cases of gravidic cholestasis, we administered oral ursodeoxycholic acid 1 g a day from the 34th week of amenorrhea to delivery. In each case, it took 3 days of treatment for the pruritus to regress incompletely and for plasma levels of biliary acid and transaminases to decrease.

A family with dominant oculoauriculovertebral spectrum.

In 1990, Gorlin et al. [Syndromes of the Head and Neck, New York: Oxford University Press, pp 641-649, 707-708] proposed to lump several syndromes together, including facioauriculovertebral syndrome, hemifacial microsomia, otomandibular dysostosis, Goldenhar syndrome, the first branchial arch anomalies and the first and second branchial arches anomalies. They proposed to use the term oculoauriculovertebral "spectrum.

[Bilateral subdural hematoma following epidural anesthesia].

Purpose: The authors report a case of bilateral subdural hematoma (SDH) which occurred following epidural analgesia for labour, complicated by post dural puncture headache (PDPH). Physiopathological mechanisms are discussed.

Clinical Features: A 27-yr-old woman displayed typical PDPH following epidural anaesthesia.

Prenatal diagnosis of Walker-Warburg syndrome in three sibs.

Walker-Warburg syndrome (WWS) is an autosomal recessive condition characterized by diffuse neurodysplasia, resulting in brain and eye abnormalities. We report on 3 prenatally diagnosed cases of this syndrome born to a consanguineous couple. An ultrasonographic examination showed hydrocephalus at the 27th week of the first pregnancy.

[Urinary complications during laparoscopy: a urachal diverticula injury].

The authors report a bladder injury during laparoscopic procedure. A laparotomy is performed immediately and shows an urachal anomaly with the bladder reaching the umbilic. One of the accessory trocars perforates the bladder in its unusual position.

[Meckel syndrome. Update on a recurrent case].

Meckel's syndrome is an autosomal recessive disorder classically defined by occipital encephalocele, multicystic kidneys and polydactyly. However, a very wide phenotypic spectrum is characteristic of Meckel's syndrome. The prenatal diagnosis of this lethal syndrome is approached with ultrasound examination.