Objective: This study was undertaken to report on the prevalence and management of late complications in twin-to-twin transfusion syndrome (TTTS) treated by laser therapy when both twins are alive 1 week after surgery...Objective: This study was undertaken to report on the prevalence and management of late complications in twin-to-twin transfusion syndrome (TTTS) treated by laser therapy when both twins are alive 1 week after surgery. Study design: A total of 151 consecutive TTTS cases were treated by selective fetoscopic laser therapy. Cases in which both twins were alive 1 week after surgery were followed up with ultrasound and Doppler examination, including middle-cerebral artery peak systolic velocity measurement (MCA-PSV). Results: In the 151 cases treated with laser, both twins were still alive 7 days after the procedure in 101 cases. Intrauterine death of 1 and both twins occurred in 7 and 1 cases, respectively. Recurrence of TTTS with the polyhydramnios-oligohydramnios sequence occurred in 14 (14% ) cases. In another 13 (13% ) cases,amniotic fluid remained normal in both sacs, but MCA- PSV increased above 1.5 MoM in 1 twin and decreased concomitantly below 0.8 MoM in the co-twin. This was related to anemia and polycythemia, respectively, and resulted from unidirectional feto-fetal blood transfusion, mainly from former recipients into former donors. Late complications were managed accordingly by repeat laser, amnioreduction, cord coagulation, intrauterine blood transfusion, or elective delivery. Conclusion: MCA-PSV Doppler measurements are useful in the follow-up of double survivors to detect and manage late complications after selective laser therapy.展开更多
Description of acute per-partum feto-fetal transfusion. The risk of twin-twin transfusion syndrome in monochorionic twin pregnancies is well known. This pathology starts in the second trimester and has a chronic cours...Description of acute per-partum feto-fetal transfusion. The risk of twin-twin transfusion syndrome in monochorionic twin pregnancies is well known. This pathology starts in the second trimester and has a chronic course. Acute per-partum feto-fetal transfusion seems to be less frequent and has not been studied. In the study, we described two cases of acute per-partum fetofetal transfusion. The outcomes of the pregnancies were as follows: following a successful delivery, the first set of twins presented hypovolemic shock at birth due to an acute anemia. The second set of twins was polyglobulic, but otherwise healthy at birth. The risk of hypovolemic shock seems to be unpredictable, even if the pregnancy is monitored. Obstetricians and pediatricians must keep this pathology in mind when dealing with this kind of pregnancy. Moreover, it would be interesting to obtain systematically a full blood count of each set of twins of monochorionic pregnancies, in order to detect every case of feto-oetal transfusion.展开更多
Objectives. We evaluated the results of surgical insertion of a polypropylene mesh via the vaginal route in young women presenting genital prolapse. Material and methods. Retrospective study concerning 20 women under ...Objectives. We evaluated the results of surgical insertion of a polypropylene mesh via the vaginal route in young women presenting genital prolapse. Material and methods. Retrospective study concerning 20 women under age 50 who underwent between July 2000 and December 2003 surgical insertion of an anterior (n = 14), posterior (n = 3) or double (anterior and posterior) (n = 3) polypropylene mesh via the vaginal route. A minimum follow-up of 6 months was required for inclusion in the study. Anatomical results were assessed using the Pelvic Organ ProlapseQuantification (POP- Q) according to ICS (International Continence Society) recommendations. To document the functional results, the patients answered 3 validated self-assessment questionnaires related to pelvic symptoms, sexual behaviors and quality of life. Results. Mean follow-up was 21 months (6 to 52 months). A vaginal erosion of the mesh occurred in 2 women (10% ). Cystocele recurred in one woman among the 17 patients who had an anterior polypropylenemesh (GynemeshTM, Gynecare ,Ethicon ). Seventeen women were sexually active before the surgical procedure and 19 post-operatively. Among these women, 5 (26% ) reported alteration of sexual activity after surgery (with dyspareunia in 4 cases (21% ), and 14 women (74% ) reported no changes or improvement in sexual activty. Conclusion. Surgical management of genital prolapse using a polypropylene mesh inserted via the vaginal route has proven its anatomical efficacy in young women. The potential adverse consequences on sexual life would require clinical research concerning the surgical approach (abdominal or vaginal route) and synthetic materials used in prolapse surgery for young women.展开更多
To describe the frequency of maternal and neonatal complications resulting from the use of Thierry’s spatulas. Materials and methods. This retrospective study included 166 patients treated during a 17- month period. ...To describe the frequency of maternal and neonatal complications resulting from the use of Thierry’s spatulas. Materials and methods. This retrospective study included 166 patients treated during a 17- month period. Results. For 100% of the patients, the use of the spatulas allowed the extraction of the new born, in 68 cases (41% ) the new born was engaged between one and two centimeters below the spines. A mediolateral episiotomy was performed in 159 patients (96% ). A serious perineal tear (Type 3) occurred for 6 of these patients (3.6% ). A simple perineal tear (Type 1) or vaginal tear occurred in 24 (18% ). Episiotomy was performed in 18 patients and was significantly protective. No case of serious neonatal complication were related to the use of the spatulas. Conclusion. We found that perineal tear rate is similar to that observed with other instruments used for fetal extraction. No case of fetal trauma could be related to the use of the spatulas; this was the goal of Thierry who creation the instrument. The use of Thierry’s spatulas as a reference instrument is warranted, particularly for cases of prematurity, as these spatulas fulfil the modern obstetrics requirements of fetal protection, without maternal risk.展开更多
Objective.- To evaluate the results of laparoscopic surgery in the management of ovarian cysts in pregnant patients. Patients and methods.-Retrospective study including 26 pregnant patients who underwent the laparosco...Objective.- To evaluate the results of laparoscopic surgery in the management of ovarian cysts in pregnant patients. Patients and methods.-Retrospective study including 26 pregnant patients who underwent the laparoscopic management of ovarian cysts. The indications for surgery were persistent adnexal mass, abnormal ovarian cysts revealed by ultrasound examination, suspicion of cyst complications. The technique used, the immediate postoperative results and obstetrical outcomes were studied. Results.-Twelve patients were operated during the first trimester of pregnancy,13 in the second, and one in the third trimester. A 12 mmHg CO2 pneumoperitoneum was created, using a Veress needle in 22 cases, and an open technique in 4 cases. Trocar sites were decided according to the uterine size and to the cyst situation. A cystectomy was performed in 11 cases, an adnexectomy in 7 cases, an oophorectomy in one case, a cyst aspiration with a biopsy of the cyst wall in 6 cases and an ovarian torsion removal in one case. A conversion to laparotomy was necessary in 3 cases. There were no immediate postoperative complications and obstetrical outcomes were good in all cases. Discussion and conclusion.-In pregnant patients, laparoscopic management of adnexal masses appears to be safe for both mother and child.展开更多
Introduction. Prosthetic reinforcement by the vaginal approach for surgical repair of pelvic prolapse is experiencing increasing popularity despite problems with tolerance. The most frequently described complication i...Introduction. Prosthetic reinforcement by the vaginal approach for surgical repair of pelvic prolapse is experiencing increasing popularity despite problems with tolerance. The most frequently described complication is prosthesis exposure, also known as erosion or granuloma. The mechanism is associated with defective vaginal healing and is independent of major infection such as pelvic cellulitis. The purpose of our study was to define the course of this complication and the best therapeutic strategy for patients with prosthesis exposure. Materials and method. Our continuous and retrospective study conducted over a period of 24 months between January 2002 and December 2003 recorded 34 files. These patients underwent prosthetic treatment via the vaginal approach of genital prolapse associated with prosthesis exposure. The procedure, known as TVM (Tension free Vaginal Mesh), involves the insertion without fixing of a synthetic prosthesis in areas of bladder-vagina and rectum-vagina detachment. Results. In 33 cases out of 34, the exposure site was located on the anterior colpotomy scar (97% ). These prosthesis exposures were managed in two stages, using antiseptic treatment first. This treatment cured 9 patients (26.47% ). In the event of failure, a procedure was carried out under brief general anesthesia on an outpatient basis or during a 24- hour hospital stay. This single resection was sufficient for 20 patients (88% ). Two patients nevertheless required a second removal procedure (8% ) and one patient a third procedure (4% ). To notice, one patient presented with a bladder-vagina fistula after resection. This observation of a bladder-vagina fistula following partial removal led us to recommend a blue test and/or cystoscopy as routine practice for each procedure. Conclusion. With this new vaginal approach for prolapse repair, it is important to monitor prosthesis exposure. To manage exposures, it is necessary to begin with antiseptic or estrogenic treatment. In the event of failure, a partial resection is warranted. We recommend careful prosthesis resection and systematic verification of the bladder.展开更多
Objective. To determine risk factors of failed labor in case of fetal macrosomia. Materials and methods. Medical charts of two hundred and forty six women who delivered macrosomic infants ( > 4,000g) between Januar...Objective. To determine risk factors of failed labor in case of fetal macrosomia. Materials and methods. Medical charts of two hundred and forty six women who delivered macrosomic infants ( > 4,000g) between January 2004 and May 2005 were reviewed. Maternal and obstetrical data were analyzed by mode of delivery. Univariate and multivariate (logistic regression analysis) were performed to identify risk factors of failed labor. Results. Rate of cesarean delivery was 18.3% . Indications for cesarean were: failure to progress in 55.6% , arrest in fetal descent in 22.2% , fetal distress in 6.7% , and other in 8.9% . There was a higher risk of failed labor in nulliparous women (p < 0.001), in case of a symphysio-fundal measurements > 34cm (p = 0.004), in nulliparity associated with symphysio-fundal measurements > 34cm (p < 0.001), in case of previous cesarean delivery (p = 0.004), in cases of maternal height < 1.65m (p = 0.02), and with ocytocin use (p = 0.05). In multivariate analysis, nulliparity associated with symphysio-fundal measurements > 34cm (OR = 5.2; CI 1.5- 18.4), previous cesarean section (OR = 3.7; CI 1.1- 12.4) and maternal height < 1.65m (OR = 2.6; CI 1.2- 5.5) were independent factors of failed labor. Conclusion. Failure of labor in case of macrosomia can be predicted in the event of previous cesarean section, shorter maternal height, and association of nulliparity and symphysio- fundal measurements > 34cm.展开更多
文摘Objective: This study was undertaken to report on the prevalence and management of late complications in twin-to-twin transfusion syndrome (TTTS) treated by laser therapy when both twins are alive 1 week after surgery. Study design: A total of 151 consecutive TTTS cases were treated by selective fetoscopic laser therapy. Cases in which both twins were alive 1 week after surgery were followed up with ultrasound and Doppler examination, including middle-cerebral artery peak systolic velocity measurement (MCA-PSV). Results: In the 151 cases treated with laser, both twins were still alive 7 days after the procedure in 101 cases. Intrauterine death of 1 and both twins occurred in 7 and 1 cases, respectively. Recurrence of TTTS with the polyhydramnios-oligohydramnios sequence occurred in 14 (14% ) cases. In another 13 (13% ) cases,amniotic fluid remained normal in both sacs, but MCA- PSV increased above 1.5 MoM in 1 twin and decreased concomitantly below 0.8 MoM in the co-twin. This was related to anemia and polycythemia, respectively, and resulted from unidirectional feto-fetal blood transfusion, mainly from former recipients into former donors. Late complications were managed accordingly by repeat laser, amnioreduction, cord coagulation, intrauterine blood transfusion, or elective delivery. Conclusion: MCA-PSV Doppler measurements are useful in the follow-up of double survivors to detect and manage late complications after selective laser therapy.
文摘Description of acute per-partum feto-fetal transfusion. The risk of twin-twin transfusion syndrome in monochorionic twin pregnancies is well known. This pathology starts in the second trimester and has a chronic course. Acute per-partum feto-fetal transfusion seems to be less frequent and has not been studied. In the study, we described two cases of acute per-partum fetofetal transfusion. The outcomes of the pregnancies were as follows: following a successful delivery, the first set of twins presented hypovolemic shock at birth due to an acute anemia. The second set of twins was polyglobulic, but otherwise healthy at birth. The risk of hypovolemic shock seems to be unpredictable, even if the pregnancy is monitored. Obstetricians and pediatricians must keep this pathology in mind when dealing with this kind of pregnancy. Moreover, it would be interesting to obtain systematically a full blood count of each set of twins of monochorionic pregnancies, in order to detect every case of feto-oetal transfusion.
文摘Objectives. We evaluated the results of surgical insertion of a polypropylene mesh via the vaginal route in young women presenting genital prolapse. Material and methods. Retrospective study concerning 20 women under age 50 who underwent between July 2000 and December 2003 surgical insertion of an anterior (n = 14), posterior (n = 3) or double (anterior and posterior) (n = 3) polypropylene mesh via the vaginal route. A minimum follow-up of 6 months was required for inclusion in the study. Anatomical results were assessed using the Pelvic Organ ProlapseQuantification (POP- Q) according to ICS (International Continence Society) recommendations. To document the functional results, the patients answered 3 validated self-assessment questionnaires related to pelvic symptoms, sexual behaviors and quality of life. Results. Mean follow-up was 21 months (6 to 52 months). A vaginal erosion of the mesh occurred in 2 women (10% ). Cystocele recurred in one woman among the 17 patients who had an anterior polypropylenemesh (GynemeshTM, Gynecare ,Ethicon ). Seventeen women were sexually active before the surgical procedure and 19 post-operatively. Among these women, 5 (26% ) reported alteration of sexual activity after surgery (with dyspareunia in 4 cases (21% ), and 14 women (74% ) reported no changes or improvement in sexual activty. Conclusion. Surgical management of genital prolapse using a polypropylene mesh inserted via the vaginal route has proven its anatomical efficacy in young women. The potential adverse consequences on sexual life would require clinical research concerning the surgical approach (abdominal or vaginal route) and synthetic materials used in prolapse surgery for young women.
文摘To describe the frequency of maternal and neonatal complications resulting from the use of Thierry’s spatulas. Materials and methods. This retrospective study included 166 patients treated during a 17- month period. Results. For 100% of the patients, the use of the spatulas allowed the extraction of the new born, in 68 cases (41% ) the new born was engaged between one and two centimeters below the spines. A mediolateral episiotomy was performed in 159 patients (96% ). A serious perineal tear (Type 3) occurred for 6 of these patients (3.6% ). A simple perineal tear (Type 1) or vaginal tear occurred in 24 (18% ). Episiotomy was performed in 18 patients and was significantly protective. No case of serious neonatal complication were related to the use of the spatulas. Conclusion. We found that perineal tear rate is similar to that observed with other instruments used for fetal extraction. No case of fetal trauma could be related to the use of the spatulas; this was the goal of Thierry who creation the instrument. The use of Thierry’s spatulas as a reference instrument is warranted, particularly for cases of prematurity, as these spatulas fulfil the modern obstetrics requirements of fetal protection, without maternal risk.
文摘Objective.- To evaluate the results of laparoscopic surgery in the management of ovarian cysts in pregnant patients. Patients and methods.-Retrospective study including 26 pregnant patients who underwent the laparoscopic management of ovarian cysts. The indications for surgery were persistent adnexal mass, abnormal ovarian cysts revealed by ultrasound examination, suspicion of cyst complications. The technique used, the immediate postoperative results and obstetrical outcomes were studied. Results.-Twelve patients were operated during the first trimester of pregnancy,13 in the second, and one in the third trimester. A 12 mmHg CO2 pneumoperitoneum was created, using a Veress needle in 22 cases, and an open technique in 4 cases. Trocar sites were decided according to the uterine size and to the cyst situation. A cystectomy was performed in 11 cases, an adnexectomy in 7 cases, an oophorectomy in one case, a cyst aspiration with a biopsy of the cyst wall in 6 cases and an ovarian torsion removal in one case. A conversion to laparotomy was necessary in 3 cases. There were no immediate postoperative complications and obstetrical outcomes were good in all cases. Discussion and conclusion.-In pregnant patients, laparoscopic management of adnexal masses appears to be safe for both mother and child.
文摘Introduction. Prosthetic reinforcement by the vaginal approach for surgical repair of pelvic prolapse is experiencing increasing popularity despite problems with tolerance. The most frequently described complication is prosthesis exposure, also known as erosion or granuloma. The mechanism is associated with defective vaginal healing and is independent of major infection such as pelvic cellulitis. The purpose of our study was to define the course of this complication and the best therapeutic strategy for patients with prosthesis exposure. Materials and method. Our continuous and retrospective study conducted over a period of 24 months between January 2002 and December 2003 recorded 34 files. These patients underwent prosthetic treatment via the vaginal approach of genital prolapse associated with prosthesis exposure. The procedure, known as TVM (Tension free Vaginal Mesh), involves the insertion without fixing of a synthetic prosthesis in areas of bladder-vagina and rectum-vagina detachment. Results. In 33 cases out of 34, the exposure site was located on the anterior colpotomy scar (97% ). These prosthesis exposures were managed in two stages, using antiseptic treatment first. This treatment cured 9 patients (26.47% ). In the event of failure, a procedure was carried out under brief general anesthesia on an outpatient basis or during a 24- hour hospital stay. This single resection was sufficient for 20 patients (88% ). Two patients nevertheless required a second removal procedure (8% ) and one patient a third procedure (4% ). To notice, one patient presented with a bladder-vagina fistula after resection. This observation of a bladder-vagina fistula following partial removal led us to recommend a blue test and/or cystoscopy as routine practice for each procedure. Conclusion. With this new vaginal approach for prolapse repair, it is important to monitor prosthesis exposure. To manage exposures, it is necessary to begin with antiseptic or estrogenic treatment. In the event of failure, a partial resection is warranted. We recommend careful prosthesis resection and systematic verification of the bladder.
文摘Objective. To determine risk factors of failed labor in case of fetal macrosomia. Materials and methods. Medical charts of two hundred and forty six women who delivered macrosomic infants ( > 4,000g) between January 2004 and May 2005 were reviewed. Maternal and obstetrical data were analyzed by mode of delivery. Univariate and multivariate (logistic regression analysis) were performed to identify risk factors of failed labor. Results. Rate of cesarean delivery was 18.3% . Indications for cesarean were: failure to progress in 55.6% , arrest in fetal descent in 22.2% , fetal distress in 6.7% , and other in 8.9% . There was a higher risk of failed labor in nulliparous women (p < 0.001), in case of a symphysio-fundal measurements > 34cm (p = 0.004), in nulliparity associated with symphysio-fundal measurements > 34cm (p < 0.001), in case of previous cesarean delivery (p = 0.004), in cases of maternal height < 1.65m (p = 0.02), and with ocytocin use (p = 0.05). In multivariate analysis, nulliparity associated with symphysio-fundal measurements > 34cm (OR = 5.2; CI 1.5- 18.4), previous cesarean section (OR = 3.7; CI 1.1- 12.4) and maternal height < 1.65m (OR = 2.6; CI 1.2- 5.5) were independent factors of failed labor. Conclusion. Failure of labor in case of macrosomia can be predicted in the event of previous cesarean section, shorter maternal height, and association of nulliparity and symphysio- fundal measurements > 34cm.
