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Introduction: Port insertion is a high-risk period during laparoscopy. The French Gynecologist and Obstetricians College (CNGOF) published recommendations in 2010 to minimize those risks. The aim of our analysis was to establish the accidents' circumstances and consequences and to determine if those incidents could have been depending on whether recommendations had been respected or not., Material and Methods: Gynerisq is an approved organism by the Haute Autorité de santé (HAS). Its mission is to evaluate and improve practices by a risk management centered approach. We analysed incidents reported by Gynerisq's adherents in an experience report database., Results: Above 114 incidents analysed in the Gynerisq's database, we reported 31 bowel injuries. Those injuries occurred for 77.4% (24/31) during planned interventions. For 32.3% of the cases (10/31), interventions were judged complex by the surgeons. A total of 54.8% (17/31) of the patients had a history of laparotomy. Above 27 injuries occurred during Veress needle or open laparoscopy, 17 could have been avoided regarding to the surgeon. The causes reported were in 10 cases that the recommendations had not been respected, in 2 cases another cause and in 5 cases no causes were given to explain the incident., Conclusion: Our analysis shows that bowel injuries after port insertion, in open laparoscopy or Veress needle use, do not seem to occur only in an emergency context or during complicated interventions. However, most of the incidents occurred for patients with risk factors., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objective: The objective of the study was to provide guidelines for clinical practice from the French college of obstetrics and gynecology (CNGOF), based on the best evidence available, concerning hysterectomy for benign pathology., Methods: Each recommendation for practice was allocated a grade which depends on the level of evidence (guidelines for clinical practice method)., Results: Hysterectomy should be performed by a high volume surgeon (>10 procedures of hysterectomy per year) (grade C). Rectal enema stimulant laxatives are not recommended prior to hysterectomy (grade C). It is recommended to carry out vaginal disinfection using povidone iodine solution prior to an hysterectomy (grade B). Antibioprophylaxis is recommended during a hysterectomy, regardless of the surgical route (grade B). The vaginal or the laparoscopic routes are recommended for hysterectomy for benign pathology (grade B), even if the uterus is large and/or the patient is obese (grade C). The choice between these two surgical approaches depends on others parameters, such as the surgeon's experience, the mode of anesthesia and organizational constraints (operative duration and medico economic factors). Hysterectomy by vaginal route is not contraindicated in nulliparous women (grade C) or in women with previous c-section (grade C). No specific technique to achieve hemostasis is recommended with a view to avoid urinary tract injuries (grade C). In the absence of ovarian pathology and personal or family history of breast/ovarian carcinoma, it is recommended to conserve ovaries in pre-menopausal women (grade B). Subtotal hysterectomy is not recommended in order to diminish the risk of per- or postoperative complications (grade B)., Conclusion: The application of these recommendations should minimize risks associated with hysterectomy., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

The authors report a case of massive intracerebral haemorrhage which was diagnosed in utero by ultrasound. The ultrasound of the brain showed a total disorganisation of all known structures with the appearance of unhomogeneous zones spread across both hemispheres and including a large dilatation of the ventricles. Transcervical puncture of the fontanelle allowed the delivery of a stillborn child without other congenital abnormalities. CMV infection was thought to be the cause. A review of the literature shows that there are different ways of treating this conditions depending on the ultrasound appearances. The prognosis must be very guarded and depends on the aetiology.

The authors carried out a combined study using Doppler Flow Studies of the umbilical and fetal anterior cerebral arteries in 26 pregnancies which were complicated by maternal hypertension. Using the ratio between the cerebral and the umbilical blood flow it may be possible to diagnose intra-uterine growth retardation more accurately than using classical measurements. An inversion of the ratio between the cerebral and the umbilical flows has a great prognostic value with a sensibility of 91.6%, a specificity of 87.5% and a positive predictive value of 84.6% with a negative predictive value of 93.13%. There may however quite often be a lengthy interval of time between the appearance of change in the ratio and the appearance of fetal distress, so that this sign can only be one indication for delivery of the fetus.

A prospective study using umbilical artery velocimetry was carried out with continuous Doppler wave forms coupled to a spectral analyser (D.F.P.C. Slous) with placement of Pourcelot's placental resistance index in 94 deliveries at term of singleton normal pregnancies. Neither the position of the patient, rupture of the membranes, epidural anaesthesia, oxytocics, Dextrofemine, nor the length of labour, change the placental resistance levels during the delivery. These remain constant and equal R = 0.51 +/- 0.10 (M +/- 2 DS) whatever the appearance of the RCF at the start of labour, during dilatation and during the delivery. We considered term as being between the 38th and the 42nd week of amenorrhea. Our results show that changes in the index of resistance in the umbilical artery do not help in assessing deliveries in normal pregnancies.

Having had a case of ectopia cordis which was diagnosed early in utero, the authors have analysed the information they have obtained and they have suggested what steps to take according to the features revealed by the ultrasound pictures and taking into account the different anatomical forms. They have also considered the lesions that are associated with this condition and the principal prognostic features.

Doppler pulses or continuous flow in the umbilical artery is a technique recently used in practical obstetrics and of value particularly in screening at risk pregnancies. The authors wish to study its value as a diagnostic and prognostic tool in the special cases where ultrasound has given rise to a suggestion that there may be intra-uterine growth retardation (I.U.G.R.). In a preliminary publication they report their experience in 100 normal pregnancies so that they have obtained a control diagram. Then, working on a population of 117 pregnancies with ultrasonically diagnosed I.U.G.R. they studied the birth-weight, the early neonatal morbidity and the neonatal mortality as a function of the Pourcelot S - D/S index. They were able to separate out 63 cases of I.U.G.R. without any hypertension and 54 cases associated with hypertension. They analyse the same parameters. They then discuss first the value of the diagram they have made in comparison with other known curves, also the diagnostic and prognostic performance of the method. They conclude that there is a moderate diagnostic value in Doppler velocimetry. The prognostic value is much better because the Doppler can differentiate those case of slow growth that are going to do well against those that are going to do badly.