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Pelvic congestion syndrome is a debilitating condition that is often under-diagnosed and under-treated, defined by chronic pelvic pain in the presence of pelvic varicose veins in women or, more rarely, in men. The differential diagnosis of chronic abdominal pain is vast and often leads to lengthy and costly diagnostic procedures. Conservative treatment is often insufficient, and embolization of pelvic varices is the treatment of choice to improve symptoms. A multidisciplinary management algorithm is proposed to facilitate the clinical path for these patients., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

One in three women in Switzerland gives birth by c-section. This high incidence of c-section frequently exposes obstetricians and midwives to the management of women and their deliveries with a scarred uterus. The decision of couples is multifactorial, but the information that will be delivered by their gynaecologist will necessarily influence the delivery route choice. We propose to review the international recommendations and the literature on the subject, to provide the couple and the attending physician with elements of reflection to guide the choice of delivery route or to monitor adequately when attempting vaginal delivery after a caesarean section., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Preeclampsia is a disease which originates in the placenta and is specific to human pregnancy. It is one of the main causes of maternal and perinatal morbidity and mortality. The introduction of assays for angiogenic and anti-angiogenic markers reflecting placental dysfunction, which lies at the root of preeclampsia, is a turning point in the management of women with suspected preeclampsia or with an atypical form of the disease. The sFlt1/PlGF ratio assay, which has been covered by health insurance since July 2019, is a valuable diagnostic aid : the disease can be ruled out, with a high negative predictive value, when the ratio is low, thus avoiding unnecessary hospital admission and premature delivery. A high ratio can help to confirm the diagnosis of preeclampsia, albeit with a lower positive predictive value., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Pelvic congestion syndrome is an underdiagnosed disease, defined as chronic pelvic pain lasting more than 6 months, associated with pelvic varicose veins in premenopausal women. Diagnose is based on imagery after exclusion of other causes of pelvic pains. Echography is first line diagnostic modality. Conservative treatment is often insufficient and pelvic veins embolization is required to improve symptoms., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Management of patients at high risk of extreme premature birth between 23 and 26 weeks should be performed by an experienced multidisciplinary team. In order to optimize guidance for couples with regard to this complex decision, we developed joint guidelines between obstetricians and neonatologists, in order to standardize practices and insure individualized care plans. Fetal outcome is not solely associated with gestational age but is multifactorial, and this should be considered when counseling parents. Thus, enhancement of fetal lung maturation, a major prognostic factor, should be promptly acted upon when delivery is anticipated. Antenatal corticosteroids should not be withheld while awaiting the parents' ultimate decision on neonatal care., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Following the introduction of non-invasive tests, antenatal screening for trisomy 21 underwent important changes. Clinicians had to rapidly adapt their practice, especially in the field of antenatal counseling. On a population wide scale, new strategies and guidelines have been implemented. This article reviews the basic concepts of antenatal screening, including the use of non-invasive cell-free fetal DNA testing., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Choosing between vaginal delivery and caesarean section in cases of breech presentation is still a matter of controversy. In this article, we present the Lausanne University Hospital's protocol following the introduction of an institutional vaginal breech delivery policy. Vaginal breech delivery is a viable alternative to caesarean section in the presence of an experienced obstetrician and rigorous patient-selection criteria., Competing Interests: Les auteurs ne déclarent aucun conflit d’intérêts en relation avec cet article.

We conducted a retrospective study was conducted in the Centre Hospitalier Universitaire Vaudois (CHUV) including all births between the 1st January 1997 and 31st December 2011 to analyze the cesarean section (CS) rate using the different groups of the Robson classification in a Swiss maternity hospital. The overall CS rate was 29 %, mainly related to group 5 (multiparous with previous CS) and group 2 (nulliparous women induced or who had CS before labor). The study also shows that induction of labor on maternal request in nulliparous at term (group 2a) increased significantly the risk of CS compared to induction of labor for medical reason (p<0.001). The Robson classification system appears as a simple tool for monitoring CS rates. The main strategies for reducing CS rates will be through better selection of women for VBAC (vaginal birth after caesarean) and limitation of induction of labor, especially in nulliparous women., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêt en relation avec cet article.

Nutrition is central in pediatric care : essential for growth and development, it plays also a role in the prevention of many diseases.Even if breastfeeding is highly recommended, its implementation may be difficult in particular for premature and ill newborns. The creation of a specific unit for breastfeeding support in neonatology allows to help mothers willing to nurse and to improve the rate of breastfeeding for these vulnerable infants.Eating disorders represent an important challenge for patient care. Early detection and rapid management of anorexia is essential for the prognosis. This article describes the challenges and the practical process underlying the development of a practical guideline to manage children and adolescents hospitalized for anorexia., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The medical, psychological and social aspects of disorders of sex development (DSD) represent a challenge for the management of these patients. However, advances in our understanding of the etiology and genetics of this condition, novel surgical approaches and the growing influence of patient groups as well as wider recognition of ethical issues have helped improve the care of patients with a DSD. Importantly, a multidisciplinary approach involving specialists is crucial for understanding and treating such rare and complex cases. According to the recommendations of the Swiss National Ethical Commission, we shall use the term « Variation of Sex Development » rather than « Disorder of Sex Development » in this publication. This article addresses the care of DSD patients throughout development from the point of view of specialists in complementary fields., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Studies report that between 6 and 13% of women experience symptoms of depression during pregnancy and the postpartum period. The abundant data available make selective serotonin reuptake inhibitors (SSRIs) the first line treatment in pregnancy when a pharmacological treatment is required. Risks associated with the use of SSRIs during pregnancy are limited (moderate effect size) and are often not distinguishable from those inherent to the mother's disease. Yet, several questions regarding the SSRI safety profile for the unborn child are still under debate or require additional epidemiological data. The decision of SSRI use during pregnancy needs an individual evaluation of the risk-benefit balance.

The peripheral sexual response is achieved by the the Clitoro-Urethro-Vaginal Complex who is responsible of the transmission of the sensitive stimulation to the CNS where this information is modulated by the different cerebral areas. These latter will send this message to the peripheral sexual organs using efferent somatic and autonomic pathways able to induce vaso congestive response of clitoridal area with contractions of pelvic floor muscles. Muscles stretch injuries after obstetrical or surgical trauma can decrease the quality of the sexual peripheral response. These modifications of peripheral sexual response have to be evaluated with a specific questionnaire and pelvic floor clinical examination and recently, with a new microsystem device able to record continuously intra-vaginal pressure modifications.

The occurrence of electrolyte disorders as hypocalcemia and/or hyponatremia is an uncommon event in preeclampsia, which can be the sign of serious situation, with potentially unfavourable consequences for the mother and her fœtus. Hyponatremia in the setting of preeclampsia is an indicator of severity, and requires the understanding of the etiologic mechanisms to initiate an appropriate treatment. Indeed the often-considered fluid restriction is rarely a treatment option for pregnant women. Hypocalcemia is a complication that must be monitored when a treatment with high doses of intravenous magnesium sulphate is introduced. In this context, hypocalcemia must be sought, with the exclusion of other etiologies as vitamin D deficiency, hypoparathyroidism or renal and extrarenal loss of calcium. A replacement therapy, intravenous or oral according to circumstances, should be considered in case of severe or symptomatic hypocalcemia., (Copyright © 2014. Published by Elsevier SAS.)

Decreasing perinatal morbidity and mortality is one of the main goals of obstetrics. Prognosis of preterm births depends on gestational age and birthweight. Multidisciplinary management is discussed with the parents according to these two parameters. In other circumstances, a suspected macrosomy will influence the management of the last weeks of pregnancy. Induction of labor or Cesarean delivery will be considered to avoid shoulder dystocia, brachial plexus injury or perinatal asphyxia. Birthweight needs to be estimated with accuracy, and this article describes the efficiency of various ultrasound weight estimation formulae for small and large fetuses.

In our area, varicella is a frequent and essentially benign childhood disease. In contrast, the disease course is likely to be more severe or complicated in the adult, particularly so in the pregnant woman. There is a definite risk of congenital varicella syndrome when the chickenpox occurs during the first 20 weeks of pregnancy. This syndrome predominantly affects the skin, the subcutaneous tissue, muscles and bones, as well as the central nervous system, and can bring about major functional sequellae. In case of chickenpox occurring at the very end of pregnancy, transplacental transfer of the virus may result in a perinatal varicella disease. We propose a approach of each of these different situations.

Fast-track multimodal rehabilitation after cesarean, the sum of all tricks Fast-track multimodal rehabilitation after caesarean is an interdisciplinary concept allowing an accelerated return to normal physiology. Fast-track rehabilitation combines minimising surgical trauma, regional anaesthesia and active management of pain control, minimally invasive postoperative care while promoting return to autonomy.

In the field of perinatality, development of prenatal diagnosis and neonatal management have been impressive. But these were also associated with the emergence of the increasingly important emotional dimension for parents and professionals. Obstetricians dealing with the difficult breaking of bad news, the uncertainties of prenatal diagnosis and the complex somatic, psychological and social follow-up have to work in a multidisciplinary approach. The securing role of a coherent teamwork is recognised by parents as well as health care providers This article discusses interprofessional relationship as an obstetrical goal and give some landmarks in order to improve the management and the collaboration with parents.

Hypertension in pregnancy Hypertension in pregnancy, whether chronic or recently diagnosed, is always a matter of concern for the general practitioner or the obstetrician. Even if this situation often evolves favorably, and although a "wait and see" attitude may be preferred to an aggressive one in such cases, one should also be aware of how dramatic the outcome may also be. As a matter of fact, what is considered as one of the most frequent complications of pregnancy can run out of control, a possibility which shouldn't be dismissed. In this article, we shall discuss the various strategies for managing this disorder.

The müllerian anomalies or congenital uterine anomalies are relatively frequent if we keep in mind that 3-4% of our female patients present with a müllerian anomaly, although many among them are asymptomatic. It is important to evoke this diagnosis for all patients with a history of recurrent miscarriage, late abortion and premature delivery, for the adolescent consulting for primary amenorrhea, dysmenorrhea or dyspareunia as well as for the woman consulting for infertility. We will review pathogenesis, diagnostic methods, standard classification with a description of the different types of congenital uterine anomalies and the recommended management.

Fetal arrhythmias form a complicating factor in 1-2% of all pregnancies and in 10% of those cases morbidity or even mortality is encountered. The most frequent occurring arrhythmias are premature atrial contractions (PAC). These are usually benign phenomena which resolve spontaneously, but require some follow-up to exclude the development of supraventricular tachycardias (SVT). SVTs are rare but are frequently complicated by fetal congestive heart failure or even fetal death. Timely prenatal pharmacotherapeutic intervention is generally advised to return to an adequate heart rate, preferably sinus rhythm. This study reports on the local experience with these forms of pathologies: of the 26 fetuses encountered with PAC or/and SVT between 2003 and 2005, none experienced serious complications, while 6 required pharmacotherapeutic intervention with sotalol.

Cardiac defects form the most frequently encountered group of congenital malformations (0.8%). Despite the improving ultrasonographic technology and the teaching of the investigators, the prenatal recognition of cardiac defects stays low (around 30%). The application of 3D technology in their recognition may well lead to a substantial improvement of this percentage. This technique consists of a consecutive summation of multiple 2D images and permits the three dimensional reconstruction of the different structures and the definition of their spatial position. Its importance is localised in the direct identification of normal anatomy and the possibility to reevaluate the data in an off-line version and if necessary to ask for a specialised second opinion on the same data set, thus opening the door for telemedical approach.

Objective: To assess the value of para-clinical exams prescribed in case of in utero foetal death, to result in the establishment of a new algorithm of diagnostic tests., Materials and Methods: A retrospective analysis on a series of 106 stillbirths gathered between September 1989 and December 1998 in the obstetrical and gynaecological department of the Lausanne University Hospital which is a tertiary centre. Stillbirth was defined as foetal death occurring as from the date of foetal viability. Thus, only pregnancies from 24 weeks and onwards were included in this series. We excluded all stillbirths occurring during medical termination of pregnancy and cases with incomplete data files. The Fretts' classification was used. The different exams asked by the physician were screened and we analysed their pertinence to determine the aetiological diagnosis for each case. The search for significant risk factors was also taken into account. We compared our management of in utero foetal death with data from the literature to propose a new algorithm., Results: The aetiology of in utero foetal death could be attributed in ninety percent of the cases. The principal causes were in utero growth retardation (19.8%), foetal congenital and chromosomal anomalies (18.9%), infections (15.1%), placental abruption (7.5%), preeclampsia (5.6%), maternal diabetes (3.8%). The remaining 18.9% are divided in to miscellaneous causes. In 10.4% of the cases we could not find any explanation to the death of the foetus. The exams that yielded the most information when done were: foetal autopsy which was abnormal in 92.7%, placental investigation which was abnormal in 93% and the babygramme (X-ray of the foetal skeleton) which was abnormal in 53%. Maternal serology for infections was informative in 6.6% of the cases., Conclusion: We present here a protocol for the diagnostic management of stillbirth which is differentiated according to the circumstances surrounding the event. This should prove useful to reduce superfluous tests.

The diagnosis of a congenital heart disease can be made by fetal ultrasound as soon as the 12th week of pregnancy. The main indications for fetal echocardiography are maternal and fetal. Sequential approach is necessary to precise the anatomy and to elaborate a therapeutic strategy for that patient. For severe heart lesions delivery and postnatal care can be programmed, avoiding thus severe hypoxia and acidosis after birth. The prognosis of these children are thus much improved.

Symphysiotomy is regularly performed in developing countries where cesarean section can be a source of significant short-term and long-term morbidity. However, this method can be useful in some rare occasions and should be taught in our countries, at least theoretically. Such a case is presented with a review describing the present surgical technique, its indications and limits with special reference to its possible complications.

The purpose of this study was to evaluate the neonatal and maternal outcome after a prolonged second stage of labor. We compared a study group of 751 women, who delivered after a prolonged second stage (mean: 189 minutes) with a control group of 5241 women, who delivered spontaneously after a short second stage (mean: 19 minutes). In the study group different factors were significantly associated with a prolonged second stage: primiparity, higher birth weight and occiput posterior position. If no arbitrary limit for the second stage of labor is used, the presentation will progress in 70% of cases and 90% of women will delivery vaginally. The high rate forceps delivery slightly increases maternal morbidity. In spite of lower umbilical pH and five-minute Apgar scores, neonatal morbidity and mortality were not increased.

Two cases of cardiac rhabdomyoma discovered fortuitously at foetal ultrasonography gave rise to no obstructive cardiac signs or arrhythmias either in the antenatal or postnatal periods. These multiple tumours often observed in Bourneville's tuberous sclerosis orientated the clinical investigations to the diagnosis of this disease from the outset. MRI demonstrated cortical tubers and subependymal nodules in both cases. A retinal hamartoma was present in one case. No renal involvement could be detected by ultrasonic examination. No neurological or cardiovascular symptoms appeared during follow-up (20 and 4 months after birth). Investigations in the parents were negative, these two cases being sporadic forms of Bourneville's tuberous sclerosis. The functional prognosis is related to the neurological outcome. Doppler echocardiography would appear to be the best method of following up cardiac rhabdomyomas, and enabled the demonstration of partial regression of the largest tumour in one of these two cases. Cardiac MRI is also an excellent diagnostic tool. As it is usually performed at the same time as cerebral MRI, essential in the follow-up of Bourneville's tuberous sclerosis, it does not represent additional discomfort to the patient.