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Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 35 - N° 3 - p. 297-300

Objective To evaluate maternal outcomes following uterine balloon tamponade in the management of postpartum hemorrhage. Design Retrospective case-series. Setting Two French hospitals, a level 3 university referral center and a level 2 private hospital. Population All women who underwent balloon tamponade treatment for primary postpartum hemorrhage. Methods Uterine tamponade was used after standard treatment of postpartum hemorrhage had failed. The study population was divided into two groups, successful cases where the bleeding stopped after the balloon tamponade, and failures requiring subsequent surgery or embolization. Main outcome measures Success rates. Results Uterine tamponade was used in 49 women: 30 (61%) after vaginal delivery and 19 (39%) after cesarean section. Uterine atony was the main cause of hemorrhage (86%). The overall success rate was 65%. Of 17 failures, surgery was required in 16 cases, including hysterectomy in 11, and uterine artery embolization in one case. Demographic and obstetric characteristics did not differ significantly between the success and failure groups. No complications were directly attributed to the balloon tamponade in the postpartum period. Two women had a subsequent full-term pregnancy without recurrence of postpartum hemorrhage. Conclusions Balloon tamponade is an effective, safe and readily available method for treating primary postpartum hemorrhage and could reduce the need for invasive procedures.

Resumen La anticoncepcion por dispositivo intrauterino, metodo simple, eficaz y reversible, es una de las mas utilizadas en el mundo. Actualmente solo se comercializan dos tipos de dispositivos intrauterinos: con cobre y con levonorgestrel. Su accion contraconceptiva se ejerce tanto a nivel de las trompas y espermatozoides como a nivel de la cavidad uterina. Los fenomenos inflamatorios alteran el valor funcional de las trompas y espermatozoides impidiendo la fecundacion. Los progestagenos atrofian el endometrio, volviendolo inadecuado para la nidacion, y hacen al moco cervical hostil para los espermatozoides. A fin de obtener mejores resultados, deben conocerse tanto los efectos secundarios de los dispositivos intrauterinos como sus posibles complicaciones y contraindicaciones.

Objective To compare the effects of betamethasone and dexamethasone on fetal heart rate in appropriately grown fetuses. Methods Eighty-two pregnant women (97 fetuses) with preterm labour were randomly allocated to receive betamethasone (n= 42) or dexamethasone (n= 40) for fetal lung maturation in a nonblinded fashion. Computerised cardiotocogram (CTG) parameters were compared before, during and after treatment. Results A decrease in fetal heart rate variability was found with betamethasone but no significant changes were found with dexamethasone. Fetal heart rate variability returned to pre-treatment values within a week after cessation of treatment with betamethasone. Neonatal outcome was similar in the two groups. Conclusions These findings might prove useful in the management of compromised fetuses with decreased fetal heart rate variability in which the CTG should be used together with other parameters to assess fetal wellbeing during corticosteroid treatment. Dexamethasone may be preferable as the drug of choice since it was associated with significantly less alteration in fetal heart rate variability compared with betamethasone.

Objectif Nous decrivons le cas du diagnostic antenatal d’une thrombose de la veine cave inferieure (VCI) et de la veine renale (VR) droite chez un fœtus d’une patiente de 37 ans a 33 semaines d’amenorrhees (SA). Observation Une patiente de 37 ans primigeste nullipare avec un antecedent familial au premier degre de thrombose veineuse profonde consulte a 33 SA pour baisse des mouvements actifs fœtaux (MAF). Une echographie revele chez le fœtus une asymetrie renale et une thrombose de la VR droite. Il est propose une surveillance clinique et echographique rapprochee. A 39 SA, l’accouchement est declenche pour une pre-eclampsie debutante et nait une petite fille de 3,505 kg en bonne sante. Un echo-Doppler realise a j1 retrouve un rein droit atrophie, la VR droite et la VCI sus-renale ne sont pas visualisees. Un scanner thoraco-abdomino-pelvien injecte realise a j6 confirme la presence d’un thrombus calcifie de la VCI sur 25 mm de hauteur, une thrombose de la VR droite et une asymetrie renale. Le diagnostic de phlebolithe est evoque devant le caractere ancien et il est decide de ne pas anticoaguler le nourrisson. Le suivi a un mois retrouve un bon developpement staturo-ponderal, l’absence de retard psychomoteur et une fonction renale normale. L’echo-Doppler retrouve une thrombose stable. Un bilan de thrombophilie met en evidence une mutation heterozygote du facteur V et une proteine S a la limite basse de la norme. Discussion La thrombose de la VCI antenatal est une pathologie vasculaire rare mais avec une prevalence difficilement evaluable car souvent asymptomatique. Elle est frequemment associee a une thrombose de la VR. L’etiologie est inconnue. Certains cas decrits dans la litterature retrouvent des facteurs de risque maternels tels que le diabete, l’hypertension arterielle, une thrombophilie familiale. Le diagnostic est souvent fortuit mais a ete decrit chez des patientes presentant une diminution des MAF et un travail premature. Il n’existe pas de recommandations quant a la therapeutique mais on propose le plus souvent une surveillance clinique, biologique et echographique. Conclusion Le diagnostic de thrombose de la VCI peut se faire en antenatal et est souvent d’evolution asymptomatique. Il n’existe pas de traitement specifique. A l’âge adulte, certaines agenesies de la VCI ne seraient-elles pas finalement en lien avec une thrombose de la VCI comme decrit ci-dessus avec involution de celle-ci ?

Diagnosis of the Bart's hydrops fetalis [corrected].Bart's hydrops fetalis [corrected] was discovered by chance in the fetus of a female Chinese patient. Major intrauterine growth retardation, oligohydramnios, an immobile fetus, and cardiomegaly were the principal echographic signs. Cordocentesis showed fetal anemia, and electrophoresis of fetal hemoglobin revealed the presence of Bart's hemoglobin.As there is no known effective treatment, termination of pregnancy was proposed to the patient.Bart's hydrops fetallis [corrected] is a lethal condition. Early echographic signs (cardiothoracic index0.50, placental thickening) can be screened during weeks 17-18 or even during weeks 13-14 of gestation. These signs would permit a reduction of invasive examinations in couples at risk.

In breast cancer, retroareolar tumors are observed in 5 to 20% of cases; mammectomy is the conventional treatment. Conservative surgery was used in this series of 36 patients with retroareolar cancer situated less than 2 cm from the areola.Tumorectomy with resection of the areolar plaque was followed by radiotherapy. Six patients had Paget's disease of the nipple, 64% were in classes T0 or T1 and 36% in T2. Chemotherapy or radiotherapy was given for tumor reduction prior to surgery in 8 patients. Wide tumorectomy with resection of the areolar plaque and gland remodeling was performed in all patients. Three plastic surgery techniques were used. Mean tumor size was 17.3 mm (8 to 33 mm). The areola was invaded in 16 patients (44%) and the derma or retroareolar ducts in 26 (72%).The mean distance between the tumor and skin surface was 3.8 mm. The section surface was in healthy tissue in 31 patients and 2 patients underwent subsequent surgery for mammectomy. All patients had either pre-operative (n = 4) or post-operative (n = 32) radio-therapy. Secondary reconstruction of the nipple was performed in 14 patients.Histology findings and esthetic results suggested that this conservative approach can be proposed when the tumor is located close to the areola, as confirmed by our series and results from other teams using the same technique.

The ability of ultrasound to diagnose fetal anomalies is limited in the early stages of gestation. We describe a microendoscope that can be used with an 18-gauge needle at the time of amniocentesis to provide more precise diagnostic information when the first-trimester ultrasound examination suggests a problem.