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Background: The issue of cervical tissue imaging is to enable the provision of Obstetricians an objective tool for measuring cervical changes more accurate than the vaginal touch. Hitachi software “Real-time Tissue Elastography” allows an analysis of tissue elasticity, evaluated on a Young's modulus theory. This imagery evaluated for mammary tumors and liver changes elasticity, would objectively show changes in cervical consistency. Aims: The authors of the following work have attempted to:-Assess the usefulness of elastography in the uterine cervix examination.-Compare the modifications of the cervical module of elasticity before and during the maturation by prostaglandins indicated for medical reason with those raised in the clinical examination (score of Bishop). Methods: It is about a non-interventional feasibility study with regulation of the machine, realized in forward-looking. We included 30 patients scheduled for a cervical maturation by prostaglandins for medical indication. We realized a measure of the cervical module of elasticity during an endo-vaginal ultrasound for measure of the cervix before the pose of prostaglandins, 6 hours then 12 hours after the stake in contact and we compared the measure every time with the score of bishop. Results: All the patients who presented an index of high softening entered labor within the 3 hours following the examination. Furthermore, the modifications observed on the index of softening were correlated to those of the score of Bishop. Conclusion: The performance of the images of elastography with these regulations allowed a good confrontation of the results during the evaluation of the feasibility of the technique with the score of Bishop during cervical maturation. This promising technique remains a technique of research. Forward-looking studies on wide series of patients are going to be able to estimate the elastography as an additional and objective informer of the cervical maturation. © 2014 Maison du Medicine. All rights reserved. Source

Senat M.-V.,Service de gynecologie obstetrique | Tsatsaris V.,Paris Observatory
Journal de Gynecologie Obstetrique et Biologie de la Reproduction | Year: 2013

Objective.- To evaluate the performance of different antenatal tools for the monitoring of fetuses with isolated intrauterine growth restriction (IUGR). To define the prenatal management of IUGR and indications for delivery before and after 32 weeks of gestation. Method.- PubMed, Embase and the Cochrane databases were searched using the keywords "IUGR", "fetal growth restriction", "cardiotocography", "amniotic fluid", "ultrasound assessment", "biophysical profile", "Doppler ultrasonography", "randomized trial", "meta-analysis". These terms were also combined together. Results.- Fetal monitoring of isolated IUGR should be based on the combined use of fetal heart rate (FHR) and ultrasound Doppler. The use of computerized FHR, with short-term variability (STV) measurement allows longitudinal monitoring and provides objective values upon which to decide very premature delivery (LE3). The use of umbilical Doppler is associated with a decrease in perinatal morbidity, especially in IUGR (LE1). It should be the first-line mean for the monitoring of SGA and IUGR fetuses (LE1). The additional use of cerebral Doppler is associated with a better predictive value for a poor perinatal outcome than the umbilical Doppler alone (LE3). Therefore, cerebral Doppler should be used in fetuses with IUGR, whether the umbilical Doppler is normal or not. As morbidity and mortality is increased in IUGR with pathological ductus venosus, the use of this Doppler should be considered in the monitoring of IUGR at before 32 weeks (professional consensus). Routine hospitalization is not mandatory for the monitoring of fetuses with IUGR/SGA. However, tertiary referral is advisable in cases of severe IUGR at between 26 to 32 weeks (professional consensus). The decision for delivery cannot be standardized and should be based on the combined analysis of gestational age, fetal heart rate analysis and Doppler study (professional consensus). Conclusion.- Monitoring of fetuses with IUGR and decision for delivery should be based on the combined analysis of gestational age, fetal heart rate analysis and Doppler study before 32 weeks, this should ideally be performed by the association of computerized FHR and arterial and venous Doppler. © 2013 Elsevier Masson SAS. All rights reserved. Source

Fatton B.,Service de gynecologie obstetrique
Obesite | Year: 2010

Obesity is an established risk factor for SUI. Among overweight women, a weight loss program improves urinary incontinence with a reduction in the frequency of self-reported urinary incontinence episodes and may be suggested as a first-line therapy. Success rates after TVT are similar among obese patients and normal-weight patients, and TVT is the prime procedure to treat SUI in obese patients. Obesity does not appear as a risk factor for intra- and postoperative complications. © 2010 Springer Paris. Source

To propose guidelines for clinical practice for routine postnatal visit and afterpathological pregnancies.Materials and methods.-Bibliographic searches were performed with PubMed and Cochranedatabases, and within international guidelines references.Results.-Postpartum visit should be planned 6 to 8 weeks after delivery and can be performedby an obstetrician, a gynecologist, a general practitioner or a midwife, when after normal pre-gnancy and delivery (Professional consensus). If any complication occurred, this visit shouldbe handled by an obstetrician (Professional consensus). Physical examination should focus onpatient symptoms and pregnancy complications (Professional consensus). Gynecological exami-nation is not systematic (Professional consensus). Pap smear should be performed if previousexam was done more than 2 years ago or when the previous exam was abnormal (Professionalconsensus). Weight should be measured to encourage weight loss (Professional consensus), withthe aim to catch up preconceptional weight within 6 months after delivery (grade C). Professio-nal intervention may reduce weight retention (professional consensus). Tobacco, alcohol andillicit drugs cessation should be promoted (grade B) and supported by a professional (gradeA). Obstetrical risks consecutive to short interval between pregnancies should be explained(evidence level [EL]: 3) and contraception discussed regarding family project (Professionalconsensus). Mother mood, mother to child relationship and breastfeeding troubles should be sys-tematically evaluated (professional consensus). Pelvic-floor rehabilitation should be performedonly when urinary of fecal incontinence persist 3 months after delivery (Professional consensus).Serological screening for toxoplamosis (grade B) and blood hemoglobin concentration shouldnot be systematically performed (grade C). After spontaneous preterm birth, women should bescreened for uterine anomalies and treatment should be discussed (Professional consensus). Evi-dence is lacking to recommend any exploration to diagnose cervical incompetence (Professionalconsensus). When investigations are performed, there is no argument to recommend a speci-fic exam (Professional consensus). Women should be screened for antiphospholipid antibodiesafter severe or early pre-eclampsia, IUGR or intra-uterine fetal death (Professional consen-sus) but screening for inherited thrombophilia is not recommended (grade B). Women withpersistent proteinuria and/or hypertension 3 months after pre-eclampsia should be referredto a nephrologist (Professional consensus). Normalization of liver enzymes should be checked 8 to 12 weeks after intrahepatic cholestasis of pregnancy (Professional consensus). A synthe-tic document should be send to the women corresponding physicians (Professional consensus).Preconceptional counseling is recommended (Professional consensus). Conclusion.-A postpartum visit is recommended 6 to 8 weeks after delivery, including motherphysical and psychological evaluation and information about contraception, short interval bet-ween pregnancy, weight loss, smoking cessation (Professional consensus). To ensure continuityin the management of women health, relevant medical elements will be pass on to the corres-ponding physicians (Professional consensus). © 2015 Elsevier Masson SAS. Source

To assess the efficiency of arteries ligation in intractable obstetrical hemorrhage. Prospective study which concerned 53 patients who underwent internal iliac arteries ligation for persistent and severe obstetrical hemorrhage from January 2007 to June 2010. The average age of patients was 29.3 years. The mean parity was 2.2. Main etiology of hemorrhage were: uterine atony (62.2%), abruptio placentae (15.1%). Coagulation disorders and hypovolemic shock were observed respectively in 20.7 % and 37.7%. Blood transfusion was performed in all cases. Internal iliac arteries ligation allowed hemorrhage control in 90.5 % of cases. In five cases a hysterectomy was necessary to control bleeding.. No peroperative complication were observed. Internal iliac arteries ligation is a prerequisite treatment of severe postpartum hemorrhage. It is a good alternative to arterial embolization. Source

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