Service de Gynecologie obstetrique et de Medecine de la Reproduction

Sainte-Foy-lès-Lyon, France

Service de Gynecologie obstetrique et de Medecine de la Reproduction

Sainte-Foy-lès-Lyon, France
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Hamidouche A.,Service de Gynecologie obstetrique et de Medecine de la Reproduction | Vincienne M.,Service de Gynecologie obstetrique et de Medecine de la Reproduction | Thubert T.,Service de Gynecologie obstetrique et de Medecine de la Reproduction | Thubert T.,University Paris - Sud | And 5 more authors.
Gynecologie Obstetrique Fertilite | Year: 2015

Objective. - The treatment of endometrial polyps is based on hysteroscopic resection. The aim of the current study was to compare the results associated with hysteroscopic morcellation and those observed with bipolar loop resection. Patients and methods. - A single-center observational retrospective comparative study was performed, including 25 patients who underwent hysteroscopic resection of endometrial polyps from January 2012 to December 2013. The mean size of polyp was 9.2 mm in the group compared to 12.5 mm in the resection group loop (P = 0.06). Results. - Twelve patients underwent resection of the polyp morcellation with MyoSure1 and 13 with bipolar resection loop Versapoint1 24F. The mean operative time was 16 minutes in morcellation group and 17 minutes in the bipolar resection group (P = 0.76). Complete removal was achieved in 100% of cases in morcellation group and in bipolar loop resection. Regarding intraoperative and postoperative complications, no complication was observed in the two groups. Discussion and Conclusion. - Results associated with hysteroscopic morcellation and bipolar loop resection seen to be comparable. © 2014 Elsevier Masson SAS. All rights reserved.


Fermaut M.,Service de Gynecologie Obstetrique et de Medecine de la Reproduction | Nyangoh Timoh K.,University Paris - Sud | Lebacle C.,University Paris - Sud | Moszkowicz D.,University Paris - Sud | And 4 more authors.
Gynecologie Obstetrique Fertilite | Year: 2016

Objectives. - Deep pelvic endometriosis surgery may need substantial excisions, which in turn expose to risks of injury to the pelvic nerves. To limit functional complications, nerve-sparing surgical techniques have been developed but should be adapted to the specific multifocal character of endometriotic lesions. The objective was to identify the anatomical areas where the pelvic nerves are most at risk of injury during endometriotic excisions. Methods. - The Medline and Embase databases have been searched for available literature using the keywords hypogastric nerve or hypogastric plexus [Mesh] or autonomic pathway [Mesh], anatomy,endometriosis, surgery [Mesh]''. All relevant French and English publications, selected based on their available abstracts, have been reviewed. Five female adult fresh cadavers have been dissected to localize the key anatomical areas where the pelvic nerves are most at risk of injury. Results. - Six anatomical areas of high risk for pelvic nerves have been identified, analysed and described. Pelvic nerves can be damaged during the dissection of retrorectal space and the anterolateral rectal excision. Furthermore, before an uterosacral ligament excision, a parametrial excision, a colpectomy or a dissection of the vesico-uterine ligament, the hypogastric nerves, splanchnic nerves, inferior hypogastric plexus and its efferent pathways must be mapped out to avoid injury. The distance between the deep uterin vein and the pelvic splanchnic nerves were measured on four cadavers and varied from 2.5 cm to 4 cm. Conclusion. - Six key anatomical pitfalls must be known in order to limit the functional complications of the endometriotic surgical excision. Applying nerve-sparing surgical techniques for endometriosis would lead to less urinary functional complications and a better short-term postoperative satisfaction. © 2016 Elsevier Masson SAS. All rights reserved.


PubMed | Service de gynecologie obstetrique et de medecine de la reproduction and University Paris - Sud
Type: Comparative Study | Journal: Gynecologie, obstetrique & fertilite | Year: 2015

The treatment of endometrial polyps is based on hysteroscopic resection. The aim of the current study was to compare the results associated with hysteroscopic morcellation and those observed with bipolar loop resection.A single-center observational retrospective comparative study was performed, including 25 patients who underwent hysteroscopic resection of endometrial polyps from January 2012 to December 2013. The mean size of polyp was 9.2 mm in the group compared to 12.5mm in the resection group loop (P=0.06).Twelve patients underwent resection of the polyp morcellation with MyoSure() and 13 with bipolar resection loop Versapoint() 24F. The mean operative time was 16 minutes in morcellation group and 17 minutes in the bipolar resection group (P=0.76). Complete removal was achieved in 100% of cases in morcellation group and in bipolar loop resection. Regarding intraoperative and postoperative complications, no complication was observed in the two groups.Results associated with hysteroscopic morcellation and bipolar loop resection seen to be comparable.


PubMed | Service de gynecologie obstetrique et de medecine de la reproduction and University Paris - Sud
Type: Journal Article | Journal: Gynecologie, obstetrique & fertilite | Year: 2016

Deep pelvic endometriosis surgery may need substantial excisions, which in turn expose to risks of injury to the pelvic nerves. To limit functional complications, nerve-sparing surgical techniques have been developed but should be adapted to the specific multifocal character of endometriotic lesions. The objective was to identify the anatomical areas where the pelvic nerves are most at risk of injury during endometriotic excisions.The Medline and Embase databases have been searched for available literature using the keywords hypogastric nerve or hypogastric plexus [Mesh] or autonomic pathway [Mesh], anatomy, endometriosis, surgery [Mesh]. All relevant French and English publications, selected based on their available abstracts, have been reviewed. Five female adult fresh cadavers have been dissected to localize the key anatomical areas where the pelvic nerves are most at risk of injury.Six anatomical areas of high risk for pelvic nerves have been identified, analysed and described. Pelvic nerves can be damaged during the dissection of retrorectal space and the anterolateral rectal excision. Furthermore, before an uterosacral ligament excision, a parametrial excision, a colpectomy or a dissection of the vesico-uterine ligament, the hypogastric nerves, splanchnic nerves, inferior hypogastric plexus and its efferent pathways must be mapped out to avoid injury. The distance between the deep uterin vein and the pelvic splanchnic nerves were measured on four cadavers and varied from 2.5cm to 4cm.Six key anatomical pitfalls must be known in order to limit the functional complications of the endometriotic surgical excision. Applying nerve-sparing surgical techniques for endometriosis would lead to less urinary functional complications and a better short-term postoperative satisfaction.


Jnifen A.,Service de Gynecologie Obstetrique et de Medecine de la Reproduction | Fadhlaoui A.,Service de Gynecologie Obstetrique et de Medecine de la Reproduction | Chaker A.,Service de Gynecologie Obstetrique et de Medecine de la Reproduction | Zhioua F.,Service de Gynecologie Obstetrique et de Medecine de la Reproduction
Tunisie Medicale | Year: 2010

Background: Pregnancy beyond age 40 is considered as a high risk pregnancy associated with high rates of maternal and fetal complications. Aim: To analyze particularities of pregnancy and labor and to examine obstetrical and neonatal outcomes among women age 40 years and older. Methods : There was a retrospective study including two groups of 300 patients , the first including the 40 -year- old and over women (case group), and the second including 20-to 39 -year -old mothers (control group). Results: The mean age for the case group was 41 years. Ten (10.6%) of the women in the ca se group were primiparous as compared with twenty-seven (27.5%) in the control one (p=0.001).The antenatal surveillance was better in the control group. The morphologic sonograhy was performed in 73% of cases of 40-year -old -women versus 90% in the control group (p<0.001). Maternal age 40 and over was associated with an increased risk for gestational diabetes (6.4% versus 1.7%, p <0.001). The premature rupture of membranes was frequent in the case group (25.7% versus 11.7% p <0.001), and the amniotic fluid meconuim (16.3% versus 6.7%, p <0.001). The risk for cesarean section was higher in older women (25.7% versus 14% avec p <0.001). Neonatal outcomes (Apgar score, birth weight, perinatal mortality) were similar to those in the younger age group. Conclusion: The analysis of our results and the review of the literature have proven that advanced-maternal-age-pregnancy is associated with increased complications. So some recommendations' are necessary to ameliorate the management of this pregnancy.


Canis M.,Service de gynecologie obstetrique et de medecine de la reproduction | Jardon K.,Service de gynecologie obstetrique et de medecine de la reproduction | Rabischong B.,Service de gynecologie obstetrique et de medecine de la reproduction | Bourdel N.,Service de gynecologie obstetrique et de medecine de la reproduction | And 3 more authors.
Pelvi-perineologie | Year: 2010

Endometriosis is defined by the presence of ectopic endometrial epithelium and stroma. This benign disease due to hormone-dependent tissue is most often diagnosed at some time during its development, made up of sequelae and/or a reaction of the tissue under the endometrium. These sequelae or this "reactional hypertrophy" of the host tissue are as a rule hormone-independent or insensitive. At this stage, surgery becomes the only effective option, but its limits should be recognised and taken into account: recurrence of peritoneal adhesions, non-consideration of the causes or mechanisms of the disease, non-treatment of microscopic lesions. © Springer-Verlag France 2009.


Fadhlaoui A.,Service de Gynecologie Obstetrique et de Medecine de la Reproduction | Khediri Z.,Service de Gynecologie Obstetrique et de Medecine de la Reproduction | Khrouf M.,Service de Gynecologie Obstetrique et de Medecine de la Reproduction | Chaker A.,Service de Gynecologie Obstetrique et de Medecine de la Reproduction | Zhioua F.,Service de Gynecologie Obstetrique et de Medecine de la Reproduction
Imagerie de la Femme | Year: 2012

Introduction: Inclusion in an IVF program requires several additional morphological examinations such as pelvic ultrasound, hysterosalpingography (HSG) and hysteroscopy. The exploration of the uterine cavity is an essential step and the contribution of each of these morphological examinations is variably appreciated. Aim: To evaluate the contribution of hysteroscopy prior to the first IVF/ICSI attempt when compared to the couple pelvic ultrasound and hysterosalpingography and to estimate the correlation between these three exams. Material and patients: This is a retrospective study including 94 patients, included in an IVF program, in the assisted reproductive techniques center of Aziza Othmana hospital of Tunis, during a period of one year, from January 1 to December 31 2009. Results: The hysterography has a specificity of 85.71% and overall sensitivity of 39.47%, with a strong correlation with hysteroscopy. Ultrasound has, in turn, an overall specificity of 82.35% and a sensitivity of 35.29%, with a moderate correlation with hysteroscopy. Combining the results of ultrasound and hysteroscopy, this couple has a sensitivity of 72.97% if at least one of them is pathological. The pair (echo/HSG) has a specificity of 92.68% if both tests are concordant. Conclusion: The couple pelvic ultrasound and hysterosalpingography could avoid the use of hysteroscopy prior to an IVF program, provided they are concordant. © 2012 Elsevier Masson SAS. Tous droits réservés.


Fadhlaoui A.,Service de Gynecologie Obstetrique et de Medecine de la reproduction | Fadhlaoui A.,Tunis el Manar University | Khrouf M.,Service de Gynecologie Obstetrique et de Medecine de la reproduction | Khrouf M.,Tunis el Manar University | And 12 more authors.
Tunisie Medicale | Year: 2012

Background: Menstruations, by their abundance and their duration, can be a source of impaired quality of life. Women with inherited bleeding disorders appear to be, specially at risk. Aim: Assess the impact of menstrual blood loss on the quality of life for women with inherited bleeding disorders. Methods: 31 women with various inherited bleeding disorders were interviewed. They completed a quality of life questionnaire. Results: Von Willebrand disease was the most frequent inherited bleeding disorder in our population (38.7%). 54.8% of patients had a menstrual period more than 6 days 61.3% of them consider their menstrual flow to be normal. The general condition apart of the menstrual period was considered medium to poor in 35.5% of patients. The average score assessing the impact of menstruation on daily life was of 5.00 ± 3.47. Only 19.35% of patients felt that dysmenorrhea significantly affect their quality of life. Impaired quality of life was seen in 64.5% of patients according to score A and in 41.9% of them according to score B. During menstruation 22.6% of the patients didn't do to work or to school because of the menstrual flow. On the other hand, 48.4% of patients were hospitalized at least once for a heavy menstrual flow. Conclusion: The quality of life during menstruation, in women with an inherited bleeding disorder, according to the different scores appear altered. Although because of the small size of our study population, we could not prove correlation between the importance of menstrual blood loss and the impairment of quality of life.


Fadhlaoui A.,Service de Gynecologie Obstetrique et de Medecine de la Reproduction | Hassis A.,Service de Gynecologie Obstetrique et de Medecine de la Reproduction | Khrouf M.,Service de Gynecologie Obstetrique et de Medecine de la Reproduction | Ferchiou M.,Service de Gynecologie Obstetrique et de Medecine de la Reproduction | And 2 more authors.
Tunisie Medicale | Year: 2012

Background: The conduct and delivery of twin pregnancies are interspersed with as well as maternal fetal and neonatal complications. The obstetrician is faced with the birth of 2 children often fragile and a uterus often exposed to dynamic dystocia. Aim: To study the maternal and newborn morbidity and mortality in twins, in order to clear the optimal route of delivery in such circumstances. Methods: A retrospective study over a period of 3 years (1 January 2005 to December 31, 2007), about 117 twin pregnancies. Inclusion criteria were a term exceeding 28 weeks and fetuses alive. We analyzed maternal complications during and after delivery and neonatal complications. Results: Maternal complications were significantly more frequent in case of caesarean section. The frequency of perinatal complications (Apgar score, respiratory distress, immediate neonatal resuscitation and neonatal intensive care unit transfer) in the first twin was not influenced by the route of delivery as opposed to the second twin which Apgar score's alters when vaginally. The newborns of low birth weight (<1,500 Kg) and those whose term was less than 32 weeks were more at risk of an Apgar score <7 (at 1 and 5 minutes), respiratory complications, need for immediate resuscitation and transfer to intensive care and that statistically significant both for the 1st and the 2nd twins. Conclusion: The twins pregnancies' morbidity appears to be more related to prematurity and intra uterine growth retardation) more than to the mode of delivery and hence the interest to detect and prevent its anomalies. It seems that vaginal delivery has a deleterious effect at least for the second twin but cesarean section doesn't seem to be the solution. Better learning techniques and obstetric maneuvers would reduce morbidity.


PubMed | Service de Gynecologie Obstetrique et de Medecine de la Reproduction
Type: Journal Article | Journal: La Tunisie medicale | Year: 2012

Menstruations, by their abundance and their duration, can be a source of impaired quality of life. Women with inherited bleeding disorders appear to be, specially at risk.Assess the impact of menstrual blood loss on the quality of life for women with inherited bleeding disorders.31 women with various inherited bleeding disorders were interviewed. They completed a quality of life questionnaire.Von Willebrand disease was the most frequent inherited bleeding disorder in our population (38.7%). 54.8% of patients had a menstrual period more than 6 days 61.3% of them consider their menstrual flow to be normal. The general condition apart of the menstrual period was considered medium to poor in 35.5% of patients. The average score assessing the impact of menstruation on daily life was of 5.00 3.47. Only 19.35% of patients felt that dysmenorrhea significantly affect their quality of life. Impaired quality of life was seen in 64.5% of patients according to score Aand in 41.9% of them according to score B. During menstruation 22.6% of the patients didnt do to work or to school because of the menstrual flow. On the other hand, 48.4% of patients were hospitalized at least once for a heavy menstrual flow.The quality of life during menstruation, in women with an inherited bleeding disorder, according to the different scores appear altered. Although because of the small size of our study population, we could not prove correlation between the importance of menstrual blood loss and the impairment of quality of life.

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