Fetuses with features of first-trimester peritonitis and a favorable outcome.
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Female↗
Biomedical subjects
E Verspyck
Publications and source records attributed to E Verspyck.
[Fetal macrosomia and labor induction: we are definitely against it].
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Adult↗
[Posthysterectomy posterior compartment prolapse: Preliminary results of a novel transvaginal surgical procedure using polypropylene mesh via the low transobturator route].
OBJECTIVE: The aim of this study is the description and anatomical and functional outcome assessment of a novel surgical procedure, based on rectovaginal fascia defect repair with polypropylene mesh using the tension-free transobturator and infracoccygeal route based on the integral theory developed by Petros. MATERIALS AND METHOD: Prospective, consecutive and single centre study performed between February 2003 and April 2005. Inclusion criteria were symptomatic posthysterectomy stage three to four regarding posterior compartment prolapse according to the Baden and Walker classification, with no anterior and/or apical prolapse. Principles and description of this new surgical procedure are described. RESULTS: Fourteen patients, with a mean age of 63.5 years and a mean body mass index of 29.2, were included in the study. All the patients had previous hysterectomy, 64.3% reported at least one previous surgery for pelvic organ prolapse, 44.5% reported at least one reoperation. All patients complained of rectocele and/or enterocele stage three. No perioperative or postoperative complication occurred. With a median follow-up of 13 months (range 3-32.9), no recurrence and no anterior or apical compartment prolapse occurred. No vaginal erosion an infection of the mesh was observed. The mean level of subjective satisfaction was 9.23 on a visual analogical scale (0-very disappointed, 10-very satisfied). CONCLUSION: This new surgical procedure is effective and safe for the repair of posthysterectomy large posterior compartment prolapse. A long-term follow-up is required to confirm these promising results.
Aged↗
[Laparoscopic treatment of ovarian cysts during pregnancy Gynecol Obstet Fertil 2006;34:101-106].
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Animals↗
[Cystocele and stress urinary incontinence: assessment of a total treatment by monoprosthesis].
OBJECTIVES: The aim of this study is to evaluate the effectiveness and the potential complications in the short and medium terms of the transobturator and infracoccygeal hammock, a surgical technique suggested to treat in one sole operating time, by vaginal way, cystocele and stress urinary incontinence. PATIENTS AND METHODS: From February 2002 till August 2004, 45 patients aged 66+/-11 years on average, presenting a stage 3 or stage 4 cystocele associated with stress urinary incontinence (proven for 40 of them and masked by the prolapse itself for the other five) benefited from this new surgical procedure. RESULTS: With a mean follow-up of 31+/-9 months, the success rate of the technique is estimated at 98% on the anatomical aspect (one single failure) and at 91% on the urinary aspect (73% of the patients were cured, 18% improved and 9% in failure). No patient presented urinary retention except one with an infected pelvic hematoma requiring its evacuation and the partial ablation of the prosthesis. Postvoid residual volume at discharge was 83 ml. Two patients developed de novo bladder overactivity. Unfortunately we had to regret nearly 18% of exposed prosthesis. This result should be improved by the exclusive use of polypropylene monofilament prosthesis with broad meshes, weak weights and by reduced vaginal scars. DISCUSSION AND CONCLUSION: Total treatment by monoprosthesis of cystoceles with associated stress urinary incontinence constitutes an interesting prospect for some high-risk genital urinary prolapses for anatomical repetition or post-operative dysvoiding. Patients with recurrent failures of prolapse surgical cure, those with a large cystocele or by extension with a complete prolapse of the three floors, and even those with a post-hysterectomy prolapse have perhaps found a durable solution with their problem.
Adult↗
[Place of surgery in the management of gestational trophoblastic tumors].
Gestational trophoblastic tumors are authentic malignant tumors of the conception. They are mostly chemosensitive. For young women, the place of the surgery seems now restricted and more and more codified. Hysterectomy keeps a certain interest for women who do not wish to preserve their fertility. Hysterectomy limits then the complications of chemotherapy. It optimizes the chances of recovery without recurrence. If chemotherapy must nevertheless be carried out, hysterectomy decreases the necessary number of cures to obtain complete remission of the disease. Surgery is also indispensable to chemoresistant tumors. It allows exeresis of localized residual sites or isolated metastases. Other indications for surgery include uncontrollable vaginal or intra-abdominal bleedings and placental site trophoblastic tumors.
Adult↗
[Advantages of amniotic membrane transplantation in eye surface diseases].
Amniotic membrane transplantation is now a widely adopted technique in the field of eye surface diseases. Depending on the indication, the amniotic membrane can be used as either a graft or a patch. When used as a graft, the amniotic membrane serves as a substrate for regrowth of deficient epithelium; the aim is to integrate this membrane. The basal membrane reinforces the adhesion and differentiation of the corneal epithelial cells, facilitates their migration, and prevents their apoptosis. When used as a patch, the amniotic membrane is sutured epithelium-down so as to maximize the concentration of biological factors delivered by this membrane: the membrane covers the diseased cornea and acts as a biological bandage and analgesic. The best indications for amniotic membrane grafts are acute chemical burns and trophic corneal ulcers refractory to all medical treatment. When these ulcers are perforated or in the early stages of perforation, it is best to use multiple layers of amniotic membrane, restoring the thickness of the cornea. In cases of confirmed limbal deficiency, amniotic membrane grafts may be a useful complement to the necessary limbal stem cell grafts. In the future, amniotic membranes will provide an indispensable support for the expansion of cultured stem cells. Amniotic membrane grafts may also be used to reconstruct the conjunctiva following the exeresis of symblepharons or conjunctival tumors. However, the use of this technique is currently limited to diseases with little inflammation and no extensive fibrosis.
Amnion↗
[Episiotomy techniques].
OBJECTIVES: To describe the different types of episiotomy and to define the methods of repair. METHODS: A systematic review on Medline and Cochrane Database between 1980 and August 2005 was performed. RESULTS: Aseptic prevention and specific material may be used in order to reduce the risk of surgical wound infection (grade C). Episiotomy and perineal repair may be associated with considerable pain. In contrast, there has been little evaluation of the effectiveness of analgesia provided to women undergoing this procedure. The mediolateral episiotomy is a 6 cm incision at a 45 degrees angle from the inferior portion of the hymeneal ring (professional agreement). However, shorter length and lower angled episiotomies are also currently reported for routine practice (grade C). There are no data to recommend preferential use of an absorbable synthetic material (acid polyglycolic versus polyglactin 910). The use for the more rapid polylactin 910 suture material was associated with less need to remove sutures but with more wound gapping in comparison with the standard polyglactin 910 material (grade A). The continuous subcuticular technique of perineal repair may be associated with less pain in the immediate postpartum period than the interrupted technique (grade A). CONCLUSION: Mediolateral episiotomy is the method of choice in France. However, the procedure for this technique should be studied more. Subcuticular technique with an absorbable synthetic material may be the optimal method of repair.
Adult↗
[Surgical management of intractable postpartum haemorrhages].
Surgical management of an intractable postpartum haemorrhage after failure of medical and obstetric measures is not limited to the emergency peripartum hysterectomy. Uterine atony and abnormal placental insertions are the major causes of primary postpartum haemorrhages. Involving mostly young women, having few or no child, before with a healthy uterus, in first intention conservative option is recommended. The simplest methods must be known and be applied. It will be essentially progressive uterine arteries' ligation, which can be adapted to the majority of situations. Internal iliac arteries' ligation is a little less effective and technically more difficult to carry out. It remains interesting in obstetrical traumatic hurts, which do not concern the uterus. New and easier surgical methods, such as uterine compression or hemostatic suturing techniques have been described for which we lack experience. The quality of the result depends of the length of intervention and the cause of the bleeding. Nevertheless the main cause of failure with conservative treatments is placenta accreta. In case of failure of a conservative treatment, it would be dangerous to multiply techniques. Emergency peripartum hysterectomy then should remain the choice procedure.
Female↗
[Decreased fetal movements in the third trimester: what to do?].
OBJECTIVE: To appreciate at the end of pregnancy, in a low-risk pregnant population, the interest of a screening for fetal well-being in case of decreased fetal movements. To define the most adapted screening. PATIENTS AND METHODS: Retrospective study over a complete year of the patients having consulted in the same center for decreased fetal movements and subjected to the same screening for fetal activity in hospitalization during 48 hours. This screening included a study of fetal heart rate repeated three times a day, a fetal biophysical profile scoring, an umbilical artery Doppler, a Kleihauer-Betke testing, and an amnioscopy. RESULTS: One hundred and sixty patients were identified, representing 6.1% of pregnancies followed in the center. There was no relation between the age, the parity of the patients and the probability to consult for a decrease of fetal movements. Nevertheless the antecedents of pathological pregnancy or fetal malformation were frequent. Twenty-one percent of the deliveries were induced for a global rate of 18% in the center. Twenty-eight percent of the patients had a cesarean section for a global rate of 22.8%. Five percent of fetuses were at risk for prenatal asphyxia on the data of the screening. Fetal heart rate was abnormal in 3.75% of cases, fetal biophysical profile score pathological in 3.1% of cases. Just one umbilical Doppler was highly pathological. No meconium amniotic fluid was found. Two Kleihauer-Betke tests were disturbing. At the time of delivery, 28% of fetuses presented a funicular abnormality, 4.3% a severe growth restriction, 4.3% a malformation. One child only had an anemia. There was no perinatal mortality. DISCUSSION AND CONCLUSION: Screening for fetal vitality remains necessary in case of decreased fetal movements. It has to associate the study of fetal heart rate and the fetal biophysical profile with a Kleihauer-Betke testing. In a low-risk pregnant population, the study of fetal Doppler velocimetry is not profitable. Amnioscopy presents not enough interest. It is necessary to insist with the patients on the necessity of consulting in case of decreased fetal movements even in the approach of the term.
Adolescent↗
[Thrombophilias and vascular placental pathology. A survey of the literature].
PURPOSE: Hereditary thrombophilia as antiphospholipid syndrome (APS) may represent a new risk factor for placental vascular diseases. CURRENT KNOWLEDGE AND KEY POINTS: General screening for biological abnormalities related to thrombophilia is poorly associated with placental vascular diseases and therefore, may be unwarranted. Women with an history of thrombotic diseases may be at risk for late fetal loss or preeclampsia. Adverse obstetric outcomes are particularly high despite anticoagulation regimens in patients with APS. A high frequency for biological abnormalities related to thrombophilia was detected in pregnancies complicated by late fetal loss in comparison with controls. However, no beneficial strategy prevention was clearly reported and therefore, a selective testing was actually debated for these patients. FUTURE PROSPECTS AND PROJECTS: Searching for acceptable treatment alternatives in patients with APS in order to reduce the high rate for pregnancy complications which may be persistent despite anticoagulation regimens. To determine by controlled studies the role for a prophylactic low molecular weight heparin regimens in patients with haemostatic abnormalities and previous pregnancy complications.
Activated Protein C Resistance↗
[Neonatal management of a child exposed to tobacco in utero and postnatal biomarkers].
Does neonatal and postnatal management of a new-born exposed in utero to tobacco smoking differ from a non-exposed neonate? Which are the biomarkers for perinatal exposition? In order to address these two questions a Medline and Embase search was carried out. For the first question, the review of the literature suggests that tobacco is one of main factors increasing the rates of preterm birth to a significant degree and primarily early prematurity, and intrauterine growth restriction. Moreover, maternal smoking during pregnancy increases perinatal mortality. Management tends to reduce perinatal morbidity and mortality of these new-born, but there is in fact no published research which proposes precise recommendations for an accurate management distinct from the non-exposed child. Among the biomarkers used for the routine diagnosis of in utero tobacco smoke exposure, the umbilical cord cotinine level is probably the most reliable and noninvasive for the new-born. However, the maternal curve can be studied and measurement of the exhaled carbon monoxide in late pregnancy is a valid reflection of neonatal impregnation.
Biomarkers↗
Thrombophilia and fetal growth restriction.
OBJECTIVE: Genetic thrombophilia may represent a new risk factor for obstetrical complications. The aim of the study was to determine which subgroups may be associated with genetic thrombophilia for small for gestational age infants (SGA). METHODS: A case-control study was performed in three different maternity wards in Normandy. Cases (n=203) were women who had pregnancies complicated by unexplained SGA infants defined as a birth weight below the 3rd centile and control subjects (n=203) were women who had infants with birth weight > or =10th centile. Patients were tested in the immediate postpartum period and 2 months later for factor V Leiden mutation, and prothrombin 20210A mutation. Frequencies of these mutations were observed in different subgroups of SGA infants depending on pregnancy or neonatal outcomes usually associated with intrauterine growth restriction (IUGR), and were then compared with the overall prevalence for these mutations detected in the control group. RESULTS: Prevalences for factor V Leiden mutation (or=2.58; 95% confidence interval: 0.83-8.04), prothrombin 20210A mutation (or=2.03; 95% confidence interval: 0.51-8.01), were comparable between cases and controls (4.9% versus 1.9% and 2.9% versus 1.4%, respectively). Frequencies for these two polymorphisms significantly increased in subgroups of SGA infants with a normal Pourcelot index (13/133 versus 7/203; P=0.04), a gestational age > or =37 weeks of gestation (15/143 versus 7/203; P=0.01), a vaginal delivery (11/117 versus 7/203; P=0.04), a birth weight > or =2000 g (12/121 versus 7/203; P=0.03), no admission to paediatric ward (11/116 versus 7/203; P=0.01), a low Ponderal index <2.5(e) centile (6/45 versus 7/203; P=0.04), and normal head circumference >10th centile (7/53 versus 7/203; P=0.01) in comparison with the control group. CONCLUSIONS: An association was found between polymorphisms for factor V Leiden and prothrombin, and asymmetrical intrauterine growth restriction with immediate favourable neonatal outcomes.
Adult↗
Favourable outcome of a tight constriction band secondary to amniotic band syndrome.
Amniotic band syndrome or amniotic disruption complex is a well-known congenital limb abnormality, which occurs in 1 in 1200 to 1 in 15,000 live births. In cases of an isolated band constriction, it has been speculated that the bands lead to decreased blood flow in the constricted limb and subsequent natural amputation. Fetal surgery could be considered in these situations in order to release the constriction band in threatened limb amputation. We present a case of a tight constriction ring secondary to amniotic band syndrome with a favourable outcome, despite the failure of an attempted surgical procedure.
Adult↗
Does ultrasound examination when the cervix is unfavorable improve the prediction of failed labor induction?
OBJECTIVE: To compare the Bishop score, ultrasound cervical parameters and fetal fibronectin assessment for predicting failed labor induction when the cervix is unfavorable. METHOD: A prospective observational study was performed in 106 consecutive pregnant women with a Bishop score < or =5 undergoing labor induction. Assessment of fetal fibronectin and ultrasound measurement of cervical length, cervical wedging and cervical lip areas were performed. The relationship between these parameters and failure of labor induction was determined. RESULTS: Failure of labor induction was defined as failure to reach a cervical dilatation of > or =5 cm, and it occurred in 16 patients (15.1%). Induction failure was associated with low Bishop scores before (P = 0.004) and 6 h after the start of induction (P = 0.007), increased clinical cervical length (P = 0.02) and increased ultrasound anterior cervical lip area (P = 0.04). The logistic regression model identified the Bishop score before induction (odds ratio = 2.25; 95% CI, 1.30-3.91; P = 0.003) and the clinical cervical length (odds ratio = 3.95; 95% CI, 1.3-11.7; P = 0.01) as being independent predictors of failed induction. To predict an induction failure, the best Bishop score cut-off value was 4, with a sensitivity of 87.5%, a specificity of 45.6%, a likelihood ratio of 1.58, a positive predictive value of 22.2% and a negative predictive value of 95.4%. CONCLUSION: Compared with the Bishop score, cervical length by ultrasound is not a better predictor for the outcome of labor induction in an unfavorable cervix. Nevertheless, the Bishop score appears to be of poor predictive value for failed induction of labor.
Adult↗
The role of ultrasound and fetal fibronectin in predicting the length of induced labor when the cervix is unfavorable.
OBJECTIVE: To compare cervical clinical data, ultrasound parameters and fetal fibronectin assessment in the prediction of the duration of induced labor when the cervix is unfavorable. METHODS: This was a prospective study of 90 pregnant women with a Bishop score </= 5 undergoing labor induction. The Bishop score and its components, parity, cervical ultrasound parameters and fetal fibronectin level were analyzed using Cox's model in order to determine the most predictive factors for the duration of the latent and active phases of labor as well as its total duration. RESULTS: There was a significant correlation between duration of the latent phase and the whole of labor, and digitally assessed cervical dilatation (P = 0.003 and P < 0.001, respectively), parity (P = 0.006 and P < 0.001), the Bishop score (P = 0.019 and P = 0.003) and ultrasound-determined cervical length (P = 0.035 and P = 0.003). The length of the active phase of labor did not correlate with the cervical status. Funneling did not appear to be predictive of the duration of labor and it had a poor correlation with digital cervical dilatation. The length of the latent phase and that of the whole of labor was significantly longer when cervical dilatation was </= 2 cm (P < 0.001 in each case), when women were nulliparous (P = 0.002 and P < 0.001) and when ultrasound cervical length was >/= 27 mm (P = 0.002 and P = 0.005). CONCLUSION: Cervical dilatation as assessed by digital examination is the best predictor of the duration of the latent phase and of that of the whole of labor. Ultrasound measurement of cervical length is not more accurate at predicting the duration of labor than are clinical data.
Biomarkers↗
[Intractable postpartum haemorrhages: where is the place of vascular ligations, emergency peripartum hysterectomy or arterial embolization?].
OBJECTIVE: Update of knowledge on the various methods of management of intractable postpartum haemorrhage. METHOD: PubMed, MEDLINE were the electronic sources, in English and French languages, used for data retrieval. Uterine atony and abnormal placental insertions (placenta praevia or accreta) are the major causes of primary postpartum haemorrhages. To preserve fertility, we dispose of angiographic selective embolization or surgical vascular ligations. Embolization is a non-invasive method practicable by simple catheterization under local anesthesia. Vascular ligations of the uterine vessels or internal iliac arteries require mostly laparotomy. New and easier surgical methods, such as uterine compression or hemostatic suturing techniques have been described for which we lack experience. RESULTS: For uterine atony, the success rate of arterial embolization and uterine artery ligations is close to 100%. Ligation of internal iliac arteries is a little less effective and technically more difficult to carry out. It remains interesting in obstetrical traumatic hurts, which do not concern the uterus. If bleeding from the lower segment occurs during caesarean section, low uterine artery ligatures are necessary. These methods are all the more effective than they are prematurely implemented before the rise of major coagulopathy. In this case, uterine devascularization has also to be applied to ovarian vessels. With placenta accreta, accreta portion of the placenta can be left in place and arterial embolization or vascular ligations can be done. Nevertheless the main cause of failure with conservative treatments is placenta accreta. CONCLUSION: The simplest and the least morbid methods must be retained. After vaginal birth, arterial embolization can be done, if there is no maternal haemodynamic disorder nor interventional vascular radiology unit nearby. During caesarean section, progressive uterine artery ligation can be done adapted to the bleeding cause. In case of failure of a conservative treatment, it would be dangerous to multiply techniques. Emergency peripartum then should remain the choice procedure.
Arteries↗
[Does tension-free vaginal tape (TVT) have a place in the treatment of sphincter incompetence?].
OBJECTIVE: The objective of this article is to estimate results and place of TVT in female stress urinary incontinence with intrinsic sphincter incompetence. MATERIAL AND METHOD: This was a retrospective study over a period of 57 months in a population of 38 patients treated by TVT for sphincter incompetence with or without inefficient pressure transmission. Mean patient age was 52 years. Fourteen patients (37%) had a history of incontinence surgery. The physical examination demonstrated urethral mobility in 22 patients (58%) and positive Bonney or Jacquetin tests in 15 patients (39%). Mean maximum urethral closure pressure was 40 cm H2O, with 12 patients (32%) 30 cm. Six patients (16%) had detrusor instability. Seven patients (18%) had pure sphincter incompetence. RESULTS: Median follow-up was eight months (two months to 32 months). Twenty five patients (66%) were cured, nine (24%) improved and treatment failed in four (10%). Results are less satisfactory for patients with preliminary failure of incontinence surgery, fixed urethra, pure sphincter incompetence or with detrusor instability without inefficient pressure transmission. The only major complication was an expulsion of the prosthesis. CONCLUSION: Results of TVT in sphincter incompetence are slightly less satisfactory than in pure urinary stress incontinence. In a short follow-up, they are comparable in sphincter incompetence to those of sling procedures which are the current gold standard. Risk of urinary retention is lesser. The minimally invasive nature of TVT suggests that it will replace sling procedures in the future for this particular indication. Longer follow-up will be necessary for confirmation.
Adult↗