[Severe anti-D allo-immunization: failure of repeated antenatal plasmapheresis (a case report)].
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Biomedical subjects
Publications and source records attributed to J Y Gillet.
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Uterine adenomyosis is a common, almost banal, lesion, since it is found in one uterus out of three by careful histological examination. In a continuous series of 926 hysterectomies for various indications, 246 adenomyosis lesions were demonstrated. In only 65 cases, adenomyosis was the sole histological lesion explaining bleeding or pain, symptoms refractory to routine conservative treatment (haemostatic curettage and/or hormone treatment) and therefore justifying surgical removal of the uterus. The role of adenomyosis in the failure of conservative treatment for diffuse fibromatosis at around the age of the menopause must be remembered. Almost 50% of specimens of hysterectomy for fibroma show evidence of associated histological lesions of internal uterine endometriosis. Whilst the hysterographic diagnosis may be suspected in almost 2/3 of cases, direct appearances of adenomyosis are found in only one case in four.
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The use of heparin to interfere with the appearance of fetal maldevelopment (or to correct it) is logical but the results are difficult to prove because it is difficult to be certain of early diagnosis at the time when therapy has the best chances of being efficacious. The authors compare two groups of pregnant women in whom the muscular vascular tone of the cervix is abolished. The second group was treated with heparin. The results are statistically significant and prove that treatment with heparin is well based in cases of underdevelopment of the fetus when it is due to abnormalities in the maternal microscopic circulation (acute atherosis). They confirm that the enzyme, hormone and ultrasound parameters return to normal from the beginning of treatment with heparin.
The study of 53 pregnancies which were the result of induction of ovulation using a standard treatment with 100 mg of clomiphene citrate and 3 injections of 1,500 I.U. of H.C.G. showed no increase in the risk of fetal malformation. Before treatment this same group of women has a high risk of spontaneous abortion (43p. 100). After treatment in 53 conceptions 7 ended with an abortion which, is 13p. 100. The risks which follow this treatment are above all dominated by the definite increase in twin pregnancies and in prematurity which follows from this factor.