Ectopic pregnancy: which side to operate?
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Diagnostic Errors↗
Biomedical subjects
Jean-Marc Ayoubi
Publications and source records attributed to Jean-Marc Ayoubi.
Rupture of a uterine horn after laparoscopic salpingectomy. A case report.
BACKGROUND: Uterine rupture after salpingectomy, especially associated with cornual resection, is a rare, serious pregnancy complication. CASE: A spontaneous uterine rupture occurred during the second trimester of pregnancy, following salpingectomy with resection of the interstitial portion. Conservative treatment was performed, and fertility was preserved. CONCLUSION: Postsalpingectomy pregnancies must be carefully and frequently monitored, with ultrasonography used at the slightest clinical symptom. A postsalpingectomy rupture must be treated surgically, preferably with conservative treatment rather than hysterectomy.
Adult↗
Delivery of the second twin: comparison of two approaches.
OBJECTIVE: To compare two obstetrical approaches toward delivery of the second twin: one of expectant management, and the other, active; to compare the neonatal and maternal results and thereby identify, if possible, the optimal approach. STUDY DESIGN: This retrospective study looked at twin births in two maternity units in the Paris, France metropolitan region: Antoine Béclère (AB) in Clamart, and Port-Royal (PR) in Paris and concerned 113 deliveries of pairs of twins at AB and 78 at PR. RESULTS: The mean duration of the interbirth interval was 9 min at AB and 5 min at PR (P < 0.001). The characteristics of the pregnancies and the deliveries of twin A were comparable. Spontaneous birth accounted for 51% of twin A births at AB and 27% at PR (P < 0.001). Intrauterine manipulation of twin B occurred in 2% of the births at AB and 43% at PR (P < 0.001). At AB, there were five cesareans to deliver the second twin, but none at PR. The Apgar scores at AB and PR were identical, at 1 and 5 min, and for births before 32 weeks' gestation as well as for those afterwards. At AB, 19% (n = 21) of second twins were transferred to the neonatal intensive care unit, and at PR, 18% (n = 14). CONCLUSION: The neonatal results were similar in both groups, even though both the rate of obstetric maneuvers and the interbirth interval differed significantly. The two methods therefore appear to be equivalent when judged by the second twin's neonatal indicators. Our data suggest that an active approach diminishes the likelihood of cesarean delivery for the second twin, without increasing the neonatal risk.
Adult↗
Fetal heart rate and survival of the very premature newborn.
OBJECTIVE: Our purpose was to study the likelihood of survival of infants who are born before 28 weeks of gestation and to examine the influence of fetal heart rate findings on neonatal death. STUDY DESIGN: In this retrospective study, we analyzed the mortality rate of infants at 2 months of age as a function of various obstetric and prenatal indicators. RESULTS: At 2 months, 207 of 325 children were still alive. The survival rate was also a function of gestational age, birth weight, the administration of corticosteroids, multiple pregnancies, and fetal heart rate. Fetal heart rate had the greatest effect on the mortality rate. Children with a reactive rate were 4 times more likely to survive than children with a flat tracing (P =.003; odd ratio, 4; 95% CI, 12.1; 39.8). CONCLUSION: The results in our study lead us to think that recording the fetal heart rate before and during labor may be useful in the prediction of perinatal death and may help obstetric decision-making.
Adrenal Cortex Hormones↗
Ultrasonographic observation of uterine contractility. New perspectives.
The possibility of noninvasively assessing uterine contractility in ultrasound scans allows improvements in our understanding of hormonal regulation and of the influence of uterine contractility on the human embryo implantation process in natural and controlled ovarian hyperstimulation cycles. Ultrasound is a reliable tool for studying contractions of the nonpregnant uterus and confirms that uterine contractility is influenced by ovarian hormones and indicate that it partakes in the embryo implantation process in humans.
Administration, Intravaginal↗
Three-dimensional ultrasonographic reconstruction of the uterine cavity: toward virtual hysteroscopy?
The aim of this study was to evaluate the possibility of diagnosing intrauterine abnormalities, using a "virtual endoscopy" technique based on 3D hysterosonographic data. Five patients who presented intrauterine abnormalities (polyps, n=2; leiomyomas, n=3) underwent 3D transvaginal hysterosonography. The 3D data set was subsequently processed by using a proper software that creates virtual endoscopy images. After ultrasonographic examination, patients had a conventional hysteroscopy. In all patients intrauterine lesions were easily and reliably detected by computer-reconstructed 3D hysterosonography. Images obtained by this "virtual hysteroscopy" technique, including fine intrauterine details, were remarkably comparable to those obtained by conventional hysteroscopy. The results of this pilot study indicate that computerized reconstruction of 3D hysterosonography offers adequate visualization and characterization of intrauterine lesions.
Adult↗