Biomedical subjects
Publications and source records attributed to A Bongain.
We present a case report of cervical pregnancy with medical treatment. Medical treatment consisted in injection of methotrexate (50 mg) into the pregnancy, on the first, third and seventh day. Ultrasound and Doppler give important information for follow up. The pregnancy totally resolved and the patient did not need any further treatment.
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OBJECTIVE: To investigate the relationship between human immunodeficiency virus (HIV) and cervical intra-epithelial neoplasia (CIN). DESIGN: A prospective study to determine the prevalence of cervical intra-epithelial neoplasia in 111 HIV-positive women. METHODS: In total, 111 HIV + women were enrolled and underwent cervical biopsy and CD4 T-lymphocyte determination. Of the 111 women, 26 (23.4%) had CIN and another 26 (23.4%) had histologic evidence of cervicitis. RESULTS: No significant difference was found between transmission group, CDC stage of disease, CD4 T-lymphocyte count and pregnancy. There was a significant association with concomitant human papillomavirus (HPV) infection (P < 0.001). CONCLUSION: Public health measures are needed to provide Papanicolaou smear screening and appropriate clinical follow-up and treatment of women infected with the human immunodeficiency virus.
OBJECTIVE: We attempted to determine whether the risk of mother-to-child transmission of human immunodeficiency virus type 1 is related to events in pregnancy, labor, and delivery. STUDY DESIGN: In a prospective multicenter cohort study of human immunodeficiency virus type 1-infected mothers and their children, we studied pregnancy histories, labor (including gestational age, induction, membrane rupture, length of labor, intrapartum procedures, bleeding, infection, antiseptic technique, and antiretroviral therapy), and conditions of delivery. RESULTS: Among 1632 singleton infants, 310 were confirmed infected with human immunodeficiency virus type 1 at age 18 months (19.0% +/- 1.9%). Procedures (in particular, amniocentesis and amnioscopy) and sexually transmitted diseases during pregnancy, preterm delivery, premature membrane rupture, hemorrhage in labor, and bloody amniotic fluid were associated with increased transmission. Transmission was not related to mode of delivery or to the conditions of labor and delivery. CONCLUSIONS: Transmission was not decreased after emergency or elective cesarean section. Most risk factors either were rare or appeared poorly amenable to obstetric management, with the exception of invasive procedures, which should be avoided.
OBJECTIVE: To define the rate of maternal death on the basis of maternal deaths recorded from January 1986 to May 1993. To determine whether the patients had received "standard" quality health care. METHOD: A Reproductive Age Mortality Survey was performed retrospectively on causes of death in women from 14 to 45 years of age; death registries and clinical records at the Nice University Hospital were used. RESULTS: There were 23 cases of pregnancy-associated death. Maternal mortality was 32.9 per 100000 live births. According to the INSERM survey, the "real" national rate would be 18.3 per 100000. This is a classical underestimation. The overmortality in Nice is partially explained by the AIDS epidemic which was the major cause of female deaths between 14 and 45 years (96/322). Nevertheless, there was an unsatisfactorily large number of cases in which standard obstetrical practises were not applied. This was often due to a combination of factors including poor obstetrical surveillance, insufficient attention by physicians, poor organisation of obstetrical care in the emergency room and referrals. Cesarean section was implicated in 7 out of 12 maternal deaths during the third trimester of pregnancy (58%). The cause of certain maternal deaths remained unexplained; amniotic embolus was always suggested. Unfortunately, an autopsy was performed in only 36% of the cases and its quality was insufficient to determine certain diagnosis.
HIV infection in children is mainly the result of a mother-to-child transmission. The contamination during pregnancy is well known but intrapartum vertical transmission may also occur through ascending infection, blood exchange between mother and child, or direct contact with vaginal or cervical secretions. In addition HIV can be transmitted via breast milk. The reported rates of vertical transmission are highly variable: 14.4% in a European study, 18.3% in a French survey, 20 to 25% in the USA, 35 to 50% in Africa. It is unclear whether such a large variation of the rate of transmission is due to methodological differences or to different distributions of risk factors in the populations. There are some known predictive factors of HIV transmission such as low CD4 cells count, positive p24 antigenaemia and elevated concentrations of virus. The role of other factors is still debated: prematurity, virus (CMV, HTLV-1, HVB, HVC), C section prior labour, rupture of membranes. The prevention of HIV infection in infants is mainly based on contra-indication of pregnancy in infected women, desinfection of the vagina at the beginning of labour, early protection of the newborn by avoiding skin lesions and immediate washing, preventive treatment by zidovudin during pregnancy.
There have been no other cases of migration of an intrauterin device reported to have caused venous compression. In the case reported here, the intrauterin device was removed surgically together with a portion of the damaged vein. A venous graft from the internal jugular vein was performed. The mechanisms of perforations, different localizations are discussed and diagnostic and therapeutic approaches are proposed.
Umbilical endometriosis is a rare site of the disease. The authors report a case of umbilical endometriosis only. Umbilical involvement is estimated at 0.5 to 1% of all site of the disease. This is a disorder affecting women of childbearing age, with a mean age of about 40. Medical treatment by progestogens or Danazol is inconstantly and partially effective regarding umbilical endometriosis. Surgical excision remains the only effective treatment: omphalectomy with wide removal of the tumor and reconstruction of an umbilicus. Surgery enables histologic study and, in the presence of suggestive symptomatology, search for and treatment of other genital sites.
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OBJECTIVES: Our purpose was to evaluate the prevalence of thrombocytopenia related to human immunodeficiency virus among seropositive pregnant women and its impact on maternal and neonatal outcome. STUDY DESIGN: A retrospective survey of all deliveries of women infected with human immunodeficiency virus in 14 maternity units in France over a 6-year period collected data on mothers who had thrombocytopenia < 100.10(9)/ and their infants. RESULTS: Among 890 women, 29 were thrombocytopenic (3.2%, 95% confidence interval 2.1% to 4.3%). Thrombocytopenia appeared directly related to human immunodeficiency virus infection in 25 of these women. During pregnancy 16 patients were treated for thrombocytopenia with zidovudine, corticosteroids, or high-dose intravenous gamma globulin. Zidovudine was effective in five of seven cases, and intravenous gamma globulin was effective in five of 11 cases. Cesarean sections were performed in 13 of 29 women. Abnormal intrapartum or postpartum bleeding was recorded in five cases. Among 28 infants for whom neonatal platelet counts were available, only one had thrombocytopenia < 100.10(9)/L at birth; he went on to have early-onset acquired immunodeficiency syndrome. CONCLUSIONS: The incidence of fetal or neonatal thrombocytopenia appears low and may not justify invasive sampling or routine cesarean delivery. Therapy with zidovudine or intravenous gamma globulin should be considered for women with severe thrombocytopenia, because of the risk of maternal hemorrhage.
HIV transmission risks were specified during infertility treatment. An investigation was performed by gynecologists who work in IVF. Most of gynecologist refuse to treat infertility in these cases.
A case of twin pregnancy in a bicervical uterus with double vagina is reported. The malformation was known before conception. Caesarean section was performed for premature rupture of the membranes at 34 weeks. This enabled the extraction of two low-birth-weight premature infants free of any particular pathology. The possibility of twin pregnancy in a bicervical bicornuate uterus is 1/1,000,000 and implies the maturation of at least two oocytes. This is a high risk pregnancy. Spontaneous abortions, prematurity (40%), low-birth-weight (25%) are the most notable complications. Although the probability of dynamic dystocia is multiplied by 7, vaginal delivery is not excluded when the obstetric past history is satisfactory and the presentation of both twins cephalic. Caesarean involves hysterotomy of each horn and raises no special technical problems. Double delivery increases the risk of hemorrhage.
Two cases of thrombophlebitis of the right ovarian vein, one occurring after cesarean section and the other after natural childbirth, are reported. The clinical diagnosis was based on the symptoms of postpartum fever in association with right flank pain and confirmed by abdominal CT scans. In both cases the thrombosis extended into the inferior vena cava and was associated with a free-floating thrombus extending up to the renal veins. Thrombectomy of the inferior vena cava and ligation of the right ovarian vein were performed with good results in both cases, as shown by late follow-up CT scans. This and alternative therapeutic strategies are discussed.
A laparotomy for hysterectomy was performed in a 46-year-old nulliparous woman who had worn an intra-uterine sterilization device for 8 years. The patient was in poor general health and had had abdominal pain and repeated episodes of fever over the preceding 3 months. An abscess of the abdominal muscle was found peroperatively. No perforations of the small or large intestine were observed. The pathology examination yielded the diagnosis of Actinomycosis. Actinomyces israeli is the most frequency observed Actinomycae in humans. It is a saprophyte organism of the intestinal flora, not usually found in the vagina and observed in 3.5% of cervical swabs of patients wearing an intra-uterine device (Gupta bodies). The frequency increases with the duration of insertion and the pathogenicity appears when the immune responses are deficient and/or when a cofactor is involved. Treatment relies on surgical exeresis and prolonged antibiotics (penicillin G or macrolides). Hyperbar treatment is sometimes used.
The authors report two cases of puerperal right ovarian vein thrombophlebitis (POVT) with floating thrombus in the inferior vena cava (IVC). The originality of this report lies in the first line surgical treatment approach. POVT is recognized as presenting usually within the first week post-partum after about 0.05% of deliveries. The syndrome consists of lower abdominal or flank pain, unexplained fever and a tender abdominal mass. Abdominal or pelvic findings are often scanty. In some cases, the thrombus may extend to the inferior vena cava, leading to the risk of pulmonary embolism or low grade renal insufficiency. Diagnosis has been difficult in the past. Since acute appendicitis is the commonest differential diagnosis, laparotomy is frequent. CT scan provides a readily available, accurate, non invasive technique for the diagnosis of POVT. Criteria are: enlargement of the vein, a low density lumen within the vessel wall and a sharply defined vessel wall enhanced by contrast media. The treatment of POVT is initially medical. Antibiotics should be given to cover the commonest infecting organisms. Heparin should also be prescribed at therapeutic IV doses to be followed by oral anticoagulants for at least six weeks. Surgery is usually only recommended when the patient remains symptomatic despite proper medical management, develops clinical, scan or arteriographic evidence of pulmonary embolism, or cannot be anticoagulated. The recommended surgical technique is to clamp the anastomosis of the ovarian vein with the vena cava.(ABSTRACT TRUNCATED AT 250 WORDS)