[Systematic screening for Chlamydia trachomatis with the molecular biological AMP-CT test in urine samples from young women]

OBJECTIVE

We report the results of a systematic direct detection screening protocol for Chlamydia trachomatis in urine samples from young women.

MATERIAL AND METHOD

The study included 1026 patients aged 13 to 30 years. Urine samples were tested with a molecular biology assay: AMP-CT.

RESULTS

Thirty-five patients (3.4%) were positive: 80% of the positive patients were aged less than 25 years, 48.6% less than 20 years. All these patients were treated and post treatment controls were negative.

CONCLUSION

This study suggests that national screening programs for Chlamydia trachomatis could be beneficial for women aged between 15 and 25 years and that the "Calmat" law could be modified in consequence.

[Role of misoprostol in the delivery outcome]

OBJECTIVES

Delivery-induced hemorrhage is defined as a blood loss greater than 500 ml within the first 24 hours after delivery. Loss of more than 1000 ml is a sign of gravity. For certain authors, 40% of these hemorrhages could be avoided with systematic preventive measures using uterotonic agents to control the third phase of labor. The aim of our work was to assess the preventive efficacy of active management measures during the third phase of labor and to determine which agents are most effective.

PATIENTS AND METHODS

We compared two protocols for controlled deliver: a conventional method using ocytocin (2.5 IU i.v. bolus), and a more recent method using a prostaglandin E1 analog: misoprostol (Cytotec, 3 tablets per os). We compared the two methods with a control group where no preventive measures were used, the standard procedure in our maternity unit.

RESULTS

Six hundred two women participated in the study. They were divided into 3 homogeneous groups (ocytocin group misoprostol group, control group). There was a 46% reduction in delivery-induced hemorrhage in the ocytocin group but only a minimal preventive effect against severe hemorrhage. Misoprostol did not demonstrate any efficacy in our study.

DISCUSSION

It would appear appropriate to take preventive measures against delivery-induced hemorrhage for all deliveries. A bolus intravenous injection of ocytocin immediately after delivery should bed used. The dose should be greater than that used in this study in order to prevent the development of severe hemorrhage. The most satisfactory results can be obtained with 5 IU (1 ampoule of Syntocinon). It is important to obtain a precise quantification of excessive blood loss in order to institute appropriate care rapidly. Misoprostol should be assessed with other prospective studies because of its easy administration, its low cost and easy storage, important advantages in countries with limited resources.

[Removal or conservation of ovaries during hysterectomy for benign lesions]

At the time of hysterectomy, the aging ovary presents a dilemma. We conducted a prospective study to assess the feasibility of systematic oophorectomy in women 50 years or older and a retrospective study of hysterectomy history in patients who developed cancer of the ovary. Our finding and data in the literature point out the requirement for careful assessment of two aspects of the problem, one technical (feasibility of adnexectomy) and the other functional (ovary function and risk of cancer on the retained ovary).

[Maternal mortality in the gynaecological and obstetrical clinic of the University Hospital in Rennes. A retrospective study over 10 years, from 1969 to 1979 (author's transl)]

Maternal mortality in the C.H.U. of Rennes from the 1st January 1969 to the 1st January 1979 consisted of 8 deaths in 24.911 deliveries and 1.381 Caesarean sections, which gives a mortality of 32 per 100.000 deliveries. There was 1 death due to hyperemesis gravidarum, 1 due to toxaemia of pregnancy, 3 due to haemorrhage, 1 due to puerperal sepsis, 1 due to cerebral haemorrhage and lastly 1 due to cancer of the pancreas. 2 women died during Caesarean section, which works out at 1 death per 690 Caesareans. Of these 8 deaths, 4 were possibly avoidable, and 3 of their children survived. In spite of continual progress since the end of the second world war, maternal mortality should decrease still further and tend down to the figures for Scandinavia or England (10 deaths for 100.000 deliveries).

[A consideration of "avoidable deaths". A study on early neonatal mortality in Ille-et-Vilaine from 1972 to 1977 (author's transl)]

The authors have made a study of 514 case notes of early neonatal deaths that occurred in Ille-et-Viliane from the 1st January 1972 to the 1st January 1977 among a total of 61,400 deliveries. They had 3 objects in mind: 1. To know what mechanisms had produced these deaths. In order to do this they divided their observations into 4 groups according to what seemed to them at the time to be the primary cause of the death, namely a lethal congenital malformation, a complication occurring in pregnancy, an accident that happened during the delivery, prematurity and dysmaturity. 2. To establish the importance of what is now called "avoidable deaths" and the conditions under which they were produced. 3. To show the means and methods that might eventually reduce this mortality after studying these results. On the conclusion of this study it seems to them that this improvement can here and now be obtained not so much by new procedures as by better monitoring of the state of pregnancy and the puerperium, and by more attention to the classical rules and more sensible use of the numerous techniques that already exist today.

[Radio-anatomy of uterine malformations]

33 cases of uterine anomalies were studied from the external morphological point of views as well as by hysterography. These cases were grouped according to R. Mussel's classification (1964) which is itself the synthesis of radiological and anatomical investigations.