[Post-partum depressive symptoms: Prevalence, risk factors and relationship with quality of life]

OBJECTIVE

The objective of our study was to estimate the prevalence of the post-partum depressive symptomatology in a sample of Tunisian women, to study associated factors and to assess its relationship to quality of life.

PATIENTS AND METHODS

This is a prospective study carried out in two stages: during the first week (T1), then between sixth and eighth week post-partum (T2). Depressive symptomatology and quality of life were assessed respectively by the Edinburgh Postnatal Depression Scale and the World Health Organization Quality of Life scale.

RESULTS

In the first stage, the prevalence of depressive symptomatology in the total sample (150 women) was 14.7% and was related to age above 35 years, low school level, personal psychiatric history, multiparity, caesarean delivery or forceps in the previous pregnancy and unplanned pregnancy. This prevalence was 19.8% among the 126 women reviewed in T2 and was correlated with the exaggerated sympathetic signs during pregnancy, namely perversion of taste and fatigue. Quality of life was strongly correlated with depressive symptoms in T1 and T2.

CONCLUSION

Post-partum depressive symptoms were common in our sample and were correlated with quality of life. Therapeutic measures should be proposed for women with post-partum depressive symptoms and particularly with several risk factors in order to improve their quality of life.

[Sexuality and contraception: a prospective study of 85 cases]

BACKGROUND

Contraception opposing procreation interferes with the primary purpose of sexuality. Few studies have yet been made on the actual interaction between contraception and sexuality.

AIM

To study contraceptive practices ie non medicalized contraception and oral contraception, study aspects of women's sexuality and to study the physiological impact and psychological contraception on women's sexuality.

METHODS

Prospective and analytical study conducted over a period spanning from October 2008 to February 2009. This study was based on a survey, carried out through an oral questionnaire to 85 women in reproductive age, married, with contraceptive-based pill or natural birth control for at least one cycle, having experienced during their personal background a sexuality contraception or at least one contraceptive method other than its current average.

RESULTS

Comparison between the group of women using oral contraception and women not using contraception medicalized showed significant differences in outcomes relating to: the average frequency of intercourse / month (p = 0.01), sexual desire ( p = 0.01), sexual pleasure (p = 0.03). The comparison of the different parameters of sexuality among the group of women using intra uterine device and women using oral contraceptives showed no significant differences in the parameters of sexuality.

CONCLUSION

The awareness of the big importance of the interaction between sexuality and contraception, in one way or another, could help us tailor our applications to contraceptive practices of each woman.

[Prospective study of 45 cases of disseminated intravascular coagulation]

BACKGROUND

Disseminated intravascular coagulation (DIC) in obstetric disorders is a severe complication.

AIM

To study the frequency and means of diagnosis of DIC and the therapeutic care and maternal morbidity induced.

METHODS

Monocentric, prospective and descriptive study about 45 cases of intravascular coagulation in an obstetrical service collected at the University Hospital of Obstetrics and Gynecology Hedi Chaker of Sfax over a period ranging from June 2007 to June 2010. All the pregnant patients who have given birth beyond 28 weeks and have presented a DIC were selected for this study.

RESULTS

The mean age of patients was 31.4 years. The mean parity was 2.6. The main diseases during pregnancy were: severe preeclampsia (22.2%), diabetes (28.8%), intrauterine fetal death (17.7%), previa placenta (8.8%). The main causes of DIC were: uterine atony (44.4%), abruptio placenta (22.2%), Hellp syndrome (11.1%) and uterine rupture (6, 6%). The lowest rate of platelets was 21000/mm3. The fibrinogen level was <0.5 g in 40% of cases. Despite reanimation and transfusion with blood products, surgical treatment was necessary in 77.7% of cases. All the patients were transferred in intensive care unit with an average stay of about three days. No maternal death was reported.

CONCLUSION

DIC is a frequent complication of many obstetrical diseases. The treatment is urgent. It requires first to the cause and the shock by massive transfusions of packed red blood cells, fresh frozen plasma, and platelets, associated with antifibrinolytic drugs, if necessary.

[Emergency peripartum hysterectomy: indications and prognosis]

AIM

Detect the risk factors, indications and maternal morbidity of haemostatic hysterectomy.

METHODS

A retrospective study of 46 women who had haemostatic hysterectomy between 2005 and 2009.

RESULTS

The mean age was 33.3 years. The mean parity was 3.5. 35% of patients had a previous cesarean section. The mode of delivery was: vaginal delivery (47.8%), cesarean delivery (52.2 %). The hysterectomy was subtotal in 39 cases (85%). The indications of haemostatic hysterectomy was: uterine inertia (44%), disseminated intravascular coagulation (26%), placenta accreta (8.7%), Placenta praevia (13%), uterine rupture (8.7%).Three patients were dead. Five patients had a depression. Six patients had a dyspareunia. Five patients had a decrease of sexual desire.

CONCLUSION

Haemostatic hysterectomy is a mutilating surgery giving an irreversible infertility. The development of arterial embolization avoid the appeal to this surgery.

[Cervical ripening at term. A randomized and prospective study: Misoprotol versus dinoprostone]

AIM

To compare the efficacy and safety of cervical ripening at term by vaginal Misoprostol and Dinoprostone.

METHODS

We performed a prospective randomized study on cervical ripening with misoprostol and dinoprostone in the third trimester of pregnancy. 300 patients have been divided into two groups: one consisted by 150 patients who received Misoprostol (Cytotec ®) and the second consisted by 150 patients who received Dinoprostone (Prépidil ®).

RESULTS

Analysis of our results allowed to reveal: a significant decrease in the time of entry into work for the Misoprostol group (9.08 hours versus 12.51 hours, p = 0.007), a significant reduction delivery time (14.48 hours versus 19.30 hours, p = 0.001). Moreover, the birth rate in the first 24 hours after the first dose was significantly higher in the Misoprostol group (86.7% versus 72.7%, p = 0.003). The use of oxytocin was significantly reduced with Misoprostol (44% versus 58.7%, p = 0.01). The mode of delivery was not influenced by membership in one or other of the two groups.

CONCLUSION

Misoprostol seems an interesting molecule for cervical ripening and labor induction.

[Ligation of internal iliac arteries for severe hemorrhage in obstetric]

AIM

To assess the efficiency of arteries ligation in intractable obstetrical hemorrhage.

METHODS

Prospective study which concerned 53 patients who underwent internal iliac arteries ligation for persistent and severe obstetrical hemorrhage from January 2007 to June 2010.

RESULTS

The average age of patients was 29.3 years. The mean parity was 2.2. Main etiology of hemorrhage were: uterine atony (62.2%), abruptio placentae (15.1%). Coagulation disorders and hypovolemic shock were observed respectively in 20.7 % and 37.7%. Blood transfusion was performed in all cases. Internal iliac arteries ligation allowed hemorrhage control in 90.5 % of cases. In five cases a hysterectomy was necessary to control bleeding.. No peroperative complication were observed.

CONCLUSION

Internal iliac arteries ligation is a prerequisite treatment of severe postpartum hemorrhage. It is a good alternative to arterial embolization.

[Anatomic and functional results after surgical treatment of uro genital prolapse: prospective study about 93 cases]

BACKGROUND

genital polapse is a frequent olisease several techniques were described.

AIM

To evaluate the anatomical and functional results of surgery for genital prolapse by vaginal and abdominal approach.

METHODS

Prospective study on 93 patients operated for urogenital prolapse (50 by high and 43 vaginal approach) in the department of obstetrics and gynecology of Sfax. Anatomic results and postoperative patient satisfaction was assessed. Quality of life was assessed using the French versions of the questionnaires Pelvic Floor Distress Inventory (PFDI 20), Pelvic Floor Impact Questionnaire (PISQ 7).

RESULTS

The mean age of patients was 59 years. 85.9% of our population consisted of postmenopausal women. The results of the postoperative visit, after a mean of 28.7 months, showed about the anatomical level, a success rate for the treatment of prolapse by high 82% against 72.1% for vaginal delivery, but the difference is not significant (P = 0.45). For prolapse of grades 1 and 2, surgical treatment by high and low has corrected all the elements of prolapse. For prolapse of grades 3 and 4, high surgery has resulted in a satisfactory anatomical result in 86%, while the lower channel yielded a significant result in 76.5%, and recurrence were interested mainly the anterior stage. The questionnaire PFDI 20, showed an improvement in the quality of life after surgery significantly in both groups (p<0.003). The improvement was more significant PFDI 20 after surgery by high versus vaginal surgery (p <0.002). Regarding PFIQ 7, improved quality of life was observed after surgery without significant differences between the two groups.

CONCLUSION

The treatment of urogenital prolapse is mainly based on surgical and reconstructive surgery to restore anatomical and functional surgery also in order to improve the quality of life of patients.

[Obstetrical prognosis following ligation of hypogastric arteries]

BACKGROUND

Ligation of hypogastric arteries is a conservative surgical treatment in cases of postpartum hemorrhage.

AIM

To study the fertility and pregnancies outcome in women who required hypogastric artery ligation for severe post-partum haemorrhage in our hospital.

METHODS

The fertility and pregnancy outcome parameters were retrieved from medical files and telephone interviews

RESULTS

34 patients required hypogastric ligation on this period. 39 pregnancies were observed with 30 term deliveries, 1 ectopic pregnancies and 8 miscarriages. Two patients had infertility and pregnancy was obtained in less than 10 months most once desired.Pregnancy outcome was normal. 73,3% of deliveries were by caesarean.

CONCLUSION

Hypogastric artery ligation for post-partum haemorrhage is not responsible for secondary infertility. Following pregnancies do not suffer complications from the ligation.

[Prospective study of the correlation of ultrasonography and CA125 in the management of ovarian cysts: a study of 77 cases]

AIM

To study the correlation between ultrasound, Doppler,measurement of CA 125 and histology in the preoperative diagnosis of ovarian cysts.

METHODS

Prospective and analytical study about 77 patients in whom we analyzed the contribution of ultrasound, the assay of CA125, the couple CA125 ultrasonography and laparoscopy in the diagnosis and management of cysts the ovary. The value of CA125 was considered pathological like the one adopted by our biochemistry laboratory of the CHU Habib Bourguiba, Sfax (> 35 UI / ml).

RESULTS

The mean age was 35.6 years. On the whole, ultrasound has a sensitivity of 71.41% and a specificity of 80%. The positive predictive value was 35.71% and negative predictive value was 96.55%. The sensitivity of CA125 to detect malignant lesions among ovarian cysts was 85.71% and a specificity of 85.93%. The PPV was low (42.85%). The combination Ultrasound-CA125 had a sensitivity of 85.7%, a specificity of 82.8%, a PPV and NPV respectively 35.3% and 98.1%. The concordance between the macroscopic perlaparoscopic and histological diagnosis of different tumors was 83.3% for functional cysts, 77.7% for serous cysts, and 100% for dermoid cysts, endometriosis and bleeding.

CONCLUSION

The contribution of Doppler ultrasound and tumor markers is essential in the diagnosis of ovarian cysts.

[Genital prolapse in young women: a study of risk factors]

AIM

To determine the risk factors for genital prolapse in a group of 33 young women less than 45 years old.

METHODS

We studied 33 young women who had been operated for genital prolapse, whereas the control group consisted of women operated for benign gynaecologic disorders.

RESULTS

In the study group the number of pregnancies and deliveries, the babies'weight, the positive family history of prolapse were heavier than in the control group. The women with prolapse had more often chronic pulmonary diseases, asthma, as well as operations for abdominal hernias. The mode of delivery, be it a cesarean section or the use of forceps, and the active second stage of labor had no effect whatever on the occurring of genital prolapse in young women.

CONCLUSION

Our data support the suggestion that multiparity, babies weight and congenital factors are responsible for a higher rate of genital prolapse in young women.