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Objective: The Essure(®) system is a hysteroscopic sterilization method. The purpose of our study was to retrospectively evaluate the sterilization procedure with Essure(®) devices without anesthesia., Patients and Methods: The descriptive study included all tubal sterilizations with Essure(®) devices performed without anesthesia, with MEOPA, from January 1st, 2013 till February 28th, 2014 in the CHU of Besançon. The evaluation of the global satisfaction of the patients was collected by telephone survey., Results: A hundred and forty-three patients benefited from Essure(®) without anesthesia during the period of study in the CHU of Besançon and among them, 120 patients answered the telephone survey questionnaire. The average age was of 41.3 years. As regards the satisfaction and the tolerance, 89.2% of the patients declared to be globally satisfied by this procedure and 95.8% would recommend it to a friend. Indeed, 66.6% of the patients declared to have felt no pain or moderate pain. Furthermore, the MEOPA was well tolerated at 79.9% of the patients. As regards the procedure of Essure(®) inserts without anesthesia the rate of failure was 9.2% and at 3 months the radiological control was satisfactory in 94.5% of the patients., Discussion and Conclusion: The tubaire sterilization by implants Essure(®) is a fast and effective procedure. Our study shows, that at present, this technique can be realized without anesthesia, during a dedicated consultation, with an important rate of global satisfaction of the patients. It thus allows to decrease the number of hospitalization in ambulatory surgery and to decrease the cost of this intervention., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

We report a 50-year-old woman case with an extensive necrotizing fasciitis (NF). The NF appeared 10 years after a tension free vaginal tape procedure for urinary stress incontinence. Vital prognosis was engaged due to the initial sepsis severity. This kind of complication is rare and could be under estimated. NF usually appear soon after surgery, whatever within the year following implantation. Anyway, NF are always related to a vaginal erosion of the tape., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Genital-pelvic actinomycosis is an uncommon disease which often arises on women with long term use of intrauterine device. Its diagnostic remains difficult. Even if different clinical locations has been reported, location to the psoas muscle is exceptional. We report such a case, diagnosed on a 53 years old woman. Both a tumoral and a severe infectious syndrome appeared three months after an intra-uterine device removal. The septic syndrome led to a laparotomic approach. Unusual clinical presentation, delay between device removal and septic syndrome and lack of genital infection explain the issues to reach the final diagnosis., (Copyright © 2013. Published by Elsevier SAS.)

Liver subcapsular haematoma and its consequence, spontaneous hepatic rupture, are very rare complications of pregnancy. They are mainly associated with pre-eclampsia. The diagnosis is difficult and the maternal and fetal mortality rates are high. We report the case of a spontaneous hepatic rupture on a normal liver during an uncomplicated twin pregnancy with a favorable outcome for both the mother and the newborns., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Breast angiosarcoma is a rare but serious complication of radiotherapy. We report two cases of radiation-induced breast angiosarcoma in two patients having benefited from breast conserving surgery with radiation. We shall put emphasis on the etiopathogeny of these tumours and their clinical and therapeutic aspects., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)

We report a case of ruptured ovarian molar pregnancy, diagnosed in the context of haemorragic shock 19 days following evacuation of an intrauterine hydatiform mole. To our knowledge, this is the first reported case of heterotopic molar pregnancy.

Objectives: The ovarian remnant syndrome is a rare condition after unilateral or bilateral oophorectomy, with or without a hysterectomy. This syndrome occurs when a fragment of ovarian tissue is left behind and becomes functional and cystic. The purpose of this study is to report the cases of patients treated surgically for an ovarian remnant syndrome during the last 10 years and to recall the diagnostic and therapeutic difficulties., Patients and Methods: A retrospective, observational study was carried out between 1997 and 2006. Seven patients were treated surgically for an ovarian remnant syndrome. Perioperative data analysis (history, surgical techniques, and postoperative follow-up) was carried out., Results: The mean age of the patients was 46 years (36-55). The number of previous abdominal surgical procedures ranged from 2 to 5. The syndrome appeared after a mean period of 4 years and 4 months (range 5 months-12 years) after oophorectomy. Among the 7 patients, 3 had had a previous hysterectomy. Pelvic pain was found in all cases. Gonadotropin-releasing hormones agonists were used in 1 patient without success. Aspiration was performed in 2 cases before surgical treatment. Two patients underwent a laparotomy in the first place. Laparoscopy was performed in 5 cases and laparoconversion was necessary in 1 case. Intraoperative difficulties and anatomic variations were found in all cases. Ureteral catheters were placed in 2 cases. Radiotherapy was performed in 1 patient who had a recurrent ovarian remnant., Discussion and Conclusion: The ovarian remnant syndrome is a rare complication. Surgery, either by laparoscopy or by laparotomy, is the recommended treatment. These operations are often difficult and associated with a high risk of complications. Histologically, remnant ovarian tissue associated with hemorragic corpus luteum cysts is the most common finding. The prevention of the ovarian remnant syndrome is based on rigorous surgical treatment during the oophorectomy so as not to leave behind ovarian tissue.

A descriptive analysis of available data on reported cases of uterine carcinosarcomas associated with tamoxifen therapy is undertaken. The role of aromatase inhibitors as alternative to tamoxifen therapy in the adjuvant setting of breast cancer is discussed. The eventual implications of the presumed association of uterine carcinosarcoma and tamoxifen therapy on the choice of the therapeutic agent in the adjuvant setting of hormone-sensitive breast cancer are discussed.

We report a case of spontaneous uterine rupture in a 19 year-old patient Gravida 1 para 2 with no past history of uterine surgery. The diagnosis of uterine rupture, evoked in the early post-partum in the presence of acute abdominal pain, collapsus and haemoperitoneum on ultrasonography, was confirmed by laparotomy. Treatment consisted in hysterorrhaphy. The etiopathogenesis, clinical and therapeutical aspects of spontaneous unscarred uterine ruptures are discussed throughout a literature review.

Objectives: The presenting symptoms of leiomyosarcoma (LMS) are the same as those of leiomyoma. The diagnosis of LMS is usually achieved retrospectively after pathological analysis of hysterectomy specimens. The aim of surgery in uterine sarcomas being resection without tumor morcellation, LMS poses the problem of the choice of surgical route because it is more likely to occur in relatively young women. This study was undertaken to determine, firstly, the frequency of LMS in a series of hysterectomies performed for presumed leiomyomas, secondly, if there exist any particular context in which LMS should be considered and how this may modify the choice of surgical route, thirdly, to discuss about the therapeutical aspects of those cases of LMS diagnosed incidentally after uterine morcellation., Patients and Methods: A retrospective review, from 1996 to 2005, of cases of LMS diagnosed retrospectively in patients having benefited from hysterectomy for presumed leiomyomas, at the department of Obstetrics-Gynaecology, Belfort Hospital., Results: From 1996 to 2005, 1297 hysterectomies have been performed for presumed leiomyomas in our department. Patients' mean age was 48 years (34 to 77 years). Menometrorraghia was the most common symptom having motivated surgery (57%), followed by pelvic pain (31%) and the notion of a rapidly growing uterine mass (12%). The distribution of surgical route was as follows: laparotomic route, n=393 (30%); vaginal route, n=855 (66%) and laparoscopic assisted vaginal route, n=49 (4%). Pathological analysis had revealed LMS in three patients (0.23%)., Discussion and Conclusion: LMS is usually diagnosed incidentally on hysterectomy specimen analysis. Indeed, the surgeon may find himself in a therapeutic dilemma in cases where vaginal extraction has required tumour morcellation with an increased risk of peritoneal and/or vaginal dissemination. However, given the extremely low incidence of LMS in series of hysterectomies performed for presumed leiomyomas and the lack of specific preoperative context to clearly evoke this diagnosis, the fear of leiomyosarcoma should not make us apprehend nonlaparotomic surgical routes.

Objective: Assisted delivery is necessary in many obstetrical conditions but is involved in maternal and foetal complications. The legal pressure and the commendable aim consisting in less neonatal morbidity and mortality have called forth a reflection about the type and the way of instrumental foetal extraction. In 1950, Thierry had already felt this problem and he invented spatula to replace obstetrical forceps. Although this instrument appears empirically little deleterious, literature about its evaluation is very poor. We studied this instrument in a retrospective 190 cases series., Patients and Method: Retrospective study of 190 Thierry's spatula extractions, over a seven-year period (January 1996 to December 2002), at the Centre Hospitalier General of Montbeliard., Results: Out of a total of 8126 deliveries for the study period, the instrumental extraction rate was 5.3%, with 40.6% spatula extractions (190 cases). No failure of Thierry's spatula extraction was noted. DISCUSSION ET CONCLUSION: Our study concludes that spatula is efficient but does not usually permit anterior rotation of occipito-posterior presentation. Maternal and foetal morbidity is not frequent.

Objective: To evaluate the validity and the feasibility of fetal scalp lactate sampling during labour in the assessment of non reassuring fetal status., Patients and Method: A prospective observational study was conducted on 129 fetal scalp blood samplings. Scalp lactate measurements were compared to scalp pH (gold standard procedure), neonatal cord blood gas (pH and lactates) and Apgar score. Pathological values taken were for scalp lactates>5 mmol/l, scalp pH<7.20, cord arterial pH<7.10, cord arterial lactates>6,35 mmol/l, and Apgar score<7 at one and five minutes. All measurements were performed using the Rapid Lab 860 device from Bayer., Results: Scalp lactate correlated significantly with scalp pH (R=-0.54, P=0.001), with umbilical artery pH (R=-0.46, P=0,01), with umbilical artery lactate (P=0.49, P=0.01), but with neither Apgar score at one minute (R=-0.21, ns) nor at 5 minutes (R=-0.11, ns). Scalp lactate at a cut-off value of 5 mmol/l had the same predictive values than scalp pH at 7.20 to predict neonatal acidosis. Sampling failure with scalp lactate was inferior to 1 vs 18% for scalp pH., Discussion and Conclusion: The measurement of lactate in fetal blood scalp seems correlated to the fetal scalp pH. It may be an attractive alternative to pH analysis and a useful tool for monitoring fetal asphyxia, especially with the advent of handheld devices requiring small sample volumes.

Objective: To evaluate risk factors associated with failed attempts of vacuum extraction and their outcomes., Patients and Methods: All trial vacuum extractions (metal Minicup) from 1992 to 2000 in Besançon University Hospital Center were retrospectively analysed, namely 2447 cases. Univariate and multivariate analyses of failed vacuum extraction risk factors and descriptive analyse of outcomes were performed., Results: The rate of failed vacuum extractions was 3.47% (85/2447). A multivariate analysis showed the following independent risks factors in failed extraction: extraction above pelvic level + 2 (OR = 1.8; CI 95%: 1.1-3), newborn weight (OR = 2.9; CI 95%: 1.8-4.9), parity >2 (OR = 0.08; CI 95%: 0.01-0.6). In case of failed vacuum extraction, newborns had a significantly higher rate of Apgar score <7 at 1 min (P = 0.0002), but not at 5 min. These newborns were most regularly admitted in pediatric care units (P = 0.01)., Conclusion: The failed trial attempt vacuum extraction rate stays low. These failed instrumental extractions are more common in an extraction above pelvic + 2, a high fetal weight and an arrest during the second stage of labor. There is an increased adverse neonatal outcome. Clinical fetal weight estimation and diagnosis of presentation level in mother pelvis must be performed before vacuum extraction.

Ultrasonography should benefit many pathological events which occur in delivery rooms. The authors analyse the scarce literature about this subject and propose indications in which this complementary examination seems to be interesting.

Contrary to the forceps, the vacuum extractor has clearly progressed in the last years. The use of the vacuum extractor increases in every developed countries, certainly because of an easier learning than forceps. Furthermore, maternal after-effects of the delivery like sphincters injuries and anal incontinence seem to be less frequent with vacuum extractor than with forceps. For these reasons the American College of Gynecologists and Obstetricians (ACOG) recommend a large use and a priority teaching of this fetal extraction instrument. The technical aspects of use of the vacuum extractor are developed in this article, and personnel results are added as commentaries.