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Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease, asymptomatic during a protracted time, characterized by changes in the small-sized bile ducts near portal spaces. The etiology of PBC is undefined, but immunologic and environmental disturbances may contribute to the disease. Infertility is often associated with PBC and cirrhosis, but pregnancy may well occur in women with PBC and without cirrhosis or in some others with compensated cirrhosis. A pluridisciplinary approach including gastroenterologists and obstetricians is recommended. The patient must be closely monitored throughout her pregnancy with maternal and routine antenatal care. Medical treatment requires ursodeoxycholic acid (UDCA). In non-cirrhotic UDCA-treated women with PBC, pregnancy often follows a normal course with vaginal delivery. In cirrhotic patients, UDCA must be continued during pregnancy, esophageal and gastric varices must be evaluated before pregnancy, and endoscopic ligature is recommended for treating large varices. Additionally, beta-blocker therapy may be associated, especially when variceal rupture occurred previously. Elective cesarean section is recommended in patients with large esophageal or gastric varices because of the potentially increased risk of variceal bleeding during maternal expulsive efforts in case of vaginal delivery.

The interest for diagnostic laparoscopy for the diagnosis of endometriosis is not longer discussed. Indications could be pelvic pain, infertility, menorragia, and/or organic ovarian tumour. Several lesions, typical and non typical, have been described and should be recognized. Histological confirmation seems suitable even though the correlation with visual inspection is not perfect. New laparoscopic techniques seem interesting to increase diagnostic relevance. Visual inspection should be associated with palpation. For deep infiltrating endometriotic lesions diagnostic laparoscopy has shown its limits. Precisions concerning peri-operative methods and operative reports are described. The place of the different classifications has been discussed.

Resume La myomectomie est un acte chirurgical permettant aux patientes de conserver leur uterus dans le cadre d'une maladie myomateuse. Differentes voies d'abord peuvent etre envisagees pour realiser cette intervention. Cependant, une hemorragie peroperatoire importante peut etre a l'origine de complications comme, par exemple, une chirurgie incomplete, une modification de voie d'abord, un choc hypovolemique, une transfusion sanguine et une anemie severe postoperatoire, imposant une transfusion ou un traitement martial et ralentissant la reprise d'activite. Devant ces constatations, il semble legitime de s'interesser aux differents moyens permettant de prevenir l'hemorragie peroperatoire. Plusieurs moyens medicaux preoperatoires ont beneficie d'une evaluation serieuse. L'utilisation d'agonistes de la Gn-RH (gonadotrophin releasing hormone) en preoperatoire semble permettre, via une reduction du volume uterin par remaniements vasculaires du myometre, une diminution de l'hemorragie peroperatoire, mais ces resultats sont encore controverses. Les administrations d'antagonistes de la GnRH, de misoprostol ou d'antiprogesterone semblent prometteuses, mais des etudes complementaires doivent etre realisees avant de pouvoir conclure. L'embolisation preoperatoire des myomes pourrait reduire les pertes sanguines peroperatoires. Cependant, son utilisation chez les femmes desireuses de grossesse est en cours d'evaluation. Des moyens peroperatoires sont egalement utilisables : chimiques avec l'utilisation de produits vasoconstricteurs ou d'ocytociques, et mecaniques interrompant temporairement le flux sanguin myometrial. Certains d'entre eux ont fait la preuve de leur efficacite. Les alternatives a la chirurgie, comme les techniques de myolyse, qui impliquent une destruction in situ des myomes, necessitent, notamment chez les femmes jeunes desireuses de grossesse, des donnees complementaires.

A case of primary choriocarcinoma of the ovary in a 32-year-old woman, 1 month after a voluntary interruption of pregnancy, is reported. A review of the literature shows that this tumour is rare and the distinction between a gestational and a non-gestational choriocarcinoma is difficult. The distinction between these two diagnoses and specific treatment are discussed.

Resume Objectif. – Evaluer l’echographie endovaginale pour expliquer les troubles mictionnels observes dans les suites du TVT® (Tension-free Vaginal Tape). Patientes et methodes. – Cinquante-quatre patientes ont beneficie d’une echographie endovaginale trois mois apres TVT avec mesure de la taille de la bandelette et de sa distance par rapport au col vesical. Parallelement, la guerison (groupe 1), l’existence de troubles mictionnels a type de dysurie (groupe 2), l’existence d’imperiosites (groupe 3) ou la persistance de fuites urinaires sont evaluees par un autoquestionnaire et un examen clinique. Les analyses statistiques utilisent le test de comparaison de variance (Anova). Resultats. – L’analyse des mesures de la distance bandelette–col vesical montre une difference significative entre les groupes 1 et 2 : 13,2 vs 7,6 mm et entre les groupes 1 et 3 : 13,2 vs 17,7 mm. De meme, il apparait une difference significative dans l’analyse des tailles de bandelettes entre les groupe 1 et 2 : 8,8 vs 6,6 mm et entre les groupes 1 et 3 : 8,8 vs 6,5 mm. L’analyse des distances bandelette–col vesical dans les groupes 2 et 3 montre une difference significative : 7,6 vs 17,7 mm. En revanche, la taille de la bandelette n’est pas significativement differente entre ces deux groupes (6,6 vs 6,5 mm). Discussion et conclusion. – Ces resultats montrent une correlation entre les differents troubles mictionnels observes a distance du TVT et la mesure echographique par voie endovaginale de la distance entre la bandelette et le col vesical.

Endometriosis is a common gynecologic condition and has been described in several locations, mostly in the pelvis. Extragenital endometriosis may appear as a painful nodule evoking an inguinal hernia. Scar endometriosis after inguinal hernia repair seems to be a rare occurrence. We report an unusual case of a 28-year-old woman who developed a scar endometriosis 2 years after an inguinal hernia repair. This case highlights that the presence of a painless inguinal mass similar to a recurrent hernia, with possible swelling related to the menstrual cycle, may evoke endometriosis, especially after a previous hernia repair and should lead to prompt diagnosis, wide excision, and gynecological advice.

This article aims to draw together recent thinking on pregnancy and acute pancreatitis (AP), with a particular emphasis on pregnancy complications, birth outcomes and management of AP during pregnancy contingent on the etiology. AP during pregnancy is a rare but severe disease with a high maternal-fetal mortality, which has recently decreased thanks to earlier diagnosis and some maternal and neonatal intensive care improvement. AP usually occurs during the third trimester or the early postpartum period. The most common causes of AP are gallstones (65 to 100%), alcohol abuse and hypertriglyceridemia. Although the diagnostic criteria for AP are not specific for pregnant patients, Ranson and Balthazar criteria are used to evaluate the severity and treat AP during pregnancy. The fetal risks from AP during pregnancy are threatened preterm labor, prematurity and in utero fetal death. In cases of acute biliary pancreatitis during pregnancy, a consensual strategy could be adopted according to the gestational age, and taking in consideration the high risk of recurrence of AP (70%) with conservative treatment and the specific risks of each treatment. This could include: conservative treatment in first trimester and laparoscopic cholecystectomy in second trimester. During the third trimester, conservative treatment or endoscopic retrograde cholangiopancreatography with biliary endoscopic sphincterotomy, and laparoscopic cholecystectomy in early postpartum period are recommended. A multidisciplinary approach, including gastroenterologists and obstetricians, seems to be the key in making the best choice for the management of AP during pregnancy.