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Heterotopic pregnancy is the combination of intra-uterin pregnancy and ectopic pregnancy in the same patient whatever is the localization of the ectopic pregnancy. The aim of this work was to precise the epidemics and clinics factors, the diagnosis means and the therapeutic methods of the spontaneous heterotopic pregnancy in Moroccan context. In a period of 6 years (1993–1998), 8 patients were treated for heterotopic pregnancy in Lalla Meryem Maternity of Casablanca, with a rate of 0.2‰. Patients’ages ranged from 19 to 37. The backgrounds were: abortions (4 cases), secondary sterility (2 cases) and genital infection (2 cases). Five patients consulted for metrorragies associated to pelvic pain. Two for pelvic pain and one for metrorragies. The diagnosis was confirmed before echography in 5 cases. All patients were operated, 3 in a board of haemorrhagical shock. Ectopic pregnancy lied at the level of the fallopian tube in 7 cases and at the level of the ovary in one. The treatment consisted of a salpingectomy in the 7 patients with tubar localisations, the ovary pregnancy benefited from ovariectomy. Evolution has been marked byexpulsion of intra-uterin pregnancy in 6 cases. Two women were able to carry out their pregnancy. Heterotopic pregnancy is more and more frequent because of genital infections increase and especially the wide diffusion of the assisted medical procreation. [Copyright &y& Elsevier]

Tuberculosis is a curable infectious disease which can mimic ovarian cancer. This case report illustrates that the association of a pelvic mass with elevated CA125 is not necessarily suggestive of ovarian malignancy. A 22-Year-old woman presenting with bilateral ovarian masses and an elevated CA 125 underwent an exploratory laparotomy to search for ovarian tumor. The final pathology diagnosis was ovarian tuberculosis without pulmonary involvement. Tuberculosis is a differential diagnosis to consider in patients with a pelvic mass because of the lack of pathognomonic clinical and biological signs.

A 37-year-old woman was seen for pelvic pain. Ultrasonography and laparoscopy led to the diagnosis of bilateral hydrosalpinx. Analgesics and antibiotics were given several times but the clinical picture worsened. Laparotomy was performed and disclosed bilateral hydatidosis of the fallopian tubes requiring bilateral salpingectomy. Postoperatively, hydatic serology was strongly positive and a calcified hydatic splenic cyst was identified. Medical treatment with albendazole was prescribed for these multiple localizations of hydatid cysts.

The pregnancy at women infected by the HIV characterizes by the risk of transmission of the HIV to the child. The goal of this retrospective study concerning 9 deliveries of women infected by the HIV cured in the Infectious Diseases Service and the Lalla Meryem's Maternity of Casablanca CHU Ibn-rochd during 10 years (1990-1999) is to specify the experience of two services of concerning plug in cost of the patients infected by HIV by trying to pull some a protocol of plug in cost. The antiretroviral therapy has been used in 8 cases out 9. The AZT long protocol has been used in 6 cases and the bitherapy in 2 cases. The delivery has taken place by the natural way under cover of AZT in all cases. All babies have received the AZT in syrup and none has been breastfed to the breast. Two newborns on 9 out 9 have been contaminated by the HIV.

Objectives: We examined cases of mammary tuberculosis in order to determine the different modes of presentation and analyze diagnostic difficulties., Methods: Retrospective analysis of 14 cases of mammary tuberculosis treated at the Ibn Rochd University Hospital in Casablanca over a 16 year period., Results: Patient age ranged from 16 to 65 years. Contact with a contaminated person was recognized in 2 cases. The predominant clinical presentation was a tumor formation (12 cases) which sometimes simulated cancer. Axillary nodes were observed in 10 cases with 1 case of fistulization. Mammography suggested cancer in 3 cases. The diagnosis of mammary tuberculosis was based on pathology findings in 14 cases (2 biopsies, 12 peroperative specimens) and isolation of bacilli from pus in one case. Medical treatment was given. Surgery was associated as needed (abscess drainage, residual lesions). Except for one death due to tuberculous meningoencephalitis, clinical course was favorable with ad integrun breast recovery., Discussion: Mammary tuberculosis is uncommon and often produces a pseudoneoplastic presentation. Pathology confirmation is required for diagnosis.

We report a case of granulomatous mastitis during pregnancy which raised important diagnostic and therapeutic problems. Several diagnoses were suspected and subsequently different therapeutic regimen were tried (antibiotic therapy associated with nonsteroidal antiinflammatory drugs, progestogens, vein tonicity drugs and bromocriptine). All were ineffective and the patients status worsened. Histology confirmed the diagnosis of granulomatous recurrent mastitis. Corticosteroid therapy and interruption of pregnancy successfully controlled the disease process.

The aim of this study is to have an idea about the epidemiologic and clinic profile of the PRM, the management of the PRM. We conclude from this retrospective study about 374 cases, that the PRM frequency is about 2.67%. It reaches particularly the young women, primipar (57.48%) and not happen of this accident. The diagnosis was clinical in general. In the doubtful cases, amniotic infection was present in 25.13%. The delivery was characterized by the complications were dominated by prematurity and neonatal infection which both caused a high perinatal mortality 49.3%). A better sanitary education of any pregnant woman, a regular follow-up of the pregnancies, a treatment of each etiologic factor of this accident, a good per and postnatal supervision could remarkably limit the incidence of this obstetrical accident and also improve the maternal and fetal prognosis.

Fibromatosis (desmoid tumors) is a rare entity expressing a mesenchymatous proliferation. The breast is an exceptional localisation. The origin is either the gland itself or the breast is an extension of a desmoid tumor originating from the chest wall or shoulder. Etiology is still unknown. Clinical and radiological features mimic the breast carcinoma. Diagnosis is made by histological studies which show a benign structure contrasting with its aggressive potential. Surgery is the treatment of choice and consists of wide excision which can lead to mutilation. Hormonotherapy is used if surgery is too invasive. We report a case of a female patient aged 21 years who presented for a mammary fibromatosis, treated by a large surgical excision. Evolution was marked by the appearance of an other localisation in the contralateral breast.

Phyllode tumors of the breast are fibroepithelial tumors similar to fibroadenomas but with a predominant conjunctive tissue component. The aim of this work was to determine the specific diagnostic, therapeutic and prognostic features of this tumor. A retrospective series of 41 cases was collected in the gynecology-obstetrics ward from 1980 to 1991. The analysis of this series showed the following characteristics: incidence of phyllode tumors was 0.46% of all breast tumors. Mean age at diagnosis was 30 years, in 75.6% of the women were in a period of reproductive activity. Mean delay between the first clinical signs and diagnosis was 20 months. Mean size was 12 cm Diagnosis was confirmed at pathology examination in all cases. The tumor was classed grade 1 and 2 in 65.9% of the cases, grade 3 in 9.8%, grade 4 in 17.1%. Surgical treatment alone was used in all cases with large tumorectomy (48%), simple mastectomy (30%), and total mastectomy with node dissection (22%). After a follow-up of 1 to 7 years, there were 3 deaths and 11 local recurrences requiring reoperation. In the remaining cases, the outcome was favorable without recurrence or metastasis. These results together with those reported in the literature show that histological confirmation is required for the diagnosis of phyllode tumors. Surgical treatment alone is required with wide exeresis because of the voluminous tumor formation the age of the patient and the histological grade. Finally, prognosis depends on the histological characteristics of the conjunctive tissue component of the tumors.

Defined as a blood collection under the Glisson capsule, the subcapsular haematoma of liver is a rare complication of pre-eclampsia. We observed 6 cases of subcapsular haematoma of the liver in the Gynaecology-Obstetrics ward of the Ibnou Rochd University Hospital in Casablanca, Morocco. Age range was 18 to 39 years. Five of the patients were multiparous. All except one had at least one sign of pre-eclampsia. The diagnosis was made post-partum in 5 cases and was only confirmed intra-operatively in 6 cases. The treatment was tamponing-drainage of the peritoneal cavity in 3 cases, ligature of the hepatic artery in 2, and in one case with rupture of the liver, no therapy could be performed. There were 3 maternal deaths and 2 foetal deaths. These results were compared with those in the literature to determine the epidemiologic, diagnostic, therapeutic and prognostic characteristics of the subcapsular haematoma of the liver. The prognosis is poor and requires early diagnosis and treatment. Effective prevention of this severe complication should be based on correct screening and care for pregnant patients with hypertension.

This study involved an analysis of 25 cases of sarcoma of the uterine body collected at the Gynecology and Obstetrics Clinic of the Ibn Rochd CHU teaching hospital, Casablanca (Morocco) during a 15-year period (1977-1992). These are unusual malignant tumours (accounting for only 0.9% of uterine cancers) which occur after the menopause and have an appalling prognosis. Metrorrhagia was the most common alerting symptom. Presurgical diagnosis was difficult and uterine sarcoma was usually identified during surgery. The most common histological type encountered was leiomyosarcoma. Treatment was primarily surgical: total hysterectomy combined with bilateral appendectomy (20 cases), with radiotherapy (5 cases) or with adjuvant chemotherapy (1 case). Radiotherapy was the only treatment in 2 patients. The survival rate was low: 10% after 2 years, 5% after 5 years. Age, histological type, extent of the tumor and method of treatment were all recognised as prognostic factors. One interest of this work is to recall the existence and the severity of this pathology in those periods of endoscopic games and excessive conservative treatments.

Three cases of an association of carcinoma of the ovary and pregnancy are reported. The authors stress the following points: the diagnosis should be made earlier by clinical and sonographic monitoring of pregnancy; high incidence of low-malignancy forms; fetal prognosis is particularly threatened during the first three months of pregnancy; treatment can be conservative in forms limited to one ovary.

Through a series of 76 cases of jaundice observed in pregnant women, the authors emphasize on the biggest frequency of viral hepatitis among the all of etiology. In fact that one represents the 2/3 of cases. They insist on the graves forms of the diseases which are responsible of a high maternal mortality and big foetal complications.

The authors report the case of uterine rupture occurring after 28 weeks of amenorrhea and related to placenta accreta and treated by means of hysterectomy. They stress the diagnostic problems and discuss possible conservative treatment.

The authors report three cases of subcapsular liver hematomas occurring after delivery and diagnosed by ultrasonography (1 case), and exploratory laparotomy (2 cases). These three cases compared with the data from the literature, illustrate the conditions of occurrence and the clinical signs of subcapsular liver hematomas during pregnancy or in the post-partum period. The frequency of this complication is most likely underestimated, since benign forms remain latent and the severe forms, responsible for sudden death, eludes the diagnosis in the absence of anatomical confirmation.

There were 156 uterine ruptures collected out of 34,807 deliveries in the gynaecological and obstetrical department of the University Hospital of Averroes in Casablanca. This is a rate of 1 per 223 deliveries. The factors that predispose to this complication are low socio-economic status of the patients, multiparity and, above all, a scarred uterus. Surgical abnormalities of the pelvis and dystocia due to malpresentations and above all inappropriate manoeuvres which continue to be practised are all responsible for the condition. The rupture usually occurs in the lower segment. When the lesions are extensive the cervix and the bladder are most often damaged. Treatment should be as conservative as possible to maintain the woman's fertility but at the same time doing whatever is necessary for her.