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To evaluate the interest of examination of the gastric aspirate (GA) as a contribution to decision making of initial antimicrobial therapy, all 3,989 neonates delivered in Orléans Maternity Hospital in 1990 have been studied. Microscopic examination: polymorphonuclear leukocytes (PMN) were, respectively, absent/present/abundant in 180/130/25 treated (T) and in 2,567/1,032/90 untreated (NT) newboms. PMN were demonstrated in 2/5 documented, 4/6 obvious, 2/2 suspected and 34/ 58 possible infections. Bacteria were, respectively, absent/ present/abundant in 201/109/46 T newboms and in 2,722/ 877/56 NT newboms. Bacteria were demonstrated in 3/5 documented, 4/6 obvious, 2/2 suspected and 32/58 possible infections. Culture: the number of initially T and NT newboms was, respectively, for each bacterial species: Enterobacteriaceae 33/294, streptococci B (GBS), D and α-hemolytic 60/107, 12/110 and 18/70, Streptococcus pneumoniae 2/2, anaerobes 12/402, Listeria 3/0, Haemophilus species 4/4, Staphylococcus aureus 5/7, coagulase-negative staphylococci 25/1335, Lactobacillus 14/345, corynebacteria 10/196. In the 5 newboms with documented early onset meningitis and/or septicemia, 3 grew with GBS, Escherichia coli and Listeria. In the 4 newboms (2 meningitis and 2 urinary tract infections) with lateonset infection, no positive GA could be demonstrated. Although microscopic examination and cultures were statistically more frequently positive in T newboms, with variations dependent on the species of bacteria, more newboms without infection were colonized whatever the bacteria. Thus, bacteriological results of GA, if considered out of the clinical context, cannot be an argument for treatment.

Repeated transfusions in utero by umbilical cord puncture enable the treatment of severe forms of rhesus incompatibility. The two cases reported, including one involving seven transfusions between twenty and thirty seven weeks since the LMP, form the basis of a review of the literature defining the advantages and results of this technique.

Placental villitis, which is defined by the presence of lymphocytic or macrophagic inflammatory cells within the villosities, constitutes a recently-described histopathological entity. This condition is the consequence of an immune response of the feto-placental unit towards a non-specific, multiple aggression and the incidence is very low. The extent of the inflammatory reaction may culminate in placentitis, resulting in miscarriage. Although a large number of infecting agents are known to be responsible for the pathogenesis of villitis, in most cases the etiology remains unknown. The hypothesis of a failure of the mechanisms of immunotolerance during pregnancy is suggested by many authors to explain their origin.

The authors report a case of premature separation of a normally located placenta at 28 weeks, associated with factor XI deficiency. The deficiency became known 6 weeks before the acute episode. In this particular case the deficiency did not occur in the context of congenital abnormalities, hepatocellular insufficiency nor any autoimmune disease. This rare case raises the problem of the role of a coagulation disorder in the etiopathogenesis of retroplacental hematoma.

From June 1988 to October 1989, 190 women from the department of Obstetrics-Gynecology with bacteriuria due to Gram-negative rods were studied. One hundred and three were investigated as ambulatory patients. Fifty three had received treatment with a bêta-lactam antibiotic during the past three months and 11 between three and six-months before sampling. The organisms causing bacteriuria were 163 E. coli, 12 P. mirabilis and 15 were due to other species. Thirty three E. coli and the 15 other species were resistant to amoxicillin and/or to cefalotin. When comparing previous treatment and resistance to amino-penicillins it appears that: of the women who had received a beta-lactam antibiotic within the three months before testing, 57% of the strains recovered were found resistant for amino-penicillins; of the women without treatment during the past six months, 89% of the strains recovered were sensitive and six per cent of E. coli plus five per cent of another Gram negative rod were resistant to amino-penicillins.

The authors report a case of neonatal death at 24 hours following maternal trauma during a traffic accident. The abdominal trauma did not result in any maternal injury. Caesarean delivery was justified by fetal rhythm disorders. A wide variety of fetal injuries, in the absence of maternal injuries, are reported in the literature. Some benefit from an early diagnosis, improving therefore the fetal prognosis.

The determination of the lecithin/sphingomyelin ratio in amniotic fluid is a useful index for assessing fetal pulmonary maturity. The authors propose a simple and specific method : the amniotic lipids are extracted and thin layer chromatography is carried out in an acetic acid containing medium. The L/S ratio was studied and discussed in 138 normal and pathological cases.

A new technique of hysteroplasty is proposed for the septate uterus. The uterine incision is anterior medline, leaving the posterior wall of the uterus untouched. The septum is split into two hemi-septa which are increased in such a way as to obtain two pediculated flaps, covered by endometrium. Anterior and posterior distribution of the flaps makes it possible to recreate a spacious single cavity.

The insertion of a cervical circling suture before conisation, with tightening around an endo-uterine sound after excision of the specimen, ensures effective haemostasis of the cervical remnant. In addition, this circling suture may be used to apply the necessary traction to the cervix away from the pathological zone, without causing any lesion of the epithelium to be studied.

Interruption and expulsion of a stillborn fetus in patients with an IUD Candida albicans chorioamniotic infection is a very rare obstetrical event. Generally, the diagnosis is established in retrospect by the routine histological examination of the products of expulsion and the demonstration of a specific chorioamniotic infection. This infection occurs by upward dissemination in a pregnancy where the amniotic membrane is unbroken, with the IUD being the facilitating factor of infection. Prevention appears to be the withdrawal of an IUD at the beginning of pregnancy.

The walls of the artificial cavity created by recto-vesical cleavage in the surgical treatment of congenital absence of the vagina never become covered with epidermis and this lack of epithelialisation is the source of progressive stenosis. The use of pediculated mucosal flaps with a broad, well vascularised base, obtained by cleavage and folding of the labia minora, makes it possible to appropriately and durably cover the first centimeters of the neovagina.

Spontaneous rupture of the spleen related to an ectopic pregnancy is exceptional but must be kept in mind. The clinical picture is dominated by signs of haemoperitoneum and shock. Except in an emergency, the plasma BhCG titration, abdominal ultrasonography and CT-Scan, offer a major contribution. If the exploration through a Pfannenstiel incision is normal, the surgeon should not hesitate to extend it through the mid-line. The diagnosis is almost always made on pathological examination.

The authors report a new case where polymyositis/dermatomyositis and pregnancy were associated. The polymyositis and dermatomyositis appeared in the last third of the pregnancy. A caesarean operation had to be performed for fetal distress after 37 weeks of amenorrhoea. An apparently dead small-for-dates baby was born. Progress, however, after resuscitation of the baby was good. At 20 months after delivery the polymyositis and dermatomyositis also were improved. Two and a half years later there was no recurrence. In the light of cases that have previously been reported in the literature, it has been established that on the one hand pregnancy may trigger off the condition and worsen the PM/DM and on the other hand the condition has a bad effect on the progress of the pregnancy. 50% of the babies are born dead or die in the week after delivery and 55% are born prematurely. We discuss the possibility that PM/DM is of viral origin. A confirmation of this is the presence of viral inclusion bodies on electron microscopy found in the muscle cells of the patients who have PM/DM. However, in the previous history of these patients an acute viral myositis in childhood is a troublesome factor. Pregnancy, because it involves alterations in the immune responses of the patients, may lead to a recrudescence of a "sleeping" virus and so be responsible for the appearance or aggravation of polymyositis and dermatomyositis.

Phyllodes tumors represent a particular class in breast pathology. They are defined as bi-tissue, fibro-epithelial tumors, similar to fibro-adenomas, but their connective tissue component is greatly predominant. They are infrequent as they represent only 3% of breast tumors. They mainly occur during the premenopausal period, since alteration of the hormonal balance may play a role. The authors feel that they represent only a type of the evolution of the fibroadenomas with a relationship, in time, following the sequence: fibroadenomaphyllodes tumor-sarcoma. The diagnosis is exclusively made by histology and there is no pathognomonic sign, whether it is clinical or mammographic. The course is essentially characterized by the possibility of local recurrences, sometimes numerous, and by the occurrence of metastases in case of malignant phyllodes tumor. These two possibilities are correlated with the histological stage of the tumor. The treatment is definitely surgical, possibly mastectomy in case of large or aggressively active tumor.