Badreddine Bouguerra

Déclenchement du travail à terme par le misoprostol: expérience d’une maternité tunisienne

To evaluate the efficacy and safety of vaginal misoprostol for term labour induction. A prospective study conducted at the Department of Obstetrics and Gynecology B of hospital Charles Nicolle, Tunis, over a period of 4 months. The group of subjects, selected to represent the population of interest, were pregnant patients at term undergoing cervical ripening. Patients received 50 mcg vaginal misoprostol every 12 hours. The parameters studied were: contractile abnormalities, abnormalities of fetal heart rate (FHR), mode of delivery, delayed delivery and neonatal status. 44 patients underwent cervical ripening with misoprostol. The average term was 40 WA. Nulliparous rate was 23/44 (52%). Vaginal birth rate was 31/44 (70.4%). 84% of patients received a single dose of misoprostol. FHR abnormalities were observed in 14/44 (32%). The rates of meconium-stained amniotic fluid was 12/44 (27%). Apgar score of less than 7 at 5 minutes was found in 7/44 (16%). A case of uterine rupture occurred in a primipara after a single dose of misoprostol. Our results are disappointing due to the occurrence of 1 uterine rupture and of 1 significant neonatal morbidity. Other multicentre prospective studies will be useful to better ensure the effectiveness but primarily the safety of low-dose misoprostol for induction of labour at term.

Conservative Management of Placenta Percreta: Tunisian Prospective Study

Objective: To evaluate conservative management of placenta percreta and postoperative results. Study design: In a prospective study we included all cases of placenta percreta diagnosed during pregnancy in the department of gynaecology and obstetrics B of university hospital of Charles Nicolle between 2011 and 2014. For these patients, conservative approach was attempted. In this procedure placenta was left in place until complete resorption. Results: Thirteen patients with placenta percreta diagnosed in prenatal were identified. All patients were undergone conservative management. Median gestational age at delivery was 36 weeks. Prophylactic ligation of hypogastric was performed in 7 cases. No patient had blood transfusion in intraoperative. No patient had stayed in intensive cares. Postoperatively, four cases of endometritis occurred. A secondary hysterectomy was performed in 4 cases because of secondary haemorrhage. In 9 cases, there was complete involution of the placenta within a maximum period of 6 months. Conclusion: In order to reduce morbidity and mortality in placenta percreta, conservative treatment is an interesting alternative especially if subsequent pregnancy desire. However, it exposes to infection and secondary bleeding, this risk requires a long follow up.