ABSTRACT: IntroductionTouchant un tiers des femmes de tous âges, le prolapsus pelvi-génital constitue une préoccupation majeure des chirurgiens
gynécologues. De nombreux éléments et facteurs de risque rendent la physiopathologie du prolapsus complexe. Les ligaments
pelviens semblent jouer un rôle prépondérant dans les troubles de la statique pelvienne. L’objectif de notre étude est de
définir les propriétés mécaniques des ligaments utérins afin de mieux comprendre leur implication dans la physiopathologie
et la chirurgie du prolapsus génital.
Matériels et méthodesLes ligaments utérosacrés, ronds et larges ont été prélevés sur des bassins de cadavres féminins indemnes de prolapsus et
de chirurgie pelvienne. Ces prélèvements ont été réalisés sur 13 cadavres. Des tests de traction uniaxiale, à vitesse de déformation
constante, ont été réalisés pour chaque ligament. Le grand nombre de résultats ont permis une étude statistique des propriétés
RésultatsLes tests mécaniques réalisés sur les ligaments utérins, prélevés sur 13 cadavres féminins, ont permis de mettre en évidence
un comportement mécanique élastique non linéaire. Dans ce cas, le comportement mécanique des ligaments peut se caractériser
par deux paramètres, C0 et C1, relatifs à la rigidité à faible et forte déformation. La reproductibilité intra-individuelle est satisfaisante. Le ligament
utérosacré apparaît comme le ligament le plus rigide des trois ligaments étudiés, que ce soit à faible ou forte déformation.
Une dispersion interindividuelle a été constatée. Chacune des patientes étudiées présentait une latéralisation avec un côté
(droite ou gauche) plus rigide que l’autre. Onze des 13 patientes ont eu un prélèvement de tissu vaginal associé, permettant
ainsi de montrer que le tissu vaginal est moins rigide que le tissu ligamentaire.
ConclusionIl a été mis en évidence, pour la première fois, le comportement mécanique hyperélastique des ligaments utérosacrés, ronds
et larges. Cette approche montre que le ligament utérosacré est le plus rigide par rapport aux ligaments ronds, larges ou
encore au tissu vaginal. Sa contribution en statique pelvienne apparaît donc comme majeure. Une étude mécanique complémentaire
de ces ligaments en situation de prolapsus génital permettrait d’apporter des réponses supplémentaires quant aux étiologies
des récidives des cures chirurgicales de prolapsus.
IntroductionPelvic organ prolapse (POP) affects one-third of women of all ages, and is a major concern for gynaecologic surgeons. Many
elements and risk factors make the physiopathology of prolapse complex. Pelvic ligaments seem to play a predominant role in
pelvic floor dysfunction. The aim of our study is to define the mechanical properties of uterine ligaments to gain a better
understanding of their role in the physiopathology and surgery of POP.
Methods and materialsThe uterosacral, round and broad ligaments were removed from female cadavers with no history of prolapse or pelvic surgery.
A total of 13 cadavers were used. Each ligament was tested for uniaxial tensile strength at constant deformation rate. The
large number of results obtained enabled a statistical study of mechanical properties.
ResultsThe mechanical tests performed on uterine ligaments taken from 13 female cadavers showed the existence of nonlinear elastic
behaviour. In this case, the mechanical behaviour of the ligaments could be expressed by two parameters C0 and C1, relating to stiffness at low and high deformation rates. Intra-individualreproducibility was satisfactory. The uterosacral
ligament was found to be the stiffest of the three ligaments studied, at both low and high deformation rates. Inter-individual
dispersion was noted. Each subject studied displayed lateralisation, with one side (either right or left) stiffer than the
other. A vaginal tissue sample was also taken from 11 of the 13 subjects, which made it possible to show that vaginal tissue
is less stiff than ligament tissue.
ConclusionThe hyperelastic mechanical behaviour of the uterosacral, round and broad ligaments was shown for the first time. This approach
showed that the uterosacral ligament is stiffer than the round and broad ligaments and vaginal tissue. Therefore, it appears
that it plays a more important role in pelvic floor support. Further mechanical studies of these ligaments in POP would provide
further answers to the aetiologies of the recurrence of prolapse after curative surgery.
Mots clésLigaments utérins–Statique pelvienne–Prolapsus–Gynécologie–Urologie
KeywordsUterine ligaments–Pelvic floor–Prolapse–Gynaecology–Urology
Pelvi-périnéologie 04/2012; 6(2):67-74. · 0.07 Impact Factor
ABSTRACT: Intrauterine infection could be responsible for 25% up to 40% of preterm births. This relationship was initially demonstrated using animal models, inducing their abortion by injecting bacteria or endotoxins. In human research, examination of amniocentesis fluid showed the anteriority of infection over labor induction, and the existence of a subclinical latency phase between these two phenomena. The ascending route is preponderant, and four stages can be distinguished: cervical and vaginal infection, chorio-decidual infection, intra-amniotic infection, fetal infection. The intrauterine infection is very frequent in case of early preterm birth (<30 WG). It is associated with an increase of neurological and pulmonary morbidity. Most commonly found bacterial species are mycoplasma species, but also Escherichia coli, Gardnerella vaginalis and streptococcus B. Several markers of the infection have been studied: a maternal leukocytosis>15,000/mm(3) or a C-Reactive Protein (CRP)>20mg/l, an increase of fibronectin and/or IL-6 cervical, a short cervical length especially before 32 WG, a leukocytosis of the amniotic fluid, and/or high interleukin concentrations. The main marker used for the newborn is the CRP, but other markers can also be used for an early diagnosis of an infection, especially interleukin 6.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 12/2011; 41(1):14-25. · 0.42 Impact Factor
ABSTRACT: Myocardial infarction is rare during pregnancy and is associated with a high maternal and foetal mortality rate. We report the case of a 32-year-old woman at 38 weeks gestation who developed a myocardial infarction with spontaneous coronary dissection treated with coronary angioplasty and who needed an emergency caesarean section. We discuss the anaesthetic management of urgent caesarean section in this context.
Annales francaises d'anesthesie et de reanimation 12/2011; 31(2):162-5. · 0.77 Impact Factor
ABSTRACT: More and more perimenopausal and menopausal women seek an alternative to hysterectomy because they desire future pregnancy or wish to retain their uteri even if they have completed childbearing. Myomectomy may be an option. We can't know the evolution of leiomyomas. Hysteroscopic myomectomy is the treatment of submucous fibromas. Recurrence and subsequent surgery occurs in 16 to 21 % of cases. Intramural and subserousal myomas can be treated by myomectomy. Myomectomy should be performed laparoscopically because of shorter hospital stay, faster recovery and reduced postoperative pain. Second surgery is needed in 4-16 % of patients. If hysterectomy is performed, it should be by vaginal or laparoscopic route. There is no difference in perioperative morbidity between hysterectomy and myomectomy. Intra- and postoperative complications are similar between myomectomy and hysterectomy. Hysterectomy may be prefered if there is risk factor of malignancy or if the fibroma is discovered or has a rapid growth after menopause.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 11/2011; 40(8):902-17. · 0.42 Impact Factor
ABSTRACT: Assessment of fetal head engagement by digital examination is highly subjective even though this method remains the gold standard. Ultrasonography could be helpful to determine fetal head engagement during the second stage of labor.
Prospective unicentric study to compare the diagnostic of fetal head orientation and engagement between digital examination and ultrasonography. One hundred measurements were performed in 100 patients at complete cervical dilatation.
In 80 % of patients, abdominal ultrasound assessments were consistent with digital examinations in depicting fetal head position. We were not able to evaluate engagement by abdominal ultrasonography. Perineum to fetal head distance was measured between 12 and 83mm by translabial ultrasonography. When the head was not engaged (-1), the mean distance was 66.4±7.53mm. The measure was 56.15±10.86mm when the head was at the upper part of the birth canal (+1), 46.47±12.49mm at the middle part (+2) and 35.81±10.42mm at the lower part (+3; +4). A threshold of 55mm was associated with a sensibility and a negative predictive value of 100 % for vaginal birth.
Abdominal intrapartum ultrasound increases the accuracy of fetal head position assessment. Translabial ultrasound is a simple and easy method to define fetal head engagement by measuring the distance between perineum and fetal head. Ultrasound during the second stage of labor may serve as an educational tool for physicians in training.
Gynécologie Obstétrique & Fertilité 10/2011; 40(3):148-52. · 0.52 Impact Factor
ABSTRACT: The use of mesh for pelvic organ prolapse repair through the vaginal route has increased within the last decade. The main objective is to improve anatomical results (based on the superiority of sacropexy with meshes when compared to vaginal traditional surgery), with the advantages of the vaginal route. An increasing number of cohort series and randomized control trials have been published. There is level-1 evidence that the use of mesh for the treatment of cystocele through the vaginal route improves anatomical results when compared to traditional surgery. The rates of complications between these two techniques seem equivalent, even for de novo dyspareunia.
Gynécologie Obstétrique & Fertilité 03/2011; 39(4):232-44. · 0.52 Impact Factor
ABSTRACT: To survey French trainees in obstetrics and gynaecology on the type of short and long-term professional activity they wish to have following specialisation.
A questionnaire was sent to the 909 trainees in obstetrics and gynaecology during the academic year 2005-2006.
Answer rate was 34.5%. Almost all trainees (96.5%) wish to have a two-year hospital position before applying for consultant or beginning a private practice. Only 55.6% of these trainees think this option realistic. Overall, 78.7% of trainees wish to continue practicing obstetrics, 66.9% surgery, 41.4% ultrasound screening or prenatal diagnosis, 34.1% office gynaecology, 28% oncogynaecology and 23.6% assisted medical procreation. An exclusive public hospital position was desired by 51.6% of trainees, with 45.1% in academic hospitals and 54.9% in non academic hospitals. Exclusive private practice was desired by 8.9% of trainees and 47.7% wish a private practice with a part-time public hospital position.
Actual trainees in obstetrics and gynaecology see their future practice as polyvalent, mostly in public hospitals and including for most at least obstetrics.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 07/2008; 37(4):400-8. · 0.42 Impact Factor
ABSTRACT: The aim of our work was to objectify and quantify the mechanical benefits of healing with regards to tearing meshes off of tissues and maximal resistance after cicatrization. In vivo, we tested the mechanical gain in resistance by healing after implantation of a Prolene mesh. We measured the value of forces when traction was exerted until mobilization at different stages of cicatrization. Resistance increased progressively at the beginning of tissue inclusion. A maximal plateau was reached around the 25th day. It is important to understand the role of sustaining and reinforcement we hope tissue integration of the mesh will play. We can thus adapt procedures to have the best kinetics and maximal resistance of montages. Study of the kinetics and maximal plateau allows us to make the best clinical recommendations.
International Urogynecology Journal 04/2008; 19(3):397-400. · 1.83 Impact Factor