Objective To assess the effect of early amniotomy on labor duration, maternal and neonatal outcom... more Objective To assess the effect of early amniotomy on labor duration, maternal and neonatal outcomes during induction of labor (IOL). Methods This was a randomized controlled trial, conducted over a period of eight months at a monocentric site. Singleton pregnancies in nulliparous and parous patients with cephalic presentation and Bishop score � 6 were enrolled in the study. One hundred participants were randomized into two groups: early amniotomy (initiating IOL with amniotomy followed by oxytocin) versus late amniotomy (initiating IOL with oxytocin followed by amniotomy 4 hours later). The primary endpoint was the time to active phase (cervical dilation � 5 cm) during IOL. Secondary outcomes were time to vaginal delivery, mode of delivery, and maternal and fetal outcomes. Results Early amniotomy reduced time to active phase by 2 hours and 46 minutes compared to the late amniotomy group (3 h 42 min vs. 6 h 28 min; p<0.0001). It also reduced time to vaginal delivery by 2 hours and 52 minutes (5 h 17 min vs. 8 h 9 min; p = 0.0003). The rate of cesarean section (CS) for failed IOL was significantly lower in the early amniotomy group (31.2% vs. 70.0%; p = 0.02), without any significant difference in the overall rate of cesarean section between the two groups (32.0% vs. 40.8%; p = 0.36). There was no significant difference in maternal or fetal outcomes. Conclusions Early amniotomy in IOL significantly shortens the time to active phase as well as the overall duration of labor without compromising maternal and neonatal safety.
Key Clinical MessagePathologists should consider the differential diagnoses of placental chorioan... more Key Clinical MessagePathologists should consider the differential diagnoses of placental chorioangioma, which encompass chorangiosis, chorangiomatosis, chorangiocarcinoma, intervillous thrombus, and placental infarct.Chorioangiomas are rare non‐trophoblastic vascular neoplasms of the placenta, occurring in approximately 1% of pregnancies. Large chorioangiomas (>4 cm) are infrequent and associated with an increased risk of pregnancy complications. There are limited reports in the literature regarding uncomplicated cases of large placental chorioangiomas.
Objectives: To evaluate the impact of a targeted training program on the quality of nuchal transl... more Objectives: To evaluate the impact of a targeted training program on the quality of nuchal translucency measurements performed by a sample of Tunisian trainees in obstetrics and gynecology. Methods: A longitudinal, prospective and analytic study conducted on a sample of 31 trainees in Obstetrics and Gynecology. This study was organised into three steps (S1, S2,S3): During S1, each trainer achieved 10 first trimester ultrasound exams. All measurements were evaluated by two reviewers according to quality control systems. S2 consisted on an interactive training session during which participants received a detailed feedback report on their first series of images. During S3, each candidate performed again ten first trimester exams that were corrected by the same examiners. Subsequently we compared the results obtained before and after the training session. Results: During S1, the mean Hermann score was 4.1 [0–8] with 38% unacceptable exams. The main difficulty encountered by participants was obtaining the sagittal section plane. The latter was present only on 2.9% of the images. There was no correlation between the quality of the measurements and the participant’s level of study. During S3, we found a significant improvement of the technical settings and the mean Hermann score (5.4 vs. 4.1; p <0.001) with a significant reduction of unacceptable exams (15% vs. 38%; p = 0.002). However, this improvement was insufficient view that only 37% of the trainees had significantly improved their scores. Moreover, there was no significant improvement in median measures of nuchal translucency (0.71 MoM vs. 0.72 MoM; p = 0.45) with a general tendency to underestimation. Conclusions: The training program evaluated in this study can guide the trainee in his daily self evaluation. However, a single session is insufficient to reach the goal of a quality screening measures, above all when this project lacks of hands-on training sessions.
La sexualité de l'adolescent varie en fonction des individus, des pays, des cultures et de l'époq... more La sexualité de l'adolescent varie en fonction des individus, des pays, des cultures et de l'époque. Dans le présent travail, les auteurs essayent d'approcher la question de la sexualité de l'adolescent en Tunisie à l'aide d'une enquête transversale, par autoquestionnaire auprès de 800 étudiants(es). Le taux de non-réponse était élevé (56 % de non-réponses). Les résultats montrent 352 réponses valides, avec une moyenne d'âge de 20,5 ans. 37,8 % des adolescents signalaient une activité sexuelle autoérotique (masturbations), entourée de sentiments de culpabilité pour 80 %. Des préoccupations d'ordre sanitaire et religieux sous-tendraient cette culpabilité pour la plupart de ces adolescents. Le taux élevé d'activité hétérosexuelle signalé par nos adolescents (60,1 %) soulignerait le relâchement des freins religieux et culturels vis-à-vis de la sexualité prémaritale ; cela pourrait illustrer un des aspects du phénomène d'acculturation de plus en plus prononcé sous nos climats. Malgré cette apparente « libération sexuelle », 40,1 % affirmaient avoir des difficultés à entrer en contact avec les sujets de l'autre sexe. Une difficulté à assumer leur identité sexuée apparaît à travers le désir d'avoir le statut de l'autre sexe pour 19,3 % des sujets. Le manque de connaissances en matière de santé sexuelle et reproductive (31 %) et l'éducation sexuelle, jugée insuffisante (30,4 %), risquent de compromettre la santé aussi bien physique que mentale de ces jeunes (vie sexuelle et affective perturbée, grossesse, maladie sexuellement transmissible). Un dialogue pertinent et une éducation sexuelle impliquant les pairs et les enseignants pourraient éclairer nos jeunes et les aider à avoir un comportement sexuel « sain », sans risques, et à développer une identité sexuelle adaptée à notre contexte maghrébin.
months vs 70; p=0.033), and stage 1 vs 2 and 3 (79 months vs 29 vs 28; p<0.001). Conclusions Surv... more months vs 70; p=0.033), and stage 1 vs 2 and 3 (79 months vs 29 vs 28; p<0.001). Conclusions Survival in elderly with endometrial carcinoma is much lower when compared to the general population especially with high grade or advanced stage disease. They are more likely to receive suboptimal treatment due to their health condition. Further clinical studies will give us the opportunity to develop treatment guidelines to improve outcomes.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Objective To assess the effect of early amniotomy on labor duration, maternal and neonatal outcom... more Objective To assess the effect of early amniotomy on labor duration, maternal and neonatal outcomes during induction of labor (IOL). Methods This was a randomized controlled trial, conducted over a period of eight months at a monocentric site. Singleton pregnancies in nulliparous and parous patients with cephalic presentation and Bishop score � 6 were enrolled in the study. One hundred participants were randomized into two groups: early amniotomy (initiating IOL with amniotomy followed by oxytocin) versus late amniotomy (initiating IOL with oxytocin followed by amniotomy 4 hours later). The primary endpoint was the time to active phase (cervical dilation � 5 cm) during IOL. Secondary outcomes were time to vaginal delivery, mode of delivery, and maternal and fetal outcomes. Results Early amniotomy reduced time to active phase by 2 hours and 46 minutes compared to the late amniotomy group (3 h 42 min vs. 6 h 28 min; p<0.0001). It also reduced time to vaginal delivery by 2 hours and 52 minutes (5 h 17 min vs. 8 h 9 min; p = 0.0003). The rate of cesarean section (CS) for failed IOL was significantly lower in the early amniotomy group (31.2% vs. 70.0%; p = 0.02), without any significant difference in the overall rate of cesarean section between the two groups (32.0% vs. 40.8%; p = 0.36). There was no significant difference in maternal or fetal outcomes. Conclusions Early amniotomy in IOL significantly shortens the time to active phase as well as the overall duration of labor without compromising maternal and neonatal safety.
Key Clinical MessagePathologists should consider the differential diagnoses of placental chorioan... more Key Clinical MessagePathologists should consider the differential diagnoses of placental chorioangioma, which encompass chorangiosis, chorangiomatosis, chorangiocarcinoma, intervillous thrombus, and placental infarct.Chorioangiomas are rare non‐trophoblastic vascular neoplasms of the placenta, occurring in approximately 1% of pregnancies. Large chorioangiomas (>4 cm) are infrequent and associated with an increased risk of pregnancy complications. There are limited reports in the literature regarding uncomplicated cases of large placental chorioangiomas.
Objectives: To evaluate the impact of a targeted training program on the quality of nuchal transl... more Objectives: To evaluate the impact of a targeted training program on the quality of nuchal translucency measurements performed by a sample of Tunisian trainees in obstetrics and gynecology. Methods: A longitudinal, prospective and analytic study conducted on a sample of 31 trainees in Obstetrics and Gynecology. This study was organised into three steps (S1, S2,S3): During S1, each trainer achieved 10 first trimester ultrasound exams. All measurements were evaluated by two reviewers according to quality control systems. S2 consisted on an interactive training session during which participants received a detailed feedback report on their first series of images. During S3, each candidate performed again ten first trimester exams that were corrected by the same examiners. Subsequently we compared the results obtained before and after the training session. Results: During S1, the mean Hermann score was 4.1 [0–8] with 38% unacceptable exams. The main difficulty encountered by participants was obtaining the sagittal section plane. The latter was present only on 2.9% of the images. There was no correlation between the quality of the measurements and the participant’s level of study. During S3, we found a significant improvement of the technical settings and the mean Hermann score (5.4 vs. 4.1; p <0.001) with a significant reduction of unacceptable exams (15% vs. 38%; p = 0.002). However, this improvement was insufficient view that only 37% of the trainees had significantly improved their scores. Moreover, there was no significant improvement in median measures of nuchal translucency (0.71 MoM vs. 0.72 MoM; p = 0.45) with a general tendency to underestimation. Conclusions: The training program evaluated in this study can guide the trainee in his daily self evaluation. However, a single session is insufficient to reach the goal of a quality screening measures, above all when this project lacks of hands-on training sessions.
La sexualité de l'adolescent varie en fonction des individus, des pays, des cultures et de l'époq... more La sexualité de l'adolescent varie en fonction des individus, des pays, des cultures et de l'époque. Dans le présent travail, les auteurs essayent d'approcher la question de la sexualité de l'adolescent en Tunisie à l'aide d'une enquête transversale, par autoquestionnaire auprès de 800 étudiants(es). Le taux de non-réponse était élevé (56 % de non-réponses). Les résultats montrent 352 réponses valides, avec une moyenne d'âge de 20,5 ans. 37,8 % des adolescents signalaient une activité sexuelle autoérotique (masturbations), entourée de sentiments de culpabilité pour 80 %. Des préoccupations d'ordre sanitaire et religieux sous-tendraient cette culpabilité pour la plupart de ces adolescents. Le taux élevé d'activité hétérosexuelle signalé par nos adolescents (60,1 %) soulignerait le relâchement des freins religieux et culturels vis-à-vis de la sexualité prémaritale ; cela pourrait illustrer un des aspects du phénomène d'acculturation de plus en plus prononcé sous nos climats. Malgré cette apparente « libération sexuelle », 40,1 % affirmaient avoir des difficultés à entrer en contact avec les sujets de l'autre sexe. Une difficulté à assumer leur identité sexuée apparaît à travers le désir d'avoir le statut de l'autre sexe pour 19,3 % des sujets. Le manque de connaissances en matière de santé sexuelle et reproductive (31 %) et l'éducation sexuelle, jugée insuffisante (30,4 %), risquent de compromettre la santé aussi bien physique que mentale de ces jeunes (vie sexuelle et affective perturbée, grossesse, maladie sexuellement transmissible). Un dialogue pertinent et une éducation sexuelle impliquant les pairs et les enseignants pourraient éclairer nos jeunes et les aider à avoir un comportement sexuel « sain », sans risques, et à développer une identité sexuelle adaptée à notre contexte maghrébin.
months vs 70; p=0.033), and stage 1 vs 2 and 3 (79 months vs 29 vs 28; p<0.001). Conclusions Surv... more months vs 70; p=0.033), and stage 1 vs 2 and 3 (79 months vs 29 vs 28; p<0.001). Conclusions Survival in elderly with endometrial carcinoma is much lower when compared to the general population especially with high grade or advanced stage disease. They are more likely to receive suboptimal treatment due to their health condition. Further clinical studies will give us the opportunity to develop treatment guidelines to improve outcomes.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
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