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BACKGROUND Ultrasonography is an essential tool in the management of twin pregnancies. Fetal weig... more BACKGROUND Ultrasonography is an essential tool in the management of twin pregnancies. Fetal weight estimation is useful to anticipate neonatal care in case of weight restriction or growth discordance. AIMS To assess the accuracy of estimated fetal weight (EFW) in twins and to assess the accuracy of sonographic examination to predict birth weight discordance (BWD) and small birth weight (SBW). Methods : This was a longitudinal prospective study over a period of one year. We have included 50 twin pregnancies with a first trimester ultrasound calculated term and specified chorionicity. An ultrasound EFW was scheduled for all patients within an interval of 4 days before delivery. We calculated the differences between EFW and BW in terms of absolute difference and percentage error. We studied the correlation and the agreement between EFW and BW. Finally we calculated the sensitivity, the specificity, PPV and NPV of ultrasound in the diagnosis of BWD and SBW. RESULTS Absolute differe...
AIM To analyze the contribution of prenatal ultrasound in the diagnosis of arthrogryposis multipl... more AIM To analyze the contribution of prenatal ultrasound in the diagnosis of arthrogryposis multiplex congenital according to its type and antenatal expression. METHODS Retrospective study led between January 1993 and November 2007. We studied the cases of arthrogryposis suspected or diagnosed by antenatal ultrasound while analyzing the circumstances of discovery, the profile of the pregnant women and the abnormal scan findings. RESULTS 16 observations have been collected. We recovered one multiple pterigium syndrome and five observations of severe fetal akinesia sequences diagnosed in the second trimester. The arthrogryposis was part of different syndromes in other cases. Four distal arthrogryposis had been diagnosed in the second trimester. All cases suspected during the third trimester were associated to an anomaly of the amniotic fluid, mainly to a polyhydramnios. The abnormal scan findings were less specific to this term. CONCLUSION Arthrogryposis multiplex congenital is rare. It...
OBJECTIVES To evaluate the impact of a targeted training program on the quality of NT measures pe... more OBJECTIVES To evaluate the impact of a targeted training program on the quality of NT measures performed by OBST/GYN trainees. METHODS Prospective study. Step1: each trainee achieved 10 T1US . All were evaluated by 2 experts. Step 2: interactive training session where participants received a detailed feedback report. Step3: each candidate performed again 10 T1US. The results obtained before and after the training session were compared. RESULTS Step1: Herman score was 4.1 with 38% of unacceptable exams. There was no correlation between the score and the level of the training curriculum. Main difficulty was about obtaining sagittal plane. Step2: self-assigned score before the session overestimated image quality (4.5 Vs. 4.1, p=0.03). At the end of the session, It decreased to 3.1. Step3: a significant improvement of technical settings, mean score (5.4 Vs. 4.1; p <0.001) , percentage of acceptable images (85% Vs. 62%, p = 0.002) and sagittal plane (6.4% Vs. 2.9%; p = 0.003). Only 37...
International Journal of Gynecology & Obstetrics
Pan African Medical Journal
European Journal of Obstetrics & Gynecology and Reproductive Biology
European Journal of Obstetrics & Gynecology and Reproductive Biology
La Tunisie medicale, 2016
La Tunisie medicale, 2016
Ultrasonography is an essential tool in the management of twin pregnancies. Fetal weight estimati... more Ultrasonography is an essential tool in the management of twin pregnancies. Fetal weight estimation is useful to anticipate neonatal care in case of weight restriction or growth discordance. To assess the accuracy of estimated fetal weight (EFW) in twins and to assess the accuracy of sonographic examination to predict birth weight discordance (BWD) and small birth weight (SBW). Methods : This was a longitudinal prospective study over a period of one year. We have included 50 twin pregnancies with a first trimester ultrasound calculated term and specified chorionicity. An ultrasound EFW was scheduled for all patients within an interval of 4 days before delivery. We calculated the differences between EFW and BW in terms of absolute difference and percentage error. We studied the correlation and the agreement between EFW and BW. Finally we calculated the sensitivity, the specificity, PPV and NPV of ultrasound in the diagnosis of BWD and SBW. Absolute differences between BWF and BW ...
La Tunisie medicale, 2017
Preterm delivery is the major cause of adverse outcomes in twin pregnancy. A shortened cervix at... more Preterm delivery is the major cause of adverse outcomes in twin pregnancy. A shortened cervix at 20-24 weeks of amenorrhea is a good predictor of preterm birth in asymptomatic patients. However, there are no recommendations for serial cervical length measurements for these high risk pregnancies. To evaluate the benefits from monthly cervical length monitoring in asymptomatic twin pregnancies. This was a prospective study. We compared two groups of twin pregnancies (groupe 1: patients with a monthly and systematic transvaginal ultrasound measurement of the cervical length and groupe2 : patients without monitoring of cervical length) in terms of premature labor screening, mean gestational age at the diagnosis of preterm labor, time saved by tocolysis in case of preterm labor and mean gestational age at delivery. Ninety nine twin pregnancies were included: 35 patients had a systematic, monthly cervical length (group1) and 64 women had a traditional prenatal care without monitoring of...
La Tunisie medicale, 2017
To evaluate the impact of a targeted training program on the quality of NT measures performed by ... more To evaluate the impact of a targeted training program on the quality of NT measures performed by OBST/GYN trainees. Prospective study. Step1: each trainee achieved 10 T1US . All were evaluated by 2 experts. Step 2: interactive training session where participants received a detailed feedback report. Step3: each candidate performed again 10 T1US. The results obtained before and after the training session were compared. Step1: Herman score was 4.1 with 38% of unacceptable exams. There was no correlation between the score and the level of the training curriculum. Main difficulty was about obtaining sagittal plane. Step2: self-assigned score before the session overestimated image quality (4.5 Vs. 4.1, p=0.03). At the end of the session, It decreased to 3.1. Step3: a significant improvement of technical settings, mean score (5.4 Vs. 4.1; p <0.001) , percentage of acceptable images (85% Vs. 62%, p = 0.002) and sagittal plane (6.4% Vs. 2.9%; p = 0.003). Only 37% had significantly improve...
Ultrasound in Obstetrics & Gynecology
European Journal of Obstetrics & Gynecology and Reproductive Biology
Journal of Obstetrics and Gynaecology
La Tunisie medicale, 2016
Cause-of-death data are critical to formulating good public health programs. In Tunisia, the mort... more Cause-of-death data are critical to formulating good public health programs. In Tunisia, the mortality surveys of reproductive age women are specifically interested in maternal mortality and we do not have data on deaths from noncommunicable diseases including cancer. To identify the main cancers causing death among Tunisian women in reproductive age. A retrospective national RAMOS survey (Reproductive Age Mortality Study). This survey was conducted in 2010 and included all deaths of women aged 15-49 years which occurred in 2008 and were due to cancer. Data collection was based on the verbal autopsy method. In Tunisia, cancer is the leading cause of death among reproductive age women, especially breast cancer. The most exposed women are housewives (64.4%), aged 40-49 years (55.3%), living in urban areas (62.2%), belonging to the middle tercile classification of households (45.4%) and reaching a level of basic education (44.2%). Cancer should receive priority funding of health care...
La Tunisie medicale, 2016
Background In Tunisia, the information system on medical causes of death is based on the use of ... more Background In Tunisia, the information system on medical causes of death is based on the use of standard death certificate model based on international model recommended by the World Organization started in January 2001. However, this system is still burdened with a major death causes of under-registration. Only specific surveys on mortality have FAR generate reliable mortality indicators. Objectives to study the use of verbal autopsy in order to assess cancer mortality among Tunisian women in reproductive age (WRA) . Methods A retrospective national RAMOS survey (Reproductive Age Mortality Study). This survey was conducted in 2010 and included all deaths of women aged 15-49 years which occurred in 2008 and were due to cancer. Data were collected from civil status records and information gathered from families and from health institution's registers. For all deaths of women aged 15-49 years, the detailed circumstances and the sequence of events leading to death were grouped o...
Pan African Medical Journal, 2016
Pan African Medical Journal, 2016
Le recours systématique à l'estimation échographique du poids foetal en salle de naissances augme... more Le recours systématique à l'estimation échographique du poids foetal en salle de naissances augmente-t-il le risque d'accouchement par césarienne? Investigating into whether systematic fetal weight estimation by ultrasound in the delivery room increases the risk of cesarean delivery
BACKGROUND Ultrasonography is an essential tool in the management of twin pregnancies. Fetal weig... more BACKGROUND Ultrasonography is an essential tool in the management of twin pregnancies. Fetal weight estimation is useful to anticipate neonatal care in case of weight restriction or growth discordance. AIMS To assess the accuracy of estimated fetal weight (EFW) in twins and to assess the accuracy of sonographic examination to predict birth weight discordance (BWD) and small birth weight (SBW). Methods : This was a longitudinal prospective study over a period of one year. We have included 50 twin pregnancies with a first trimester ultrasound calculated term and specified chorionicity. An ultrasound EFW was scheduled for all patients within an interval of 4 days before delivery. We calculated the differences between EFW and BW in terms of absolute difference and percentage error. We studied the correlation and the agreement between EFW and BW. Finally we calculated the sensitivity, the specificity, PPV and NPV of ultrasound in the diagnosis of BWD and SBW. RESULTS Absolute differe...
AIM To analyze the contribution of prenatal ultrasound in the diagnosis of arthrogryposis multipl... more AIM To analyze the contribution of prenatal ultrasound in the diagnosis of arthrogryposis multiplex congenital according to its type and antenatal expression. METHODS Retrospective study led between January 1993 and November 2007. We studied the cases of arthrogryposis suspected or diagnosed by antenatal ultrasound while analyzing the circumstances of discovery, the profile of the pregnant women and the abnormal scan findings. RESULTS 16 observations have been collected. We recovered one multiple pterigium syndrome and five observations of severe fetal akinesia sequences diagnosed in the second trimester. The arthrogryposis was part of different syndromes in other cases. Four distal arthrogryposis had been diagnosed in the second trimester. All cases suspected during the third trimester were associated to an anomaly of the amniotic fluid, mainly to a polyhydramnios. The abnormal scan findings were less specific to this term. CONCLUSION Arthrogryposis multiplex congenital is rare. It...
OBJECTIVES To evaluate the impact of a targeted training program on the quality of NT measures pe... more OBJECTIVES To evaluate the impact of a targeted training program on the quality of NT measures performed by OBST/GYN trainees. METHODS Prospective study. Step1: each trainee achieved 10 T1US . All were evaluated by 2 experts. Step 2: interactive training session where participants received a detailed feedback report. Step3: each candidate performed again 10 T1US. The results obtained before and after the training session were compared. RESULTS Step1: Herman score was 4.1 with 38% of unacceptable exams. There was no correlation between the score and the level of the training curriculum. Main difficulty was about obtaining sagittal plane. Step2: self-assigned score before the session overestimated image quality (4.5 Vs. 4.1, p=0.03). At the end of the session, It decreased to 3.1. Step3: a significant improvement of technical settings, mean score (5.4 Vs. 4.1; p <0.001) , percentage of acceptable images (85% Vs. 62%, p = 0.002) and sagittal plane (6.4% Vs. 2.9%; p = 0.003). Only 37...
International Journal of Gynecology & Obstetrics
Pan African Medical Journal
European Journal of Obstetrics & Gynecology and Reproductive Biology
European Journal of Obstetrics & Gynecology and Reproductive Biology
La Tunisie medicale, 2016
La Tunisie medicale, 2016
Ultrasonography is an essential tool in the management of twin pregnancies. Fetal weight estimati... more Ultrasonography is an essential tool in the management of twin pregnancies. Fetal weight estimation is useful to anticipate neonatal care in case of weight restriction or growth discordance. To assess the accuracy of estimated fetal weight (EFW) in twins and to assess the accuracy of sonographic examination to predict birth weight discordance (BWD) and small birth weight (SBW). Methods : This was a longitudinal prospective study over a period of one year. We have included 50 twin pregnancies with a first trimester ultrasound calculated term and specified chorionicity. An ultrasound EFW was scheduled for all patients within an interval of 4 days before delivery. We calculated the differences between EFW and BW in terms of absolute difference and percentage error. We studied the correlation and the agreement between EFW and BW. Finally we calculated the sensitivity, the specificity, PPV and NPV of ultrasound in the diagnosis of BWD and SBW. Absolute differences between BWF and BW ...
La Tunisie medicale, 2017
Preterm delivery is the major cause of adverse outcomes in twin pregnancy. A shortened cervix at... more Preterm delivery is the major cause of adverse outcomes in twin pregnancy. A shortened cervix at 20-24 weeks of amenorrhea is a good predictor of preterm birth in asymptomatic patients. However, there are no recommendations for serial cervical length measurements for these high risk pregnancies. To evaluate the benefits from monthly cervical length monitoring in asymptomatic twin pregnancies. This was a prospective study. We compared two groups of twin pregnancies (groupe 1: patients with a monthly and systematic transvaginal ultrasound measurement of the cervical length and groupe2 : patients without monitoring of cervical length) in terms of premature labor screening, mean gestational age at the diagnosis of preterm labor, time saved by tocolysis in case of preterm labor and mean gestational age at delivery. Ninety nine twin pregnancies were included: 35 patients had a systematic, monthly cervical length (group1) and 64 women had a traditional prenatal care without monitoring of...
La Tunisie medicale, 2017
To evaluate the impact of a targeted training program on the quality of NT measures performed by ... more To evaluate the impact of a targeted training program on the quality of NT measures performed by OBST/GYN trainees. Prospective study. Step1: each trainee achieved 10 T1US . All were evaluated by 2 experts. Step 2: interactive training session where participants received a detailed feedback report. Step3: each candidate performed again 10 T1US. The results obtained before and after the training session were compared. Step1: Herman score was 4.1 with 38% of unacceptable exams. There was no correlation between the score and the level of the training curriculum. Main difficulty was about obtaining sagittal plane. Step2: self-assigned score before the session overestimated image quality (4.5 Vs. 4.1, p=0.03). At the end of the session, It decreased to 3.1. Step3: a significant improvement of technical settings, mean score (5.4 Vs. 4.1; p <0.001) , percentage of acceptable images (85% Vs. 62%, p = 0.002) and sagittal plane (6.4% Vs. 2.9%; p = 0.003). Only 37% had significantly improve...
Ultrasound in Obstetrics & Gynecology
European Journal of Obstetrics & Gynecology and Reproductive Biology
Journal of Obstetrics and Gynaecology
La Tunisie medicale, 2016
Cause-of-death data are critical to formulating good public health programs. In Tunisia, the mort... more Cause-of-death data are critical to formulating good public health programs. In Tunisia, the mortality surveys of reproductive age women are specifically interested in maternal mortality and we do not have data on deaths from noncommunicable diseases including cancer. To identify the main cancers causing death among Tunisian women in reproductive age. A retrospective national RAMOS survey (Reproductive Age Mortality Study). This survey was conducted in 2010 and included all deaths of women aged 15-49 years which occurred in 2008 and were due to cancer. Data collection was based on the verbal autopsy method. In Tunisia, cancer is the leading cause of death among reproductive age women, especially breast cancer. The most exposed women are housewives (64.4%), aged 40-49 years (55.3%), living in urban areas (62.2%), belonging to the middle tercile classification of households (45.4%) and reaching a level of basic education (44.2%). Cancer should receive priority funding of health care...
La Tunisie medicale, 2016
Background In Tunisia, the information system on medical causes of death is based on the use of ... more Background In Tunisia, the information system on medical causes of death is based on the use of standard death certificate model based on international model recommended by the World Organization started in January 2001. However, this system is still burdened with a major death causes of under-registration. Only specific surveys on mortality have FAR generate reliable mortality indicators. Objectives to study the use of verbal autopsy in order to assess cancer mortality among Tunisian women in reproductive age (WRA) . Methods A retrospective national RAMOS survey (Reproductive Age Mortality Study). This survey was conducted in 2010 and included all deaths of women aged 15-49 years which occurred in 2008 and were due to cancer. Data were collected from civil status records and information gathered from families and from health institution's registers. For all deaths of women aged 15-49 years, the detailed circumstances and the sequence of events leading to death were grouped o...
Pan African Medical Journal, 2016
Pan African Medical Journal, 2016
Le recours systématique à l'estimation échographique du poids foetal en salle de naissances augme... more Le recours systématique à l'estimation échographique du poids foetal en salle de naissances augmente-t-il le risque d'accouchement par césarienne? Investigating into whether systematic fetal weight estimation by ultrasound in the delivery room increases the risk of cesarean delivery