Kaouther Dimassi | University of Tunis El Manar (original) (raw)
Papers by Kaouther Dimassi
L'auto-évaluation est tenue pour être centrale dans l'apprentissage autodirigé et dans la... more L'auto-évaluation est tenue pour être centrale dans l'apprentissage autodirigé et dans la régulation de la pratique dans le domaine de la santé. Cependant, plusieurs hypothèses neuropsychologiques tendent à conforter la notion selon laquelle l'exactitude de l'auto-évaluation lorsqu'elle est comparée à des évalua-tions externes est relativement médiocre (Dory et al., 2009). Ainsi, les orientations actuelles tendent à recommander d'entraîner les futurs praticiens et les praticiens diplômés à solliciter une rétroaction externe ou feedback et à en combiner les résultats avec ceux de leur auto-évaluation dans l'optique d'orienter leurs apprentissages et d'optimiser leurs pratiques (Dory et al., 2009). Nous avons appliqué ces concepts dans l'élaboration d'un programme de formation en pratique de l'échographie du premier trimestre de la grossesse. Nous nous proposons d'évaluer l'impact d'un tel programme basé à la fois sur l'a...
Looking for the etiology of an increased nuchal translucency in a patient aged of 22 years G1P0, ... more Looking for the etiology of an increased nuchal translucency in a patient aged of 22 years G1P0, We performed initially a kary-otype whose formula was normal: 46xy. A Fetal echocardiogra-phy realized at 18 and 22 weeks' gestation was normal and brain MRI was normal also. At 22 weeks' gestation, ultrasonog-raphy revealed a hepatic vascular abnormality without other symptoms. The suspected diagnosis was agenesis of the ductus venosus with creation of a high grade arteriovenous shunt between the umbilical vein and the inferior vena cava. The geneticist suspected also a genetic syndrome but the patient refused any investigation. Agenesis of the ductus venosus may be one expression of the different possible systemic-portal-umbilical abnormalities. Physiological consequences vary according to the type of substitutive anastomoses. Agenesis of the ductus venosus can be strictly isolated. It can be also one of a manifestation of a genetic syndrome like NOONAN and JOUBERT SYNDROME. In...
PLOS ONE, 2021
Objective To determine whether the French AmbUlatory Cesarean Section (FAUCS) technique reduces p... more Objective To determine whether the French AmbUlatory Cesarean Section (FAUCS) technique reduces postoperative pain and promotes maternal autonomy compared with the Misgav Ladach cesarean section (MLCS) technique in elective conditions. Study design One hundred pregnant women were randomly, but in a non-blinded manner, assigned to undergo FAUCS or MLCS. The primary outcome was a postoperative mean pain score (PMPS), and secondary outcomes were a combined pain/medication score, time to regain autonomy, surgical duration, calculated blood loss, surgical complications, and neonatal outcome. Results Women in the FAUCS group experienced less pain than those in the MLCS group (PMPS = 1.87 [1.04–2.41] vs. 2.93 [2.46–3.75], respectively; p < 0.001). Six hours after surgery, the combined pain/medication score for FAUCS patients was 33% lower than that for MLCS patients (p < 0.001). FAUCS patients more rapidly regained autonomy, with 94% reaching autonomy within 12 h vs. 4% of MLCS patie...
La Tunisie medicale, 2016
Background Although Oxytocin is used systematically during caesarean section, no recommendation p... more Background Although Oxytocin is used systematically during caesarean section, no recommendation precise optimal dose for this indication. The bolus administration of 10 IU intravenously after extraction of the newborn, is accompanied by side effects mainly hemodynamic. Objectives To compare two Oxytocin protocols: 05 IU bolus Vs. 10 IU bolus during Cesarean section by studying their respective effectiveness (effects on uterine tone) and adverse effects. Methods A prospective randomized double-blind study including 87 term parturients for undergoing a C-section under loco regional anesthesia. Parturients were randomized into two groups depending on the injected Oxytocine dose : - Group 1 (n = 43): 10 IU + 25 IU IVD in 500 ml of serum / 3h - Group 2 (n = 44): 5 IU IVD + 25 IU in 500 ml serum / 3h. Results The variation of the heart rate and the incidence of low blood pressure were significantly greater for Group 1. No significant differences between the two groups regarding blood los...
Objective: To test the hypothesis that compared to single layer continuous uterine suture (SLCUS)... more Objective: To test the hypothesis that compared to single layer continuous uterine suture (SLCUS), a double layered purse string uterine suture (PSUS) significantly reduces cesarean scar defect (CSD) rates, without increasing the perioperative maternal morbidity. Design : Interventional prospective, randomized study . Setting: University obstetric units in Tunisia. Population: 100 pregnant women with an indication of a planned Caesarean. Methods: Patients were enrolled in 2 groups according to the uterine suture technique: SLCUS or PSUS. A Saline infusion hysterosonography was performed by the same senior obstetrician blinded to the uterine suture technique 6 months after surgery . Main Outcome measures: Operative time and Calculated blood loss (CBL) were used for the short time analysis . Uterine and CSD measurements were used for the mid time analysis . Results : Despite a few minutes longer operative time in SUS group (7.17 ± 2.31 min Vs. 6.31 ± 3.04 min, p = 0.028 in SLCUS group...
International Journal of Gynecology & Obstetrics, 2019
The French ambulatory cesarean technique was safe and successful. Operative time was longer, but ... more The French ambulatory cesarean technique was safe and successful. Operative time was longer, but maternal condition was improved as compared with a standard cesarean procedure.
Pan African Medical Journal, 2019
The severe hypertriglyceridemia during pregnancy is a rare condition. It is a problem for diagnos... more The severe hypertriglyceridemia during pregnancy is a rare condition. It is a problem for diagnostic, prognostic and therapeutic. This dyslipidemia benefit from specific and effective treatments, but it is still poorly codified. Dietary is still the essential therapeutic, but fetal extraction should also be considered if the gestational age permits. Post-partum monitoring is required but etiologic thorough is not recommended if the triglycerides rate normalizes. The major complication of hypertriglyceridemia should be actively sought because of important maternal mortality rate.
Cahiers de Santé, 2008
La trisomie 21 (T21) ou syndrome de Down est l’anomalie chromosomique congenitale la plus frequen... more La trisomie 21 (T21) ou syndrome de Down est l’anomalie chromosomique congenitale la plus frequente chez l’homme. Les signes cliniques sont actuellement bien connus. Les moyens de depistage antenatal de la T21 se sont nettement ameliores depuis une vingtaine d’annees.ObjectifIl s’agit de rapporter notre experience en matiere de depistage antenatal de la T21 en evaluant les moyens utilises et les resultats obtenus.Materiel et methodesIl s’agit d’une etude retrospective menee sur quatre ans. Nous avons evalue les circonstances de diagnostic antenatal de T21. Nous avons adopte une strategie de depistage sequentielle.ResultatsNous avons collige 22 cas de T21 durant la periode d’etude. La prevalence totale de la T21 etait de 0,98 ‰ grossesses. Le diagnostic de T21 a ete pose en antenatal chez 13 patientes. Une patiente regulierement suivie dans notre unite a echappe au diagnostic. Les signes echographiques ont constitue le principal motif ayant mene au diagnostic de T21. Le terme moyen de diagnostic etait tardif : 21 semaines d’amenorrhee (SA).ConclusionLa T21 est generalement mal acceptee tant sur le plan social que familial, et ce d’autant plus il n’existe pas de centres specialises pour la prise en charge des enfants trisomiques en Tunisie. L’etablissement d’une strategie de depistage antenatal de la T21 est necessaire afin d’esperer reduire le handicap. Il faudrait commencer par generaliser l’echographie du premier trimestre avec mesure de la clarte nucale (CN). En meme temps, le dosage des marqueurs seriques devrait pouvoir etre propose a toutes les patientes. Le diagnostic prenatal permet actuellement de depister precocement les anomalies et malformations fœtales. S’il existe une demande du couple d’interrompre la grossesse a risque, le comite d’ethique local se reunit, discute le cas et autorise l’interruption de grossesse si les anomalies ou le risque d’handicap sont juges importants. Le calcul du risque integre permettra sans doute de reduire le recours aux amniocenteses systematiques indiquees si l’âge maternel est avance.
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, 2017
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016
following the introduction of the WC to NHS Lothian. We specifically evaluate the effectiveness a... more following the introduction of the WC to NHS Lothian. We specifically evaluate the effectiveness and acceptability of the WC, as well as the impact on surgically managed cases of vulval abscesses/cysts. Methods: We performed a retrospective audit of all identifiable cases of Bartholin's and vulval abscesses/cysts between June 2014 and June 2015. Cases were identified from completed proforma sheets, theatre coding and the gynaecology triage attendance diary. Following insertion of a WC, women were followed up by telephone within 23-25 days. The catheter is left in for a maximum of 4 weeks. The outcomes audited included appropriate use and completion of the proforma sheet, patient satisfaction, recurrence rates at 6months and need for theatre. We reviewed theatre cases separately and compared the numbers, average theatre waiting time and duration of hospitalisation before and after the introduction of the WC. Results: In RIE, fifty-six case notes were reviewed. 79% had WC insertion, 18% had marsupialisation and 3% were conservatively managed. One patient had surgical excision of the Bartholin's gland. The proforma was appropriately completed in 79% of cases. All women fitted with a WC were followed up within 23-25 days. Patient satisfaction rates were 84%. There were two cases of recurrences at 6 months. Before the introduction of the WC 43 women were managed surgically. Majority of these were done as emergencies. The average theatre waiting time was 5 days. In contrast, following the WC, only 11 cases were taken to theatre. This represented a 73% reduction in the number of theatre cases. At SJH, twenty-two case notes were reviewed. 32% had WC insertion, 32% had marsupialisation and 14% were conservatively managed. There were no recurrences at 6months It was difficult to access patient satisfaction at SJH as there was relatively poor proforma completion. However, following the introduction of the WC the number of theatre cases fell by an impressive 56%. Conclusion: The WC is a safe, effective and acceptable option in the management of vulval abscesses/cysts. It has the added benefit of reducing the pressure on theatre space and hospital inpatient beds.
Ultrasound in Obstetrics & Gynecology, 2017
Objectives: International guidelines suggest that a temperature increase of 4 • C for more than 4... more Objectives: International guidelines suggest that a temperature increase of 4 • C for more than 4 minutes can be dangerous for the fetus. For endocavitary examinations, self-heating of the probe plays a significant role, but this effect is not considered in calculating the thermal index. We measured the temperature rise at the probe surface during 23 transvaginal scans, to assess the thermal hazard in clinical practice and to sample data on scan duration and temperature increase for standard examinations. Methods: We monitored the temperature variations using 75μm fine wire K-type insulated thermocouples, mounted on the tip of the probe. The absence of artefacts due to the sensor was verified. 23 scans (16 for obstetrics and 7 for gynecology) were performed in the Obstetric Ultrasound department at a large maternity unit in London. Samsung WS80 + V5-9 and GE VolusonE8 + RIC5-9D were used. Colour flow mode was employed in approximately 70% of the scans. Results: The average duration of the scans was 7 minutes 15 seconds (minimum 3, maximum 18 minutes. The majority of the scans last around 4 minutes. The average peak temperature was 36.3 • C, minimum 34.1 • C, maximum 38 • C, with most of the scans showing a value around 37.5 • C, with no significant difference between the machines. For 20 cases, the highest temperature was seen at the end of the ultrasound examination, however in some cases temperature peaks were observed, likely caused by mode change a variation of the operating parameters. Conclusions: The measured temperature never approached the values reported as hazardous in the international standards. For an average body temperature of 36.5 • C, the most frequent temperature rise was around 1 • C. Results of duration and maximum temperature are in line with previous studies. Further investigations will match the modes used of the ultrasound equipment with the corresponding temperature variations.
Journal of Obstetrics and Gynaecology, 2017
Revue d'Épidémiologie et de Santé Publique, 2017
Background.-In Tunisia, the ''Revolution'' of January 2011 highlighted significant regional dispa... more Background.-In Tunisia, the ''Revolution'' of January 2011 highlighted significant regional disparities and social inequalities in access to health care, including reproductive health services. The purpose of this study was to analyze the social determinants of the use of contraception in Tunisia. Methods.-A cross-sectional national study conducted in 2012; on a sample of 15 to 49-year married women (n = 4374) drawn by a two levels random sampling. Prevalence of contraception and its association factors were assessed. Logistic regression was used to evaluate the variation of contraception prevalence with area of residence, age, level of education, number of children and household income. Results.-The prevalence of contraception was 66.4 %. Eighty-two percent of women used a modern contraceptive method. The use of contraceptive methods was significantly dependent on the age (P < 0.001), area of residence (P = 0.008), education (P < 0.001). The prevalence of contraception was higher in North West (OR = 1.1 [0.81-1.5]; P < 0.001), among multiparous women (OR = 4.49 [3.57-5.66]; P < 0.001), among the youngest women (OR = 1.4 [0.9-2,19]; P < 0.001) and among those with higher levels of education (OR = 1.62 [1.19-2.21]; P = 0.008). Conclusion.-Tunisia, precursor Arab country in family planning, is recording a slowdown in the use of contraception in comparison with other countries of North Africa. Social determinants, such as, age, living conditions, area of residence and level of education are indicators to consider when targeting interventions.
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
Le dépistage des aneuploïdies en Tunisie: à quand la généralisation du calcul de risque intégré a... more Le dépistage des aneuploïdies en Tunisie: à quand la généralisation du calcul de risque intégré au premier trimestre ? Aneuploidy screening in Tunisia: when will the generalization of integrated risk-calculation into the first quarter be established ?
L'auto-évaluation est tenue pour être centrale dans l'apprentissage autodirigé et dans la... more L'auto-évaluation est tenue pour être centrale dans l'apprentissage autodirigé et dans la régulation de la pratique dans le domaine de la santé. Cependant, plusieurs hypothèses neuropsychologiques tendent à conforter la notion selon laquelle l'exactitude de l'auto-évaluation lorsqu'elle est comparée à des évalua-tions externes est relativement médiocre (Dory et al., 2009). Ainsi, les orientations actuelles tendent à recommander d'entraîner les futurs praticiens et les praticiens diplômés à solliciter une rétroaction externe ou feedback et à en combiner les résultats avec ceux de leur auto-évaluation dans l'optique d'orienter leurs apprentissages et d'optimiser leurs pratiques (Dory et al., 2009). Nous avons appliqué ces concepts dans l'élaboration d'un programme de formation en pratique de l'échographie du premier trimestre de la grossesse. Nous nous proposons d'évaluer l'impact d'un tel programme basé à la fois sur l'a...
Looking for the etiology of an increased nuchal translucency in a patient aged of 22 years G1P0, ... more Looking for the etiology of an increased nuchal translucency in a patient aged of 22 years G1P0, We performed initially a kary-otype whose formula was normal: 46xy. A Fetal echocardiogra-phy realized at 18 and 22 weeks' gestation was normal and brain MRI was normal also. At 22 weeks' gestation, ultrasonog-raphy revealed a hepatic vascular abnormality without other symptoms. The suspected diagnosis was agenesis of the ductus venosus with creation of a high grade arteriovenous shunt between the umbilical vein and the inferior vena cava. The geneticist suspected also a genetic syndrome but the patient refused any investigation. Agenesis of the ductus venosus may be one expression of the different possible systemic-portal-umbilical abnormalities. Physiological consequences vary according to the type of substitutive anastomoses. Agenesis of the ductus venosus can be strictly isolated. It can be also one of a manifestation of a genetic syndrome like NOONAN and JOUBERT SYNDROME. In...
PLOS ONE, 2021
Objective To determine whether the French AmbUlatory Cesarean Section (FAUCS) technique reduces p... more Objective To determine whether the French AmbUlatory Cesarean Section (FAUCS) technique reduces postoperative pain and promotes maternal autonomy compared with the Misgav Ladach cesarean section (MLCS) technique in elective conditions. Study design One hundred pregnant women were randomly, but in a non-blinded manner, assigned to undergo FAUCS or MLCS. The primary outcome was a postoperative mean pain score (PMPS), and secondary outcomes were a combined pain/medication score, time to regain autonomy, surgical duration, calculated blood loss, surgical complications, and neonatal outcome. Results Women in the FAUCS group experienced less pain than those in the MLCS group (PMPS = 1.87 [1.04–2.41] vs. 2.93 [2.46–3.75], respectively; p < 0.001). Six hours after surgery, the combined pain/medication score for FAUCS patients was 33% lower than that for MLCS patients (p < 0.001). FAUCS patients more rapidly regained autonomy, with 94% reaching autonomy within 12 h vs. 4% of MLCS patie...
La Tunisie medicale, 2016
Background Although Oxytocin is used systematically during caesarean section, no recommendation p... more Background Although Oxytocin is used systematically during caesarean section, no recommendation precise optimal dose for this indication. The bolus administration of 10 IU intravenously after extraction of the newborn, is accompanied by side effects mainly hemodynamic. Objectives To compare two Oxytocin protocols: 05 IU bolus Vs. 10 IU bolus during Cesarean section by studying their respective effectiveness (effects on uterine tone) and adverse effects. Methods A prospective randomized double-blind study including 87 term parturients for undergoing a C-section under loco regional anesthesia. Parturients were randomized into two groups depending on the injected Oxytocine dose : - Group 1 (n = 43): 10 IU + 25 IU IVD in 500 ml of serum / 3h - Group 2 (n = 44): 5 IU IVD + 25 IU in 500 ml serum / 3h. Results The variation of the heart rate and the incidence of low blood pressure were significantly greater for Group 1. No significant differences between the two groups regarding blood los...
Objective: To test the hypothesis that compared to single layer continuous uterine suture (SLCUS)... more Objective: To test the hypothesis that compared to single layer continuous uterine suture (SLCUS), a double layered purse string uterine suture (PSUS) significantly reduces cesarean scar defect (CSD) rates, without increasing the perioperative maternal morbidity. Design : Interventional prospective, randomized study . Setting: University obstetric units in Tunisia. Population: 100 pregnant women with an indication of a planned Caesarean. Methods: Patients were enrolled in 2 groups according to the uterine suture technique: SLCUS or PSUS. A Saline infusion hysterosonography was performed by the same senior obstetrician blinded to the uterine suture technique 6 months after surgery . Main Outcome measures: Operative time and Calculated blood loss (CBL) were used for the short time analysis . Uterine and CSD measurements were used for the mid time analysis . Results : Despite a few minutes longer operative time in SUS group (7.17 ± 2.31 min Vs. 6.31 ± 3.04 min, p = 0.028 in SLCUS group...
International Journal of Gynecology & Obstetrics, 2019
The French ambulatory cesarean technique was safe and successful. Operative time was longer, but ... more The French ambulatory cesarean technique was safe and successful. Operative time was longer, but maternal condition was improved as compared with a standard cesarean procedure.
Pan African Medical Journal, 2019
The severe hypertriglyceridemia during pregnancy is a rare condition. It is a problem for diagnos... more The severe hypertriglyceridemia during pregnancy is a rare condition. It is a problem for diagnostic, prognostic and therapeutic. This dyslipidemia benefit from specific and effective treatments, but it is still poorly codified. Dietary is still the essential therapeutic, but fetal extraction should also be considered if the gestational age permits. Post-partum monitoring is required but etiologic thorough is not recommended if the triglycerides rate normalizes. The major complication of hypertriglyceridemia should be actively sought because of important maternal mortality rate.
Cahiers de Santé, 2008
La trisomie 21 (T21) ou syndrome de Down est l’anomalie chromosomique congenitale la plus frequen... more La trisomie 21 (T21) ou syndrome de Down est l’anomalie chromosomique congenitale la plus frequente chez l’homme. Les signes cliniques sont actuellement bien connus. Les moyens de depistage antenatal de la T21 se sont nettement ameliores depuis une vingtaine d’annees.ObjectifIl s’agit de rapporter notre experience en matiere de depistage antenatal de la T21 en evaluant les moyens utilises et les resultats obtenus.Materiel et methodesIl s’agit d’une etude retrospective menee sur quatre ans. Nous avons evalue les circonstances de diagnostic antenatal de T21. Nous avons adopte une strategie de depistage sequentielle.ResultatsNous avons collige 22 cas de T21 durant la periode d’etude. La prevalence totale de la T21 etait de 0,98 ‰ grossesses. Le diagnostic de T21 a ete pose en antenatal chez 13 patientes. Une patiente regulierement suivie dans notre unite a echappe au diagnostic. Les signes echographiques ont constitue le principal motif ayant mene au diagnostic de T21. Le terme moyen de diagnostic etait tardif : 21 semaines d’amenorrhee (SA).ConclusionLa T21 est generalement mal acceptee tant sur le plan social que familial, et ce d’autant plus il n’existe pas de centres specialises pour la prise en charge des enfants trisomiques en Tunisie. L’etablissement d’une strategie de depistage antenatal de la T21 est necessaire afin d’esperer reduire le handicap. Il faudrait commencer par generaliser l’echographie du premier trimestre avec mesure de la clarte nucale (CN). En meme temps, le dosage des marqueurs seriques devrait pouvoir etre propose a toutes les patientes. Le diagnostic prenatal permet actuellement de depister precocement les anomalies et malformations fœtales. S’il existe une demande du couple d’interrompre la grossesse a risque, le comite d’ethique local se reunit, discute le cas et autorise l’interruption de grossesse si les anomalies ou le risque d’handicap sont juges importants. Le calcul du risque integre permettra sans doute de reduire le recours aux amniocenteses systematiques indiquees si l’âge maternel est avance.
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, 2017
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016
following the introduction of the WC to NHS Lothian. We specifically evaluate the effectiveness a... more following the introduction of the WC to NHS Lothian. We specifically evaluate the effectiveness and acceptability of the WC, as well as the impact on surgically managed cases of vulval abscesses/cysts. Methods: We performed a retrospective audit of all identifiable cases of Bartholin's and vulval abscesses/cysts between June 2014 and June 2015. Cases were identified from completed proforma sheets, theatre coding and the gynaecology triage attendance diary. Following insertion of a WC, women were followed up by telephone within 23-25 days. The catheter is left in for a maximum of 4 weeks. The outcomes audited included appropriate use and completion of the proforma sheet, patient satisfaction, recurrence rates at 6months and need for theatre. We reviewed theatre cases separately and compared the numbers, average theatre waiting time and duration of hospitalisation before and after the introduction of the WC. Results: In RIE, fifty-six case notes were reviewed. 79% had WC insertion, 18% had marsupialisation and 3% were conservatively managed. One patient had surgical excision of the Bartholin's gland. The proforma was appropriately completed in 79% of cases. All women fitted with a WC were followed up within 23-25 days. Patient satisfaction rates were 84%. There were two cases of recurrences at 6 months. Before the introduction of the WC 43 women were managed surgically. Majority of these were done as emergencies. The average theatre waiting time was 5 days. In contrast, following the WC, only 11 cases were taken to theatre. This represented a 73% reduction in the number of theatre cases. At SJH, twenty-two case notes were reviewed. 32% had WC insertion, 32% had marsupialisation and 14% were conservatively managed. There were no recurrences at 6months It was difficult to access patient satisfaction at SJH as there was relatively poor proforma completion. However, following the introduction of the WC the number of theatre cases fell by an impressive 56%. Conclusion: The WC is a safe, effective and acceptable option in the management of vulval abscesses/cysts. It has the added benefit of reducing the pressure on theatre space and hospital inpatient beds.
Ultrasound in Obstetrics & Gynecology, 2017
Objectives: International guidelines suggest that a temperature increase of 4 • C for more than 4... more Objectives: International guidelines suggest that a temperature increase of 4 • C for more than 4 minutes can be dangerous for the fetus. For endocavitary examinations, self-heating of the probe plays a significant role, but this effect is not considered in calculating the thermal index. We measured the temperature rise at the probe surface during 23 transvaginal scans, to assess the thermal hazard in clinical practice and to sample data on scan duration and temperature increase for standard examinations. Methods: We monitored the temperature variations using 75μm fine wire K-type insulated thermocouples, mounted on the tip of the probe. The absence of artefacts due to the sensor was verified. 23 scans (16 for obstetrics and 7 for gynecology) were performed in the Obstetric Ultrasound department at a large maternity unit in London. Samsung WS80 + V5-9 and GE VolusonE8 + RIC5-9D were used. Colour flow mode was employed in approximately 70% of the scans. Results: The average duration of the scans was 7 minutes 15 seconds (minimum 3, maximum 18 minutes. The majority of the scans last around 4 minutes. The average peak temperature was 36.3 • C, minimum 34.1 • C, maximum 38 • C, with most of the scans showing a value around 37.5 • C, with no significant difference between the machines. For 20 cases, the highest temperature was seen at the end of the ultrasound examination, however in some cases temperature peaks were observed, likely caused by mode change a variation of the operating parameters. Conclusions: The measured temperature never approached the values reported as hazardous in the international standards. For an average body temperature of 36.5 • C, the most frequent temperature rise was around 1 • C. Results of duration and maximum temperature are in line with previous studies. Further investigations will match the modes used of the ultrasound equipment with the corresponding temperature variations.
Journal of Obstetrics and Gynaecology, 2017
Revue d'Épidémiologie et de Santé Publique, 2017
Background.-In Tunisia, the ''Revolution'' of January 2011 highlighted significant regional dispa... more Background.-In Tunisia, the ''Revolution'' of January 2011 highlighted significant regional disparities and social inequalities in access to health care, including reproductive health services. The purpose of this study was to analyze the social determinants of the use of contraception in Tunisia. Methods.-A cross-sectional national study conducted in 2012; on a sample of 15 to 49-year married women (n = 4374) drawn by a two levels random sampling. Prevalence of contraception and its association factors were assessed. Logistic regression was used to evaluate the variation of contraception prevalence with area of residence, age, level of education, number of children and household income. Results.-The prevalence of contraception was 66.4 %. Eighty-two percent of women used a modern contraceptive method. The use of contraceptive methods was significantly dependent on the age (P < 0.001), area of residence (P = 0.008), education (P < 0.001). The prevalence of contraception was higher in North West (OR = 1.1 [0.81-1.5]; P < 0.001), among multiparous women (OR = 4.49 [3.57-5.66]; P < 0.001), among the youngest women (OR = 1.4 [0.9-2,19]; P < 0.001) and among those with higher levels of education (OR = 1.62 [1.19-2.21]; P = 0.008). Conclusion.-Tunisia, precursor Arab country in family planning, is recording a slowdown in the use of contraception in comparison with other countries of North Africa. Social determinants, such as, age, living conditions, area of residence and level of education are indicators to consider when targeting interventions.
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
Le dépistage des aneuploïdies en Tunisie: à quand la généralisation du calcul de risque intégré a... more Le dépistage des aneuploïdies en Tunisie: à quand la généralisation du calcul de risque intégré au premier trimestre ? Aneuploidy screening in Tunisia: when will the generalization of integrated risk-calculation into the first quarter be established ?