Main Article Content
Abstract
But : montrer l’intérêt d’une cœlioscopie d’adhésiolyse et de pronostic après traitement médical de la grossesse extra-utérine dans nos contrées.
Matériel et Méthode : il s’agissait d’une étude rétrospective dans le service de gynécologie-obstétrique de l’Hôpital Général de Douala de janvier 1999 à janvier 2008, portant sur des comptes-rendus opératoires bien documentés chez des patientes ayant eu une laparotomie ou une coeliochirugie pour grossesse extra-utérine.
Résultats : 122 patientes ont été incluses dans l’étude. La laparotomie avait concerné 84 patientes (68,85%) et la coeliochirurgie 38 patientes (31,15%). Dans 93 cas (76,22%) nous avions observé des séquelles de maladie inflammatoire pelvienne chronique. Les adhérences annexielles étaient controlatérales à l’ectopique dans 59 cas (48,36%) et ipsilatérales dans 90 cas (73,77 %.)
Conclusion : Une coelioscopie, à visée d’adhésiolyse éventuelle et de pronostic en terme de fertilité ultérieure est indiquée après traitement médical de la GEU dans notre milieu.
Summary
Objective: To illustrate the importance of laparoscopic surgery in the treatment of adhesions and prognosis following medical treatment of ectopic pregnancy in our milieu.
Material and Method: We conducted a retrospective study in the Obstetrics and Gynaecology Service of the Douala General Hospital, from January 1999 to January 2008. Postoperative notes of patients who underwent laparoscopy or laparotomy for ectopic pregnancy were reviewed.
Results: 122 files were included in the study. Laparoscopic surgery was performed on 84 patients (68.85%) while laparotomy was perfomed on 38 patients (31.15%).
Complications of chronic pelvic inflammatory disease were observed in 93 patients (76.22%). Adnexal adhesions were contralateral to the ectopic site in 59 patients (48.36%) and homolateral in 90 patients (73.77%).
Conclusion: Laparoscopic surgery for treatment of adhesions and improvement of fertility outcome is highly recommended after successful medical treatment of ectopic pregnancy.
Article Details
References
- REFERENCES
- - Kouam L, Kamdom Moyo J, Ngassa P, Doh AS, Salihu HM. Management of ectopic pregnancy by laparotomy and subsequent fertility. Journal of Obstetrics and Gynaecology 1998;18(2):169-170.
- - Fernandez H, Lelaidier C, Touvenez V, Frydman R. The use of pretherapeutic predictive score to determine inclusion criteria for the non-surgical treatment of ectopic pregnancy. Hum Reprod 1991;6:995-8.
- - Chow W, Dailin JR, Cates W, Greenberg RS. Epidemiology of ectopic pregnancy. Epidemiol Rev 1987;9:70-94.
- - Bouyer J, Coste J, Shojaei T, Pouly JL, Fernandez H, Gerbaub L, et al. Risk factors of ectopic pregnancy : a comprehensive analysis base on a large case-control population base study in France. Am J Epidemiol 2003;57:185-94.
- - Egger M, Low N, Smith GD, Linblom B, Herman R. Screening for Chlamydia infections and the risk of ectopic pregnancy in a country in Sweden : ecological analysis. Br Med 1998;316:1776- 80.
- - Baron JA, La Vecchia C, Levi F. The antiestrogenic effect of cigarette smoking in women . Am J Obstet Gynecol 1990;162:502-14.
- - Erny R, Ducassou MJ, Garcia M. Grossesses extra-utérines récidivantes. Dans : Progrès en gynécologie grossesse extra-utérine. Paris, Doin Editeurs, 988, pp 85-94.
- - Drolette CM, Badaway SZA. Pathophysiology of pelvic adhesions. J Reprod Med 1992;37:107-121.
- - Berger G, Westrom L. Treatment of ectopic pregnancy after pelvic inflammatory disease. New York, Raven Press 1992, pp 139-162.
- - Lundorff P, Thorburn J, Hahlin M, Kalifelt B, Lindblom B. Laparoscopic surgery in ectopic pregnancy: a randomised trial versus laparotomy. Acta Obstet Gynecol Scand 1991;70:343-8.
- - Pouly JL, Chapron C, Manhès H, Canis M, Wattiez A, Bruhat MA. Multifactorial analysis of fertility after conservative laparoscopic treatment of ectopic pregnancy in a series of 223 patients. Fertil Steril 1991;56:453-60.
- - Rongières C, Kattygnarath V. Grossesse extra-utérine: conséquences pour la fertilité ultérieure et facteurs décisionnels d’une prise en charge en assistance médicale à la procréation. J Gynecol Obstet Biol Reprod 2003;32:3S83-3S92.
- -Murphy AA, Nager CW, Wujek JJ, Kettel MM, Torp VA, Chin HG. Operative laparoscopy versus laparotomy for the management of ectopic pregnancy : a prospective trial. Fertil Steril 1992;57:1180–5.
- – Seifer DB, Gutman JN, Grant WD, Kamps CA, DeCherney AH. Comparison of persistant ectopic pregnancy after laparoscopic salpingotomy for ectopic pregnancy. Obstet Gynecol 1993;81:1180-5.
- - Gray DT, Thorbun J, Lundorff P, Strandell A, Lindblom B. A cost effectiveness study of a randomised trial of laparoscopy versus laparotomy for ectopic pregnancy. Lancet 1995;345:1139- 43.
- - Mboudou E, Ndoumba A, Foumane P, Ze Minkande J, Belley Priso E, Nnang GM, Doh AS. Traitement médical de la grossesse extra-utérine par utilisation de methotrexate intra-musculaire en milieu Africain. J Afr Imag Méd 2007;2(4):234-240.
References
REFERENCES
- Kouam L, Kamdom Moyo J, Ngassa P, Doh AS, Salihu HM. Management of ectopic pregnancy by laparotomy and subsequent fertility. Journal of Obstetrics and Gynaecology 1998;18(2):169-170.
- Fernandez H, Lelaidier C, Touvenez V, Frydman R. The use of pretherapeutic predictive score to determine inclusion criteria for the non-surgical treatment of ectopic pregnancy. Hum Reprod 1991;6:995-8.
- Chow W, Dailin JR, Cates W, Greenberg RS. Epidemiology of ectopic pregnancy. Epidemiol Rev 1987;9:70-94.
- Bouyer J, Coste J, Shojaei T, Pouly JL, Fernandez H, Gerbaub L, et al. Risk factors of ectopic pregnancy : a comprehensive analysis base on a large case-control population base study in France. Am J Epidemiol 2003;57:185-94.
- Egger M, Low N, Smith GD, Linblom B, Herman R. Screening for Chlamydia infections and the risk of ectopic pregnancy in a country in Sweden : ecological analysis. Br Med 1998;316:1776- 80.
- Baron JA, La Vecchia C, Levi F. The antiestrogenic effect of cigarette smoking in women . Am J Obstet Gynecol 1990;162:502-14.
- Erny R, Ducassou MJ, Garcia M. Grossesses extra-utérines récidivantes. Dans : Progrès en gynécologie grossesse extra-utérine. Paris, Doin Editeurs, 988, pp 85-94.
- Drolette CM, Badaway SZA. Pathophysiology of pelvic adhesions. J Reprod Med 1992;37:107-121.
- Berger G, Westrom L. Treatment of ectopic pregnancy after pelvic inflammatory disease. New York, Raven Press 1992, pp 139-162.
- Lundorff P, Thorburn J, Hahlin M, Kalifelt B, Lindblom B. Laparoscopic surgery in ectopic pregnancy: a randomised trial versus laparotomy. Acta Obstet Gynecol Scand 1991;70:343-8.
- Pouly JL, Chapron C, Manhès H, Canis M, Wattiez A, Bruhat MA. Multifactorial analysis of fertility after conservative laparoscopic treatment of ectopic pregnancy in a series of 223 patients. Fertil Steril 1991;56:453-60.
- Rongières C, Kattygnarath V. Grossesse extra-utérine: conséquences pour la fertilité ultérieure et facteurs décisionnels d’une prise en charge en assistance médicale à la procréation. J Gynecol Obstet Biol Reprod 2003;32:3S83-3S92.
-Murphy AA, Nager CW, Wujek JJ, Kettel MM, Torp VA, Chin HG. Operative laparoscopy versus laparotomy for the management of ectopic pregnancy : a prospective trial. Fertil Steril 1992;57:1180–5.
– Seifer DB, Gutman JN, Grant WD, Kamps CA, DeCherney AH. Comparison of persistant ectopic pregnancy after laparoscopic salpingotomy for ectopic pregnancy. Obstet Gynecol 1993;81:1180-5.
- Gray DT, Thorbun J, Lundorff P, Strandell A, Lindblom B. A cost effectiveness study of a randomised trial of laparoscopy versus laparotomy for ectopic pregnancy. Lancet 1995;345:1139- 43.
- Mboudou E, Ndoumba A, Foumane P, Ze Minkande J, Belley Priso E, Nnang GM, Doh AS. Traitement médical de la grossesse extra-utérine par utilisation de methotrexate intra-musculaire en milieu Africain. J Afr Imag Méd 2007;2(4):234-240.