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ABSTRACT: Fetal brain tumors are rare and have different histologies. Although the definitive diagnosis relies on the histopathology of the tumor, it is useful to distinguish the tumors potentially curable from the tumors rapidly fatal after birth. Nevertheless, some intracranial masses are not tumors. We report four cases of intracerebral masses diagnosed prenatally corresponding to different histological lesions: teratoma, fetus-in-fetu, chraniopharyngioma, hemangioma. We discuss the elements of the differential diagnosis, which can be identified prenatally.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 01/2013; · 0.42 Impact Factor
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ABSTRACT: The objective of this study was to identify factors associated with favourable perinatal outcome after emergency cervical cerclage during mid-trimester of pregnancy.
This is a retrospective study of all cases who underwent emergency cervical cerclage between 16 to 28 weeks of gestation (WG) over a period of 16 years in a University Hospital.
Among the 32 cases, the postnatal survival rate (day 28) was 80%. Delivery occurred at a mean gestational age of 33.1 WG [18-41.3 WG] and after 37 WG in 39% of cases. The perinatal outcome was improved by absence of bleeding (P=0.01), unripened cervix (P=0.02), cervical dilatation below 2 cm (P=0.002), no protruding membranes (P=0.02) and more advanced gestational age at the procedure (P=0.005). When no uterine contraction and no maternal blood inflammation were observed at admission, an expectancy of 48 hours before the procedure did not improve significantly perinatal outcome (gestational age at birth and survival rate [P=0.1 and P=0.3 respectively]).
Perinatal outcome after emergency cerclage depends on cervical status and gestational age at procedure. It is not influenced by an expectancy of 48 hours before intervention for patients with no uterine contraction and no maternal blood inflammation at admission.
Gynécologie Obstétrique & Fertilité 08/2011; 39(11):609-13. · 0.52 Impact Factor
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D Gallot,
C Bonnefoy,
P Blanc,
K Coste,
A Delabaere,
P Dechelotte, H Laurichesse-Delmas,
A Labbe,
B Jacquetin,
D Lemery,
V Sapin
Ultrasound in Obstetrics and Gynecology 07/2011; 38(1):119-20. · 3.01 Impact Factor
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A Delabaere,
M Accoceberry,
J Niro,
L Velemir, H Laurichesse-Delmas,
K Coste,
B Bœuf,
A Labbe,
B Storme,
D Lemery,
D Gallot
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ABSTRACT: Our objective was to report perinatal outcome during the first three years of an emerging centre for laser photocoagulation in twin-twin transfusion syndrome (TTTS) and to compare with outcome observed earlier in the same centre when management consisted in recurrent amniodrainage.
We conducted a single centre retrospective study. We compared perinatal outcome of 19 consecutive cases of mid trimester TTTS managed by amniodrainage over a 10-year period with 49 cases of TTTS managed by laser photocoagulation over a 3-year period.
Laser photocoagulation increased survival rate at birth (P=0.02) and at postnatal day 28 (P=0.01). Neurologic and cardiologic complications did not differ significantly (P=0.5 and P=0.3 respectively). We observed a significant increase in survival of the donor after laser coagulation at birth (P=0.04).
Our study demonstrated better outcome after laser photocoagulation. Early results of an emerging centre appeared comparable to those of more experienced centres.
Gynécologie Obstétrique & Fertilité 05/2011; 39(9):482-5. · 0.52 Impact Factor
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ABSTRACT: Ballantyne's syndrome also known as Mirror syndrome is the association of fetal hydrops and maternal hydric retention. The maternal condition is often misdiagnosed as preeclampsia. We report two cases of Ballantyne syndrome associated with materno-fetal Parvovirus B19 infection. In the first case, the syndrome occurred at 26GW in a context of premature rupture of membranes. Parents and medical staff opted for termination of pregnancy because of the poor fetal prognosis. Maternal symptoms regressed after delivery. In the second case, the patient presented a Ballantyne's syndrome at 25GW. Intrauterine transfusions reversed symptomatology. Fetal hydrops of any etiology can be associated with this syndrome. Specific treatment of the fetus can avoid maternal complication allowing continuation of the pregnancy.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 01/2011; 40(3):262-6. · 0.42 Impact Factor
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C Bonnefoy,
P Blanc,
K Coste,
A Delabaere,
P J Dechelotte, H Laurichesse-Delmas,
A Labbe,
B Jacquetin,
D Lemery,
V Sapin,
D Gallot
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ABSTRACT: We report three cases of fetal lobar bronchial atresia referred to our Fetal Medicine Center during the mid-trimester of pregnancy over the last 15 years. Lobar bronchial atresia can mimic a main stem bronchial atresia on mid-trimester ultrasound examination as it induces extensive lobar enlargement, major mediastinal shift and eversion of the diaphragm. It was associated with severe pulmonary hypoplasia in all three cases, even though polyhydramnios and ascites were absent in two. Termination of pregnancy was performed at parental request after extensive counseling in each of the cases and necropsy confirmed one or two enlarged lung lobes leading to major compression of the remaining lobe(s) of the ipsilateral lung, the contralateral lung and the heart. No other anomalies were observed and the karyotype was normal in all cases.
Ultrasound in Obstetrics and Gynecology 09/2010; 37(1):110-2. · 3.01 Impact Factor
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A. S. Gremeau,
K. Coste,
P. Blanc,
C. Goumy,
C. Francannet,
P. J. Dechelotte,
P. Vago, H. Laurichesse-Delmas,
A. Labbe,
D. Lemery,
V. Sapin,
D. Gallot
Prenatal Diagnosis 05/2009; 29(8):816 - 818. · 2.11 Impact Factor
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Gynécologie Obstétrique & Fertilité 12/2008; 36(12):1245-7. · 0.52 Impact Factor
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M Durand,
K Coste,
A Martin,
T Scheye,
I Creveaux,
P Vanlieferinghen, H Laurichesse-Delmas,
P J Dechelotte,
A Labbe,
B Jacquetin,
D Lemery,
D Gallot
Prenatal Diagnosis 10/2008; 28(10):973-4. · 2.11 Impact Factor
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H Laurichesse Delmas,
N Winer,
D Gallot,
K Lopes,
F Perrotin,
S Fluncker,
F Geissler,
A M Beaufrere,
F Vendittelli,
C Couture,
D Lemery
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ABSTRACT: To describe and assess the sonographic findings, evolution and clinical implications of thrombosis of the fetal dural sinuses.
We compiled a multicenter report of the outcomes of five cases with a prenatal diagnosis of thrombosis of the dural sinuses, and one case in which thrombosis of the dural sinus was diagnosed at necroscopy after termination of pregnancy. Prognostic factors are discussed, and suggestions made for prenatal and postnatal management.
The mean (range) gestational age at diagnosis of thrombosis of the dural sinuses in the five cases in which it was made prenatally was 25.2 (22-31) weeks. In these five cases, diagnosis was made by sonography and confirmed by magnetic resonance imaging (MRI), which showed a blood clot in the region of the torcular herophili. Three of the six cases delivered vaginally with favorable sonographic findings, and normal clinical neurological development. Two pregnancies were terminated at the request of the parents. In one of these cases the prognosis was poor, with signs of fetal decompensation or cardiac failure; the pregnancy was terminated and necropsy revealed thrombosis of the occipital dural sinuses associated with a hemangioma. One infant, in whom the thrombosis developed in conjunction with a dural sinus malformation, died at 4 months of age.
Thrombosis of the cerebral venous circulation can occur antenatally and is detectable by fetal real-time and color Doppler ultrasound examination. A review of the literature supports targeted evaluation of the fetus by serial ultrasound imaging and MRI to help guide the diagnosis, and to improve the counseling and management of such cases. Partial or total regression, isolated abnormality, absence of fetal decompensation or signs of cardiac failure and favorable clinical evolution are suggestive of favorable prognosis. In such cases, non-interventional neonatal management is recommended.
Ultrasound in Obstetrics and Gynecology 07/2008; 32(2):188-98. · 3.01 Impact Factor
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ABSTRACT: Lobar congenital emphysema is a rare pulmonary malformation corresponding to progressive overinflation of a pulmonary lobe secondary to partial bronchial obstruction. Prenatal diagnosis is mainly based on lung hyperechoic area. Sonographic features are not specific highlighting the interest of fetal MRI or postnatal tomodensitometry. This case report describes prenatal detection including pitfalls and postnatal management.
Gynécologie Obstétrique & Fertilité 06/2008; 36(5):529-31. · 0.52 Impact Factor
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Ultrasound in Obstetrics and Gynecology 05/2008; 31(4):479-81. · 3.01 Impact Factor
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E Lagrange,
M Ab der Halden,
S Ughetto,
C Boda,
M Accoceberry,
C Neyrat,
C Houlle,
F Vendittelli, H Laurichesse-Delmas,
B Jacquetin,
D Lémery,
D Gallot
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ABSTRACT: To investigate the influence of obstetrician and patient respectively on mode of delivery in case of breech presentation at term.
This retrospective study included all women with a singleton pregnancy in a breech presentation delivered at term in a tertiary care maternity unit from January 1998 to December 2004. Mode of delivery was suggested by a score based on maternal age, parity, obstetrical past history, radiopelvimetry and cephalopelvic confrontation. The obstetrician was free to follow or not the score indication and patient's informed consent was required concerning the mode of delivery. Our main outcome measurements were mode of delivery and neonatal parameters.
Two hundred cases were identified. Elective cesarean section increased progressively (from 52% in 1998 to 80% in 2004 [P=0,002]). Neonatal status and proportion of score in favour of vaginal birth remained stable during the study period. The rise in cesarean section rate was mainly due to patient's request (P=0,001) whereas the trend of obstetrician in favour of cesarean did not reach significance (P=0,3).
The rise of elective cesarean section for term breech delivery in a maternity unit using a predefinite score is mainly induced by patient's request. This evolution has no effect on neonatal status.
Gynécologie Obstétrique & Fertilité 10/2007; 35(9):757-63. · 0.52 Impact Factor
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D Gallot,
C Boda,
S Ughetto,
I Perthus,
E Robert-Gnansia,
C Francannet, H Laurichesse-Delmas,
J Jani,
K Coste,
J Deprest,
A Labbe,
V Sapin,
D Lemery
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ABSTRACT: To describe the true incidence, prenatal detection rate and fetal outcome of congenital diaphragmatic hernia (CDH) in a systematically registered population over an 18-year period and to determine any change in trends over time.
This was a retrospective study of all cases of CDH registered in the Central-Eastern France Birth Defects Registry from 1986 to 2003. All fetuses and infants up to 1 year of age diagnosed with CDH were registered, including miscarriages later than 22 weeks of gestation, stillbirths and terminations of pregnancy (TOP). Routine prenatal screening consisted of three ultrasound examinations and there was no upper limit of gestational age for TOP.
Five hundred and one cases of CDH were identified from a total of 1 835 022 live births (2.7 cases per 10 000 live births). The overall prenatal detection rate was 54%. There was a significant increase over time in the detection rate mainly for associated CDH and left-sided CDH (P < 0.0001), and in the proportion of neonates delivered in tertiary centers (P < 0.0001). The overall survival rate at discharge was 47% and this increased significantly over time for isolated CDH (P = 0.04), whereas it was lower and remained stable for associated CDH (P = 0.64). The TOP rate for isolated CDH did not vary significantly in contrast to that for associated CDH cases in which the TOP rate increased over time, progressively replacing the neonatal death rate (P = 0.01).
Over an 18-year period, this large population-based study demonstrated increasing prenatal detection rates for associated CDH and left-sided CDH and confirmed an increasing survival rate mainly for isolated CDH.
Ultrasound in Obstetrics and Gynecology 03/2007; 29(3):276-83. · 3.01 Impact Factor
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Ultrasound in Obstetrics and Gynecology 08/2006; 28(4):437 - 437. · 3.01 Impact Factor
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Ultrasound in Obstetrics and Gynecology 08/2006; 28(4):566 - 567. · 3.01 Impact Factor
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ABSTRACT: We described a new case of mosaic isochromosome 20q revealed by amniocentesis. The propositus presented with craniofacial dysmorphism, clubfeet, and vertebral abnormalities. A 46,XX,i(20)(q10)[14]/46,XX[1] karyotype was confirmed by FISH on cultured cells. The pregnancy was terminated. From review of literature, fetus with mosaic isochromosome 20q identified on amniocentesis are most likely to be phenotypically and cytogenetically normal after birth. So we performed CGH and array-CGH to exclude another possible imbalance. We discuss here the possible relation between this chromosomal abnormality and the abnormal phenotype.
Prenatal Diagnosis 09/2005; 25(8):653-5. · 2.11 Impact Factor
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Ultrasound in Obstetrics and Gynecology 04/2005; 25(3):308-9. · 3.01 Impact Factor
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ABSTRACT: To compare the mode of delivery in two groups of patients selected by their response after induction of labour with mifepristone.
We studied retrospectively 89 cases of labour induction with viable children after 41 weeks of gestation. Bishop scores were less than 6. Patients were given 200 mg of mifepristone per day for 48 h. They were retrospectively divided into group 1 (spontaneous onset of labour or premature rupture of membranes before the third day) and group 2 (not in labour by that date).
The mean Bishop score at inclusion was 3.1 +/- 1.3. Among the 51 patients (53.9%) in group 1, one required prostaglandins and we performed 10 cesarean sections. In group 2, the mean Bishop score at the 3rd day was 4.4 +/- 1.3 (P < 0.0001). Twenty-four patients required prostaglandins (P < 0.0001) and we performed 17 cesarean sections (P = 0.01). The number of cesarean sections increased with the dose of prostaglandins (P = 0.025). We observed no maternal or fetal complications.
Mifepristone was successful in inducing labour spontaneously in over 50% of pregnancies after 41 weeks of gestation. In the other group, the probability of vaginal delivery was reduced especially when high doses of prostaglandins were required. After the use of mifepristone, we suggest to shorten the duration of prostaglandin administration (two applications of 2 mg dinoprostone) before performing cesarean section.
Gynécologie Obstétrique & Fertilité 10/2004; 32(9):708-12. · 0.52 Impact Factor
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ABSTRACT: Diffuse chorioangiomatosis is a rare placental pathology characterized by multiple chorioangiomas, inducing a high risk of fetal complications, especially cardiovascular, with a risk of fetal death. The physiopathology is not clearly established but seems to be related with an over-expression of vascular growth factors related to hypobaric-hypoxia. Here, we describe a case of recurrent chorioangiomatosis with fetal demise. No risk factors were identified (high altitude, genetic disease like Beckwith-Wiedemann, diabetes). Intra-amniotic, plasmatic values of alphafetoprotein and plasmatic beta gonadotrophin chorionic hormone remained low. Ultrasonographic assessment of placental thickness was in the normal range, at 22 and 32 weeks of gestation. In case of previous chorioangiomatosis, we recommend a weekly sonographic monitoring to diagnose fetal complications associated with an early inpatient hospitalization for daily surveillance at the age of previous accidents. Labor will be induced in case of fetal intolerance or systematically after 37-38 weeks of gestation.
Gynécologie Obstétrique & Fertilité 12/2003; 31(11):943-7. · 0.52 Impact Factor
