- [Show abstract] [Hide abstract] ABSTRACT: Evaluation of amnioinfusion results during labour in case of thick meconial amniotic fluid or in case of oligo-hydramnios associated with variable deceleration of the fetal heart response. Prospective non randomized study. Amnioinfusion was applied to 47 cases of thick meconial amniotic fluid and to 18 cases of variable fetal heart decelerations associated with oligo-hydramnios. Obstetrical and neonatal data were compared with a similar group without amnioinfusion (n = 32). Comparing both groups shows that amnioinfusion offers a better fetal well-being during labour, according to Kreb's fetal heart evaluation during labour (8.53 +/- 1.06 vs 6.56 +/- 0.35--p < 0.01), lows the cesarean section rate (8.5% vs 31.2%--p < 0.01). Amnioinfusion is also associated with a higher Apgar's score at one minute after delivery (9.4 +/- 0.8 vs 8.7 +/- 1.7--p = 0.01) and a lower rate of thick meconium inhalation (13.7% vs 40.7%--p < 0.01). There was no difference for children's first days of life. We found no serious complication following amnioinfusion. We confirm general agreement about amnioinfusion, according to international literature. Amnioinfusion needs an acute care to prevent classically described complications. In case of thick meconial amniotic fluid or variable decelerations associated with oligo-hydramnios, amnioinfusion during labour offers a better fetal well-being.
- [Show abstract] [Hide abstract] ABSTRACT: This report describes a prenatal diagnosis of intraspinal lipoma. This pathology, not well known by obstetricians, forms a part of neural tube defects. Echographic aspect, embryologic origin, differential diagnosis, neurosurgical prognosis and treatment are reviewed and discussed.
- [Show abstract] [Hide abstract] ABSTRACT: Urinary tract infections are common during pregnancy. When unrecognized, they can be responsible for complications such as threatened premature labour and impaired intra-uterine development. Detection and appropriate treatment are thus essential. This article reviews the pathophysiology of urinary tract infections during pregnancy and the three major entities involved--different but related to each other--are detailed (significant asymptomatic bacteriuria or SAB, acute cystitis and acute pyelonephritis), together with their specific treatment. SAB tends to persist during pregnancy, then leading in the absence of treatment to a potentially serious complication (acute pyelonephritis) in approximately one woman in five. SAB should be sought at the first prenatal visit by microscopic and bacteriological examination of a properly obtained urine specimen. Lower genital infections should also be sought and treated, without forgetting to remind the patient of preventive measures (adequate hygiene, sufficient urine output, post-coital micturition, regular bowel habit).
- [Show abstract] [Hide abstract] ABSTRACT: The aim of this retrospective study was to evaluate the characteristics and the requirement for intensive care support of women during pregnancy or post-partum. From their 37 cases, compared to litterature's data, the authors tried to find criteria for admission in an intensive care unit (ICU). These women represented 0.75 % of the admissions in ICU and 0.15 % of the deliveries. They presented essentially with three diagnosis : malignant hypertension (n = 14) often discovered through a complication (86 %), haemorrhages (n = 10) principally with disseminated intravascular coagulation, and severe sepsis (n = 5). The analysed data were : age (26.8 ± 6 years), ICU stay (3.4 ± 4.7 days), Simplified Acute Physiology Score (11.3 ± 4.2), total and daily Omega scores (respectively 36.9 % ± 34.2 and 15.4 ± 7.7), requirement for ventilatory support (31 %) or for central venous catheter (56 %). Compared with an age-matched group of women from the same ICU, neither gravity or total workload were different, but ICU stay was shorter (p < 0.01) and dialy workload higher (p < 0.001). Neonatal mortality occurred in 31 % of these pregnancies. The low incidence of these complications confirm the uselessness of obstetric ICU. Young age, absence of anterior illness and good prognosis despite of fearsome evolution risk, justify an early transfert in non specific ICU. It is impossible to define objective admission criteria.
- [Show abstract] [Hide abstract] ABSTRACT: This study extends a previous study and confirms that the detection of anti-P30 IgA antibodies is very helpful in the diagnosis of acute acquired or congenital toxoplasmosis. Moreover, we demonstrate that an anti-P30 IgA response can be mounted in the fetuses infected by Toxoplasma gondii during their intra-uterine life as early as week 23 of gestation. A double-sandwich ELISA described in our previous work was used to detect anti-P30 IgA antibodies in 1378 human serum samples collected from 551 patients, including 162 fetuses whose mothers had been infected by T. gondii during pregnancy, 46 congenitally infected and 90 uninfected newborns and 253 women suspected of having been infected during pregnancy, including the mothers of fetuses and newborns previously described. Anti-P30 IgA antibodies were detected in all cases of acute toxoplasmosis but in no case of chronic toxoplasmosis: in the majority of cases, the IgA antibody titre fell below cut-off in 3-9 months. Among the 46 congenitally infected newborns, anti-P30 IgA antibodies were detected in sera of 41 infected newborns (38 at birth, two in the first months of life, one in the seventh month of life), while anti-P30 IgM antibodies were detected in only 30 cases at birth and in one case during the first month of life. Among 162 fetuses, anti-P30 IgA response was observed in five infected fetuses, but was not detected in either 152 uninfected fetuses or in five fetuses considered as infected. The absence or presence of anti-P30 IgA antibodies in the fetus is discussed in relation to the date of maternal infection and collection of the fetal blood. It clearly appears from our study that the combined testing of both IgM and IgA in the fetus and the newborn is essential for a more efficient diagnosis of infection.
- [Show abstract] [Hide abstract] ABSTRACT: In 18 women compared with 1,181 controls, foetal digestive tract stenoses were discriminated, independently of the gestational age, by a more than 50 IU/l level of gamma-glutamyl transpeptidase in the amniotic fluid. This test had a specificity of 99% and a sensitivity of 85% which was accounted for by the inclusion in the study of distal stenoses and oesophageal atresias, all conditions where the gamma-glutamyl transpeptidase level is normal. In cases with ultrasonically detected abdominal wall abnormalities, this test is also useful in the diagnosis of subjacent digestive tract stenosis.
- [Show abstract] [Hide abstract] ABSTRACT: Hare-lips and cleft palates are the most frequent manifestations of facial malformations (approximately 1 in 1,000 deliveries). The authors point out their technique for ultrasound assessment of the normal and pathological fetal face in the antenatal period. The antenatal examination gives an excellent diagnostic approach of the site and the nature and the extent of the abnormality. The screening for facial defects can be carried out routinely when studying the morphology in the second trimester of pregnancy or when there are other indications for doing this. Although the malformation is usually an isolated one, the management of these cases really depends mainly on any associated malformations than on the normality of the karyotype.
- [Show abstract] [Hide abstract] ABSTRACT: Amniotic fluid infection and its principal sequel bacterial infection of the newborn are major problems in obstetric pathology. The authors hav analysed prospectively 346 obstetrical casenotes over a period of 18 months in order to try to describe and specify the clinical features and to try and work out using bacteriological tests the risk of infecting the neonate by materno-fetal transmission. They compared a control group (27 case histories) and the group at risk (235 cases). 4% of the control group and 18.7% of the "at risk" group were biologically infected (p less than 10(-2)). The following are among the classical clinical criteria to correlate this risk: maternal pyrexia, premature delivery, urinary tract infections and fetal distress; an apparent lessening in active fetal movements is also well correlated to the risk of infection. The bacteriological criteria are: the presence of quantities of altered polymorphonuclear cells in the amniotic fluid--this seems to be more important than others (sensitivity = 70%, specificity = 89%, but positive predictive value = 60% and negative predictive value = 93%). From this study it should be possible to work out antenatally whether the newborn baby will be at high risk of developing an infection in order to consider giving antibiotics to prevent materno-fetal transmission.
- [Show abstract] [Hide abstract] ABSTRACT: Measurement, in amniotic fluid, of gamma-glutamyl-transferase (GGT) alkaline phosphatase and of thermostable and thermolabile (TLAP) isoenzyme allows to anticipate the unexpected risk of hyaline membrane disease. ROC method adapted to three ratio of these enzymatic activities shows that TLAP/GGT is the most performant at the level of 0.9 with a sensitivity of 96% and a specificity of 60%.
- [Show abstract] [Hide abstract] ABSTRACT: The Hellp syndrome defined as the association of micro-angiopathic haemolytic anemia, hepatic cytolysis and thrombocytopenia, correspond to a severe form of gravidic toxemia, combined to manifestations of classic-pre-eclampsia. This retrospective study, conducted over 6 years, concerns 9 cases of Hellp syndrome, including 2 occurring during the immediate post-partum. Only cases where this biological triad was obvious and not associated with manifestations of disseminated intravascular coagulation, were considered in this study. In addition to the usual criteria of gravidic toxemia, the early clinical manifestation occur, in this study, between 28 and 38 weeks of amenorrhea and gastrointestinal manifestations are predominant. The physiopathogenic hypotheses of this syndrome remain variable and management varies depending on the authors. Treatment is that of pre-eclampsia. Medical treatments (steroids, heparin, immunosuppressants,...) are discussed, but severe feto-maternal complications require, most of the time, a surgical approach, depending on the number of pregnancies, the obstetrical conditions, the stage of the pregnancy and the severity of the syndrome.
- [Show abstract] [Hide abstract] ABSTRACT: Pelvic ultrasound has become very important in the diagnostic planning of utero-vaginal malformations. Having studies 93 congenital malformations of the utero-vaginal tract, the authors used ultrasound investigations as a first or second line of approach. They are able to describe the way ultrasound can be used for each type of malformation. Ultrasound is undeniably reliable for diagnosing bilateral incomplete aplasia of the uterus; so avoiding the need for laparoscopy. When failure of the uterus to develop on one side occurs it is possible to look for a closed or canalized rudimentary uterine nodule to confirm the diagnosis of a pseudo-unicorn uterus. The diagnosis by ultrasound of a bifid uterus shows up by the appearance of a "V" shape on the bladder. An intra-uterine septum can be diagnosed according to how serious the embryological abnormality is on ultrasound. Similarly the difference between a bicornuate uterus that is really just arcuate or partially septate cannot always be made with ultrasound because the embryological defect is a relatively minor one. Ultrasound examination is able to give a lot of information in diagnosing and calculating how much of the menstrual fluid is held back either on one side or completely. Its value is less when the two sides of the uterus communicate with one another. Although this way of examining patients may make it possible quite often to avoid carrying out hysterosalpingogram and laparoscopy, its greatest value is found when all methods of diagnosis are combined and interpreted in the context of a clinical situation.
- [Show abstract] [Hide abstract] ABSTRACT: A multicenter study was able to utilize 120 medical files of children born from mothers who presented an abnormal thyroid function, 67 euthyroid goiters, 29 hyperthyroidisms, and 24 hypothyroidisms. In the first case, whether or not an inhibiting treatment was initiated, all children were perfectly normal. In case of maternal hyperthyroidism, the risk of malformations is not increased, deaths in utero and mostly in utero growth delays (1 case in 2) are more frequent. At birth, the child may present a hyperthyroidism due to the effect of SAT with elevated TSH and a goiter, sometimes compressing and impairing breathing, or also a hyperthyroidism due to transplacental crossing of stimulating immunoglobulins with possibility of thyreotoxic crises and heart failure. The diagnosis could be made in utero in the presence of tachycardia or with T4 and TSH assays in the cord. In case of maternal hypothyroidism, usually the children have no problems and the risk of neonatal hypothyroidism is mostly present in premature infants if the maternal balance is poor (2 in 24 cases in our series). Finally, in the reference population, the risk of neonatal hypothyroidism remains 1 in 3600 and justifies systematic screening on the 5th day of life.
- [Show abstract] [Hide abstract] ABSTRACT: The computerized obstetrical record of the North-Pas-de-Calais region proceeds from the desire of a number of people from the Regional Health Observatory, to dispose of a prospective epidemiologic tool in the field of perinatology. The objective is a better knowledge of the cause of perinatal death, analyzing the modalities of prenatal monitoring, delivery conditions, transfer of the newborns, as well as socio-economical conditions. The program manages the computerization of a usual obstetrical file, in the region, including approximately 200 items and allowing every possible comparison with the well-known CCIM record. The program permits local treatment of the data (statistical calculations) in each maternity hospital: rapid transmission of information between maternity and correspondents (computerized personalized mail), a base of agreement between the different protagonists: midwives, pediatricians, specialists, an easier collaboration with the protection agencies and, especially, the Regional Direction of Sanitary and Social Affairs, with automatic response to hundreds of questions of the yearly questionnaire, which saves a great deal of time and an extreme reliability of the information. This program is compatible with any IBM PC microcomputer and includes a hard disk of 10 or 20 mega-octets. The current price (microcomputer with hard disk, monitor, keyboard, letter-quality printer, management program) make all these performances available at a relatively low expense, under 25,000 francs (not including the tax).
- [Show abstract] [Hide abstract] ABSTRACT: A combination of an extra-uterine and an intra-uterine pregnancy is defined as heterotopic twin pregnancy. A case is reported where the 2 infants were born alive and have had a normal psychomotor development at 3 years of age. It is a case where the first observation taken by ultrasound made the diagnosis possible at 27 weeks of the pregnancy and therefore gave rise to the crucial problem of how to manage the case. Because of this case history we have discussed the frequency (one in every 30,000 pregnancies), the aetiological factors, the clinical factors, the prognostic factors and what is to be done. The discussion takes note of the modern ways of diagnosing it (ultrasound), of monitoring it and of handling in a specialised unit this exceptional kind of "high risk" pregnancy.
- [Show abstract] [Hide abstract] ABSTRACT: Colonization of the gastrointestinal tract in newborns delivered by Cesarean section occurs during the first days of life by bacteria provided by the environment. It is more rapid in breast-fed infants than in bottle-fed babies. The intestinal flora is more diversified if the infants receive formula feeding. The first bacteria encountered are facultative anaerobes; they remain predominant during the first two weeks of life. In comparison to vaginal delivery, there were low levels of strict anaerobes after Cesarean section; members of the Bacteroides fragilis group were still completely lacking after 14 days of life and Bifidobacteria were only isolated sporadically.
- [Show abstract] [Hide abstract] ABSTRACT: Neopterin and biopterin concentrations were measured in amniotic fluid in 226 pregnancies from the 12th week of gestation to term. At mid-gestation, neopterin and biopterin levels were low and remained relatively constant between 12 and 26 weeks of gestation, whereas during the third trimester, a progressive increase was observed. Near term the values were greater than those in maternal serum and the higher neopterin to biopterin ratio suggested that pteridine concentration in amniotic fluid may reflect the maturation of pteridine metabolism in the fetus.
Hôpital Saint PhilibertЛомм, Nord-Pas-de-Calais, France