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Biomedical subjects

C D'ercole

Publications and source records attributed to C D'ercole.

9 recordsLinked to original sources
PubMed2005

[Instrumental extraction with Thierry's spatula: 166 cases].

OBJECTIVES: To describe the frequency of maternal and neonatal complications resulting from the use of Thierry's spatulas. MATERIALS AND METHODS: This retrospective study included 166 patients treated during a 17-month period. RESULTS: For 100% of the patients, the use of the spatulas allowed the extraction of the new born, in 68 cases (41%) the new born was engaged between one and two centimeters below the spines. A medio-lateral episiotomy was performed in 159 patients (96%). A serious perineal tear (Type 3) occurred for 6 of these patients (3.6%). A simple perineal tear (Type 1) or vaginal tear occurred in 24 (18%). Episiotomy was performed in 18 patients and was significantly protective. No case of serious neonatal complication were related to the use of the spatulas. CONCLUSION: We found that perineal tear rate is similar to that observed with other instruments used for fetal extraction. No case of fetal trauma could be related to the use of the spatulas; this was the goal of Thierry who creation the instrument. The use of Thierry's spatulas as a reference instrument is warranted, particularly for cases of prematurity, as these spatulas fulfil the modern obstetrics requirements of fetal protection, without maternal risk.

Episiotomy↗
PubMed2004

Fetal brain injury.

Improvements in MRI techniques widen the indications for fetal brain imaging and fetal brain injury represents the third indication of fetal brain magnetic resonance imaging (MRI) after the evaluation of suspected central nervous system (CNS) malformations and ventricular dilatation. Optimal MR imaging technique is necessary in order to collect as much data as possible about the fetal brain. Diffusion images can be used routinely in addition to the standard protocol of fetal brain MRI that consists of T1 and T2 weighted images of the fetal brain. Monovoxel proton magnetic resonance spectroscopy can also be performed in utero, but this technique is still more part of research protocol than of routine clinical protocol. Fetal brain injury includes hypoxia-ischemia, congenital infections (especially toxoplasmosis and cytomegalovirus infections), brain damage due to malformation such as vascular brain malformation and heart malformation, pregnancies at risk of fetal brain damage, and even inherited metabolic diseases, especially mitochondrial diseases. MRI findings in fetal brain injury consist of acute or chronic lesions that can be seen alone or in combination. Acute response of the fetal brain is less commonly seen than the chronic response compared to the brain response encountered in the postnatal period.

Brain Injuries↗
PubMed2002

[Tocolysis: indications and contraindications. When to start and when to stop].

Clinical trials have demonstrated that most tocolytic agents such as beta mimetics, atosiban and indometacine -exception made for magnesium sulfate- extend the duration of pregnancy, when compared to placebo. They reduce the rate of delivery at 24 hours, 48 hours and at 7 days. There is no proof however for their beneficial effect on perinatal or neonatal outcomes. Usual obstetrical contraindications of tocolytic treatments (infection, genital haemorrhage, fetal distress and certain maternal conditions) are often determined on a case by case basis, rather than upon evidence based medicine. Tocolysis may be considered in case of maternal infection without chorioamniotitis or during moderate hemorrhage due to placenta preavia (NP 4). There is no objective argument to refute a tocolytic attempt due and in accordance with a low gestationnal age limit. The risk for neonatal respiratory distress syndrome is higher at 34 weeks compared to 35 and 36 weeks. The studies were however realized before the corticosteroid era of fetal lung maturation. There are no available randomized trials concerning the benefits of tocolysis after 34 weeks of amenorrhea. Furthermore, there are no satisfactory trials preconising a specific tocolytic agent based on amniotic liquid study of lung maturity. In case of advanced cervical dilatation, rare studies have concluded the usefulness of tocolysis to allow fetal lung maturation by corticosteroids. Most studies have evaluated the effectiveness of tocolytic treatment during 48 hours. There is no evidence for continuing tocolytic treatment after an effective tocolysis prescribed during the first 48 hours. For intermediate situations, between franc success or failure of tocolysis (such as reduction but persistent painful uterine contractions or major cervical modification at a low gestational age despite reduction of uterine contractile activity), literature guidelines are poorly contributive. The management of such patients is most often empirical.

Clinical Trials as Topic↗
PubMed2001

Vaginal birth following two previous cesarean sections.

OBJECTIVE: To evaluate the management of vaginal delivery among women with two previous cesarean sections. The maternal and fetal morbidities of this attitude were studied. SETTING: University hospital. DESIGN: Retrospective study made over 6 years, from January 1st 1990 to December 31st 1995. PATIENTS: Among 180 patients with two uterine scars, 96 patients with cephalic presentation and normal pelvic dimensions were allowed trial of labor. RESULTS: The rate of vaginal birth following trial of labor was 65.6%. Three patients had an uterine scar dehiscence; among them, one hysterectomy was performed for haemorrhage with uterine atony. Neonatal issue was always favorable. Twenty-two newborns had superior birthweights compared to those born from the preceding cesarean section. CONCLUSION: Trial of labor following two previous cesarean sections is acceptable in the majority of cases. It leads to a high vaginal delivery rate and low maternal and fetal morbidity.

Analgesia, Epidural↗
PubMed2000

Neutrophil activation in preeclampsia and isolated intrauterine growth restriction.

OBJECTIVE: Neutrophils have been implicated in the pathogenesis of preeclampsia. Because preeclampsia and intrauterine growth restriction result from similar placental lesions, the aim of this study was to investigate neutrophil activation in isolated intrauterine growth restriction relative to preeclampsia and uncomplicated pregnancy. Polymorphonuclear neutrophil activation was analyzed by measuring cell surface and soluble cell adhesion molecule expressions. STUDY DESIGN: L -Selectin (CD62L ) and CD11b surface expressions on polymorphonuclear neutrophils were analyzed in 13 women with preeclampsia, 11 women with isolated intrauterine growth restriction, and 17 age- and gestation-matched control women by means of a standardized quantitative flow cytometry assay. Serum levels of soluble L -selectin were measured by enzyme-linked immunosorbent assay. RESULTS: Neutrophils from women with isolated intrauterine growth restriction and women with preeclampsia displayed higher levels of CD11b and lower levels of CD62L than did neutrophils from healthy pregnant women. Soluble L -selectin serum levels were significantly increased in the preeclampsia and intrauterine growth restriction groups relative to normal values. No significant difference in the levels of CD11b, CD62L, and soluble L -selectin were observed between women with isolated intrauterine growth restriction and those with preeclampsia. Leukocyte activation was not correlated with disease severity. CONCLUSION: The observed alteration in polymorphonuclear neutrophil adhesion molecule expressions and increased serum soluble L -selectin levels are consistent with activation of peripheral blood neutrophils occurring in isolated intrauterine growth restriction in a manner similar to that seen in preeclampsia. This evidence of neutrophil activation may help to advance our understanding of the disease process in isolated intrauterine growth restriction.

Adult↗
PubMed2000

[Hormone replacement therapy in menopause and colorectal disease].

Colorectal disease is frequent. Accumulating evidence indicates that postmenopausal hormone replacement therapy may reduce the risk of this pathology in women. Through MEDLINE computer searches, we identified English-language articles with quantitative data on the relation of postmenopausal hormone replacement therapy to colorectal cancers and adenoma. Twenty-four studies about colorectal cancer and five studies about colorectal adenoma were reviewed. Epidemiological data suggest a 20 to 30% reduced risk of colorectal cancer and adenoma among women taking postmenopausal hormones. There is biological evidence to support this association.

Colorectal Neoplasms↗