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Biomedical subjects

C Tchobroutsky

Publications and source records attributed to C Tchobroutsky.

At least 19 recordsLinked to original sources
PubMed1992

Predictive value of uterine artery velocity waveforms in pregnancies complicated by systemic lupus erythematosus and the antiphospholipid syndrome.

The objective of this study was to see if determination of uterine artery velocity waveforms between 20 and 30 weeks in lupus pregnancy and the antiphospholipid syndrome (APS) have a good predictive value for later fetal distress before labor, intrauterine growth retardation, and preeclampsia. Uterine and umbilical artery blood flow velocity waveforms were determined in 21 pregnancies complicated by systemic lupus erythematosus (SLE): 12 with antiphospholipid antibodies (aPL), 9 without aPL. We also studied 7 pregnancies with APS. This retrospective study was running from January 1st 1986 to July 31st 1991, at the Port-Royal Maternity, Paris, France. Abnormal uterine artery blood flow velocity waveforms were found in 10 out of 28 pregnancies at the first examination performed between 20 and 30 weeks gestational age. All the later adverse fetal and neonatal events were predicted by an abnormal uterine artery blood flow velocity waveform. From the 7 cases of fetal distress diagnosed during pregnancy, 6 were predicted by abnormal uterine waveforms and all of these pregnancies resulted in induced delivery before 32 weeks of gestational age. Twelve pregnancies with aPL and normal uterine artery waveforms were uncomplicated. Only 1 out of 7 pregnancies with abnormal uterine artery waveform and aPL ended without complication. Determination of uterine artery flow velocity waveform is a good adjunct to the management of pregnancies complicated by SLE or aPL. This determination has a better predictive value than the presence of aPL.

Adult↗
PubMed1990

[Obstetric management and delivery in diabetics].

A review of the obstetrical management of diabetic pregnancies is presented. The best way to avoid complications is to achieve the best possible diabetic control. Ultrasonics are able to determine gestational age in the first weeks of pregnancy, to detect fetal malformations and to follow fetal growth. At the end of pregnancy, fetal heart rate monitoring is the golden standard to judge fetal well being. Delivery at term is of paramount importance. The presence of fetal macrosomia is an important parameter of the decision of the mode of delivery.

Congenital Abnormalities↗
PubMed1978

The lecithin/sphingomyelin ratio in 132 insulin-dependent diabetic pregnancies.

A total of 228 determinations of L/S ratios were performed in 132 insulin-dependent diabetic pregnancies. A declining L/S ratio was observed in 6 per cent of the cases without adverse effects on the fetus. No significant difference in the percentage of mature L/S ratios by weeks of pregnancy was found in the different classes of diabetes. An immature L/S ratio was associated with a significant increase of low Apgar scores. At each stage of pregnancy, there was no significant difference in the percentage of mature L/S ratios according to the sex of the baby nor according to the presence or absence of polyhydramnios. Among the five infants with HMD two had a mature L/S ratio within 2 days of birth. This represents 3 per cent incidence of false-positive results. Despite this finding, we feel that the determination of L/S ratio is a useful advance in the management of diabetic pregnancies.

Amniotic Fluid↗
PubMed1977

Fetal breathing and adaptation to maternal hemorrhage in the sheep.

The effect of maternal hemorrhage in chronic preparations was studied on fetal lambs in the last month of gestation. Fourteen to 20 per cent of maternal blood was estimated to have been removed within 30 minutes, which resulted in a drop of 30 per cent of mean maternal arterial pressure. A fetal bradycardia started 28 +/- 13 minutes after the beginning of maternal hemorrhage. It lasted 30 +/- 15 minutes and was concomitant with a rise in fetal arterial pressure. It was followed by a long-lasting fetal tachycardia of 130 +/- 38 minutes and was corrected only by reinfusion of blood to the mother. The fetal blood gases demonstrated a mild asphyxia with a persistent metabolic acidemia until reinfusion of blood to the mother. Maternal and fetal plasma cortisol levels rose significantly at the end of the hemorrhage. Tracheal fluid flow did not change. Fetal breathing recorded 20 hours before and 24 hours after the experiment did not show consistent changes, but during fetal bradycardia there was no fetal breathing. Recent clinical investigations in this field have been made in the human fetus to estimate standards of fetal well being. These peculiar animal experiments do not show any significant improvement by recording fetal breathing over the recording of prelabor fetal heart rate.

Adaptation, Physiological↗
PubMedDate not supplied

[The lecithin-sphynogomyelin ratio in the amniotic fluid in insulin dependent diabetic pregnancies].

A delay in the pulmonary maturation of the foetus of diabetic mothers assessed by the lecithin-sphingomyelin (L/S) ratio has been reported (2, 3, 5). A suggestion has been raised that the results of the L/S ratio should be viewed with caution in predicting lung maturity in pregnancies complicated by maternal diabetes (8). We report our findings on 52 insulin-dependent diabetic pregnancies which involved 90 estimations of the L/S ratio on the amniotic fluid. In all cases, the L/S ratio accurately reflected lung maturity, as no hyaline membrane disease (HMD) was observed with a L/S ratio greater than 2. There was no significant difference in the proportion of mature fetal lung between insulin-dependent diabetics and controls for each week of pregnancy between 32 and 38 weeks. There is no statistical difference in the mature L/S ratio between classes B + C and D + F diabetics.

Amniotic Fluid↗
PubMedDate not supplied

Risk/benefit ratio of changing late obstetrical strategies in the management of insulin-dependent diabetic pregnancies. A comparison between 1971-1977 and 1978-1985 periods in 389 pregnancies.

We compared the results of 166 pregestational insulin dependent diabetic pregnancies in the period 1971-1977 to those of 223 in the period of 1978-1985, after the introduction of self monitoring of blood glucose. During this second study period late obstetrical strategies changed to prolongation of pregnancy up to term, avoidance of final hospitalization and decrease of the rate of cesarean section. Maternal blood glucose control was less optimal in the second period resulting in a higher incidence of fetal macrosomia. Despite this, unexplained stillbirth disappeared, neonatal morbidity did not change significantly and the overall benefit was a reduction of preterm birth and a better quality of life for our patients. We conclude that the final hospitalization from week 32 onward in insulin dependent diabetic pregnancies is no more mandatory.

Birth Weight↗