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Biomedical subjects

D Cabrol

Publications and source records attributed to D Cabrol.

At least 73 records · Page 4Linked to original sources
PubMed1995

Effects of gemeprost and mifepristone on the mechanical properties of the cervix prior to first trimester termination of pregnancy.

OBJECTIVE: To study the effects of oral mifepristone and vaginal gemeprost on the mechanical properties of the cervix prior to first trimester termination of pregnancy by vacuum aspiration. DESIGN: A comparative study. Each patient served as her own control. SETTING: The Royal Infirmary of Edinburgh, Scotland, UK. SUBJECTS: Forty nulliparous women at six to twelve weeks of pregnancy. INTERVENTIONS: The women received either gemeprost (1 mg) 3 h prior to termination of pregnancy or mifepristone (200 mg) 48 h before operation. MAIN OUTCOME MEASURES: Two different objective methods of assessment of the mechanical properties of the cervix, one measuring the distensibility of the cervix before drug administration and immediately before the operation, and the other measuring the force necessary to dilate the cervix; incidence of new symptoms following drug intake; immediate complications and estimated blood loss. RESULTS: Both treatments significantly increased cervical distensibility. Baseline dilatation was greater in the mifepristone group. The force required to dilate the cervix was significantly reduced in mifepristone-treated patients. There was a good correlation between the two different methods of assessment of the mechanical properties of the cervix only in the gemeprost group. CONCLUSION: Cervagem and mifepristone can be used to increase cervical distensibility. Cervical dilatation is easier with a 48 h regimen of mifepristone than with gemeprost.

Abortifacient Agents, Nonsteroidal↗
PubMed1995

[Manual rotation of vertex presentations in posterior occipital-iliac or transverse position. Technique and value].

OBJECTIVE: Evaluate of the usefulness of manual rotation of occipito-posterior or transverse presentation. DESIGN: One year retrospective study (1991). SETTING: Maternity hospital, Clinique Universitaire Baudelocque. SUBJECTS: All patients during labour having a spontaneous (n = 160) or a manual rotation (n = 368) of an occipito-posterior or occipitotransverse presentation. The manual rotation could be indicated for a fetal distress, a protracted first stage of labour or prophylactically. INTERVENTION: Manual rotation as described by Tarnier, was performed at least at 7 cm cervical dilatation. MAIN OUTCOME MEASURES: Success rate of manual rotation, cesarean section rate, maternal, fetal and neonatal complications.

Adolescent↗
PubMed1995

[Practical use of sulprostone in the treatment of hemorrhages during delivery].

OBJECTIVE: To assess intravenous use of sulprostone (Nalador), a prostaglandin E2 analogue, is case of post-partum haemorrhage due to uterine atonia. MATERIALS AND METHODS: A retrospective study on 315 cases of post-partum haemorrhage (PPH) from 1st January 1990 to 31st December 1992 in Baudelocque maternity. In 91 cases of PPH due to uterine atonia, usual oxytocin drugs were not sufficient and intravenous sulprostone was used. Characteristics of the patients, mode of sulprostone administration, side effects and treatment failures are reported. RESULTS: One or two dose of 500 micrograms were sufficient in 71% cases. Mean perfusion rate was 8.3 micrograms/mn. Success of treatment was 89% with few side effects (5.5%). No serious complication due to sulprostone was observed. Risk of treatment failure was 8.3 times greater when the delay between diagnosis of uterine atonia and sulprostone administration was more than 30 mn. CONCLUSION: Prostaglandins treatment, and particularly sulprostone, could be used more frequently and earlier in case of PPH due to uterine atonia. Further controlled studies are necessary to know if they should be used as a first line treatment instead of oxytocin in this indication.

Adult↗
PubMed1995

[Preliminary study of the use of fetal pulse oximetry during labor].

OBJECTIVE: To assess continuous monitoring of fetal blood oxygen staturation (SpO2) during labour using a fetal pulse oxymeter. STUDY DESIGN: Preliminary results obtained with the Nellcor N-400 fetal pulse oxymeter at the Maternité Port-Royal-Baudelocque between November 1992 and November 1993 in cases of abnormal fetal heart rate are presented. We analyzed: the correlation between SpO2 during labour and cord vein pH as well as Apgar score, the correlation between changes in SpO2, expressed as a desaturation index, and cord vein pH as well as Apgar score. The negative predictive value of oxymetry was assessed. RESULTS: We found a significant positive correlation between the last SpO2 measurement during labour and umbilical vein pH as well as 1 minute Apgar score. We observed a highly significant correlation between the index of desaturation and cord vein pH as well as 1 minute Apgar score. No neonatal pH below 7.20 was observed when SpO2 was > or = 40% during labour. The negative predictive value of oxymetry was 100% in this short series of patients. CONCLUSION: If these results were confirmed in a larger series of patients, a normal SpO2 value during labour could be reassuring in case of abnormal fetal heart rate.

Apgar Score↗
PubMed1994

Fetal pulse oximetry: correlation between changes in oxygen saturation and neonatal outcome. Preliminary report on 39 cases.

Arterial oxygen saturation of the fetus during labour (SPO2) measured with a fetal pulse oximeter was compared to the neonatal condition measured by umbilical vein pH and Apgar score. Changes in oxygen saturation (index of desaturation) during the second stage of labour were also compared to neonatal outcome. Fifty-five patients with abnormal fetal heart rate pattern during labour had a continuous monitoring of fetal oxygen saturation using the Nellcor N-400 pulse oximeter. SPO2 measurement during the last 10 min of labour was significantly correlated to umbilical vein pH and to 1-min Apgar score (P = 0.022 and P = 0.025, respectively). A much higher correlation was found between the index of desaturation and umbilical vein pH at birth and with 1-min Apgar score (P = 0.002 and P < 0.001, respectively). When considering the lower value of umbilical vein pH at birth to be 7.20, and the normal value of SPO2 during labour to be > or = 40% (negative test), we observed a 100% negative predictive value of oximetry. If these results are confirmed in a larger series of patients, analysis of the changes in fetal arterial oxygen saturation during labour (index of desaturation) could be a good indicator of the condition of the newborn. A normal SPO2 value during labour could be reassuring in case of abnormal fetal heart rate.

Apgar Score↗
PubMed1994

[Torsion of the pregnant uterus].

The authors report a case of 180 degrees torsion of the pregnant uterus. Torsion has been defined as a rotation of more than 45 degrees of the uterus around its long axis and is rare in humans. Clinical diagnosis is difficult since symptoms are either absent or non specific (cervical dystocia, painful uterine contractions, dynamic hypertonia...). Uterine torsion is often associated to pathologies of the uterus such as uterine myomas or congenital deformities, abnormal fetal presentations, pelvic tumours or abnormal pelvis. Maternal prognosis is good after surgical treatment, however, perinatal mortality remains high.

Adult↗
PubMed1992

Fetal cerebral blood flow velocity during labour. Preliminary report.

The authors have tried to ascertain in a preliminary study if monitoring of fetal cerebral blood flow velocity during labour could identify a situation threatening the fetal brain, which could justify a compulsory fetal extraction. Nine patients were explored at term during labour. The Doppler signal was recorded using the abdominal route at the level of the fetal internal carotid. The diastolic carotid index was used (DCI = D/S). In 5 cases, fetal heart rate (FHR) was normal during labour and the DCI was on average comparable for each of the patients and the mean DCI (20.1 +/- 1%) was in close agreement with the values normally seen after 33 weeks of amenorrhoea during pregnancy. The case of isolated deceleration shows that deceleration causes an almost instant drop in the telediastolic flux, but the index increases more rapidly than could be expected from the increase in cardiac frequency if this phenomenon were of purely cardiogenic origin. In the case of bradycardia, it was noticed that during the return to the initial FHR frequency, the DCI was much higher than during the measurements performed before bradycardia. In the 1st case of pathological FHR, the index was very high and remained elevated during all the observation period. The fetus presented at birth a normal Apgar score as well as normal blood pH and neurological examination. In the 2nd case of pathological FHR, the FHR was abnormal with decelerations, the DCI increased rapidly and remained high.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1992

[Preliminary study on the variability of the fetal cerebral velocimetry in various vessels of the Circle of Willis].

The authors have tried to analyse in a small series, the possibility as well as the variability of blood flow velocity waveforms in the different vessels of the circle of willis using colour Doppler. Fourteen patients were assessed. The 14 fetuses were of normal growth and/or had normal umbilical arterial blood flow velocity waveforms as well as normal uterine blood flow. The mean term at the time of examination was 23.8 +/- 2.9 standard deviation with the extremes going from 28.5 standard deviation to 40.5. The examinations were carried out using colour Doppler (Acuson) machine by the abdominal route with a 3.5-5 MHz bi-frequency sound. The vessels that were explored were the middle cerebral artery (CM), posterior cerebral artery (CP), the internal carotid artery (CI), the anterior cerebral artery (CA) in the region of the circle of Willis. CM and CA were able to be recorded in 100% of the cases, CP and CI in 93% of cases (13 out of 14 cases). The difference between he mean index (D/S, D = residual velocity in the diastole, S = maximum velocity in the systole) in each of these vessels was not statistically significant. In 3 out of 16 measurements (19%) the CP index was considered to be pathological while the index in the other vessels was normal, or when a different form of measurement was carried out in the region of CP, it was normal. This was also the case once for CA, but never for CM or CI.(ABSTRACT TRUNCATED AT 250 WORDS)

Artifacts↗
PubMed1991

Induction of labor and cervical maturation using mifepristone (RU 486) in the late pregnant rat. Influence of a cyclooxygenase inhibitor (Diclofenac).

The mechanism of action of RU 486 (Mifepristone), an antiprogesterone compound, on labor induction and on cervical maturation, is still not well documented. We have investigated the effect of RU 486, alone and in association with a cyclooxygenase inhibitor (Diclofenac) on the induction of preterm delivery and on concomitant changes in the distribution of cervical glycosaminoglycans (GAGs) in pregnant Wistar rats: a control group (n = 18), a RU 486 treated group (n = 36), and a RU 486 and Diclofenac treated group (n = 15). The results of this study confirm the ability of this antiprogesterone treatment to induce preterm delivery in the rat. This effect was antagonized by cyclooxygenase inhibition, suggesting that the action of RU 486 on labor induction could be mediated by prostaglandins. The absence of an increase in plasma prostaglandin E2 (PGE2) levels in RU 486 treated animals could be explained by local uterine changes in prostaglandin concentrations. Mifepristone also induced some of the biochemical features of cervical maturation (i.e. increased hydration and hyaluronic acid concentration). This effect was not inhibited in Diclofenac treated animals suggesting that factors other than prostaglandins play a role in this phenomenon.

Animals↗
PubMed1991

Prognostic value of cervical distensibility index measurement in the outcome of pregnancies with threatened premature labor.

Threatened premature labor remains a difficult diagnostic and therapeutic problem, and various clinical scores have been designed to evaluate its prognosis. This study presents the use of a cervicotonometer to measure cervical distensibility in 58 women hospitalized for threatened premature labor. This value will be used to determine whether preterm labor is preceded by preterm cervical maturation and thus to assess prognosis. The cervical distensibility index (CDI) obtained with the cervicotonometer was significantly elevated at the time of hospitalization in women who had a preterm delivery when compared to those who delivered at or after 37 weeks of amenorrhea, whereas clinical scores showed no difference between these two groups. No preterm deliveries occurred when the CDI was normal or low at the time of hospitalization. Therefore, CDI measurement, reflecting cervical maturation, seems to be a good prognostic indicator in premature labor.

Anthropometry↗
PubMed1991

Relationship between mechanical properties of the uterine cervix and occurrence of postdate pregnancy.

Postmaturity is associated with an increased risk of fetal distress and of intrauterine fetal death. In order to assess the probability of the occurrence of postdate delivery, we have determined the Bishop score and measured the cervical distensibility index (CDI) using a cervicotonometer in 52 normal pregnant primiparous women between 37 and 40 weeks of pregnancy. 16 out of the 52 patients delivered after 41 weeks. Bishop scores and CDI were significantly lower in women who delivered after term than in those who delivered at or before 41 weeks (p less than 0.05; Student's test). The patients who had both a low Bishop score (less than or equal to 4) and a CDI less than 4 cm.kg-1 delivered after 41 weeks in 73% of the cases. Those who had a Bishop score less than or equal to 4 associated with a CDI greater than 4 cm.kg-1 delivered at or before 41 weeks in 80% of the cases. These results confirm the etiologic role of incomplete cervical maturation in postdate pregnancies. CDI measurement associated with the Bishop score could permit selection of the patients who would benefit from pharmacological cervical ripening.

Anthropometry↗
PubMed1990

Induction of labor with mifepristone (RU 486) in intrauterine fetal death.

In a double-blind controlled multicentric study involving 94 patients with an intrauterine fetal death, we investigated the efficacy and tolerance of mifepristone (RU 486), a steroid compound that antagonizes progesterone action at the receptor level. Success of treatment was defined as the occurrence of fetal expulsion within 72 hours after the first drug intake. Mifepristone treatment (600 mg per day for 2 days) was considered to be effective in 29 of 46 patients (63%). There were only eight successes in 48 patients (17.4%) in the placebo group (p = 0.001, chi 2 test). Tolerance was good in the mifepristone group. In the placebo group, disseminated intravascular coagulation occurred in one woman for whom the investigator waited several weeks for spontaneous expulsion. This large double-blind controlled study provides evidence that mifepristone is of interest in the management of intrauterine fetal death. It could provide a pharmacologic alternative to the use of prostaglandins in this indication.

Adult↗
PubMed1990

Cyclooxygenase and lipoxygenase inhibitors--induced changes in the distribution of glycosaminoglycans in the pregnant rat uterine cervix.

In order to study the hormonal control mechanisms of cervical maturation, we investigated cyclooxygenase and 5-lipoxygenase inhibitors-induced changes in the distribution of glycosaminoglycans (GAG) in pregnant Wistar rat uterine cervices at term. The GAG were measured in a control (n = 11), in a Diclofenac (cyclooxygenase inhibitor) treated group (n = 8), in a BW 755C (dual inhibitor of cyclooxygenase and 5-lipoxygenase) treated group (n = 6), and a L 651392 (5-lipoxygenase inhibitor) treated group (n = 9). The results of these studies suggest, that cervical hyaluronic acid metabolism and cervical hydration are controlled in association by prostaglandins and leukotrienes (and perhaps by other phospholipids metabolites), whereas heparan sulphate metabolism is obviously controlled by prostaglandins. Nevertheless complete and normal cervical maturation is probably controlled in association by arachidonic acid metabolites and other factors (steroids and peptides).

4,5-Dihydro-1-(3-(trifluoromethyl)phenyl)-1H-pyraz↗