Prenatal diagnosis of congenital megalourethra associated with VACTERL sequence in twin pregnancy: favorable postnatal outcome.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
D Subtil
Publications and source records attributed to D Subtil.
[Antiphospholipid antibodies in HELLP syndrome: clinical and biological study in 68 women].
PURPOSE: Pregnancy complicated by the HELLP syndrome and antiphospholipid syndrome have rarely been reported. We report a study on anticardiolipin antibodies in HELLP syndrome. METHODS: Between March 1996 and September 1999, anticardiolipin antibodies were checked in all women with HELLP syndrome hospitalised in a maternity of the North of France. The women with positive anticardiolipin antibodies were seen month later in a internal medicine department. RESULTS: In the period 68 women with HELLP syndrome were checked for anticardiolipin antibodies. Apl were present in 9 patients (Incidence 42.8/1000 HELLP Year). They persisted after the accident only in 3 patients. Antiphospholipid syndrome was diagnosed in 2 patients, prevalence between the HELLP syndrome for the 42 month period was 0.03. CONCLUSIONS: HELLP syndrome may be a manifestation linked to the antiphospholipid syndrome and may revealed it.
Adult↗
In-hospital mortality of newborn infants born before 33 weeks of gestation depends on the initial level of neonatal care: the EPIPAGE study.
AIM: To determine the relation between the level of initial neonatal care and in-hospital mortality of infants born before 33 wk of gestation in the era of surfactant therapy. METHODS: A 1 y prospective population-based survey was conducted in the north of France, as part of the EPIPAGE (Epidemiologie des Petits Ages Gestationnels) survey. Perinatal data were recorded for 585 very premature newborns transferred to a neonatal intensive care unit in 1997. The relation between the level of the neonatal unit that provided care for the first consecutive 48 h and in-hospital mortality was assessed by multivariate logistic regression, and adjusted for perinatal data and initial disease severity, estimated by the Clinical Risk Index for Babies (CRIB). RESULTS: The average gestational age (mean +/- SD) was 31.6 +/- 0.62 wk in level I, 30.7 +/- 0.21 in level II, 29.9 +/- 0.13 in non-teaching level III, and 29.0 +/- 0.15 in the level III teaching unit (p < 0.0001). The mean in-hospital mortality rate was 8.4% and did not differ by level of care (p(trend) = 0.17). After adjustment for perinatal data and CRIB, however, with the teaching unit as the reference, the risk of death was significantly higher in level I-II units [adjusted odds ratio (ORa) = 7.9, 95% confidence interval (95% CI) 2.2-29.1], but not in the non-teaching level III units (ORa = 0.8, 95% CI 0.3-2.1). CONCLUSION: In-hospital mortality in non-teaching level III units was similar to that in a teaching unit, but significantly higher in level I-level II units. Neonatal care of newborns delivered before 33 wk of gestation should initially occur in level III units.
Female↗
[Comparison of fertility rates after ectopic pregnancy in Auvergne and Lille regions].
OBJECTIVES: Fertility rates after ectopic pregnancy (EP) were compared between the Auvergne region (central France) and the Lille region (northern France) in order to determine whether fertility factors are similar. We also wanted to determine whether regional differences persist if known fertility factors are taken into account. MATERIAL AND METHODS: Data from the Auvergne EP register 1992-1998 (1.285 women, among whom 552 tried to become pregnant again) and from Lille register 1994-1997 (678 women, among whom 343 tried to become pregnant again) were analyzed. Fertility was characterized by the time to a new pregnancy and its outcome (EP recurrence, intrauterine pregnancy (IUP)). Censored data methodology was used. RESULTS: Despite differences in general fertility characteristics between regions, fertility factors were the same with similar relative risks for age, history of infertility, previous tubal damage, use of an intrauterine device at the time of EP and EP treatment. When these factors were taken into account, fertility rate after EP remained significantly better in Auvergne than in the Lille region. CONCLUSION: This common analysis of data from two registers confirms, from a quantitative point of view, the role of the main factors associated with fertility after EP. However, other factors such as EP management or the surgical technique may intervene.
Adult↗
Successful treatment of extremely severe fetal anemia due to Kell alloimmunization.
BACKGROUND: Repeated plasmapheresis was used to prevent fetal death from severe anti-Kell alloimmunization until intrauterine transfusions were feasible. CASE: Repeated maternal plasma exchanges (N = 40) beginning at 7 weeks' gestation were used to treat severe anti-Kell alloimmunization. Ultrasound examination at 19 weeks' gestation revealed diffuse hydrops in this fetus (umbilical venous hemoglobin, 1.2 g/dL), which then required nine intrauterine transfusions through 34 weeks. A healthy 3840-g girl was delivered by cesarean delivery at 36 weeks. Despite aplastic anemia during the first 3 months of life, she is healthy and has no observable abnormalities at age 8. CONCLUSION: A highly aggressive course of plasmapheresis and intrauterine transfusions can successfully treat fetal anemia caused by anti-Kell alloimmunization even when fetal hemoglobin is extremely low.
Adult↗
[Fertility after ectopic pregnancy: the population-based register of the urban area around Lille, Northern France].
The aims of this work were the evaluation of the reproductive outcome after ectopic pregnancy, and the assessment of the role of infertility risk factors and treatment's strategy. All patients in the population-based register of the urban area around Lille, Northern France, were followed-up. 345 women treated between April 1994 and March 1997, who were trying to become pregnant were interviewed by telephone every 6 months and then every year. The cumulative pregnancy rates were calculated by the Kaplan-Meier estimation. Associations between infertility risk factors and intrauterine pregnancy were tested by the logrank test, and by a Cox model for multivariate analysis. The mean duration of follow-up was 22 months, and 228 (66%) women had obtained a new pregnancy at the time of the analysis. 23 (10%) of the first pregnancies were recurrences. For women for whom EP occurred with an IUCD (17 patients), the 1 year intrauterine pregnancy (IUP) reached 67%. For the others, the 1 year IUP rate was 56%, and reached 67% after 2 years. After adjusting factors associated with fertility with a Cox regression, 3 factors seemed to lower reproductive performances: age > 35 years, previous history of infertility, and anterior tubal damage. More than half the women treated for EP obtained spontaneously a normally progressive pregnancy after 1 year. Reproductive performances are associated with characteristics of the patients, but do not depend on radical or conservative treatment.
Adult↗
[Hyperemesis in the first trimester of pregnancy: role of biological hyperthyroidism and fetal sex].
OBJECTIVES: Our objectives were to link hyperemesis gravidarum with biochemical hyperthyroidism and hormonal modification (HCG and estradiol) and to test the hypothesis that biological abnormalities (ionogram and liver enzyme) are more often reported in hyperemesis gravidarum with biochemical hyperthyroidism. STUDY DESIGN: Thirty three patients admitted in "Hôpital Jeanne de Flandre" with hyperemesis gravidarum were studied prospectively. RESULTS: Twenty-two patients (66.7%) had biochemical hyperthyroïdsm (suppressed thyroid stimulating hormone or increased triiodothyronine index or tetraiodothyronine index). Hyperthyroid patients were more likely than euthyroid patients to have abnormal electrolyte levels (16/22 [72.7%] vs 3/1 [27.3%], P < 0.02) or increased liver enzyme levels (8/22 [36.4%] vs 3/11 [27.3%]). The severity of hyperemesis was found to vary directly with the degree of hyperthyroidism. We report a female predominance among the offspring of mothers with hyperemesis gravidarum. CONCLUSION: Our results are suggestive of the involvement of hyperthyroidism and fetal sex in the pathogenesis of hyperemesis gravidarum. Also these hypothesis are not clearly understood, human chorionic gonadotrophin occurred in the two mechanisms.
Adult↗
[Reflections on the use of obstetric echography].
Explore the source record for details and available documents.
Female↗
[Placental chorioangiomas diagnosed during the second trimester of pregnancy: four cases].
Placental chorioangioma is a benign vascular tumor found in about 1% of pregnancies at routine histological examination of the placenta. The large placental tumor may cause serious fetal complications. We report 4 cases of placental chorioangioma diagnosed during the second trimester. Three pregnancies with rapidly growing tumors measuring more than 4 cm led to fetal hydrops and perinatal death despite thoracocentesis and cesarean delivery at 33 weeks (1 case) and repeated amniodrainage (1 case). The only surviving infant presented with a 3.3cm tumor which grew progressively to 8 cm at 38 weeks and did not induce polyhydramnios or hydrops. Although aggressive prenatal management of placental chorioangioma has been reported using amniodrainage, intrauterine transfusions, embolization, or ligation of the tumor vessel supply, prognosis remains poor for large tumors and largely depends on fetal hemodynamic tolerance.
Adult↗
[Prognostic and therapeutic value of biologic signs of infection in the management of preterm labor (amniocentesis excepted)].
During threatened preterm delivery, both general and local signs of infection increase the risks of amniotic infection, premature rupture of membranes, preterm delivery, and neonatal and/or maternal morbidity of infectious origin. Nonetheless, as antibiotics have not been sufficiently studied to be proved of benefit in chorioamnionitis with intact membranes, search for these general (C Reactive Protein, hyperleucocytosis) or cervical/vaginal (Group B Streptococcus, Escherichia Coli, bacterial vaginosis) signs of infection have not been proved to be really necessary. We have to except Group B Streptococcus, which have to be searched during weeks that precede delivery: in those cases where it is shown to be present in the cervix or the vagina, antibiotics must be prescribed during delivery (ANAES recommendation). Finally, it must be emphasized that these recommendations are mainly based on the absence of studies specifically done to prove the benefits or risks of antenatal antibiotics - or fetal extraction - in case of chorioamnionitis with intact membranes. Systematic vaginal and blood samples (CRP, leukocytes, vaginal micro-organisms) would be helpful in determining the appropriate option in those situations.
Amniocentesis↗
Survival analysis of fertility after ectopic pregnancy.
OBJECTIVE: To evaluate the reproductive outcome after ectopic pregnancy and to assess the contribution of risk factors to future fertility. DESIGN: Prospective follow-up in a population-based sample. SETTING: Register of ectopic pregnancies established in an urban area around Lille, France. PATIENT(S): Three hundred and twenty-eight women treated between April 1994 and March 1997 who had not been using an IUCD at the time of the ectopic pregnancy and were trying to become pregnant. INTERVENTION(S): Interviews by telephone every 6 months for 2 years and once yearly thereafter. MAIN OUTCOME MEASURE(S): Cumulative pregnancy rate. RESULT(S): Two hundred fifteen (65.5%) women became pregnant after a mean of 5 months. One hundred eighty-two (84.7%) pregnancies were intrauterine; 22 (10.2%) were recurrent ectopic pregnancies; and in 11 women (5.1%), it was too early to define implantation. The cumulative intrauterine pregnancy rate was 56% at 1 year and 67% at 2 years. After applying Cox regression, three factors associated with fertility seemed to decrease reproductive performance: age > 35 years, history of infertility, and anterior tubal damage . CONCLUSION(S): More than half of the women treated for ectopic pregnancy spontaneously conceived and had a normally progressive pregnancy at 1 year. Fertility depends more on established patient characteristics than characteristics of ectopic pregnancy itself or treatment thereof.
Adult↗
Preclinical phase of polycythemia vera in pregnancy.
BACKGROUND: In some cases, complications of pregnancy are related to thrombophilia. We describe a preclinical phase of polycythemia vera. CASE: A woman, who experienced perinatal deaths in her first two pregnancies, was diagnosed with polycythemia vera during antenatal counseling for a third pregnancy. During this pregnancy, phlebotomies, low molecular weight heparin, and low-dose aspirin treatments resulted in the delivery of a healthy baby. CONCLUSION: Polycythemia vera is a rare condition in women of childbearing age and can exist in a preclinical phase for many years. During pregnancy, it can cause severe but preventable thrombotic complications of placental origin.
Counseling↗
Patient satisfaction with management of ectopic pregnancy.
OBJECTIVES: This study was designed (1) to identify characteristics of patients and their treatment and aspects of care that may be associated with satisfaction, and (2) to investigate the way these factors contribute to the degree of satisfaction expressed after treatment of ectopic pregnancy. Our ultimate goal in so doing was to determine how to improve ectopic pregnancy management. STUDY DESIGN: We used data from a register of ectopic pregnancy established in an urban area (Communauté Urbaine de Lille) in northern France. Two months after ectopic pregnancy, a self-administered satisfaction questionnaire was completed by 192 women treated between January 1995 and July 1996. We searched which factors were associated with satisfaction by a logistic regression model. RESULTS: Greater satisfaction was significantly associated with average education. Women were more satisfied when pregnancy was an expected event, and when fallopian tube was unruptured. Patients satisfied with the way they were received, the comfort, the willingness to listen and provide explanations, were more satisfied overall. Physical pain, anxiety for later fertility, and need of psychological support were associated with lesser degrees of satisfaction. When adjusted for these factors, the following factors remained significant: level of education; conditions of conception; pain; reception and willingness to listen. CONCLUSION: This study should increase awareness amongst health care professionals of the importance of a compassionate approach when dealing with patients following an ectopic pregnancy, since patients value this aspect of care.
Adolescent↗
[Value of fetal fibronectin research for predicting premature delivery].
OBJECTIVE: To estimate the performance of the foetal fibronectin test as a predictor of preterm delivery. PATIENTS AND METHODS: This prospective study concern 61 patients who had a singleton pregnancy between 24 and 36 weeks of gestation and were hospitalized because of a threatened preterm labor without premature rupture of the membranes. For each patient the presence of foetal fibronectin in cervicovaginal secretions was determined with a rapid swab-test. RESULTS: Prematurity rate was 38% (23 patients). In case of positive result, delivery became before 37 weeks in 75% (12/16) against 24% in case of negative result (11/45). The prolongation of pregnancy after the test was on average 21 days in the positive group and 44 days in the negative group. About the prediction of preterm delivery, the results showed a sensibility of 52%, a specificity of 89%, a positive predictive value of 75%, a negative predictive value of 76%. To predict a delivery within the two weeks after the test, the sensibility was 88%, the specificity 83%, and the negative predictive value 98%. CONCLUSION: The presence of foetal fibronectin in cervicovaginal secretions represent an increased risk of preterm delivery, whereas its excellent negative predictive value allow to be reassuring, especially within a period of 15 days.
Adult↗
[An ischemic pulmonary malformation of the surviving fetus occurring after selective embryo reduction in bichorionic pregnancy. Report of one case and literature review].
We describe, to our knowledge, the first case of a pulmonary malformation called acinar dysplasia occurring at a surviving fetus after selective embryo reduction in a bichorionic pregnancy. The chronological and histological observations suggest that this anomaly may be linked with a feticide achieved at 13 week's gestation. Literature review concerning selective embryo reduction shows rare cases of vascular connections in bichorionic pregnancies especially during the first half of gestation, that can explain in part the apparition of survivor's anomalies.
Adult↗
[Trisomy 18: ultrasound aspects. Report of 40 cases].
OBJECTIVE: We describe the different ultrasound findings suggestive of trisomy 18. PATIENTS AND METHODS: We conducted a retrospective study in 40 cases of trisomy 18 diagnosed in the department of obstetrics at the Lille University Hospital between 1988 and 1998. RESULTS: Eighty percent of the women in this series were multiparous. Mean maternal age at discovery of the trisomy as 33.2 years and the mean gestational age was 20.4 weeks. Fifty-five percent of the cases were discovered during the second trimester of pregnancy, 22.5% during the third trimester and 22.5% during the first trimester. One ultrasound abnormality, at least, was detected in 36/40 cases (90%) a percentage that reached 96.8% taking into consideration the ultrasound examinations performed during the second and third trimesters (30/31 cases). The most frequently detected ultrasound abnormalities were: intra uterine growth retardation (IUGR: 50%), poly-hydramnios (42.5%), limb abnormalities (42.5%), cardiac defects (30%), facial abnormalities (37.5%), meningomyelocele (32.5%), digestive abnormalities (32.5%), urinary tract abnormalities (27.5%), lymphangiectasia and cystic hygroma (15%), and single umbilical artery (12.5%). Medical termination of pregnancy (TOP) was performed in 28 cases. There was one spontaneous miscarriage at 8 weeks and one in utero death (IUD) at 39 weeks in a patient who desired to continue her pregnancy. In 6 cases, the issue of the pregnancy was unknown because the patients were lost to follow-up. In 4 cases (10%), pregnancy was continued to delivery of live babies that only survived a few minutes to 7 days. CONCLUSION: The ultrasound signs suggestive of trisomy 18 change according to the term of pregnancy. At the first trimester, most of the signs are nonspecific, such as cystic hydroma or lymphangiectasia, and do not suggest the need for a karyotype. At the end of the second trimester, an association of various signs that alone would not be highly suspect suggest the need for further exploration in search of other signs: early IUGR, associated or not with poly-hydramnios, limb abnormalities, cardiac defects, omphalocele, diaphragmatic hernia, meningomyelocele, enlarged cisterna magna, choroid plexus cysts, single umbilical artery, facial dysmorphism, facial cleft, hydronephrosis.
Abnormalities, Multiple↗
[Hypertension in pregnancy. Diagnosis, complications, treatment].
Explore the source record for details and available documents.
Delivery, Obstetric↗
[Fetal arrhythmias: diagnosis, prognosis, treatment; apropos of 33 cases].
From October 1993 to February 1998, 33 cases of fetal cardiac arrhythmia were investigated by doppler-echocardiography at the Lille infantile and congenital cardiology department. Extrasystolic arrhythmias were the most frequently encountered disorder (25 fetuses, i.e., 76% of cases: 24 instances of extrasystolic auricular arrhythmia and one case of extrasystolic ventricular arrhythmia). They were invariably benign, and apart from one case only required standard monitoring. Tachycardia was observed in 15% of cases (three cases of supraventricular tachycardia [SVT] and two cases of auricular flutter [AF]). In no instance was a cardiopathic syndrome noted. A number of efficient treatments have been described, but the prognosis is often poor in the presence of hydrops fetalis. Direct fetal treatments (cordocentesis) are currently under evaluation, and at present can only be used as a last resort. In our series, one fetus died 15 minutes after transplacental Flecaine (flecainide) administration. Two of the three SVT and the two AF cases were successfully treated. Bradycardia, which was unassociated with extrasystolic arrhythmia, was found in 9% of cases. It is concluded that Flecaine is probably the treatment of choice for supraventricular and ventricular fetal tachycardia, as it has no teratogenic effect and crosses the placenta at a fetal concentration that is 80% of the maternal level. However, the administration of this drug is not without risk. It is known to possess certain negative side effects, and its pharmacological profile and maternal and fetal health risks have not yet been fully investigated. At present, no entirely safe and efficient treatment for fetal cardiac arrhythmia has been found.
Anti-Arrhythmia Agents↗