[The epidemiologists' point of view on medical indications for induced labor].
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Biomedical subjects
Publications and source records attributed to D Subtil.
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A monochorial biamniotic twin pregnancy was uneventful until 24-weeks amenorrhoea when severe donor-recipient transfusion syndrome occurred. Unexpectedly, the situation stabilised spontaneously with regression of amniotic fluid anomalies. Pathology examination of the placenta revealed that a central placental cotyledon had undergone ischaemic necrosis which could have led to interruption of fetal-fetal transfusion at about 23 weeks amenorrhoea.
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The results of bone density of the calcaneum measured with ultrasound in 107 menopaused women were compared with reference values provided by the manufacturer of the Walker Sonics machine and with the results of quantitative densitometry obtained with computed tomography of the calcaneum and lumbar vertebrae. The coefficient of correlation was 0.57 for the calcaneum and 0.45 for the vertebrae and was confirmed by the kappa index which was 0.58 and 0.54 respectively, indicating that bone density measurement with ultrasound attenuation is a simple non-invasive non-radiating technique which is a promising method for exploring osteoporosis in menopaused women.
The aim of this study was to investigate the effect of alcohol and caffeine consumption on birth weight and the possible interaction of these substances with smoking. The sample included 628 women who were interviewed at their first visit to the maternity hospital of Roubaix, France, in 1985-1986. A significant reduction in birth weight was found to be associated with an average daily alcohol consumption of three drinks or more after gestational age, infant sex, maternal age, parity, weight, and height, and cigarette smoking had been controlled for. There was no interaction between smoking and alcohol consumption on birth weight, but a significant relation between alcohol consumption and birth weight was observed among nonsmokers as well as heavy smokers. The relation observed between caffeine and birth weight disappeared after adjustment for smoking. Our results indicate that alcohol reduces birth weight, but do not support the hypothesis of an interaction between smoking and alcohol consumption.
OBJECTIVE: To investigate the fertility of rabbits after tubal injection of methotrexate (MTX). DESIGN: The side of injection of MTX was randomly decided in a prospective experimental trial. PARTICIPANTS: Fourteen female New Zealand White Rabbits were believed to be of normal reproductive status. INTERVENTIONS: Methotrexate or Ringer's solution were injected into the tubes of the rabbits. The nidation index was used to measure the fertility of the animals. RESULTS: The average nidation index of the control tubes was not statistically different of the one of the tubes treated with MTX. CONCLUSION: Tubal injection of MTX has no adverse effect on fertility of rabbits. It seems ethical to investigate tubal injection of MTX as an alternative to laparoscopic management of unruptured ectopic pregnancy in the human.
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STUDY OBJECTIVE: The aim was to determine the relationship between working conditions during pregnancy, women's occupation, and preterm birth. DESIGN: This was a retrospective survey. SETTING: The study was carried out in four public maternity units in France in 1987 and 1988. SUBJECTS: 1949 women were interviewed after the delivery during their stay in hospital. Of these, 1002 held a job during pregnancy, but this report is confined to 875 women who had a single live birth and who had worked for more than the first trimester of pregnancy. MEASUREMENTS AND MAIN RESULTS: Information about social and occupational status was obtained through interviews, and data about gestational length were obtained from medical records. The primary results showed that preterm birth did not vary significantly according to working conditions whereas it differed according to occupational group. CONCLUSIONS: Occupation, but not working conditions, affected the incidence of preterm birth. This result is discordant with other studies which underlined the excess of preterm births among women with strenuous working conditions. Reasons for this discrepancy may include (1) change in perception of "strenuous working conditions"; (2) improved working conditions; (3) the development of "preventive" strategies by pregnant women. Occupation is a more reliable indicator of risk than self described working conditions.
Congenital toxoplasmosis results from foetus contamination by Toxoplasma gondii during pregnancy. It is a frequent and severe condition calling for close monitoring of mothers at risk. During the last decades, numerous advances have been made specially in the antenatal diagnosis. The congenital toxoplasmosis diagnosis relies currently on PCR test of amniotic fluid, with a sensitivity of 80%. More recently, real-time quantitative PCR has been developed to improve toxoplasmosis diagnosis. We therefore compared the diagnosis value of quantitative real-time PCR with our conventional PCR-hybridization for the diagnosis of congenital toxoplasmosis.
The authors describe some situations where meta-analyses would have been of great benefit if they have been done or sufficiently published. They emphasize several problems ensued by this new method: if possible, meta-analyses have to be done each time a new trial is analysed, according to a precise method. Cumulative meta-analysis should rely on a regular and prospective registration of clinical trials. In all cases, meta-analyses should be available to a large number of physicians, in the main interest of patients.
Human parvovirus B19 primary infection during pregnancy is responsible for 27% of non autoimmune hydrops fetalis. Parvovirus B19 antigen detection and parvovirus B19 IgM and IgG antibody determination using enzyme immunoassays are not reliable for diagnostic purposes and lack of specificity. Parvovirus B19 DNA detection in amniotic fluid, fetal blood, ascitic fluid, and fetal biopsies or placenta specimens seems to be the best method for the diagnosis. Ninety-seven samples from 70 cases of spontaneous abortions after fetal death or hydrops fetalis were examined using PCR. A 270-bp length fragment of the NSI gene was amplified using PCR followed by electrophoresis, by Dot-blot hybridization assay using a biotinylated probe and by Southern-blot hybridization assay using a horseradish peroxidase-labelled probe followed by chemiluminescent assay. The Southern-blot hybridization assay was the longest test but the most sensitive. The parvovirus B19 genome was identified in 10 cases. In two cases, intrauterine blood transfusions led to the cessation of symptoms and to the birth of normal babies.
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The aim of this retrospective study is to compare the results of embryo transfer in IVF without or after cervical dilatation, and trans-myometrial trans-vaginal transfer and after ultrasound-guided transfer. From 1989 to 1996 we have performed 4,355 embryo transfers to obtain 1,115 pregnancies. The results were 25.6% pregnancy by transfer and 10.9 embryos to start a pregnancy. During this time 281 transfers were appreciated as difficult or impossible and a cervical dilatation was done. We obtain 17.4% pregnancies by transfer with 16.5 embryos per pregnancy. We also practiced for the same indication 50 transmyometrial-transvaginal transfers. The result was 18% pregnancy by transfer and 16 embryos to start a pregnancy. In 1997 we have stopped cervical dilatations to prefer in these indications ultrasound-guided embryo transfer. 74 transfer were performed with this method to obtain 28.4% pregnancies per transfer and 9.9 embryos to start one pregnancy. This results are compared to a subgroup of women 38 years old or less, with a normal partner's sperm and in witch two embryos or more were transferred. At the end we think that the use of ultrasonography for embryo transfer is benefit in IVF program.