Twin pregnancies and delayed-interval delivery: report of two cases with delivery after 35 weeks' gestation.
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Abnormalities, Multiple↗
Biomedical subjects
E Boudier
Publications and source records attributed to E Boudier.
[Obstetrical management in the event of persistent or worsening postpartum hemorrhage despite initial measures].
Sulprostone infusion must be started without further delay if the first treatment (oxytocin, manual removal of the placenta, uterine revision, vaginal and cervical examinations) has been unsuccessful in the first 30 minutes after delivery. In France, the use of this treatment has been officially authorized in this indication (marketing approval, AMM). Intramuscular and intramyometrial injections being contraindicated, sulprostone is administered through continuous intravenous infusion. Dosage is 500 microg (one vial) per hour. Starting dose is 1.7 microg/min (10 ml/h), and can be increased if necessary in steps of 1.7 microg/min (but not exceeding 8.3 microg./min). The success rate of this treatment is linked to the rapidity of its commencement (within 30 min of the diagnosis of postpartum hemorrhage). In case of contraindications, since postpartum hemorrhage is life-threatening, the benefit-risk ratio needs to be estimated. A strict monitoring of cardiovascular parameters is compulsory before and after its administration. There is no time limit after which this treatment can be considered as ineffective: it depends on the amount of blood lost, the patient's clinical state, and on means that have already been used to stop the bleeding. However, if after 30 min of sulprostone infusion, there is no improvement or if the situation is worse, other therapeutic strategies must be considered (e.g., embolization, surgery). The use of intra-rectal misoprostol is still under assessment. To date, we have been unable to find studies that justify this treatment. Intra-uterine balloon, tube, or mesh packing has been studied in a few small series, where it was successful. Use of these strategies must not delay the treatment by sulprostone.
Female↗
[Massive feto-maternal transfusion. Report of 3 cases with review of the literature].
Massive feto maternal hemorrhage is rare. Early diagnosis is important because massive feto-maternal hemorrhage has a poor prognosis. The clinical manifestations of transplacental hemorrhage are related not only to the size of the hemorrhage but also to the time at which the hemorrhage occurs. In women who are candidates for Rh immune prophylaxis, massive feto maternal hemorrhage may be detected by Kleihauer test and we suggest that 10 micrograms dose of immune globin should be administered for each estimated ml of Rh positive blood given, to prevent an immunization Disappearance of fetal cells by Kleihauer test or appearance residual antibody suggests the adequacy of therapy. Three cases of massive fetomaternal hemorrhage (more than 225 ml) are presented here. Two mothers was Rh negative and they are delivered of rhésus positive children, which necessitated the administration of large volume of anti D. One of the cases shows the possibility of association between choriocarcinoma and positive kleihauer test.
Adult↗
Etiology and prevention of pulmonary complications following beta-mimetic mediated tocolysis.
OBJECTIVES: This study documents biological (haematocrit variations) and therapeutic parameters (salbutamol doses, volumes perfused) in two groups tocolysed with salbutamol, one with and the other without APO in order to define the risk factors linked to APO and to establish a standard protocol of management. STUDY DESIGN: This retrospective study includes data from 68 intravenous salbutamol tocolysis with four resulting APOs, carried out between January 1st, 1993 and December 31st, 1995. RESULTS: There was an excessive level of salbutamol administered over 48 h in the complicated APO-group (122.5+/-52 mg) opposed to the non-APO group (44.9 21 mg) as well as an overload of perfused solute (3.1+/-1.11) versus (1.9+/-1.11). Blood hemodilution was demonstrated in the APO group with a decrease of haematocrit by over 10% between the admission and the control value. No other risk factor was found. CONCLUSION: Tocolysis should be administered at the lowest possible perfusion rate with incremental doses as long as the heart rate stays under 120 beats/min and stopped after 48 h. Administration of maximal 11 of solute perfused/day is recommended. For the patient's follow-up we estimate daily input and output fluid to avoid hydric overload, and a daily control of haematocrit whose variation must be less than 10%.
Acute Disease↗
Breech presentation after 34 weeks-a meta-analysis of corrected perinatal mortality/morbidity according to the method of delivery.
We conducted a meta-analysis of the mortality and morbidity of the breech presentation according to the method of delivery. Using the term 'breech', we used the Medline data base to search the English and French-language literature from 1978 to July 1995. Twenty-two studies (7239 deliveries) were found and analysed. The meta-analysis concerning perinatal mortality did not reveal a significant increased risk, when vaginal deliveries were compared with those delivered by a caesarean section (odds ratio: 1.90; confidence interval: 0.59-8.22) or when vaginal deliveries were compared with those done by planned caesarean section (odds ratio: 4.95; confidence interval: 0.44-80.06). The neonatal morbidity showed an increased risk with vaginal delivery. It is concluded that the practice of resorting to caesarean section for every breech presentation at term does not seem defensible.
Journal Article↗
Cervico-vaginal fetal fibronectin: predictive value during false labor.
OBJECTIVE: The purpose was to determine to what extent fetal fibronectin was a discriminative test of preterm delivery in patients hospitalized for uterine contractions without modification of the cervix. STUDY DESIGN: The prospective double-blind study included patients hospitalized between 24 and 34 week for false labor. Cervicovaginal swabs were obtained and assayed for the presence of fetal fibronectin by means of a monoclonal antibody assay. RESULTS: Out of the 61 patients included, 18 showed a positive swab. The correlation of a positive result with preterm delivery revealed a sensitivity of 56%, a specificity of 81%, and positive and negative predictive values of 56% and 81% respectively. Meta-analysis of studies published shows that the presence of fibronectin represents a significant relative risk of 3.3 (IC: 2.5-42) of preterm delivery. CONCLUSION: The presence of fetal fibronectin in cervicovaginal secretions of patients presenting with false labor indicates a major risk of preterm delivery.
Adult↗
[Antenatal diagnosis of achondrogenesis. Two successive cases in the same family].
Achondrogenesis is a rare case of fetal skeletal dysplasia. Achondrogenesis in lethal. That is a autosomal recessive fetal skeletal dysplasia. There is a very important dwarfism with extreme micromely, macrocephalia and brevity of chest. The authors enumerate the echographics, radiologics and histologics symptoms of this chondro-dysplasia. The authors comment rapidly the others diagnosis of lethal fetal skeletal dysplasia. Genetic consul is a necessity.
Adolescent↗
[The reduction of prematurity by telephone follow-up].
Twice-daily check-up of the uterine contractions by the pregnant women is a recognized and accepted necessity. Using the "green" free-phone number to report the number of contractions, to answer the questions asked and to receive the instructions given has made it possible to reduce the prematurity rate and the duration of the consequent specific hospitalization. This new method of follow-up, applied to two identically recruited groups of pregnancies offers an undeniable low-cost improvement over the systems used previously.
Female↗
[Update on delayed births].
Sixteen (16) cases of delayed births have been reported in the literature. All of these patients obtained at least one live child. This method can, therefore, be suggested in cases of premature birth after less than 28 weeks of amenorrhea for patients who present with a multiple, pluriamniotic pregnancy.
Adult↗
[Neonatal alloimmune thrombocytopenia following immunization against the platelet antigen ZWA (PLA/1). 3 case reports in the same family and analysis of the literature].
Allo-immune neonatal thrombopenia is to platelets what rhesus hemolytic disease is to red blood cells. There is a risk of haemorrhage when fetal platelets decreases below 50,000 per mm3. Such haemorrhage may occur at any time during the thrombopenia period. However they are mostly due to obstetrical traumatisms during delivery. Lethal complications and severe neurologic sequellae is estimated to affect about 30% of newborns: 1/3 these complications occur in utero and 2/3 during delivery. The authors have studied 3 familial cases of foeto-maternal allo-immunisation occurring with the PLA 1 system. They have made a briefing of the physiological, the pathological and the epidemiological aspects of such immunisation before insisting upon case findings of such affected fetus. A capillary blood sample taken from the scalp of the fetus at the beginning of labour allows a safe natural delivery if fetal blood count shows more than 50,000 platelets per mm3. A fetal blood sampling under ultrasonographic guidance will bring about to an early diagnosis and prognosis, this allowing an adequate treatment for fetus with a high risk of thrombopenia.
Antigens, Human Platelet↗
[Deferred deliveries in multiple pregnancies. Discussion on a new case report].
The authors report a new case of a triplet pregnancy in which an abortion occurred in the second trimester and twins were delivered at the 33rd week of gestation. The authors point out that it is possible to carry out a cerclage when a fetus and placenta are retained without necessarily causing an infection with clinical symptoms; but the authors do point out that there is always the possibility of infecting the mother and the fetus. As to the prognosis for the fetus, it is better it is given an opportunity to grow further in spite of the risk of infection.
Abortion, Spontaneous↗
Fetal pulse oximetry during labor of 62 patients.
The objectives of the study were to assess the ability of a fetal pulse oximeter to measure the fetal oxygen saturation (SPO2) continuously during labor and to assess the correlation between readings of fetal pulse oximetry and cord blood gases at birth. The Nellcor N-400 Fetal Oximeter was used in 62 women prospectively. The mean SPO2 was unchanged at the different stages of normal labor. 53.3 +/- 9.1 to 50.1 +/- 11.8% (n = 50). The SPO2 recorded during the pushing phase of stage II (n = 40) was correlated significantly with umbilical cord arterial pH (r = 0.55; p = 0.0002), venous pH (r = 0.63; p = 0.0001), venous PCO2 (r = 0.47; p = 0.002) and venous PO2 (r = 0.39; p = 0.01). SPO2 was also correlated with scalp pH (r = 0.52; p < 0.05; n = 21). No side effects were noted. Fetal pulse oximetry could be useful to assess fetal oxygenation during labor and at birth.
Adult↗
Antenatal diagnosis of brain damage in the survivor after the second trimester death of a monochorionic monoamniotic co-twin: case report and literature review.
At 28 weeks of amenorrhea, 1 fetus of a monoamniotic twin pregnancy died. Ultrasound and Doppler investigations of the surviving twin were normal. Three weeks later, endovaginal ultrasound and magnetic resonance imaging revealed massive bilateral cerebral ischemic necrosis in the surviving twin. In utero fetal blood sampling carried out before the termination did not reveal either anemia or thrombopenia. Current data suggest that cerebral or renal ischemic complications could set in immediately after the death of the first twin as a result of a period of acute hypotension. At least 2 weeks are necessary for them to be identifiable by ultrasound. It seems that they cannot be prevented by prompt delivery of the second twin.
Abortion, Spontaneous↗