Biomedical subjects
E Papiernik
Publications and source records attributed to E Papiernik.
Level and causes of maternal mortality in Guinea (West Africa).
In order to evaluate the level of maternal mortality at Conakry, capital of Guinea (West Africa), a descriptive epidemiological study was made of all maternal deaths occurring between July 1st, 1989 and June 30th, 1990. To ensure that cases of maternal death were recorded as exhaustively as possible, we conducted this study over 1 year in municipal and hospital maternity units, and 3 months in the urban community. One hundred thirty-nine maternal deaths were registered, representing an annual maternal mortality rate of 559/100,000 live births. The main causes of maternal death were abortion, complications linked with hypertension, and postpartum bleeding.
Risk factors for maternal mortality: results of a case-control study conducted in Conakry (Guinea).
OBJECTIVE: To assess the risk factors of maternal mortality in an urban area of West Africa (Conakry, capital of Guinea). METHOD: A case-control study where 102 maternal deaths were compared with 338 control women who had given birth and survived, during 1 year (from July 1, 1989 to June 30, 1990). RESULT: Of all the socio-demographic variables studied, only a low family income (R = 2.6; 1.1-6.5) was found to be a risk factor for maternal death In the obstetrical part of the survey, neither parity nor the number or location of pre-natal consultations constituted risk factors. However, the presence during pregnancy or delivery of signs of infection (R = 3.7; 1.4-9.8), anemia (R = 2.1; 1.1-4.1), hypertension (R = 19.8; 5.8-67.8) and dystocia (R = 9.0; 3.7-21.5) were found to be the main predictive risk factors of maternal death. The maternal mortality risk was multiplied by 12 if the women had had a cesarean section, and by 4 in the case of complications in the post-partum period. CONCLUSION: To achieve substantial reductions in maternal mortality levels, work must be done on these specific risk factors, and future programs must urgently be concentrated on a higher standard of pre-natal monitoring, obstetrical emergency facilities and training of obstetrical staff.
20 years of perinatal medicine in France: successes and failures.
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[Medically assisted procreation: when to intervene and where to stop. Economic aspects].
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[Evaluation of a public health measure for the amelioration of birth safety in Martinique: 1977-1984].
A public health programme was instituted on the island of Martinique (in the Carribean archipelago) between 1977 and 1984. Its aim was to reduce the perinatal death rate in Martinique which was 25.7 per thousand in 1977 to the level found in France in the same year, namely 14 per thousand. The measures taken to improve the safety of deliveries included closing small maternity homes and improving the hospitals both public and private. The chief measure however, was to improve the availability of specialised antenatal care chiefly administered by midwives (free care consultations near the homes) for the poor and the less well educated women. The results showed that perinatal deaths in the island dropped to 14.9 per thousand in 1984. The major improvement was that women who had been attended by midwives had 10 per thousand perinatal deaths. This involved half the population of the island and the same results were found as to the wealthier and more educated women who were attended by private obstetricians. It was found to be possible to reduce the difference in the perinatal death rate between an African population in Martinique and an European population in European France.
Mifepristone teratogenicity.
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Development after exposure to mifepristone in early pregnancy.
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Placental passage of azathiothymidine (AZT) during the second trimester of pregnancy: study by direct fetal blood sampling under ultrasound.
AZT-therapy during pregnancy is actually contraindicated. Two HIV-positive pregnant women who were due to have an induced abortion in the second trimester of pregnancy, were treated with AZT. Blood samples from mothers and fetuses and amniotic fluid samples were taken simultaneously. AZT crossed the placental barrier in the two patients. AZT and GAZT concentrations from the two fetuses were close to those obtained in the two women and in six non-pregnant volunteers.
Risk factors for ectopic pregnancy: a case-control study in France, with special focus on infectious factors.
A case-control study was conducted in 1988 in seven Paris area maternity hospitals to evaluate the role of several risk factors, particularly infectious factors, in ectopic pregnancy. A total of 279 cases and 279 controls were compared for sociodemographic characteristics, cigarette smoking, sexual, reproductive and surgical histories, and conditions of conception. Pelvic inflammatory disease confirmed by celioscopy (odds ratio (OR) = 5.5, 95% confidence interval (CI) 2.1-13.9) and Chlamydia trachomatis seropositivity (OR = 3.9, 95% CI 2.3-6.7) appeared to be important risk factors for ectopic pregnancy. Other risk factors found to be associated with an increased risk of ectopic pregnancy were dose-related cigarette smoking at the time of conception (ORs 1.3 to 2.5), appendectomy (OR = 1.6, 95% CI 1.1-2.5), prior tubal surgery (OR = 5.1, 95% CI 1.7-15.4), induced conception cycle (OR = 3.2, 95% CI 1.1-9.3), and prior ectopic pregnancy (OR = 13.3, 95% CI 4.5-39.2). However, some of the latter risk factors, i.e., prior tubal surgery, prior ectopic pregnancy, and perhaps appendectomy, may be considered to be the results of pelvic inflammatory disease and sexually transmitted diseases. Maternal age, parity, prior induced abortion, and prior spontaneous abortion were not associated with ectopic pregnancy. Use of intrauterine device, progestagen micropill, and also combined estroprogestative pill at the time of conception were associated with a better prevention of intrauterine pregnancy than of ectopic pregnancy. These findings confirm the importance of several previously reported risk factors of ectopic pregnancy: sexually transmitted diseases, cigarette smoking, and prior ectopic pregnancy. They also identified new risk factors, appendectomy and induced conception cycle, and revealed that the combined estroprogestative pill does not prevent ectopic pregnancy as effectively as it does intrauterine pregnancy.
Fetoplacental passage of 2',3'-dideoxyinosine.
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Vaginal infections, cervical ripening and preterm delivery.
A prospective study is presented which addresses the relative effect of cervicovaginal infection and precocious maturation of the uterine cervix on preterm delivery. From April 1981 through December 1983, a total of 5758 pregnant women were checked by means of a vaginal examination at every prenatal visit and a research for bacterial cervicovaginal infection whenever abnormal signs were observed. The study reveals that vaginal infection has no measurable effect when observed during the second trimester of pregnancy, and a small effect during the third trimester. This means that infection of the vagina or/and the cervix may be demonstrated as a risk factor only when the cervix is short before 28 weeks or open before 37 weeks.
Trophoblast-like cells sorted from peripheral maternal blood using flow cytometry: a multiparametric study involving transmission electron microscopy and fetal DNA amplification.
Three monoclonal antibodies (MAbs) against trophoblast (GB17, GB21, and GB25) and flow cytometry were used to sort trophoblast-like cells (TLCs) from peripheral blood of pregnant women. Sorted TLCs were processed for electron microscopy and fetal DNA amplification of the Y-specific sequences from mothers carrying male fetuses. At the ultra-structural level, most of the nucleated cells had the morphology of leucocytes, suggesting maternal contaminants, and we did not find the characteristic features of the free intervillous trophoblast cells. Nevertheless, polymerase chain reaction (PCR) analysis showed an amplification of Y-specific sequences in two out of three samples of sorted TLCs. These results suggest that besides the maternal leucocytes, sufficient trophoblast nucleated fetal cells can be obtained using cell enrichment by sorting. This sensitive method holds promise for non-invasive prenatal diagnosis of fetal sex and if sufficient Y(positive) nuclei are found, for the diagnosis of selected numerical chromosome abnormalities.
The costs of multiple pregnancy.
This paper reviews US vital statistics to describe the increase in multiple births in the United States between 1977 and 1987 and clarify the participation of differing maternal ethnic and age groups to this trend. The projected needs for NICU beds and costs of handicaps are estimated based on the distribution of low birthweights in multiple gestations. The potential methods of changing the distribution of low birthweight infants in multiple pregnancies are discussed.
Characterization of enzymes of catecholamine synthesis and metabolism in human fetal membranes at birth.
We looked for the presence of the enzymes monoamine oxidase, catechol-O-methyltransferase, and phenylethanolamine-N-methyltransferase in human fetal membranes at term. The activity of all three enzymes was detected via highly sensitive and selective radiometric enzyme assays. The most novel finding was the extremely high level of monoamine oxidase activity in the chorion compared with that in the amnion. The other enzyme of catecholamine metabolism, catechol-O-methyltransferase, did not show any difference in activity between the two layers. In addition, we observed that the enzyme phenylethanolamine-N-methyltransferase, which is primarily located in the adrenal medulla, was also present in appreciable levels in the two layers of fetal membranes. These results suggest that fetal membranes, like the placenta, possess the enzymatic machinery to metabolize catecholamines and have the capacity to synthesize epinephrine.
HIV proteins absent from placentas of 75 HIV-1-positive women studied by immunohistochemistry.
Recent epidemiological and virological data suggest that the incidence of maternofetal transmission of HIV-1 infection is between 20 and 30%. The available evidence points to a possible role of peri- and postnatal contamination, but the isolation of HIV from fetuses shows that transplacental transmission also occurs. We attempted to detect, by means of an immunohistochemical method, HIV proteins in frozen placentas from 75 HIV-1-positive women (30 at term, 45 induced abortions). In addition, in situ hybridization using HIV-specific probes was performed in three cases. Neither HIV proteins nor nucleic acid sequences were detected, but CD4+ mononuclear cells were present in the chorion and villi, regardless of the clinical and biological status of the mother (particularly in the nine cases in which the infants were infected). There are several possible mechanisms involving the placenta in the maternofetal transmission of HIV, including active transport of the HIV-immunoglobulin G complex via Fc receptors on trophoblastic cells, passive transplacental passage of HIV during a viraemic episode, the passage of infected maternal cells, and infection of the placenta itself. The methods we used could not rule out the presence of HIV DNA provirus within the genome of placental cells. In any event, immunohistochemical detection of HIV proteins in the placenta is not a technique suitable for the prenatal diagnosis of HIV infection or for identifying newborns likely to develop HIV infection.
Preterm birth prevention: an evaluation of programs in the United States.
During the last decade several programs were established to prevent the onset of preterm labor and facilitate its early identification and treatment. Although these prevention programs shared a similar goal, they varied in their primary outcome focus, target populations, study designs, and specific intervention components. Their initial reports were promising; however, subsequent evaluations of efforts in the United States produced mixed results. The current literature is suggestive of the benefits of programs to prevent preterm labor and delivery, but methodologic differences among them and deficiencies in the reported evaluations have rendered a final verdict equivocal. Many studies using historical or geographic controls found positive results, whereas randomized, controlled trials did not find a significant impact. Positive results were found in studies using low-risk populations, but investigations of high-risk patients noted little effect. Together with continued research on the factors that underlie the onset of labor, additional assessment of these programs and their individual intervention components appears to be necessary.
Multiple pregnancy and very early preterm births in a referral center.
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