[Postpartum pathologies: maternal pathology during the first 40 days].
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Adult↗
Biomedical subjects
Emmanuelle Mathieu
Publications and source records attributed to Emmanuelle Mathieu.
Fetal toxicity of valsartan and possible reversible adverse side effects.
BACKGROUND: Published cases suggest that the use of angiotensin II receptor antagonists is fetotoxic during the third trimester, but not in early pregnancy. CASE: We report a case in which the adverse fetal effect of angiotensin II receptor antagonist treatment was reversed. A woman with chronic hypertension was treated with valsartan until gestation week (GW) 20, when a complete anhydramnios was observed. Six days after interruption of the treatment, amniotic fluid reappeared. It reached a normal level at GW 23.5. The plasmatic creatinine level and the renal ultrasound examination were within normal limits at the six-month follow-up. CONCLUSIONS: Whereas angiotensin-II-receptor antagonist generates a severe renal toxicity, this case suggests that, at least in the first half of pregnancy, these effects can be reversed.
Adult↗
Luteinizing hormone concentrations after gonadotropin-releasing hormone antagonist administration do not influence pregnancy rates in in vitro fertilization-embryo transfer.
OBJECTIVE: To determine the impact of circulating LH concentrations during controlled ovarian hyperstimulation on the outcome of IVF. DESIGN: Retrospective study. SETTING: University hospital. PATIENT(S): Two-hundred seventy women who had a short stimulation protocol with GnRH antagonist and ovarian stimulation with recombinant FSH (rFSH). INTERVENTION(S): GnRH antagonist and rFSH were administered SC; blood samples were collected on the day of GnRH antagonist administration, 1 day after, and on the day of hCG administration. MAIN OUTCOME MEASURE(S): A threshold of 0.5 IU/L on the day of hCG was chosen to discriminate between women with LH concentrations 0.5 IU/L (group B, n = 151). RESULT(S): The two groups were comparable with regard to the clinical parameters. In group A, significantly lower LH concentrations were observed on day 9 of the cycle and on the day of hCG administration. The numbers of oocytes retrieved, embryos obtained, and embryos cryopreserved were significantly higher in group A compared with group B. The proportion of clinical pregnancies was similar in the two groups (21.1% vs. 22.7 % per ET). CONCLUSION(S): In GnRH antagonist and rFSH protocols, suppressed serum LH concentrations do not have any influence on the final stages of follicular maturation, pregnancy rates, or outcomes.
Adult↗
[Cancer and Pregnancy: the point of view of the obstetrician].
Onset of malignancy during pregnancy is distressing for the future parents and raises thorny problems for the oncologist and obstetric gynecologist. Many diagnostic and therapeutic approaches cannot be used. Some first-line reference treatments are known to cause fetal loss or severe birth defects, yet any delay in treatment may unacceptably worsen the maternal prognosis. In the absence of large randomized trials and cohort studies, it is difficult to know how best to manage these patients. An estimated one in ten thousand pregnancies are associated with malignancies, especially gynecologic tumors (cervix, breast, ovary), lymphomas, melanomas, brain tumors and leukemia. The obstetrician, in close collaboration with the oncologist, has a major role in choosing the most appropriate diagnostic and therapeutic strategy, and must keep the couple fully informed. Importantly, improvements in cancer cure rates and the development of conservative treatments mean that many of these young women can hope to start a new pregnancy after their treatment. The optimal interval between cure and conception must be carefully weighed up by a multidisciplinary team including oncologists and obstetric gynecologists. Chemotherapy, pelvic radiation therapy, and gynecologic surgery can impact not only on fertility but also on the course of a next pregnancy (increased risk of miscarriage and premature delivery, etc.). The obstetrician must take these risks into account.
Abortion, Induced↗