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Biomedical subjects

G Kayem

Publications and source records attributed to G Kayem.

9 recordsLinked to original sources
PubMed2005

[Obstetrical perinatal care in case of maternal prenatal smoking].

Measurement of CO during the intrapartum period is a good way to help patients become aware of the importance of smoking cessation. The objective information can be continued in the post partum period. The effect is beneficial for the neonate and helps women stop smoking during subsequent pregnancies. To date, no study has been conducted during the intrapartum period useful for adapting our clinical practice in patients who smoke during pregnancy. Prospective studies, specifically designed to measure the impact of smoking on maternal and fetal complications during labor are essential.

Counseling↗
PubMed2004

Interleukin-8 mRNA in vaginal secretions: a prenatal marker of congenital infection in case of preterm labor with intact membranes.

OBJECTIVE: To study whether interleukin-8 (IL-8) mRNA in vaginal secretions is associated with congenital infection and preterm delivery in the case of preterm labor with intact membranes. METHODS: This prospective clinical study in a tertiary referral center included 280 patients who gave birth to 360 infants from 1997 through 1999. IL-8 mRNA in vaginal secretions was determined with reverse transcriptase polymerase chain reaction. Logistic regression was used to examine the association between vaginal IL-8 mRNA and congenital infection independently of the time of birth. Main outcome measures were congenital infection and delivery before 37 and 33 weeks' gestation. RESULTS: A total of 100 women (100/280 (35.7%)) gave birth before 37 weeks. A total of 54 children (54/360 (15%)) had congenital infection. IL-8 mRNA in vaginal secretions was associated with delivery within 14 days of the sampling (24 (15.6%) vs. 7 (5.6%) p < 0.01), but not with delivery within 48 h, 7 days (p = 0.07) or before 37 or 33 weeks. There were more congenital infections in the group with detectable IL-8 mRNA (37 (19.3%) than in the negative group (17 (10.1%); p < 0.05). IL-8 mRNA was associated with congenital infection independently of the time of birth (OR: 2.6 (1.3-5.1)). This test had a sensitivity for predicting neonatal infection of 69%. Its specificity was 49%, its positive predictive value 19%, and its negative predictive value 90%. CONCLUSION: IL-8 mRNA could be a prenatal noninvasive vaginal marker of congenital infection.

Adult↗
PubMed2004

[Magnesium sulfate in obstetrics: current data].

OBJECTIVE: To review the available evidence regarding history, pharmacology, physiology, maternal/fetal side effects, and efficacy of magnesium sulfate in pregnant women. DATA SOURCES: The literature in Medline was searched from 1966 through April 2003 using the terms "magnesium sulfate," "tocolytic," "preeclampsia," "eclampsia," and "pregnancy." Reviews of bibliographies of retrieved articles provided additional references. RESULTS: Magnesium sulfate (MgSO4) has long been used for prophylaxis of preterm delivery (tocolytic affect) and eclampsia prophylaxis (neuroprotective effect). Randomized controlled trials and systematic reviews have demonstrated the efficacy of magnesium sulfate in preventing eclampsia in patients with preeclampsia or in patients with eclampsia. Whether magnesium sulfate should be administered to patients with severe preeclampsia or to mild preeclampsia is discussed in the manuscript. Inversely, it appears that magnesium sulfate is ineffective in delaying birth or preventing preterm birth when it is used as a tocolytic. Furthermore, there is evidence that high cumulative doses of magnesium sulfate may be associated with increased infant mortality. CONCLUSION: The evidence to date confirms the efficacy of magnesium sulfate therapy for women with eclampsia and preeclampsia. However, magnesium sulfate should not be used in order to treat preterm labor.

Adult↗
PubMed2003

Bacterial vaginosis: prevalence and predictive value for premature delivery and neonatal infection in women with preterm labour and intact membranes.

OBJECTIVES: Assess the predictive values of bacterial vaginosis (BV) for preterm delivery (PD) and neonatal infection and compare them with standard markers of infection among women with preterm labour (PL). STUDY DESIGN: Prospective blinded study in a tertiary referral centre in Paris. Women hospitalised for PL with intact membranes at a term between 24 and 34 weeks were included. Vaginal fluid, collected at inclusion was Gram-stained, scored, and interpreted according to Nugent's criteria. RESULTS: Out of 354 women tested, 254 had normal flora (72.3%), 76 intermediate (21.7%) and 24 BV (6.8%). A history of spontaneous miscarriage after 14 weeks was the only risk factor significantly associated with BV. BV was not significantly associated with PD<35 weeks or neonatal infection. Very preterm delivery (before 33 weeks) was significantly associated with the flora grade (P=0.02): women with normal, intermediate and abnormal flora, respectively had 27 (10.6%), 14 (18.4%) and 6 (25.0%) births before 33 weeks. Of the markers tested, the highest risk of very preterm delivery was associated with BV (odds ratio 2.95, 95% CI (1.1-0.8.1)) and CRP>20mg/dl (4.23 95% CI (1.8-9.7)). Predictive value of BV for preterm birth before 33 weeks were: sensitivity 12.8%, specificity 95.0%, positive predictive value 35.3%, and negative predictive value 84.3%. CONCLUSIONS: The frequency of BV and its association with PD are probably very variable and must be interpreted differently from one population to another. While we found an association between BV results and delivery before 33 weeks, the predictive value of BV was disappointing. Although these findings reinforce the importance of a useful marker of subclinical infection, the usefulness of testing for BV in women with PL has not been demonstrated.

Abortion, Spontaneous↗
PubMed2002

[Current clinical implications of transvaginal ultrasound measurement of the cervix during pregnancy].

Transvaginal ultrasound measurement of the cervix is increasingly used for the prediction of preterm labor. In comparison to clinical vaginal examination, it has the advantages of being highly reproducible, with a low inter-observer variability, and of offering an evaluation of the entire cervical canal, including the internal os. The sensitivity and specificity of transvaginal ultrasound have been validated by several studies in women with symptoms of preterm labor, however its clinical applications and its limits have yet to be fully determined. It is likely to be of benefit in the management of multiple gestations, but it appears unlikely to be of use in low-risk pregnancies. Finally, whether it can be applied to estimate the risk of cervical incompetence, or to determine the need for cervical cerclage placement has not yet been determined by methodologically satisfactory clinical studies.

Cerclage, Cervical↗
PubMed2002

[Diagnosis and prognosis of preterm labor: physical examination and ultrasonography].

Diagnosis. Preterm labor is defined by cervical changes associated with regular painful uterine contractions (UC) between 22 and 36 weeks + 6 days. Tocometry does not improve diagnosis or prognosis, despite the identification of more UC (NP 4). Electromyography and cervical distensibility (cervicotonometer) are promising techniques but are still in the research field. Clinical markers for prognosis. Clinical markers associated with clinical cervical examination tested in scoring systems are not validated and can't be recommended in clinical practise (NP 4). Ultrasonographic examination of the cervix. Technical evaluation of ultrasonographic examination of the cervix is satisfactory (NP 3); the transvaginal technical have to be used (NP 3). This method has a better accuracy and reproducibility than clinical examination provided a good apprenticeship (NP 3). Three ultrasound abnormal criteria are defined: a short length, a large internal cervical os and the presence of a funnel in the cervical canal. The best cut-off of cervical length to predict preterm delivery lies between 18 and 30 mm (NP 3). The choice of the cutt-off level depends on the prectitioner: high sensitivity but with many false-positives (cut-off close to 30 mm) or lower sensitivity with few false-positives (close to 20 mm). Cervical length seems to be more accurate that internal os or presence of a funnel which should be used with caution in clinical decisions (NP 3). There is no comparative study about the use of ultrasonographic examination of the cervix in women with preterm labor to evaluate benefits and adverse effects in clinical practice. However, ultrasonographic examination of the cervix supply a progress identifying women at risk of preterm delivery and this technique has a better predictive value than clinical cervical examination (NP 3). It seems reasonable to recommend utilisation of ultrasonographic examination of the cervic in preterm labor. It would not seem reasonable to replace the vaginal examination by ultrasonography. Ultrasonography could be used in association with clinical examination or in a second time if clinical examination is doubtful (NP 3). For these women, ultrasonography could reduce the number of hospitalizations, limiting treatment for some and, for others, increasing intensive interventions such as tocolysis, in utero transfer or corticsteroid treatment.

Cervix Uteri↗
PubMed1997

[The value of intravaginal ultrasonography of the cervix uteri for evaluation of the risk of premature labor].

OBJECTIVE: To determinate the predictive value of cervical length, measured by transvaginal ultrasound, for preterm delivery among patients with signs of preterm labor. PLACE: Department of Gynecology & Obstetrics, Poissy Hospital Center. MATERIAL AND METHODS: A prospective study that measured cervical length by transvaginal ultrasound was performed among 108 patients with a singleton pregnancy hospitalized with signs of premature labor between 24 and 34 weeks' gestation or within 21 days of inclusion. RESULTS: The rate of preterm birth was 22.2% (24/108). When cervical length was < or = 26 mm, the gestational age at delivery was significantly lower that when it exceeded 26 mm (36.3 +/- 3.0 weeks compared with 38.5 +/- 2.1 weeks; p < 0.0001). 40.4% (19/47) of patients whose cervical length was < or = 26 mm gave birth prematurely, compared with only 8.2% (5/61) of those with a cervix > 26 mm The sensitivity, specificity, positive predictive value, and negative predictive value of transvaginal ultrasonography were, respectively, 79.2, 66.6, 40.4, and 91.8% for delivery before 37 weeks' gestation, and 75.0, 62.0, 25.5, and 93.4% for delivery within 21 days of the ultra-sound measurement. CONCLUSION: Transvaginal ultrasound of the cervix provides an objective method for evaluating the risk of preterm delivery. Its predictive values are impressive and allow better discrimination between women at high risk of preterm delivery and those in false preterm labor.

Adult↗
PubMedDate not supplied

Strip test for bedside detection of interleukin-6 in cervical secretions is predictive for impending preterm delivery.

Inflammatory cytokines in amniotic fluid are markers of prematurity which could characterize preterm labour of infectious origin. To avoid amniocentesis, we analyzed IL-6, IL-8, IL-10, and IL-13 by RT-PCR in cervical secretions (CS) of 307 women with preterm labour. IL-6 was detected in 26.3% patients who delivered at less than 34 weeks (specificity: 95.8%). In addition, IL-6 was associated with delivery within 7 days (specificity: 91.6%). To render the detection more rapid and cheaper, a strip test was designed and evaluated comparatively with RT-PCR in 76 women. This bedside strip test was twice more sensitive than RT-PCR, with little decrease in specificity.

Cervix Uteri↗