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Biomedical subjects

H J Philippe

Publications and source records attributed to H J Philippe.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Echographic measurement of the inferior uterine segment for assessing the risk of uterine rupture].

BACKGROUND: Ultrasonography has been used to examine the scarred uterus in women who have had previous cesarean sections in an attempt to assess the risk of rupture of the scar during subsequent labor. The predictive value of such measurements has not been adequately assessed, however. We aimed to evaluate the usefulness of sonographic measurement of the lower uterine segment before labor in predicting the risk of intrapartum uterine rupture. METHODS: In this prospective observational study, the obstetricians were not told the ultrasonographic findings and did not use them to make decisions about type of delivery. Eligible patients were those with previous cesarean sections booked for delivery at our hospital. 642 patients underwent ultrasound examination at 36-38 weeks' gestation, and were allocated to four groups according to the thickness of the lower uterine segment. Ultrasonographic findings were compared with those of physical examination at delivery. FINDINGS: The overall frequency of defective scars was 4.0% (15 uterine ruptures and 10 dehiscences). The frequency of defects rose as the thickness of the lower uterine segment decreased: there were no defects among 278 women with measurements greater than 4.5 mm, three (2%) among 177 patients with values of 3.6-4.5 mm, 14 (10%) among 136 patients with values of 2.6-3.5 mm, and eight (16%) among 51 women with values of 1.6-2.5 mm. With a cut-off value of 3.5 mm, the sensitivity of ultrasonographic measurement was 88.0%, the specificity 73.2%, positive predictive value 11.8%, and negative predictive value 99.3%. INTERPRETATION: Our results show that the risk of a defective scar is directly correlated to the degree of thinning of the lower uterine segment at around 37 weeks of pregnancy. The high negative predictive value of the method may encourage obstetricians in hospitals where routine repeat elective cesarean is the standard procedure to offer a trial of labor to patients with a thickness value of 3.5 mm or greater.

Adult↗
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↗
PubMed1996

Transvaginal colpo-urethropexy with fibrin sealant: 4 years-follow up in 23 cases.

A method of transvaginal colpo-urethropexy, using fibrin sealant was studied clinically. After a fingertip vaginal retropubic dissection, fibrin sealant is instilled in the retropubic space with the intent of inducing fibrosis between the elevated urethro-vesical junction and the retropubic periosteum. Twenty-three patients with urinary stress incontinence underwent this procedure with 82% of satisfactory results and 18% failure. Complications were minimal. In the future, this technique could be useful for ambulatory surgery.

Adult↗
PubMed1996

[Rational use of fetal fibronectin in the evaluation of premature labor risk].

OBJECTIVE: To better determined the usefulness of fetal fibronectin assay to identify patients at risk of premature delivery. SUBJECTS: 155 primiparous or multiparous patients presenting with single or twin pregnancies between 24 and 34 weeks and divided into 3 groups: high risk (70 patients), medium risk (35 patients), and low risk (50 patients) of premature delivery. MAIN OUTCOME MEASURES: The occurrence of delivery in the 21 days following sampling and/or a premature delivery. RESULTS: Among the 50 patients in the low risk group, there was one false positive and no premature delivery. Among the 35 patients in the medium risk group, there was no single positive fetal fibronectin test and no premature delivery. Among the 70 patients in the high risk group, 14 had a premature rupture of the membranes with very strongly positive fetal fibronectin test and all were delivery prematurely, 11 within a period of less than 21 days. The remaining 56 patients presented a threat of premature delivery without rupture of membranes; 20 gave birth prematurely (prevalence: 35.7%). In patients with a negative fetal fibronectin test, those with positive fetal fibronectin test were significantly more likely to experience preterm birth (odds ration: 12; 95% confidence interval: 3.4 to 42.1; p = 0.001) or to deliver within 21 days (odds ratio: 29.9; 95% confidence interval: 13.3 to 243; p < 0.001). CONCLUSION: Measurement of fetal fibronectin in cervico-vaginal secretions enabled us to define an authentic sub-group at high risk of premature delivery among patients presenting uterine contractions and changes in the cervix. In contrast, measurement of fetal fibronectin in cervico-vaginal secretions of patients with low and medium risk is not suitable, due to the low rate of premature delivery in these groups and the significant increase in the cost of pregnancy monitoring.

Adult↗
PubMed1995

[Prenatal prevention of infant respiratory distress syndrome. 1st part: experimental data and pharmacological treatment].

Pulmonary maturation and growth are two time-related interdependent phenomena. The main regulatory mechanisms of pulmonary maturation are complex and the role of epithelial-mesenchymal interrelationship appear to be determinant in the phenomena leading to morphological growth of the lung and in cellular differentiation of the epithelium during development. At an early stage of morphological development of the fetal lung, endogenous hormones do not directly affect epithelial differentiation but modulate the expression of genes coding for surfactant. Later surfactant production responds to multihormone regulation. Some of these hormones or growth factors (steroids, oestradiol, prolactin, thyroxine, epidermal growth factor, fibroblast pneumocyte factor) are powerful stimulators, favoring biochemical development of the fetal lung. Inversely, other factors (insulin, androgens) limit the production of surfactant. Glucocorticoids play a specific role (stimulation of morphologic and biochemical development of the lung) and potentialize the stimulating effect of other factors. A good understanding of these mechanisms is essential before introducing treatments stimulating natural processes as closely as possible. Experimental results on the use of lung maturation induction, especially with glucocorticoids, have been quite promising. Combining thyroid hormones and thyrotropin-releasing hormone appears to be an interesting proposal, as is the use of growth factors such as epidermal growth factor.

Fetal Organ Maturity↗
PubMed1995

[Prenatal prevention of infant respiratory distress syndrome. 2nd part: clinical applications and indications].

Two types of sometimes complementary therapeutic strategies can be developed to prevent infant respiratory distress syndrome antenatally. The first is to administer a treatment aimed at accelerating the maturation process of fetal lung tissue in women at risk of premature birth. This is the only strategy with a goal of antenatal treatment. The second method is to optimize neonatal care, particularly with exogenous surfactants. The use of corticosteroids during the antenatal period has been well studied and is known to be effective with a 50% reduction in the risk of the syndrome before 34 weeks gestation. Prenatal morbidity and mortality are decreased without major adverse effects. Based on a limited number of cases, TRH-corticosteroid combination probably gives better results with no predictable unfavourable neonatal consequences. The synergic action of antenatal treatments, completed with exogenous surfactants at birth, is one of the fundamental aspects of care for very premature infants (< 28 weeks gestation).

Adrenal Cortex Hormones↗
PubMed1995

[An unusual etiology of hydramnios: prenatal cerebral vascular accident. Five cases].

Neurological anomalies of the fetus are classically reported as causes of hydramnios, but cerebral vascular events occurring in utero in the fetus are rarely mentioned. We observed five newborns with neurological complications during the neonatal period in which anomalies of cerebral vascularization were identified antenatally. The mothers had hydramnios during pregnancy. Several pathophysiological hypotheses have been proposed to explain the mechanism of hydramnios. Magnetic resonance imaging of the brain in the fetus has made it possible to identify such exceptional events with extremely poor prognosis and major sequelae.

Cerebrovascular Disorders↗
PubMed1994

[Isolated fetal tachycardia, a diagnostic event of Basedow's disease. Apropos of a case].

Two of thousand pregnancies are complicated by a Graves' disease. The circumstances of diagnosis are usually maternal disorders (tachycardia, exophthalmia, loss of weight...), also fetal disorders (tachycardia, intra-uterine growth retardation, stillborn...). The discovery of fetal tachycardia (160 beats per minute), and maternal tachycardia (120 beats per minute) associated with high blood pressure, allowed us to suspect, in this case, a Graves' disease, responsible of fetal hyperthyroidism by autoantibodies crossing the placenta. The measuring of T3, T4, TSH and autoantibodies confirmed the diagnosis. The drug of choice is the PTU (propylthiouracil). It prevents synthesis of thyroid hormones and inhibits peripheral deiodination of T4 to T3. It treats simultaneously mother and fetus; the surveillance must allow us to adjust treatment to avoid fetal hypothyroidism, maternal thyrotoxicosis of peripartum and neonatal thyrotoxicosis.

Adult↗
PubMed1994

[Induced labor: a risk factor of maternal-fetal contamination during delivery?].

OBJECTIVE: This prospective study was conducted to determine the prevalence of maternal-fetal contamination at delivery in order to evaluate the factors of risk, particularly whether inducing delivery could be of additional help in selecting portage in mothers and infants. METHODS: Over a period of 4 months, samples were obtained from 360 mother/infant pairs. Vaginal sample at the beginning of labour, gastric sample from the infant at birth. RESULTS: Positive samples were obtained from 58 women (16.1%) and from 40 infants (11%). Streptococcus B was largely predominant (60%). The rate of maternal and neonatal carriers was significantly higher in pairs for which labour had been induced (n = 92) than in those with spontaneous labour (n = 268). Taking into account solely the classical factors of risk (opening of the membranes > 12 h, T > or = 38 degrees C, prolonged labour, premature delivery, premature rupture of the membranes), only selected 37% of the infant carriers (1 criteria or more); when induced labour was added as a criteria of risk, 68.4% of the infant carriers were identified. Streptococcus B was the cause of 2 neonatal infections in this series. None of the classic risk factors was observed in either of these cases but labour had been induced in both. CONCLUSION: The fact that labour is induced appears to be an additional factor of risk of maternal and fetal colonization. Routine screening at 12 and 24 hours before inducing labour could lead to the discovery of a large number of maternal colonizations and would allow prophylaxic antibiotics to be prescribed during labour. This protocol should be evaluated in a randomized prospective study involving a large number of cases in order to identify the beneficial effect in terms of neonatal morbidity and mortality.

Adult↗
PubMed1993

[Management of a short femur discovered via ultrasound in utero. Prenatal diagnosis of Stuve-Wiedemann syndrome].

The authors report a case of familial Stuve-Wiedemann syndrome where the diagnosis was made in utero. Following this case the authors discuss the management of short femur discovered by ultrasound. The analysis of the morphology, the ultrasound appearance and the radiographic appearance (X-ray of the uterine contents) may make it possible sometimes to diagnose the syndrome. An important element is a study of the genealogy to discover the way in which a large number of these bone diseases are transmitted. The prognosis for life is very variable according to the severity of the syndrome.

Adult↗
PubMed1991

[Multiple pregnancies. Neonatal morbidity and mortality].

The increase in the number of multiple pregnancies and the high incidence of prematurity in this type of pregnancy justifies a pediatric evaluation. A retrospective study (1985-1989) compared the perinatal and neonatal characteristics of children resulting from 14 multifetal (at least 3 fetuses) pregnancies, with a gestational age of less than 34 weeks, with 27 children resulting from monofetal pregnancies of the same duration. Neonatal morbidity and mortality appeared to be similar in both groups. Thus at this very early time of onset of labour (mean gestational age of 30 weeks), fetal multiplicity expressed itself neither by any particular neonatal pathology nor by malnutrition.

Apgar Score↗
PubMed1991

[The treatment of obstetrical uterine inversion. Apropos of 3 cases].

Uterine inversion is exceptional and spectacular, although treatment is simple if diagnosed early. Three cases are reported with a review of possible obstetrical procedures for reduction. Manual repositioning by central pressure is emphasised. General anesthesia is generally needed because of associated state of shock. The three principal steps of manual reduction are: intra-abdominal repositioning of the uterus, removal of placenta, intramural injection of ocytocine to avoid immediate relapse. Ideally, obstetrical procedure should be carried out within one-half hour after inversion.

Adult↗