PubMed Health⌕ Search

Biomedical subjects

I Nisand

Publications and source records attributed to I Nisand.

At least 19 recordsLinked to original sources
PubMed1991

Embryo reduction in multifetal pregnancies after infertility therapy: obstetrical risks and perinatal benefits are related to operative strategy.

To assess the benefits that can be expected from embryo reduction of multiple pregnancies after infertility therapy, we report 58 consecutive cases of selective termination using either a transcervical or a transabdominal approach. The initial number of embryos was five or more in 13 patients, four in 29 patients, and three in 15 patients. The miscarriage rate after transabdominal procedures (23%) was one half of that after transcervical aspiration. Forty pregnancies resulted in the live birth of one child or more. The rate of prematurity was strongly related to the number of embryos left. Mean gestational age at birth was 35.5 weeks but reached 37.7 weeks when only one embryo was left. A reduction in premature birth after selective termination appeared clear for pregnancies with four or more embryos but was less significant for triplets.

Abortion, Induced↗
PubMed1991

Standard curves of cerebral Doppler flow velocity waveforms and predictive values for intrauterine growth retardation and fetal acidosis.

Cerebral Doppler measurements seem to be a future method to evaluate the degree of fetal hypoxemia. The aim of this study was (1) to elaborate standard curves for the different cerebral vessels in our own population, and (2) to describe the predictive value of Doppler measurements for intrauterine growth retardation (IUGR) and fetal acidosis. We recorded cerebral flow velocity waveforms from 71 normal pregnancies to establish standard curves for the following vessels: proximal middle cerebral artery, distal middle cerebral artery and posterior cerebral artery. Finally, we calculated the cerebroplacentar index (CPI) for each case. The predictive values from the different vessels were determined in 24 patients with IUGR and 17 cases with fetal acidosis. The poor sensitivity and the low positive predictive value of each cerebral vessel is probably explained by the rather long interval between the last Doppler assessment and delivery (22 +/- 23 days). Reducing the interval to less than 7 days, the distal middle cerebral artery and the CPI were pathological in 4 cases out of 5 fetuses that underwent cesarean section for fetal distress. These latter results have encouraged us to use cerebral Doppler flow velocity to detect fetal hypoxemia. In conclusion, the middle cerebral artery blood flow in its distal part seems to be the finest parameter to predict fetal acidosis, and this vessel should be used to optimize obstetrical management of high-risk pregnancies.

Acidosis↗
PubMed1991

[Resection under echographic control of septate uteri].

Septate uterus can be responsible for such infertility as requires surgical treatment. This series of this kind of uterine malformation in 37 cases makes it possible to evaluate the efficacy of a new technique for correction of the septum. It has the merit of not requiring laparotomy and above all it avoids carrying out hysterotomy which definitely weakens the uterus. The technique assists in correcting the defect through the cervix with scissors under ultrasound control. The morphological results on the uterine cavity are perfect in 19 patients. In 12 patients there was an arcuate fundus left and in 5 cases the section was insufficient and required a repeat procedure. This brings up to 20 the number of perfect corrections and 16 the number left with an arcuate fundus. The simplicity results were assessed in infertile patients and show that the number of abortions per patient dropped from 1.72 on average to 0.38 thanks to the ultrasound correction that was carried out. The simplicity of this method which can be carried out on an outpatient basis makes it possible to spread the indications to a situation where the Bret-Palmer technique could not be carried out and in particular in cases where IVF was being considered.

Congenital Abnormalities↗
PubMed1991

[Middle cerebral artery fetal velocimetry: criteria for extraction in severe growth retardation].

Traditional fetal extraction criteria based on the cardiotocogram (group 1) probably occur too late to serve as extraction criteria in cases of severe growth retardation. We suggest that Doppler ultrasound of the middle cerebral artery (M.C.A.) (group 2) would be used to assess the optimal moment for fetal extraction. This method has enabled us to modify perinatal mortality from 37% to 0% (p less than 0.01). The percentage rate of cerebral hemorrhage and/or neurological sequelae was 41% (9/22) in the first group whereas no infant in group 2 or 3 (control group) had these complications. The percentage rate of neonatal complication was 67% in group 1 versus 28% in group 2 (p less than 0.01). Group 1 spent 53 days (+/- 35) in intensive neonatal care unit versus 43 days (+/- 22) for group 2. Neonatal outcome was quite similar between group 2 and the control group. Cerebral Doppler could allowed us to extract severe IUGR fetuses just before cerebral ischemia and irreversible tissue damage.

Cardiotocography↗
PubMed1989

[Surveillance of fetal growth].

While clinical methods are sufficient to evaluate normal foetal growth, ultrasonography is indispensable in pathological situations. A knowledge of foetal growth is useful mainly in the 3rd trimestre of pregnancy, when the gestational age can no longer be determined. Growth is evaluated from abdominal parameters, especially perimeters. Disturbance in the development of cranial perimeter means that the brain protection mechanisms are overcome. At the moment, Doppler velocimetry cannot lead to a decision, but it provides valuable information on the perinatal prognosis. Ultrasonography is an accessory decisive factor in matters of stunted foetal growth. Cardiotocography provides instantaneous data to be used in emergencies, but ultrasonography and Doppler ultrasound provide information for long-term use. Despite the accessory position of ultrasonography as a decision-making examination, no one today would consider doing without it when monitoring foetal growth. Hence the necessity to determine exactly when and how should be obtained the data that make ultrasonography so valuable for this purpose.

Embryonic and Fetal Development↗
PubMed1989

[The obstetrical ultrasonographer and the law. Toward a medical consensus in prenatal diagnosis].

Ultrasonographers are being held to account more and more often. They are blamed for failures in diagnosis, and in particular "for false negatives". Having been taken off its pedestal, our profession seems now to have been put into the dock by a population that equates the right to treatment (encouraged by our health assurance system) with the right ot a cure and with duty by the medical profession to provide a mean to achieve the cure and good results. All forms of imaging of diagnostic interpretation are particularly vulnerable to the misunderstanding of the rights of the patient. The doctor's responsibility in civil law can be invoked when he has made a mistake, and when that mistake results in injury to the patient or her infant and where there is an obvious causal link between the mistake and the injury. The injuries that can be said to arise in the field of antenatal diagnosis are very broad-ranging, as the cases described in this article show. Comparisons between the state of affairs in France and in North America are made. The following can be involved: death of the fetus or of the newborn, emotional trauma for the parents, loss of opportunity, which is a "new" injury accepted several times since 1965 and now brought up more and more often in civil actions. This loss has not yet appeared in the penal system.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnostic Errors↗
PubMed1989

[Pre-decision algorithms for the induction of ovulation in fertilization in vitro].

The success of medically assisted procreation techniques depends on the influence of numerous parameters and, especially the quality of ovarian hyperstimulation. The need of a homogeneous treatment within the medical team has led us to elaborate a system of assistance in decision making in terms of stimulation of ovulation. A first system was developed for a classical stimulation protocol, type clomiphene-gonadotropin. The limited number of decision making parameters (six) as well as the limited number of therapeutic decisions (six) has enabled us to developed a particularly performing algorithm system.

Algorithms↗
PubMed1987

[Persistent hyperbilirubinemia after intrauterine intraperitoneal transfusions in 4 newborn infants. Role of intraperitoneal red cells present at birth].

Four neonates who had undergone intra-uterine peritoneal blood transfusions for Rhesus disease and hydrops fetalis presented, during the first days of life, with intractable hyperbilirubinemia in spite of multiple exchange transfusions. The hyperbilirubinemia was due to delayed absorption and hemolysis of peritoneal red cells. This unusual complication can be successfully managed with peritoneal lavage which should be performed when the antenatal history is contributive for low absorption of transfused blood.

Blood Transfusion, Intrauterine↗
PubMed1985

Transvaginal sonographically controlled follicle puncture for oocyte retrieval.

Transvaginal sonographically guided follicle aspiration under local anesthesia was performed on more than 100 patients and compared favorably with the other techniques that have been proposed to retrieve oocytes for in vitro fertilization. Sonography employs a sector scanner placed on the abdomen, and the needle is introduced through the posterior fornix of the vagina into the cul-de-sac and the ovary. In case of a high ovary, a transvaginal-transvesical variation may be used. The method is not painful and is easy to learn and perform. The sole adverse incidents have involved inadvertent venous puncture with no sequelae. The number and quality of recovered oocytes are good, and five normal children conceived after this method of retrieval were recently born. The technique permits substantial simplification of egg recovery for in vitro fertilization, which can now be performed in an outpatient setting without the risk and expense of laparoscopy and general anesthesia or the discomfort of transabdominal-transvesical ultrasound-guided aspiration.

Clomiphene↗
PubMed1984

[Scleroderma and pregnancy. New case and review of the literature].

A new case of the rare association of scleroderma and pregnancy is reported. The pregnancy was complicated by renal failure in the last month of gestation which was initially well controlled by anti-hypertensive therapy but then suddenly progressed to pre eclampsia with signs of foetal distress necessitating emergency caesarian section. A moderately hypotrophic child was delivered. The mother progressively recovered; diuresis and blood pressure returned to normal and the proteinuria disappeared. In the light of previously reported cases and of recent advances in our knowledge of scleroderma, especially scleroderma renal disease, the authors discuss their attitude to the management of women with scleroderma wishing to become pregnant. They review the role and place of renal biopsy in the detection of subclinical renal lesions due to the scleroderma, the presence of which would be a decisive factor in assessing the risks of pregnancy. Scleroderma renal disease is, in fact, a major contraindication to pregnancy because of the very poor foetal prognosis and the risk of maternal death due to a lethal progression of renal failure.

Abortion, Spontaneous↗
PubMed1983

Intrapericardial teratoma in a newborn infant: use of fetal echocardiography.

The case of an infant with intrapericardial benign teratoma, which was suspected in utero after fetal echocardiography, is reported. This new approach permitted very early diagnosis and surgical treatment before cardipulmonary distress appeared. The tumor was excised completely, and the patient was asymptomatic three months postoperatively.

Echocardiography↗