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J B de Meeus

Publications and source records attributed to J B de Meeus.

14 recordsLinked to original sources
PubMed1998

External cephalic version after previous cesarean section: a series of 38 cases.

OBJECTIVE: To determine if external cephalic version (ECV) is a reasonable alternative to repeat cesarean section in case of breech presentation. STUDY DESIGN: Retrospective study of 38 women with one previous cesarean section and a breech presentation after 36 weeks of gestational age who have had at least one experience of ECV. Statistics used the Fisher's test with significance when P<0.05. RESULTS: Version attempts were successful in 25 of the 38 women (65.8%). Seventy-six percent of the successful version women went on to have vaginal birth after cesarean section. A total of 19 successful vaginal deliveries occurred (50%). Success rate of ECV was lowered when breech was the indication of the previous cesarean section. The vaginal delivery rate was increased after successful ECV in patients previously vaginally delivered, but this difference did not reached significance (P=0.057). No maternal or neonatal complications occurred. CONCLUSION: ECV is acceptable and effective in women with a prior low transverse uterine scar, when safety criteria are observed.

Adult↗
PubMed1997

[Cervical maturation by repeated applications of prostaglandin E2 gel. 186 cases].

OBJECTIVE: A prospective clinical trial of cervical ripening with intracervical prostaglandin E2 gel in repeated administrations was performed. STUDY DESIGN: One hundred eighty-six patients were enrolled in this prospective trial between 01/01/89 and 31/12/93. these patients with unripe cervix (Bishop score < 5) required induction of labor because of pregnancy disorders. Mean patient age was 28.2 years (range 15 to 43), mean gestational age was 39.2 week's gestation (range 33 to 43) and mean parity was 1.8 (range 1 to 10). Our exclusion criterias were as follow: twin pregnancies, breech presentation and premature rupture of membranes. A 0.5 mg prostaglandin E2 gel was administered into the cervix every four hours maximal of three doses before induction of labor with oxytocin. Maternal and neonatal results were reviewed. RESULTS: Patients required a single dose of gel in 19.9% of cases, two doses in 26.3% and three doses in 53.8%. Induced labor during cervical ripening occurred in 55.4% of patients. A cesarean section was necessary in 22% of cases. This rate was both significantly related to the initial Bishop score and to the Bishop score at the end of the procedure. Patient with induced labor during the cervical ripening had a significantly lower cesarean section rate compared to these who needed induction with oxytocin (10.7% versus 33.8%; p < 0.01). The uterine hyperstimulation rate was 1.6%. A 1 min Apgar score less than 7 occurred in 1.1% of neonates. COMMENTS: Our results do not demonstrate benefit of repeated administration comparison to a single administration described in literature. Maternal and neonatal morbidity is low in this study but cervical ripening should be used only when pregnancy disorders require prompt delivery within twenty-four hours.

Administration, Intravaginal↗
PubMed1996

[Hepatic cytolysis caused by tocolytic treatment using micronized natural progesterone].

Micronized natural progesterone is often prescribed alone or in association with beta-agonists in the treatment of preterm labor in France. We observed drug-induced hepatitis in 4 such patients. The main manifestation of liver disease was pruritus. After drug withdrawal, elevated transaminase levels continued to rise for one week then normalized within 10 to 30 days. The imputability of this undesirable effect was assessed and considered to be likely. The effectiveness of micronized natural progesterone in the prevention of premature delivery and in decreasing perinatal mortality and morbidity has not yet been proven. This drug should therefore be used with care, keeping in mind the risk of hepatitis, particularly in patients presenting with pruritus.

Adult↗
PubMed1995

[Intra-uterine artificial insemination. Indications, techniques, results; 83 cases].

OBJECTIVES: Retrospective study of results after intra-uterine artificial insemination performed in the Poitiers University Hospital. MATERIAL: There were 95 infertile couples who benefited from intra-uterine artificial insemination. Indications involved pathology of the cervix in 53% of the cases and male infertility in 30%. Another cause of infertility was found in 5% and no cause could be identified in 12%. METHOD: The technique was as follows. Ovary stimulation using clomifene and hMG, sonographic monitoring with oestradiol assay, hCG for triggering ovulation, 2 inseminations at 24 and 48 h after swim-up sperm preparation and luteal phase supplementation. RESULTS: The overall success rate was 32.6% with a mean success rate per cycle of 11.1%. The best results were obtained in couples with unexplained infertility and cervix-related infertility (42 and 32% respectively). These results are comparable to those in the literature. CONCLUSION: The results of this series and the data reported in the literature demonstrate the interest of intra-uterine artificial insemination in cases of cervical sterility where it is indicated as first intention treatment. In case of impaired ejaculation, unexplained sterility and certain other causes of male infertility, intra-uterine artificial insemination can be useful but requires further study in order to determine the criteria for indications and the techniques to be used. Associating ovary stimulation increases the probability of success, especially in cervical sterility. Finally, more than 4 to 5 attempts do not increased success rate.

Drug Monitoring↗
PubMed1993

[Obstructive myocardiopathy and pregnancy].

We report a case of pregnancy in a patient with severe obstructive cardiomyopathy treated with beta-blockers. A review of the literature shows that in spite of possible worsening of the functional symptomatology, pregnancy does not increase the risk of mortality. The recommendations for the conduct of the delivery are reviewed. The risks for the fetus are essentially linked to the treatment with beta-blockers and the possibility of inheritance of the condition.

Adrenergic beta-Antagonists↗
PubMed1993

[Familial cancer of the ovary. A family with 6 index cases].

Greggi and Kerlikowske have worked out that a woman has a 1.4% chance of developing ovarian cancer during her life. When cancer of the ovary is found, 5 to 10% of these cases have a familial form of this pathology. Thus there are some hereditary forms of cancer of the ovary and Lynch has demonstrated that there are three types of hereditary associations with ovarian neoplastic pathology: specific familial cancer of the ovary, cancer of the ovary associated with endometrial cancer and with non-polypoidal cancer of the caecum and rectum, cancer of the ovary associated with cancer of the breast. The clinical material we are presenting here is of the first type of association and we are reporting the study of a family in which 6 members in two generations had cancer of the ovary and of whom one had cancer of the breast as well. Familial cancer of the ovary shows different characteristics coming on as it does earlier (ten years earlier) and with a shorter length of survival (1.8 as against 5 years). The risk of the next generation having ovarian neoplastic pathology is clear because there is a 50% chance in a patient who has a history of cancer of the ovary in at least two first degree relatives. For most daughters when this type of familial cancer is found it is justifiable to carry out prophylactic oophorectomy from the age of 35 year onwards. Particular supervision should be carried out for patients who are members of a family where 2 index cases have been found within 20-35 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Congenital arteriovenous malformation of the internal iliac artery discovered during pregnancy].

We report a case found at the start of labour because of the presence of a "tumour praevia". Ultrasound, Doppler and tomodensitometric examination carried out after caesarean section confirmed the vascular origin of this lesion. Arteriography made it possible to decide the pattern of this arteriovenous malformation which was occurring in several branches of the left internal iliac artery. It was not possible to obliterate it completely by selective arterial embolisation, so it was removed surgically a few months later. Little is known about the complications that occur because of these arteriovenous malformations in pregnancy and during delivery. There is the theoretical risk that spontaneous rupture will occur in pregnancy but this does not justify terminating the pregnancy. It is better to carry out caesarean section because the tumour can obstruct delivery and may rupture as well as causing delay in labour. The treatment for these lesions is sometimes difficult and complex and one has to decide whether to preserve the uterus or not. Selective embolisation and pre-operative embolisation followed by surgical removal of dysplasic tissue are the therapies of choice.

Adult↗
PubMed1993

[The role of ultrasound-guided puncture in the evaluation of liquid tumors of the ovary].

Twenty percent of liquid tumors of the ovary are persistent functional cysts. Laboratory tests of the cystic fluid should make it possible to distinguish between functional cysts and organic cysts. In 170 patients derived from a multicenter study and presenting with a liquid tumor of the ovary (including 9% of cancers), samples of the cystic fluid and serum were taken from the patient and the ACE, CA 125, CA 19-9 markers, estradiol and Progesterone were assayed. The results of these assays were subjected to computerized analysis and compared with the pathological findings. The assays were able to discriminate between organic cysts and functional cyst with 93% of sensitivity and 95% specificity. The insufficient reliability of this evaluation justified a second study (in progress) which is limited to the study of pure fluid tumors with thin walls, no partitions, no vegetations and measuring less than 8 cm in diameter in which the incidence of cancers is very low. This study should fine tune the initial findings and result in a sensitivity approaching 100 percent. If this hypothesis is confirmed, it should be possible to include ultrasound-guided puncture carried out under closely defined conditions in the therapeutic decision trees for liquid cysts of the ovary.

Adolescent↗
PubMed1992

[Distal ischemia of the upper limb due to obliteration of the ulnar artery at the wrist: surgical treatment].

So-called "Raynaud's distal ischaemic phenomena of the upper limb may be responsible for disabling functional impairement and even lesions requiring amputation of one or several fingers. The ulnar artery is usually involved in these phenomena because of its anatomical position and its importance in the blood supply of the hand and the fingers. The authors present three clinical cases of distal ischaemia of the upper limb due to obliteration of the ulnar artery at the wrist, treated by microsurgical vein graft. A review of the literature revealed only 23 well documented cases of this type of treatment, i.e. 10% of all treatment options, which gave 95 to 100% of favourable results. The three patients in our series, reviewed after 2, 3 and 5 years, were considered to be cured. Although the severity of the disease can be evaluated by the clinical course, arteriography appears to be the key examination for diagnosis, prognosis and choice of treatment. However, two practical attitudes are recommended to avoid the risk of progression towards digital necrosis: when the symptoms are chronic, arteriography is indicated in the case of resistance to medical treatment or immediately in the case of unstable symptoms. The diagnosis of occlusion of the ulnar artery at the wrist then justifies treatment by microsurgical vein graft; when the symptoms are acute, treatment should preserve as much as possible the palmar and digital ulnar arterial blood supply.

Adult↗
PubMed1992

[Are there still indications for an abdominal hysterectomy? 340 cases].

This retrospective study of 340 hysterectomies carried out abdominally concern cases only where the pathology was benign and strictly limited to the body of the uterus. This has made it possible to review the 240 cases carried out for fibroids (70.6%), 63 for simple endometrial hyperplasia (18.5%), 28 for adenomyosis (8.2%) and 9 for atrophy of the endometrium (2.6%). We looked for lesions that could have been treated laparoscopically among these pathologies: submucous fibroids with a diameter of less than 4 cms and where the uterus was less than 10 cms in height and weighted less than 200 g, simple endometrial hyperplasia (the height of the uterus less than 10 cms and the weight less than 200 g, adenomyosis (uterus less than 10 cms in height and less than 200 g weight), this last criteria still "debatable", We found that 110 lesions were selected because they could have been treated conservatively. This means that 32.5% where there seemed to have been indications for hysterectomy out of 340 cases, could have been treated otherwise. These can be divided aetiologically in to: 54 cases of simple hyperplasia of the endometrium (15.9%), 34 cases with submucous fibroids (10.6%), 26 cases of adenomyosis (5.9%). If the cases of adenomyosis are excluded 90 out of 340 hysterectomies carried out abdominally (about a quarter) could have been treated conservatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1992

[The HELLP syndrome. 13 cases].

The Hellp syndrome is a complication of raised blood pressure in pregnancy, haemolysis, a rise in liver enzymes and thrombopenia. In this retrospective study we report 12 cases of Hellp syndrome which occurred in the University Hospital Centre of Poitiers between 1982 and 1990 and we discuss causes, the progress, the prognosis and the management. Six patients were helped by prophylactic Caesarean operation. Two patients had eclamptic fits. Fortunately there was no maternal death. There were seven cases of intrauterine growth retardation, two of in utero fetal death and one of early neonatal death. When clinical and biological parameters of the Hellp syndrome come right following delivery, the outlook for the mother is quickly favourable, but the syndrome can continue and sometimes become worse after delivery. Stopping the pregnancy is the basic treatment and conservative treatment has only a very limited success. Finally, the prognosis for the future is usually good and it is unlikely to recur.

Anemia, Hemolytic↗
PubMed1991

[Delivery of large infants. Management and results of 198 cases].

We have studied the deliveries of 198 large fetuses over a period of 3 years between 1st January 1987 and 31st December 1989 in the University Hospital of Poitiers. By large fetus we mean the delivery of a child of 4,000 grammes or more. This occurs in 4.5% of deliveries. The following risk factors are present either singularly or together with others: previous delivery of a large child (12.6%), a previous history of pregnancy diabetes or its absence (2.5%), an increase of weight during pregnancy of more than 15 kgs (46.8%), obesity before the onset pregnancy (19.7%), the height of the uterus equal to or above 35 cms (75.8%). These factors were found in nearly 90% of the patients. Their presence should make one look for a large fetus. The obstetrical results were as follows: 18 ceasareans were carried out (9.09%); instrumental delivery was necessary in 43 cases (23.8%); there were 17 cases of shoulder dystocia treated by obstetrical manoeuvres (9.5%). There were therefore 122 vaginal deliveries without any interference (61%). Neonatal complications were: one lost because of malformation (0.5%), serious morbidity in 30 deliveries (15.15%); 16 fractures of the clavicle and two cases of brachial plexus paralysis of which one persisted, two facial palsies which recovered, six infections, three cases of hypoglycaemia and one serious fetal distress which recovered without any sequelae. Maternal complications were: no mortality, serious morbidity in 26 women (14.1%), 9 haemorrhages at delivery, 9 cases of trauma of the perineum, 6 infections, and 2 haematomata in the episiotomy wound.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗