[Tocolysis by first intention with atosiban].
Explore the source record for details and available documents.
Female↗
Biomedical subjects
J Gondry
Publications and source records attributed to J Gondry.
[Neonatal renal venous thrombosis following an electrical shock in pregnancy].
Neonatal renal venous thrombosis may result in severe morbidity. Predisposing conditions are well known. We report the case of an unusual and early neonatal renal venous thrombosis. The mother received an electrical shock at 34 weeks gestation. This case demonstrates that maternal electrical shock effect on the fetus should be early investigated.
Electric Injuries↗
[Prepubic TVT: a prospective study of 164 female patients treated for stress urinary incontinence].
OBJECTIVE: A prospective open study was conducted to evaluate the prepubic (TPP) route of TVT. PATIENTS AND METHODS: 164 patients suffering from stress or mixed urinary incontinence were operated by prepubic route mainly under spinal anaesthesia. The incision is more proximal and para-uretral dissection directed more lateral to reach ischiopubic bone. The tape is introduced while keeping the needle tip close to bone to perforate between bone and ischiocavernous muscle. Then the needle is brought forwards to get its tip in vertical position and pushed under vulva to supra pubic area. A cough test is done with more pulling than in TVT since in TPP the pulling forces will act more frontally and laterally. Evaluation included detailed clinical examination with stress test, pads, endoscopic and urodynamic assessments and questionnaires in order to detect prognostic factors and to have a global treatment policy for associated low urinary tract symptoms and prolapse. RESULTS: Mean follow-up time was 20 months (14-30). No significant intraoperative complications occurred. All patients urinated the first day. The mean postvoid residual urine was 45 ml. Objective cure rate was achieved in 135 (82.3%) patients and 7 (4.3%) patients were improved while failure was observed in 22 (13,4%) patients. From patients'point of view success and satisfaction rates were 85.4% and 86%. No significant modification of sexual activity occurred. DISCUSSION AND CONCLUSION: TPP is a simple technique with very low risks and the preliminary results are consonant with those of other published techniques.
Adult↗
[Diagnosis and current concepts of management of advanced abdominal pregnancy].
Authors report a case of abdominal pregnancy diagnosed by MRI at 17 SA with prospective follow-up and planned delivery at 37 SA. The diagnosis is clinically suspected when extra-uterine pregnancy risk factors or history of uterine trauma are present. This is confirmed by MRI, which may be considered as the gold standard. A conservative management may be proposed when the diagnosis is made after 20 weeks and under the following conditions: absence of fetal growth malformation, placental implantation remote from the upper abdomen, good maternal condition, close management in a hospital setting of the patient previously informed of the risks and outcomes. Placental location on the uterus seems to be a major positive factor of outcome for these pregnancies. Materno-fetal follow-up is based on physical examination, repeated ultrasonic investigations with Doppler imaging and daily fetal heart rate monitoring. In the absence of complications, a laparotomy should be planned at 34 weeks. The placenta may not be removed when a serious risk of hemorrhage is feared.
Female↗
[Epidemiology of HPV infection].
HPV DNA testing using Hybrid Capture 2 (Digene) was added to a program of liquid based (Thinprep, Cytyc) cervical cancer screening in a population of sexually active women aged from 20 to 62 years, without the history of uterine cervix pathology. 14.32% of 3832 women in this population were HPV positive. Positivity peaked in women aged 25-29 (19.4%) and gradually decreased, with 8% of positivity after 60 years. Positivity was independently related to parity, tobacco use and was correlated to cervical pathology. The rate of positivity in this population seems to preclude the use of HPV testing as a primary screening tool.
Adult↗
Chorioamniotic separation after 14 weeks' gestation associated with trisomy 21.
Explore the source record for details and available documents.
Adult↗
[Value of karyotyping women patients of couples referred for sterility].
It has been known for some 25 years that there is a causal relation between chromosomal aberrations and male infertility and that the major indication for karyotyping an infertile man is still usually an abnormal sperm analysis. The value of karyotyping women in the routine work-up of couples referred for sterility has long been debated. A French recent cytogenetic study found an overall increased frequency of chromosomal aberrations in the female and confirmed that in some cases of poor reproductive outcome there may be a contribution of maternal chromosome aberrations. Indeed, the existence of a chromosome abnormality in the female partner was associated with the group of infertile men in which there was no apparent cause of infertility. These results emphasise the need for thorough genetic work-up in couples referred for sterility. This work-up should include karyotyping of the female for some indications explained in this work.
Chromosome Aberrations↗
Cerebro-costo-mandibular syndrome in a father and a female fetus: early prenatal ultrasonographic diagnosis and autosomal dominant transmission.
Ultrasonography in a female fetus revealed cystic cervical hygroma, severe micrognathia, and vertebral and upper limb anomalies suggestive of cerebro-costo-mandibular syndrome (CCMS) which was diagnosed ultrasonographically at 16 weeks' gestation. The father is affected and presents with a Pierre Robin sequence, short stature and typical costovertebral anomalies. CCMS is a rare and severe disorder. The high frequency of sporadic cases, vertical transmission, and the excess of sibs affected via horizontal transmission suggest dominant autosomal mutation with possible germinal mosaicism. The vertical familial case detailed in the present report is a reminder of the high risk when one parent or one sibling is affected and the extreme variability of phenotype and costal ossification. Early prenatal ultrasound diagnosis is possible in a severely affected fetus.
Abortion, Therapeutic↗
Treatment of CIN after menopause.
OBJECTIVES: To characterise cervical neoplasia after the menopause. MATERIAL AND METHODS: We studied our computerized files of CIN from 1993-1999. Of the 738 cases, 78 were after menopause (11%). RESULTS: We made a report of the specificities of cytological and colposcopical diagnosis and the treatment given. Cytological results are the same after and before menopause. On the other hand, colposcopical patterns are significantly different because of a particular topography of the lesion. The majority of CIN after menopause are localized in the canal and are 44% versus 12. Incomplete conization is no more frequent after menopause than before. However, stenosis is higher: 73% unseen junction against 15%. Therefore, at this age, a total hysterectomy could possibly be preferable. In this study, we will outline the positive and the negative aspects of this form of treatment.
Cervix Uteri↗
[Removal or conservation of ovaries during hysterectomy for benign lesions].
At the time of hysterectomy, the aging ovary presents a dilemma. We conducted a prospective study to assess the feasibility of systematic oophorectomy in women 50 years or older and a retrospective study of hysterectomy history in patients who developed cancer of the ovary. Our finding and data in the literature point out the requirement for careful assessment of two aspects of the problem, one technical (feasibility of adnexectomy) and the other functional (ovary function and risk of cancer on the retained ovary).
Age Factors↗
[Role of misoprostol in the delivery outcome].
OBJECTIVES: Delivery-induced hemorrhage is defined as a blood loss greater than 500 ml within the first 24 hours after delivery. Loss of more than 1000 ml is a sign of gravity. For certain authors, 40% of these hemorrhages could be avoided with systematic preventive measures using uterotonic agents to control the third phase of labor. The aim of our work was to assess the preventive efficacy of active management measures during the third phase of labor and to determine which agents are most effective. PATIENTS AND METHODS: We compared two protocols for controlled deliver: a conventional method using ocytocin (2.5 IU i.v. bolus), and a more recent method using a prostaglandin E1 analog: misoprostol (Cytotec, 3 tablets per os). We compared the two methods with a control group where no preventive measures were used, the standard procedure in our maternity unit. RESULTS: Six hundred two women participated in the study. They were divided into 3 homogeneous groups (ocytocin group misoprostol group, control group). There was a 46% reduction in delivery-induced hemorrhage in the ocytocin group but only a minimal preventive effect against severe hemorrhage. Misoprostol did not demonstrate any efficacy in our study. DISCUSSION: It would appear appropriate to take preventive measures against delivery-induced hemorrhage for all deliveries. A bolus intravenous injection of ocytocin immediately after delivery should bed used. The dose should be greater than that used in this study in order to prevent the development of severe hemorrhage. The most satisfactory results can be obtained with 5 IU (1 ampoule of Syntocinon). It is important to obtain a precise quantification of excessive blood loss in order to institute appropriate care rapidly. Misoprostol should be assessed with other prospective studies because of its easy administration, its low cost and easy storage, important advantages in countries with limited resources.
Adult↗
Informed consent to serum screening for Down syndrome: are women given adequate information?
To assess the information given to women during a maternal serum screening (MSS) programme, we prospectively applied a questionnaire to 504 pregnant women attending for amniocentesis after a screen-positive result. The survey based on 200 usable questionnaires (39.7 per cent of our study population) showed that MSS was imposed as mandatory by 41.5 per cent of providers and done without their patients' agreement by 16 per cent. After release of the test results, 6.5 per cent of women believed that they were carrying a Down syndrome-affected fetus and 21.5 per cent thought the risk was about 50-50. A total of 38.5 per cent of the pregnant women were not informed of the risk of miscarriage after amniocentesis and 67.5 per cent believed that there was no possibility of a false-negative result with MSS. Information given over the telephone was particularly poorly understood compared with information provided during an outcome visit, since women who learned of their test result during such a visit scored significantly higher (69 per cent) when questioned about the risk of carrying a Down syndrome-affected fetus, compared with women informed of their test results by telephone (38.7 per cent) or by letter (47 per cent). We therefore suggest routine consultation with an antenatal care professional before testing to enable pregnant women to give their informed consent to MSS.
Amniocentesis↗
Use of the electrohysterogram signal for characterization of contractions during pregnancy.
This article proposes a method to evaluate the ability of the electrohysterogram signal to characterize the contractions during pregnancy, in a population with high risk of preterm deliveries. This study constitutes a first stage of a project intended to develop a monitoring system for the early diagnosis of preterm deliveries. After a proper signal denoising, we calculate some parameters characteristic of the extracted contractions. These contractions are then divided into classes of different physiological terms. Classical techniques of data analysis, such as principal component analysis and discriminant analysis, permit us to show an evolution of the contractions during pregnancy, which is different between the groups of preterm deliveries and that of deliveries at term. We show that, in an early term of pregnancy, we can separate the two populations: women delivering at term from women delivering preterm. We then show that these two kinds of pregnancy are of different evolutions. These results are encouraging, because they would permit, in a follow-up medical study, to diagnose a possible preterm delivery, as well as the proximity of the delivery.
Adult↗
[Endometrial resection for refractory menorrhagia. An alternative to hysterectomy].
ENDOMETRIAL RESECTION: Whether resection is total or partial, the superficial layer of the myometrium is exposed to a certain degree of damage. SEVERAL METHODS: Radiofrequency thermal resection, the standard method, offers the advantage of allowing histology examination. Other destructive methods have also been proposed including the more recent laser Ng-Yag ablation technique. INDICATION: Ideally, endometrial resection is indicated in women with a small uterus who develop drug resistant menometrorrhagia after the age of 40 years. MODERATE RATE OF SUCCESS: In a personal series of 105 patients who underwent radiofrequency thermal resection and with a mean follow-up of 15.5 +/- 6.6 months, results were in agreement with data reported in the literature: perforation of the uterus < 5%, hemorrhage < 1%, metabolic syndrome < 2%. Patients were entirely satisfied in 58% of the cases but secondary hysterectomy was required in 14%. PRECISE INDICATIONS: Despite the advantages over hysterectomy, endometrial resection should be reserved for selected patients in order to avoid an unsatisfactory high rate of failure.
Endometrium↗
Serum bupivacaine concentrations and transplacental transfer following repeated epidural administrations in term parturients during labour.
Bupivacaine is the most widely used local anaesthetic in obstetrics for epidural analgesia. Nineteen women (mean age 26.9 +/- 5.3 years) who underwent epidural analgesia during labour were included in this study. All parturients received a first injection of 21.8 +/- 2.5 mg 0.25% plain bupivacaine. The following administrations were given on request: 0.25% concentration was used when cervix uteri was supple, and a 0.375% concentration when it was tonic. Blood samples were collected 5 min after the first injection and then every 30 min until delivery. At delivery blood samples were collected from the infant umbilical cord vein and from the arm vein of the mother. Bupivacaine was assayed by high pressure liquid chromatography. Serum data were analyzed for each patient using a non-compartmental model. Bupivacaine was rapidly detected in serum, and maximal concentration was reached between 5 and 35 min. Pharmacokinetic parameters were estimated in 17 women after the first injection: 87 +/- 35 min for elimination half-life, 60 +/- 19 L for apparent volume of distribution and 0.5 +/- 0.3 L/min for plasmatic clearance. For a mean total duration of labour and total dose administered of respectively 222 +/- 115 min and 57.1 +/- 28.7 mg the mean value of the foeto-maternal ratio was 0.29 +/- 0.10. The infant maximal serum concentration was 0.26 microgram/mL. No side effects were spontaneously reported by the parturients and all infants had an Apgar score of 10 at 5 min after the delivery. We confirm the fast systemic absorption and rapid elimination of bupivacaine which may be used without risk of acute toxicity both in mother and child, even when it is used in a 0.375% concentration.
Adult↗
[Treatment of micro-invasive cervical cancers].
Explore the source record for details and available documents.
Conization↗
[Leukorrhea. Diagnostic orientation].
Explore the source record for details and available documents.
Adult↗
Validity in nulliparas of increased beta-human chorionic gonadotrophin at mid-term for predicting pregnancy-induced hypertension complicated with proteinuria and intrauterine growth retardation.
The objective of the present study was to investigate whether increased beta-human chorionic gonadotrophin (beta HCG) plasma concentrations in an unselected population of nulliparas could predict the occurrence of complicated pregnancy-induced hypertension (PIH). The design was that of a prospective population study. It was conducted at the obstetric departments of Amiens University Hospital and Creil General Hospital on 434 consecutive nulliparas with singleton pregnancies after natural fertilization who accepted the systematic offer of trisomy 21 screening but for whom this disorder was finally estimated. Measurement of plasma concentration of beta HCG (ELISA method) was carried out between 14 and 20 weeks (mean: 17 weeks) of amenorrhea, and measurement of blood pressure and proteinuria (> 300 mg/24 h or Albustix +2) during the first, second and third term and 2-3 months after the delivery, as well as measurement of birth weight for determination of small for gestational age (SGA) babies, 37 women developed PIH, 10 without other complication, 16 with proteinuria (5 of which with SGA babies) and 11 with SGA babies. Furthermore 2 patients presented abruptio placentae without PIH. 395 women did not develop PIH including 389 normotensive women and 6 chronic hypertensive patients without superimposed toxemia. Only 1 was diabetic. None had chronic renal disease. Mean (+/- SD) levels of beta HCG were higher in PIH than in controls: 46,805 +/- 19,068 versus 23,479 +/- 13,463 IU. A pathologic threshold was chosen as the mean for the whole population + 1 SD: 25,613 + 15,479 = 41,082 IU. Elevated levels (above this value) were significantly associated with isolated PIH or PIH complicated with proteinuria and/or with SGA babies. The positive predictive value of this criterion was respectively 11, 15 and 12% for each of these complications. The relative risk (and 95% confidence limit) of women with elevated beta HCG for each of these complications was 20 (6-79), 11 (4-43) and 22 (7-93). Elevated plasma beta HCG found around 17 weeks of amenorrhea predicts PIH complicated with either proteinuria or SGA babies with a positive predictive value comparable to that of the best and earliest test proposed up to now to select nulliparas at high risk of preeclampsia, namely the abnormalities of the Doppler waveforms of the uterine arteries. Since this test is simpler to perform, it represents the most convenient method to screen a population of nulliparas for evaluation of the benefits of low-dose aspirin.
Adult↗