Biomedical subjects

M Capella-Pavlovsky

Publications and source records attributed to M Capella-Pavlovsky.

6 recordsLinked to original sources

PubMed1989

[Operations guided by echography].

The considerable development, during the last few years, of the antenatal diagnosis of congenital abnormalities is due to progress in cytogenetics but also to rapid improvements in obstetrical ultrasonography. With high-resolution ultrasound scanners, various interventions performed increasingly early during pregnancy can be guided with an ever decreasing risk. Thus, genetic diseases can now be detected at a very early stage by chorion biopsy combined with genetic engineering, and direct foetal blood sampling with a needle guided by ultrasound increases our knowledge of foetal physiology and provides an access to antenatal pathology. In the forthcoming years a true antenatal medicine will no doubt develop, no longer to eliminate foetuses, but to treat and cure them.

Amniocentesis↗

PubMed1988

Prenatal management of 746 pregnancies at risk for congenital toxoplasmosis.

When infection with Toxoplasma gondii occurs during pregnancy, there is a risk that the parasite will cause severe congenital toxoplasmosis. We developed a method of diagnosing and treating congenital toxoplasmosis in utero. Diagnosis was based on the identification of maternal acute infection, followed by culture of fetal blood and amniotic fluid, testing of fetal blood for toxoplasma-specific IgM and nonspecific measures of infection, and ultrasound examination of the fetal brain. Treatment included the administration of antibiotics to all mothers with confirmed acute infection during pregnancy, with more intensive antibiotic treatment of those who had infected fetuses and who chose to continue the pregnancy. We report a prospective study of 746 documented cases of maternal toxoplasma infection, in which the infants were followed for at least three months. Infection was diagnosed antenatally in 39 of 42 fetuses. Twenty-four of the 39 pregnancies were terminated, and 15 were continued. All the mothers were treated with spiramycin throughout pregnancy; if fetal infection was demonstrated, pyrimethamine and either sulfadoxine or sulfadiazine were added to the regimen. Of the 15 fetuses with congenital toxoplasmosis who were carried to term, all but 2, who had chorioretinitis, remained clinically well during follow-up. We conclude that prenatal diagnosis of congenital toxoplasmosis is practical and that prenatal therapy in women who wish to continue their pregnancies reduces the severity of the manifestations of the disease.

Abortion, Induced↗

PubMed1987

Fetal blood sampling in twin pregnancies. Prenatal diagnosis and management of 19 cases.

Twin pregnancies pose particular problems in both prenatal diagnosis and obstetric management. We present 19 twin pregnancies that underwent fetal blood sampling (FBS). The indications were mostly similar to those for singleton pregnancies, with both fetuses being sampled. There was one indication specific to twin pregnancies; disseminated intravascular coagulation in the retained twin after the death-in-utero (DIU) of the other. In 5 cases, only 1 twin was sampled; in 2 because the second twin was female in the diagnosis of an X-linked disorder; in 1 because of technical failure, and in 2 the other twin had predeceased. Eight pregnancies continued after the FBS delivering 2 live, healthy infants, though 5 were delivered before 37 weeks of gestation. In 7 cases there was a discordance in the diagnosis between the twins. In 3 of these cases the affected fetus underwent selective termination by air embolism; in 2 cases the pregnancies were continued and the affected twin not resuscitated; 1 pregnancy is still in progress, and 1 patient had a non-medically supervised termination of both twins in another country. Two patients miscarried within a week of the FBS. Two patients had only 1 living twin at the time of FBS; 1 had a second DIU a month after the FBS and the other a neonatal death at 11 days of age in an infant with severe porencephaly. FBS is technically feasible for similar indications as for singleton pregnancies though discordance in diagnosis raises specific management problems.

Blood Specimen Collection↗

PubMed1985

Fetal blood sampling during pregnancy with use of a needle guided by ultrasound: a study of 606 consecutive cases.

Because of various prenatal diagnoses, 606 fetal blood samplings were carried out in 562 pregnancies from the gestational week 17 to 38 with use of a 20-gauge needle guided by ultrasound. The procedure was performed on outpatients under local anesthesia and without medication before or after the procedure. Pure fetal blood was obtained at the first attempt in 588 cases. A second attempt was necessary in 18 cases. Maternal blood contamination was never present. Amniotic fluid dilution was noted in 15 cases. At the beginning of our experience only three cords could not be punctured. The duration of the procedure was less than 10 minutes in 90% of cases. Fifty-eight pregnancies were terminated after consideration of the results of the diagnosis, and 504 pregnancies were continued. The complications found in these pregnancies were premature delivery (5%), growth retardation (8%), in utero death (1.1%), and spontaneous abortion (0.8%). In the future this new procedure could replace fetoscopy and initiate an important field of new investigations.

Blood Specimen Collection↗

PubMed1985

Prenatal diagnosis of congenital toxoplasmosis.

Prenatal diagnosis of congenital toxoplasmosis was attempted by means of fetal blood sampling at 20-24 weeks' gestation. It was possible to detect in fetal blood samples non-specific laboratory signs of fetal infection, specific antibodies of fetal origin (IgM), and parasitaemia by inoculation of the sample into mice. Amniotic-fluid samples were also inoculated into mice and parasites were often present when the fetus was infected. Ultrasound examination of the fetus was done repeatedly, mainly to detect any enlargement of the cerebral ventricles. Together the results of these examinations allowed a reliable diagnosis, which was confirmed by the presence of necrotic foci of toxoplasmic encephalitis in the fetus in every case. Only 1 case of congenital toxoplasmosis occurred among 209 cases with negative prenatal diagnoses.

Antibodies↗

PubMed1985

[Fetal karyotyping of fetal blood obtained from the umbilical vein using ultrasound].

The fetal karyotype was established during the second or third trimester of 18 at risk pregnancies after fetal blood sampling by direct puncture of the umbilical vein guided by real time ultrasound. Two karyotypes were abnormal. This rapid technique for karyotyping allows the obstetrician to decide early how the pregnancy should be conducted.

Chromosome Aberrations↗