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M Dreyfus

Publications and source records attributed to M Dreyfus.

At least 19 recordsLinked to original sources
PubMed2006

[Laparoscopic management of pelvic mass in pregnancy].

OBJECTIVES: To determine the feasibility, safety and limiting factors of laparoscopic management of pelvic mass in pregnancy. MATERIAL: and methods. During a 10-year period, 21 laparoscopic procedures were performed in patients with pelvic masses in pregnancy after exclusion of appendicitis and ectopic pregnancy. Laparoscopic surgery was done during the first trimester of pregnancy in 8 cases, the second trimester in 12 cases and the third trimester in one case. All the procedures were performed with general anesthesia and the laparoscopic cystectomies were performed with the intraperitoneal technique. RESULTS: The indications were: persistent or sonographically abnormal ovarian cyst (12 cases), torsion of ovarian cyst (5 cases), and symptomatic pelvic mass (4 cases: 2 painful cysts and 2 infarction of fibroma). One borderline tumor were discovered. The laparoscopic procedure could not be performed in two cases due to difficulty of access to the lesion. No patient encountered complications during the intra- and post-operative periods. The mean hospital stay was 4.5 days. The outcome of the pregnancy was normal in all cases. CONCLUSION: Laparoscopic management of pelvic masses in pregnancy by an experienced team, is a safe and effective procedure.

Adult↗
PubMed2005

[Misdiagnosis of venous thrombosis in childhood].

UNLABELLED: Thrombotic events are often diagnosed with a delay that may be responsible for definite post-thrombotic syndrome. CASE REPORTS: We report two cases, which emphasize the difficulty of the diagnosis of venous thrombosis in two boys, at age 11 and 12 respectively. The occurrence of a leg pain led to a misdiagnosis of arthritis of hip in both cases. CONCLUSION: Venous thrombosis must be searched for in children with unexplained persistent pain in leg. Precocious anticoagulation is essential for preventing post-thrombotic syndrome.

Arthritis↗
PubMed2005

[Magnesium sulphate and severe preeclampsia: its use in current practice].

OBJECTIVE: To evaluate indications, mode of administration and safety of magnesium sulphate in severe preeclampsia. MATERIAL AND METHODS: We conducted a retrospective descriptive study from January 2000 to December 2002, including patients with severe preeclampsia which was defined as elevated blood pressure >or=140 and/or 90 mmHg with proteinuria >or=0.3g per day, associated with one or more of the following: elevated blood pressure >or=170 and/or 110 mmHg, proteinuria>3g per day, functional symptoms such as headache, hyperreflexia, oliguria<500 ml per day, thrombocytopenia, creatinine level>100 micromol/l, HELLP syndrome. We studied a group of 57 women treated by magnesium sulphate (intravenous bolus of 4.5g during 20 minutes followed by a perfusion of 1.5g/h) associated or not with an antihypertensive treatment. RESULTS: Treatment by magnesium sulphate was started antenatally in 53 women or during immediate postpartum in 4, associated (n=25) or not (n=32) with an antihypertensive treatment. Hyperreflexia was the main indication to start magnesium sulphate treatment (75%). About half (47%) of the cases occurred before 33 weeks of gestation No eclampsia occurred in this group. There was one overdosage which regressed when perfusion was stopped. One patient presented minor side effects attributed to magnesium sulphate. CONCLUSION: Providing a rigorous protocol, indications of magnesium sulfate therapy in severe preeclampsia are well defined. It seems that this treatment could be easily used without severe complications and major side effects.

Female↗
PubMed2005

[Comparative efficacy of vaginal insert and dinoprostone gel for cervical ripening at term in current practice].

OBJECTIVE: To compare efficiency for slow release vaginal insert and vaginal gel in current practice. METHODS: This retrospective historical study included 171 women: 85 with vaginal insert (Propess, Ferring) and 86 with vaginal gel (Prostine 2mg, Pharmacia). Inclusion criterion were Bishop score 5, singleton pregnancy, vertex presentation, unruptured membranes, and patients with only one prior cesarean delivery were not excluded. Indications for cervical ripening were post-term pregnancy, maternal or fetal pathologies, convenience. The outcomes were vaginal delivery within 12 and 24 hours, cesarean section rate, mean time to delivery, uterine hyperstimulation rate and cost. The statistical analysis was done with Pearson chi2, Student test exact Fisher and U Mann-Whitney tests. RESULTS: Comparing vaginal insert to vaginal gel, no significant differences appeared for vaginal delivery by 24 hours (53% versus 58%), cesarean section (17.6% versus 19.7%) and mean time to delivery (23.8h versus 22.4h). Labor induction rate within the primipara subgroup was significantly reduced with vaginal gel (39% versus 63.6%; p=0.03) but the rate and time of vaginal delivery were similar. In the same population, the rate of uterine hyperstimulation was higher (9.8% versus 0%; p=0.05) with vaginal gel. Cost of treatment was lowered with vaginal insert. CONCLUSION: The dinoprostone vaginal insert for cervical ripening seems to have the same efficiency as vaginal 2mg gel. The cost of treatment appears to be lower, probably because only a single dose is necessary. Use of prostaglandine gel after vaginal insert is not accepted as a gold standard for cervical ripening though our conclusions only concern this retrospective study.

Administration, Intravaginal↗
PubMed2005

[Inflammatory bowel disease and pregnancy: report of 76 cases and review of the literature].

OBJECTIVE: Obstetrical prognosis for women suffering from Crohn's disease and from ulcerative colitis, and consequences of pregnancy on inflammatory bowel diseases (IBD). PATIENTS AND METHODS: Retrospective study, of 76 pregnancies, after the diagnosis of IBD among 77 women (33 ulcerative colitis, 44 Crohn's disease). RESULTS: Pregnancy did not modify the evolutive profile of IBD. No particular gravity of IBD revealed during pregnancy or post-partum was noticed. The outcome of the 54 pregnancies associated with quiescent IBD was the same as in the general population. Five of ten pregnancies started during an active period of Crohn's disease or ulcerative colitis ended in fetal loss (3 spontaneous abortions, 2 medical terminations). In women with a first acute episode or IBD reactivation during pregnancy (n=12), one-third of the newborns were low weight for gestational age, one-third were born preterm and only one-third were term babies with normal weight. Vaginal delivery did not trigger development or exacerbation of perianal Crohn's disease (n=20). Cesarean section was performed in 2 with an ileal pouch-anal anastomosis (n=4) and 1 patient with an ileo-rectal anastomosis (n=3) to avoid injury to the anal sphincter. Ileostomy (n=2) did not contraindicate delivery. CONCLUSION: Control of IBD is the main obstetrical factor for prognosis. Starting pregnancy can be advised if the disease is quiescent, with rapid and efficient management of possible flare-ups. Delivery route must be determined on a case-by-case basis, each considering pregestational anal continence and the clinical presentation of the perineum.

Chronic Disease↗
PubMed2005

[Antenatal diagnosis and management of vein of Galen aneurysm: review illustrated by a case report].

Vein of Galen aneurysm is a rare vascular congenital malformation. We report an antenatal diagnosis with duplex Doppler at 26 weeks gestation. Magnetic resonance imaging was used before and after delivery in order to determine neurological prognosis. The neonatal prognosis is poor if fetal cardiac insufficiency or cerebral lesions are present antenatally. Premature delivery does not improve the neonatal outcome. When the aneurysm is not life threatening, embolization of the malformation is at best delayed five months after birth.

Adolescent↗
PubMed2005

[Comparison of women's alcohol consumption before and during pregnancy. A prospective series of 150 women].

OBJECTIVES: Evaluation of the prevalence of prenatal alcohol exposure in relation with declared alcohol consumption (DAC). MATERIALS AND METHODS: Observational prospective study based on the DAC of 150 women in post-partum or hospitalized for abnormal pregnancies. The main selection criterion was change in DAC before and during pregnancy, classified according to alcohol use and misuse limits. Excessive alcohol intake was defined as more than 4 glasses on occasion and/or more than 14 glasses a week. Age and professional position were also taken into account. Data were obtained using semi-directive interviews. RESULTS: 79% of these women drank before pregnancy. 33.2% of them had excessive intake. Consumption of more than 14 glasses a week concerned 10% of the population. Excessive consumptions on occasion significantly affected 33% of the population. During pregnancy, 43% of these women continued drinking. Overall excessive intake, which is noxious for children, concerned 9.9% of the women. 5% declared a regular misuse above 14 glasses a week and 7% of them consumed more than 4 glasses on occasion. The average age was 29.8 years. Most of the women (61%) had a stable job. CONCLUSION: Our study confirms alcohol consumption by women, even during pregnancy. Consumptions of pregnant women is decreasing progressively. DAC is very useful to evaluate alcohol intake.

Adult↗
PubMed2004

[Complications of vacuum extractor deliveries].

OBJECTIVES: To describe maternal and neonatal complications following deliveries assisted by vacuum extraction and to compare outcomes with those obtained after spontaneous vaginal delivery. We wanted to know if vacuum extractor was a risk factor by itself. MATERIALS AND METHODS: We conducted a retrospective study of two years activity involving 4524 deliveries of which 845 (18.7%) were vacuum extractor assisted. We precisely defined maternal and neonatal complications to compare their rates in spontaneous vaginal delivery and vacuum extractor groups. RESULTS: There were 1333 maternal complications and 114 neonatal complications. The adjusted risks of maternal complications were significantly higher in the vacuum extractor group for simple vaginal tears (OR=3.0; p<0.001), the simple perineal tears (OR=1.8; p<0.001) and third degree perineal tears (OR=2.7; p<0.01). For neonatal complications, the difference was significant for cephalhematomas (OR=10; p<0.001) and scalp abrasions (OR=53; p<0.001). No cases of skull fracture or subgaleal subaponeurotic hemorrhage were recorded. CONCLUSION: Our rates of maternal and neonatal complications after vacuum extractor were similar to those described in the literature. We have been able to show that vacuum extraction is itself a risk factor for third degree perineal tears and cephalhematoma. However, these complications are so infrequent that the advantages of this method of extraction argue in favor of wide use in obstetrics.

Birth Injuries↗
PubMed2004

[Medical treatment of early spontaneous miscarriages: a prospective study of outpatient management using misoprostol].

OBJECTIVES: Medical treatment using misoprostol has been recommended as an alternative to surgical evacuation for spontaneous miscarriages in the first trimester, in order to avoid anesthesia, a surgical operation and hospitalization. Our aim was to assess the efficacy and the safety of vaginal misoprostol in out-patient management of early miscarriages. MATERIAL AND METHODS: We conducted a prospective cohort study including patients with a spontaneous miscarriage of less than 14 weeks gestation. Exclusion criteria were hemorrhagic miscarriages, gestational sac larger than 40 mm and/or cranio-caudal length of the embryo of more than 30 mm. Our protocol used 4 intravaginal tablets (800 microg) of misoprostol on Day 1, out-patient follow-up, clinical and ultrasound reassessment on Day 2. If the intra-uterine antero-posterior diameter on ultrasound examination was greater than 15 mm (or the gestational sac persisted), a second dose of misoprostol was administered or surgical evacuation was performed (failure of medical treatment). RESULTS: One hundred two patients were included, of whom 30 had an inevitable or threatened miscarriage and 72 had a missed abortion. The success rate defined by complete expulsion of the products of conception without resorting to surgical evacuation and without short-term complications, was 78.4% (80 patients). Two patients were lost to follow-up at 48 hours. Complete expulsion occurred within 2 days in 94% of cases. There were 13 emergency consultations, including 8 for expulsion pain and five surgical evacuations (3 for hemorrhagic expulsion, 2 for hemorrhagic retention). All together, there were 15 surgical evacuations for retention of the products of conception after 1 or 2 doses of misoprostol. There was one case of endometritis (1%). Thirty-four patients were hospitalized, 22 for surgical evacuation and 12 for expulsion pain. CONCLUSION: It is possible to use misoprostol as a single vaginal dose (800 microg) as out-patient treatment, since it gives satisfactory efficacy (80%) and is sufficiently safe (5% needing emergency surgery). However, out-patient management should only be performed after explaining the treatment and its risks clearly to the patient.

Abortion, Spontaneous↗
PubMed2004

[Polycythemia vera and pregnancy].

Polycythemia vera is a rare chronic myeloproliferative disease. Its exceptional association with pregnancy can lead to severe complications. Antithrombotic treatment could prevent such adverse outcome. A patient with two previous pregnancies complicated by preeclampsia, was treated by hydroxyurea for polycythemia vera. She started a new unexpected gestation without this myelosuppressive treatment and the pregnancy was conducted uneventfully with low molecular weight heparin and low dose aspirin. Thrombotic complications required the reintroduction of hydroxyurea. Diagnosis of polycythemia vera during pregnancy is a very difficult task due to physiologic changes occurring during gestation. Adverse outcome including severe vascular complications can be a preclinical phase of the disease. An adequate therapy could prevent these complications.

Adult↗
PubMed2004

[Obstetrical complications of morbid obesity].

OBJECTIVE: To determine whether morbidly obese women have an increased risk of pregnancy complications and adverse perinatal outcome. METHODS: In a retrospective study, 2472 women with morbid obesity, defined as a body mass index (BMI) more than 40 were compared with normal weight women (BMI 20-25). Fisher and Student tests were used for statistical analysis. RESULTS: In the group of morbidly obese mothers (BMI greater than 40) as compared with the normal weight mothers, there was an increased risk of the following outcomes: gravidic hypertension (7.7 vs 0.5%; p<0.05). preeclampsia (11.5 vs 2%; p<0.05), gestational diabetes (15.4 vs 1.8%; p<0.05), cesarean delivery (50 vs 15.4%; p<0.05), and macrosomia (42.3 vs 10.3%; p<0.05). However, we noted a lower rate of prematurity in the obese group (0 vs 11%). Even when morbidly obese women with preexisting diabetes and chronic hypertension were excluded from the analysis, significant differences in the perinatal outcomes still persisted. CONCLUSION: Morbid obesity appears to be an independent risk factor for perinatal and gestational complications.

Adult↗
PubMed2004

[Initial management of primary postpartum hemorrhage].

Accurate management of primary postpartum hemorrhage requires perfect knowledge of a recent protocol accessible at all times. Staff members and equipment need to be adjusted to the emergency situation. The first step is to establish a rapid diagnosis. This could be done with collecting bags, placed immediately after the birth. Once the diagnosis has been established, it has to be communicated to the whole team including obstetricians, midwives and anesthetists. A search for the cause of the hemorrhage is premordial. Abdominal uterine palpation confirms the diagnosis of uterine atony, the most frequent cause of postpartum hemorrhage. Two management schemes are possible depending on whether or not there is retention of the placenta. When the placenta is retained, manual removal has to be performed to empty the uterine cavity and to rule out uterine rupture. After placental delivery, manual control of the uterine cavity is always required. Uterine massage has to be performed after the intrauterine manoeuvres and must not be stopped too quickly. Rapidly other origins can be excluded: episiotomy or low genital tract lacerations requiring rapid repair, coagulation disorders requiring specialised care, or hematomas. During the same time, uterotonic drugs have to be used. Oxytocin (intravenous injection of 5 to 10 IU) is generally employed. Prostaglandins cannot be proposed as publications reporting their efficiency are not validated. Meanwhile, the anesthetists will have begun the first measures of resuscitation.

Decision Trees↗
PubMed2004

[Anesthesiologists at the initial stage of postpartum hemorrhage].

Adequate management of postpartum hemorrhage (PPH) requires, after early recognition, four components undertaken simultaneously: communication, resuscitation, monitoring, investigating the cause of bleeding, arresting the bleeding. Early recognition of PPH relies on either a perceived or a quantified blood loss of 500-1000 ml and over (using a collecting bag), or the presence of clinical signs of shock (hypotension, tachycardia, tachypnea, altered mental status). Precise timing of the diagnosis of PPH must be must annotated. Once the diagnosis is established, appropriate senior professionals, including the anesthesiologist at the early stage, must be called in. The cornerstones of initial resuscitation are restoration of blood volume and oxygen carrying capacity, achieved, with adequate intravenous access, initially with cristalloids, followed by colloids, associated with oxygen by face mask. Initial resuscitation is performed and its efficiency is assessed by continuous monitoring, hemoglobin bedside tests (Hemocue), full blood count and clotting screen. Oxytocine (Syntocinon) efficacy and side-effects are evaluated by anesthesiologists. Adequate anesthetic technique must be performed to permit to the obstetricians to perform a diagnostic procedure (manual removal of placenta, uterine revision), and to most frequently obtain arrest of bleeding. Hemodynamic stability is required for loco-regional anesthesia, while on the other hand, general anesthesia with crush induction and intubation will be performed. Anesthesiologists must anticipate in case of failure of initial measures, including in alerting the blood transfusion service and calling for additional help.

Anesthesia, Obstetrical↗
PubMed2004

[Obstetrical management in the event of persistent or worsening postpartum hemorrhage despite initial measures].

Sulprostone infusion must be started without further delay if the first treatment (oxytocin, manual removal of the placenta, uterine revision, vaginal and cervical examinations) has been unsuccessful in the first 30 minutes after delivery. In France, the use of this treatment has been officially authorized in this indication (marketing approval, AMM). Intramuscular and intramyometrial injections being contraindicated, sulprostone is administered through continuous intravenous infusion. Dosage is 500 microg (one vial) per hour. Starting dose is 1.7 microg/min (10 ml/h), and can be increased if necessary in steps of 1.7 microg/min (but not exceeding 8.3 microg./min). The success rate of this treatment is linked to the rapidity of its commencement (within 30 min of the diagnosis of postpartum hemorrhage). In case of contraindications, since postpartum hemorrhage is life-threatening, the benefit-risk ratio needs to be estimated. A strict monitoring of cardiovascular parameters is compulsory before and after its administration. There is no time limit after which this treatment can be considered as ineffective: it depends on the amount of blood lost, the patient's clinical state, and on means that have already been used to stop the bleeding. However, if after 30 min of sulprostone infusion, there is no improvement or if the situation is worse, other therapeutic strategies must be considered (e.g., embolization, surgery). The use of intra-rectal misoprostol is still under assessment. To date, we have been unable to find studies that justify this treatment. Intra-uterine balloon, tube, or mesh packing has been studied in a few small series, where it was successful. Use of these strategies must not delay the treatment by sulprostone.

Female↗