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P Vaast

Publications and source records attributed to P Vaast.

At least 19 recordsLinked to original sources
PubMed2006

[Maternal and foetal anaesthesia for ex utero intrapartum treatment (EXIT) procedure].

The ex utero intrapartum treatment (EXIT) procedure is a surgical procedure maintaining utero-placental circulation during caesarean section. Anaesthetic implications are described: foetal transplacental anaesthesia to avoid first breathing and to permit surgical procedure on obstructed foetal airway, deep maternal haemodynamically stable anaesthesia to relax uterine smooth muscle during a long caesarean procedure but avoiding post-partum haemorrhage. Volatile anaesthesia with sevoflurane seems to be adequate for these aims. Two cases are described.

Adult↗
PubMed2006

Prenatal prediction of survival in isolated left-sided diaphragmatic hernia.

OBJECTIVE: To investigate the potential value of antenatally determined intrathoracic herniation of the liver and the ratio of fetal lung area to head circumference (LHR) in the prediction of postnatal survival in isolated, left-sided congenital diaphragmatic hernia (CDH). METHODS: In this multicenter study, we searched the antenatal-CDH-Registry for fetuses with isolated left-sided CDH that were liveborn after 30 weeks of gestation and were followed up postnatally for at least 3 months after discharge from hospital. The patients were subdivided into those with and those without intrathoracic herniation of the liver and into subgroups according to the LHR that had been measured between 22 + 0 and 28 + 0 weeks of gestation. The rate of survival in each group and subgroup of patients was determined and compared. RESULTS: The registry search identified 184 patients that fulfilled the entry criteria. Logistic regression analysis demonstrated that significant predictors of survival were the presence or absence of intrathoracic herniation of the liver and the LHR. In 86 cases there was liver herniation (Group A) and in 98 the liver was confined to the abdomen (Group B). In Group A, the survival rate was 50.0% and was significantly associated with LHR; in Group B the survival rate was 76.5% and was unrelated to LHR. CONCLUSION: In isolated, left-sided CDH, the postnatal mortality rate is substantially higher if there is intrathoracic herniation of the liver. In fetuses with liver herniation, measurement of LHR at 22-28 weeks of gestation is useful in the prediction of subsequent survival.

Female↗
PubMed2005

Accuracy of magnetic resonance imaging for measuring fetal sheep lungs and other organs.

OBJECTIVE: Lung volume measurement by fetal magnetic resonance imaging (fetMRI) has been used to predict survival of fetuses with isolated congenital diaphragmatic hernia (CDH). So far, the accuracy and precision of fetMRI for volumetry of either the normal or hypoplastic developing lung has not been formally studied. METHODS: A total of nine sheep carrying 14 fetuses underwent fetMRI under general anesthesia at a mean of 118 days' gestational age (term = 145 days). A total of 61 organs were measured in nine normal fetal sheep and five that underwent surgical creation of diaphragmatic hernia (DH), so as to induce pulmonary hypoplasia. Lungs were measured on T2-WI (weighted images) in three different planes, while liver and kidneys were measured in the axial (T1-WI) and sagittal (T2-WI) planes, respectively. Necropsy was done within 24 h after fetMRI to determine the volume postmortem by the water displacement method. Values were linearly correlated and a Bland and Altman analysis was done for volume measurement comparison, calculating means +/- SD, bias (mean of the difference of volume measurements), precision (SD of the difference) and absolute and proportionate limits of agreement for both methods. The accuracy of fetMRI volume measurement was determined for different organ groups by calculating the median relative error and precision index, both being measures of error in proportion to the magnitude of the volume measured, as a clinically relevant proxy of potential errors. RESULTS: The fetMRI volume measurements were on average larger than postmortem volumes, except for the kidneys. Kidney volume determination had a relative error of 29%, while measurements of larger organs had larger relative errors (42% for liver). Normal lungs were less accurately measured in the coronal or sagittal than in the axial plane (relative error 53%, 73% and 38%, respectively; P < 0.05 for sagittal vs. axial). Axially-measured lung volumes were more accurate for lungs of normal sheep compared to DH lungs (relative error 38% vs. 73%, respectively; P < 0.05). CONCLUSION: FetMRI measured systematically higher volumes for organs such as fetal liver or lung. This may be related to fluid loss or lack of perfusion at the time of necropsy. Measurement of lung volume by fetMRI was most accurate in the axial plane. Measurements of lung and liver volumes by fetMRI in normal sheep were both in agreement with volumes measured at necropsy. Loss of accuracy for DH-lungs in comparison with the accuracy when measuring other similarly small organs, such as kidneys, suggests that fetMRI measurements can be less accurate for hypoplastic lungs related to CDH. With improving hardware, it might become easier to render the fetal lung and determine its volume reliably.

Algorithms↗
PubMed2004

[Maternal and fetal consequences of increased gestational weight gain in women of normal prepregnant weight].

OBJECTIVE: To study the effects of increased gestational weight gain in women of normal prepregnant weight. PATIENTS AND METHODS: We compared 174 patients gaining more than 18 kg to 174 patients gaining between 9 and 15 kg. Body mass index was normal for every woman included in the study. RESULTS: Weight gain > or =18 kg was associated with increased risk of vascular complications (5.2% vs. 1.1%, P < 0.05) but not with increased risk of mellitus diabetes (5.2% vs. 4.0%, NS). Weight gain > or =18 kg prolonged labor length (414.4 +/- 147 min vs. 376.5 +/- 166.4 min, P < 0.05) and increased the rate of cesarean section (19.5% vs. 10.3%, P < 0.05). Neonatal outcome was similar in both groups, mean birth weight was greater (3413.6 +/- 427.0 g vs. 3163.4 +/- 495.1 g, P < 0.05) and the frequency of infants weighing more than 4000 g at birth was increased (8.0% vs. 4.0%, P < 0.05) among women gaining more than 18 kg. CONCLUSION: Excess weight gain in pregnancy affects gestational and delivery outcomes and results in higher frequency of fetal macrosomia. These results confirm recommendations on weight gain in pregnancy as guidelines for pregnant women.

Adult↗
PubMed2003

[Fetal thoracic MR imaging].

Ultrasonography is the method of choice for prenatal malformation screening, but it does not always provide sufficient informations to allow a correct diagnosis or an adequate abnormality evaluation. Fetal MRImaging (MRI) indications are increasing in order to complete sonographic findings. It has been initially used for evaluation of cerebral abnormalities, but it is more and more applied to other fetal areas. An adequate analysis of fetal chest and abdomen can be obtained with fast T2 and T1 weighted sequences. This allows an easy diagnosis of congenital diaphragmatic hernia and an evaluation of the consequences on pulmonary growth. Other pulmonary malformations can be also easily identified (cystic adenoid malformation, sequestration, bronchogenic cyst, tracheal or bronchial atresia). Therefore, fetal thoracic MRI contributes to a better understanding and evaluation of fetal thoracic malformations, which is particularly useful for their postnatal management.

Bronchi↗
PubMed2003

[Magnetic resonance imaging applications in obstetrics].

PURPOSE: To review the main indications and results of magnetic resonance imaging in the pregnant women. MATERIAL AND METHOD: We reviewed MRI practice during the pregnancy based on our own experience in a prenatal diagnostic center and data in the literature. Rapid improvement in MRI technology has allowed more extensive use, giving a good contrast-to-noise ratio and multiplanar imaging. RESULTS: Although ultrasound provides primary screening information, final diagnosis may require further investigations. MRI, to be performed in the second and third trimester, is the non-invasive second line tool of choice in this context. The most widespread indications are for brain disease: search for a cause of ventriculomegaly or biometric abnormality, confirmation of a malformative or acquired lesion. Progressively, indications were widened to head and neck, thorax, abdomen and pelvis areas. Moreover, systematic indications include previous fetal pathology or the pregnancy context. Other MRI indications have been suggested: placental malposition, pelvimetry and maternal genito-urinary tract. CONCLUSION: MRI is becoming the natural and necessary second line imaging technique, with increasing indications. It must be kept in mind however that all pathological conditions cannot be depicted by these morphological studies.

Congenital Abnormalities↗
PubMed2002

Successful treatment of extremely severe fetal anemia due to Kell alloimmunization.

BACKGROUND: Repeated plasmapheresis was used to prevent fetal death from severe anti-Kell alloimmunization until intrauterine transfusions were feasible. CASE: Repeated maternal plasma exchanges (N = 40) beginning at 7 weeks' gestation were used to treat severe anti-Kell alloimmunization. Ultrasound examination at 19 weeks' gestation revealed diffuse hydrops in this fetus (umbilical venous hemoglobin, 1.2 g/dL), which then required nine intrauterine transfusions through 34 weeks. A healthy 3840-g girl was delivered by cesarean delivery at 36 weeks. Despite aplastic anemia during the first 3 months of life, she is healthy and has no observable abnormalities at age 8. CONCLUSION: A highly aggressive course of plasmapheresis and intrauterine transfusions can successfully treat fetal anemia caused by anti-Kell alloimmunization even when fetal hemoglobin is extremely low.

Adult↗
PubMed2002

[Cerebral fetal MRI and ventriculomegaly].

OBJECTIVE: To evaluate MRI usefulness in diagnosis and management of fetuses with cerebral ventriculomegaly at US. PATIENTS AND METHODS: Sonography depicted cerebral ventriculomegaly in 61 fetuses. Management included MRI in all cases and infectious screening, and karyotype in 51 cases. Final diagnosis was supported by fetal autopsy (n=24), postnatal follow-up>6 months (n=19), infectious screening or karyotype (n=8), and MR imaging when diagnosis was obvious (n=16). RESULTS: MRI was more informative than ultrasonography in 32.8% of cases with identification of the etiology in 21.3% of cases. In 45% MRI and sonography were considered to be normal. In the remaining cases, MRI confirmed the ultrasound diagnosis of cerebral malformation. Ultrasonography never depicted more anomalies than MR imaging. The 2 false negatives were gyration disorders but MR imaging was performed too early. CONCLUSION: US is the imaging modality of choice in the evaluation of fetal anomalies but MRI has to be systematically performed in case of cerebral ventriculomegaly because MRI demonstrates its usefulness in patient counseling, even if there are a few false negative results.

Abortion, Therapeutic↗
PubMed2001

[An ischemic pulmonary malformation of the surviving fetus occurring after selective embryo reduction in bichorionic pregnancy. Report of one case and literature review].

We describe, to our knowledge, the first case of a pulmonary malformation called acinar dysplasia occurring at a surviving fetus after selective embryo reduction in a bichorionic pregnancy. The chronological and histological observations suggest that this anomaly may be linked with a feticide achieved at 13 week's gestation. Literature review concerning selective embryo reduction shows rare cases of vascular connections in bichorionic pregnancies especially during the first half of gestation, that can explain in part the apparition of survivor's anomalies.

Adult↗
PubMed2000

[Trisomy 18: ultrasound aspects. Report of 40 cases].

OBJECTIVE: We describe the different ultrasound findings suggestive of trisomy 18. PATIENTS AND METHODS: We conducted a retrospective study in 40 cases of trisomy 18 diagnosed in the department of obstetrics at the Lille University Hospital between 1988 and 1998. RESULTS: Eighty percent of the women in this series were multiparous. Mean maternal age at discovery of the trisomy as 33.2 years and the mean gestational age was 20.4 weeks. Fifty-five percent of the cases were discovered during the second trimester of pregnancy, 22.5% during the third trimester and 22.5% during the first trimester. One ultrasound abnormality, at least, was detected in 36/40 cases (90%) a percentage that reached 96.8% taking into consideration the ultrasound examinations performed during the second and third trimesters (30/31 cases). The most frequently detected ultrasound abnormalities were: intra uterine growth retardation (IUGR: 50%), poly-hydramnios (42.5%), limb abnormalities (42.5%), cardiac defects (30%), facial abnormalities (37.5%), meningomyelocele (32.5%), digestive abnormalities (32.5%), urinary tract abnormalities (27.5%), lymphangiectasia and cystic hygroma (15%), and single umbilical artery (12.5%). Medical termination of pregnancy (TOP) was performed in 28 cases. There was one spontaneous miscarriage at 8 weeks and one in utero death (IUD) at 39 weeks in a patient who desired to continue her pregnancy. In 6 cases, the issue of the pregnancy was unknown because the patients were lost to follow-up. In 4 cases (10%), pregnancy was continued to delivery of live babies that only survived a few minutes to 7 days. CONCLUSION: The ultrasound signs suggestive of trisomy 18 change according to the term of pregnancy. At the first trimester, most of the signs are nonspecific, such as cystic hydroma or lymphangiectasia, and do not suggest the need for a karyotype. At the end of the second trimester, an association of various signs that alone would not be highly suspect suggest the need for further exploration in search of other signs: early IUGR, associated or not with poly-hydramnios, limb abnormalities, cardiac defects, omphalocele, diaphragmatic hernia, meningomyelocele, enlarged cisterna magna, choroid plexus cysts, single umbilical artery, facial dysmorphism, facial cleft, hydronephrosis.

Abnormalities, Multiple↗
PubMed2000

[Fetal arrhythmias: diagnosis, prognosis, treatment; apropos of 33 cases].

From October 1993 to February 1998, 33 cases of fetal cardiac arrhythmia were investigated by doppler-echocardiography at the Lille infantile and congenital cardiology department. Extrasystolic arrhythmias were the most frequently encountered disorder (25 fetuses, i.e., 76% of cases: 24 instances of extrasystolic auricular arrhythmia and one case of extrasystolic ventricular arrhythmia). They were invariably benign, and apart from one case only required standard monitoring. Tachycardia was observed in 15% of cases (three cases of supraventricular tachycardia [SVT] and two cases of auricular flutter [AF]). In no instance was a cardiopathic syndrome noted. A number of efficient treatments have been described, but the prognosis is often poor in the presence of hydrops fetalis. Direct fetal treatments (cordocentesis) are currently under evaluation, and at present can only be used as a last resort. In our series, one fetus died 15 minutes after transplacental Flecaine (flecainide) administration. Two of the three SVT and the two AF cases were successfully treated. Bradycardia, which was unassociated with extrasystolic arrhythmia, was found in 9% of cases. It is concluded that Flecaine is probably the treatment of choice for supraventricular and ventricular fetal tachycardia, as it has no teratogenic effect and crosses the placenta at a fetal concentration that is 80% of the maternal level. However, the administration of this drug is not without risk. It is known to possess certain negative side effects, and its pharmacological profile and maternal and fetal health risks have not yet been fully investigated. At present, no entirely safe and efficient treatment for fetal cardiac arrhythmia has been found.

Anti-Arrhythmia Agents↗
PubMed2000

Echographic signs of trisomy 21 in the second trimester of pregnancy: actual value after analysis of the literature.

OBJECTIVE: To evaluate the interest and to compare the major echographic signs of Down syndrome in the second trimester of pregnancy. METHODS: A bibliographic research has been performed for most of the echographic signs known and studied until now. For each study and in average for each sign, we have computed its sensitivity, its specificity, its positive and negative predictive values using the results of the different authors. Then, we have compared the benefits/risk ratio for each of these signs: the number of Down syndrome cases detected versus healthy fetus lost due to amniocentesis complications. RESULTS: The different signs can be ranked according to their benefits/risk ratio from top to bottom as follows: nuchal skinfold thickness, wide space between first and second toe, pyelectasis, large iliac angle, short humerus, short femur, hypoplasia of the middle phalanx of the fifth digit. CONCLUSION: These results suggest that second trimester echographic signs of Down syndrome must be evaluated as a function of the Down syndrome risk in the population under study. The presence of these signs does not always justify an amniocentesis; it should lead to a re-evaluation of the individual risk of a Down syndrome (a chart is given to guide this re-evaluation).

Down Syndrome↗