Biomedical subjects
Y Jacquemyn
Publications and source records attributed to Y Jacquemyn.
Use of tocolytics: what is the benefit of gaining even more time?
Today's dogma states that tocolytics can be used to prolong pregnancy for just 48 hours, allowing corticosteroids to be administered and transportation of the mother to a tertiary care centre. Surveys have shown that up to 30% of practitioners use maintenance tocolysis. Theoretically, maintenance tocolysis should be able to improve neonatal outcome by avoiding preterm birth and allowing delivery in the community maternity hospital or even at home, minimising social difficulties created by long distances between the mother and/or her baby and the rest of the family. This should result in fewer neonatal intensive care unit admissions, less respiratory distress syndrome and fewer long-term neurological sequelae. Such an effect has never been proven, probably because we do not know which women benefit from treatment, which do not require treatment because they are not in labour and which babies would better be born because chorioamnionitis and other insults jeopardize intrauterine development. Most studies on long-term tocolysis have been performed with beta-agonists. No improvement has been shown. On the contrary, a trend towards fetal harm with an increased risk for periventricular leucomalacia exists. Results from studies of one tocolytic should not be generalised; one published study on maintenance therapy with atosiban showed prolonged uterine quiescence and prolonged gestation, but was too small to detect differences in neonatal outcome. In the future, we need larger studies, not only to detect whether long-term tocolysis with newer tocolytics (oral oxytocin antagonists, prostaglandin receptor blockers) results in better neonatal outcome, especially at the lower gestational ages but also to discover methods that allow us to identify those women who will benefit from treatment and those for whom prolongation of pregnancy may cause harm.
Postpartum hemorrhage: practical approach to a life-threatening complication.
Postpartum haemorrhage (PPH) occurs in 5% of all deliveries and is responsible for a major part of maternal mortality. Adequate attendance to this complication can mean the difference between life and death. A well-trained staff together with clear and simple guidelines can make a significant difference to the patient. The aim of this article is to offer a practical guide for the management of PPH; a flowchart is presented. When faced with refractory hemorrhage, one can switch to interventional therapy or surgery. Efficiency and speed play a key part in the approach to this life threatening bleeding.
Preeclampsia and birthweight by gestational age in singleton pregnancies in Flanders, Belgium: a prospective study.
PURPOSE: Recent studies have questioned the relationship between low birthweight and hypertension in pregnancy, especially in term pregnancies. We aimed to analyse the influence of chronic hypertension, preeclampsia, gestational hypertension and superimposed preeclampsia on birth weight in singleton pregnancies at different gestational ages. METHODS: Between January 1, 2001 and December 31, 2002 data on hypertension (subdivided in chronic hypertension, preeclampsia, gestational hypertension, superimposed preeclampsia and eclampsia) were collected prospectively for all deliveries in the region of Flanders, Belgium. Multiple pregnancies and patients with diabetes were excluded from analysis. Multiple linear regression was performed to construct a model for the prediction of birthweight and to determine the contribution of hypertension. RESULTS: Hypertension was diagnosed in 5,284 of 111,007 (4.8%) singleton pregnancies, and of these 647 had chronic hypertension (0.6% of the total group), 2,253 (2%) gestational hypertension, 2,244 (2%) preeclampsia and 140 (0.1%) superimposed preeclampsia. Birthweight less than 2,500 g was most frequent in the preeclamptic group and less frequent in case of gestational hypertension, but in all hypertensive groups it was statistically more frequent compared to the normotensive pregnancies. Before 26 weeks' gestational age the presence of any kind of hypertension did not influence birthweight. From 26 weeks on preeclampsia contributed to a lower birthweight. Gestational hypertension resulted in a lower birthweight between 28 and 34 weeks, but not before or after this period. Superimposed preeclampsia only had an effect between 32 and 34 weeks and chronic hypertension only marginally contributed to birthweight. A relation with both a high birthweight (> 4000 g) and birthweight < 2500 g was found in term gestational hypertension and preeclampsia. CONCLUSION: At an early gestational age (less then 26 weeks) hypertension is not a significant factor influencing birthweight. Uncomplicated chronic hypertension is not an important factor determining birthweight but preeclampsia is. Gestational hypertension influences birthweight in a limited period between 28 and 34 weeks of gestational age. When hypertensive pregnancies reach term they tend to result both in more babies weighing < 2,500 g and > 4,000 g.
Transient bone marrow oedema of the femoral head in pregnancy--case report.
We report a case of transient oedema of the femoral head without signs of osteoporosis, and with spontaneous resolution after delivery. Magnetic resonance imaging is essential to differentiate between a traumatic necrosis and bone marrow oedema.
Compression sutures instead of emergency peripartum hysterectomy.
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Pregnancy and Takayasu's arteritis of the pulmonary artery.
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A uterus-saving procedure for postpartum hemorrhage.
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Prenatal diagnosis of pentalogy of Cantrell: a case report.
Pentalogy of Cantrell is a very rare congenital disorder characterized by ectopia cordis in combination with an abdominal wall defect. A case diagnosed prenatally at 25 weeks' gestational age is presented.
[Ultrasound screening and diagnosis of fetal structural abnormalities between 11-14 gestational weeks].
AIM OF THE STUDY: To assess the feasibility of ultrasound screening and diagnosis of structural fetal anomalies at the 11-14 week scan. METHODS: An observational prospective follow up study from March 2000 till May 2003 was performed at three referral centers by seven experienced sonographers with high-resolution ultrasound equipment. 1135 singleton pregnancies between 11+0 and 14+6 weeks gestation (w.g.) participated in the study. The first trimester scan included assessment of fetal number, viability and biometry, nuchal translucency [NT] measurement and fetal anatomy survey performed according to standardized published protocols. Increased NT > or = 95th centile and/or diagnosis of structural fetal anomaly was considered as indication for invasive prenatal diagnosis, early fetal echocardiogram and follow-up scans, including a detailed fetal anomaly scan at 18-22 w.g. and a third scan at 28-32 w.g. Pregnancy outcome was ascertained from hospital records, referring physicians or the patients themselves. RESULTS: The overall prevalence of structural fetal anomalies in the present study was 4.6% (53/1135). 22% (12/53) of the structural anomalies were detected between 11-14 w.g. 9 of those had normal karyotype, and 3 were associated with chromosomal anomalies. Furthermore, 10 cases of increased NT, with or without non-immune hydrops fetalis, were associated with congenital heart disease, rare genetic syndromes and adverse pregnancy outcome later in gestation. The ultrasound detection rate of structural fetal anomalies in the present study increased from 22% (12/53), to 69% (37/53) and 79% (42/53) for the first trimester scan, the first and second trimester scans, and the combination of all three scans, respectively. 21% (11/53) of all structural fetal anomalies were missed by prenatal ultrasound. CONCLUSIONS: The first trimester scan is a method of choice for the diagnosis of major structural fetal anomalies. NT measurement is a useful screening test for chromosomal anomalies. In cases with increased NT subsequent development of congenital heart disease, rare genetic syndromes or adverse pregnancy outcome should be ruled out. At present, the second trimester scan constitutes an indispensable tool for the detection of most structural abnormalities. Even in advanced gestation the prenatal diagnosis of certain anomalies is difficult and often unfeasible.
[First trimester ultrasound screening for structural and chromosomal anomalies in multiple pregnancy].
AIM OF THE STUDY: To assess the feasibility of first trimester ultrasound screening for structural and chromosomal fetal anomalies in multiple gestations. METHODS: An observational prospective follow up study was carried out in 32 cases of multiple pregnancies. Two scans were scheduled in each case--the first, between 6-9 weeks of gestation (w.g.) and the second, between 11-14 w.g. The aim was assessment of fetal number, viability, chorionicity/amnionicity and fetal biometry. In addition, nuchal translucency [NT] measurement, assessment of risk for chromosomal anomalies and fetal anatomy survey were always performed. Increased NT > or = 95 percentile and/or detection of structural anomaly were considered indications for invasive prenatal diagnosis and fetal karyotyping. Selective fetocide was considered in cases of chromosomal or structural anomalies and in high-order multiple gestations (> or = 3 fetuses). Pregnancy outcome was ascertained by the physical examination of the fetuses, placentas and membranes postpartum, the hospital records, the referring physicians or the parents. RESULTS: From 32 cases of multiple pregnancies included in the study, 28 were twins, and 4--triplets. 68% (19/28) of the twin pregnancies were bichorionic-biamniotic [Bi-Bi], 25% (7/28)--monochorionic-biamniotic [Mo-Bi] and 7% (2/28)--monochorionic-monoamniotic [Mo-Mo]. 4 cases of increased NT in one of the twins (1--associated with trisomy 21) were observed, as well as 2 cases of structural fetal anomalies (1--discordant for exencephaly, and 1--with conjoint twins), 2 cases of feto-fetal transfusion syndrome that developed in the second trimester (1--associated with increased NT between 11-14 w.g.), 1 case of TRAP syndrome [twin-reversed arterial perfusion] and 1 case of cord entanglement in monoamniotic twins. In addition, there were 4 cases of a vanishing twin in the first trimester, and in 2 other cases spontaneous miscarriage of both twins occurred before 24 w.g. In two of the triplet pregnancies selective fetocide was performed, one was successfully delivered at 33 w.g. and in the last case the parents chose to terminate the pregnancy. CONCLUSIONS: First trimester ultrasound is a method of choice for detection of major structural fetal anomalies in multiple gestations. Increased NT between 11-14 w.g. in multiple pregnancies is a useful screening tool for detection of chromosomal fetal anomalies, while in monochorionic twins its presence might predict the development of fetofetal transfusion syndrome. First trimester selective fetocide in high-order multiple gestations or in affected twins is one of the options in pregnancy management.
Erythropoietic protoporphyria in pregnancy.
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Twin versus singleton pregnancy and preterm prelabour rupture of the membranes.
PURPOSE: The primary purpose of this study was to compare the latency period between preterm prelabour rupture of the membranes (PPROM) and delivery in twin versus singleton pregnancies. The secondary purpose was to compare the neonatal outcome of these two groups. METHODS: A retrospective case control study was performed on 33 consecutive bichorionic twin pregnancies with gestational age 20 to 36 weeks admitted to the Antwerp University Hospital with PPROM from 1995 to 2000. These were matched with singletons experiencing PPROM at the same gestational age. Groups were compared for smoking behaviour, whether conception was spontaneous or with artificial reproductive technology, dilation at the moment of PPROM, latency period between PPROM and delivery, the use of tocolytics, antibiotics, corticosteroids, cervicovaginal culture results and neonatal morbidity and mortality. RESULTS: The latency period was significantly shorter in twins (median 19 versus median 47 hours; p = 0.01) and significantly more twins were born within 48 hours after rupture of the membranes (74.2% versus 51.5%; p = 0.01). This is due to a difference in the group with gestational age 30 or less weeks, after gestational age 30 weeks no significant difference exists. No other differences were noted between groups. CONCLUSION: No clinically relevant differences for the perinatal outcome after PPROM in twin versus singletons can be noted, but delivery is more likely to result within 48 hours after PPROM in cases of a twin pregnancy.
Bilateral cleft lip and palate associated with increased nuchal translucency and maternal cocaine abuse at 14 weeks of gestation.
A case of bilateral cleft lip and palate associated with increased fetal nuchal translucency detected at 14 weeks of gestation in a cocaine abusing pregnant woman is presented. There were no other associated structural or chromosomal abnormalities. We propose that systematic examination in both the sagittal and parasagittal plane of the fetal profile and recognition of the characteristic ultrasound appearance of a premaxillary protruding echogenic mass should make detection of this type of cleft relatively easy at the moment of the first trimester scan. First trimester diagnosis of cleft lip and palate can facilitate the parental decision-making process on continuing or terminating the pregnancy and should open the perspective of fetal surgery.
Distribution of PCBs and organochlorine pesticides in umbilical cord and maternal serum.
Polychlorinated biphenyls (PCBs) and organochlorine pesticides, such as hexachlorobenzene (HCB) and 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethylene (p,p'-DDE) are compounds widespread in the environment, highly lipophilic, and accumulate in biological systems. The newborn are exposed to these organochlorine compounds across the placenta and through breastfeeding. This study reports the levels of selected PCB congeners, p,p'-DDE and HCB in maternal blood and cord blood samples collected at delivery between November and December 1999 from 44 women living in the urban area of Antwerp, Belgium. Results show that all newborns contained detectable levels of PCBs, p,p'-DDE and HCB. The median concentration of PCBs was 450 pg/ml and ranged between 120 and 1580 pg/ml, while the median concentrations of HCB and p,p'-DDE were 70 and 490 pg/ml, respectively. Concentrations of PCBs and p,p'-DDE in cord blood (ng/ml) were positively associated with concentrations in maternal blood (ng/ml) (coefficients=0.74 and 0.92, P<0.05). We conclude that all investigated organochlorine compounds have an efficient transplacental transfer.
[Diagnostic image (79). A woman with nagging pain in the lower right abdomen. Mucocele of the appendix].
A 58-year-old woman with abdominal complaints had a cystic mass close to the uterus due to a mucocele of the appendix.
Expulsion of the fetus into the broad ligament as a complication of midtrimester termination of pregnancy.
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Intrauterine versus postnatal transport of the preterm infant: a short-distance experience.
AIM: The purpose of this study was to compare neonatal outcome (mortality, respiratory distress syndrome, intraventricular hemorrhage, necrotising enterocolitis, persisting ductus arteriosus, and septicaemia) after intrauterine transport versus neonatal transport in an area where short-distance transport is the rule. METHODS: The study was retrospective in nature. The files of all neonates delivered between 24 and 34 weeks from 1994 to 1998 and transported intrauterine or postnatally to the Antwerp University Hospital were reviewed. Cases of intrauterine fetal death and mothers discharged before delivery were excluded, as were infants with lethal congenital anomalies. RESULTS: A total of 328 deliveries after intrauterine transport, resulting in 416 neonates and 187 neonates transported postnatally were included. The maximum distance patients had to be transported was 40 km. Placental abruption was more frequent in the mothers of the neonatal transport group (13 vs. 5%, P=0.001). Corticosteroids were administered significantly less in the neonatal transport group (67 vs. 13%, P<0.0001). Preterm rupture of the membranes (36 vs. 20%, P<0.0001), preterm labour (73 vs. 36%, P<0.0001), and pre-eclampsia (10 vs. 7%, P<0.0001) were more frequent in the intrauterine transport group and this group had a lower mean birthweight and gestational age. There was no significant difference for overall neonatal mortality, respiratory distress syndrome, intraventricular hemorrhage, necrotising enterocolitis, persisting ductus arteriosus or septicaemia.