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Biomedical subjects

Y Ville

Publications and source records attributed to Y Ville.

At least 19 recordsLinked to original sources
PubMed1997

Rapid fetal fibronectin swab-test in preterm labor patients treated by betamimetics.

OBJECTIVE: A preliminary study to examine the value of a rapid fetal fibronectin swab-test used as a bedside test in the prognosis of preterm labor. STUDY DESIGN: Women presenting with preterm labor and intact membranes and less than 3 cm dilated were enrolled in a single referral center. Cervicovaginal swabs were assessed for the presence or absence of fetal fibronectin by means of a rapid monoclonal antibody assay the positivity of which was revealed by a colorimetric reaction. Results were compared with uterine contractions frequency, Bishop cervical score, duration of tocolysis and interval to delivery. The predictive value of fetal fibronectin test for delivery within 7, 14 or 21 days from sampling and before 32 and 37 weeks' of gestation was assessed in the two groups. RESULTS: Among 124 eligible patients, 19 presented with a positive fibronectin test and 105 with a negative one. Gestational age at sampling, Bishop cervical score and duration of tocolysis were identical in the two groups. The number of contractions was significantly lower and gestational age at delivery was significantly higher in the fibronectin negative group. Fetal fibronectin in cervicovaginal secretions has a high sensitivity (89%) for delivery within 7 days. Absence of fetal fibronectin in cervicovaginal secretions of patients presenting with uterine contractions could rule out preterm labor within 7 and 14 days with a predictive value of 99 and 95.2%, respectively. In negative fetal fibronectin patients, preterm delivery before 32 and 37 weeks' is unlikely to occur with a predictive value of 97 and 85%, respectively. CONCLUSION: Cervicovaginal fetal fibronectin detected by a rapid bedside swab-test in women with symptoms of preterm labor compares favourably with quantitative assays and could prove useful in the management of preterm labor. This should be confirmed in a longer prospective study.

Adrenergic beta-Agonists↗
PubMed1997

[Maternofetal disseminated candidiasis and high-grade prematurity].

BACKGROUND: Despite the frequency of vaginal yeast colonization, serious candidiasis infections in pregnant patients or neonates remain rare. Four cases of disseminated congenital candidiasis in very preterm infants are reported. CASE REPORTS: Congenital Candida albicans infection has been diagnosed in four very preterm infants. In three cases, the mothers had intrauterine devices in place throughout pregnancy. A careful macroscopic examination of the umbilical cord and placenta after birth has allowed an early management strategy in three cases. In all cases, a serious infectious alveolitis occurred. A pronounced increase in white blood cells (> 50,000/mm3) and high levels of both segmented neutrophil and band cells, despite the frequent normality of the CRP, constituted other features. Infection was controlled by parenteral amphotericin B or fluconazole. In one case, serious thrombocytopenia occurred after the first amphotericin B injection requiring substitution for fluconazole. The outcome was unfavourable in two cases with an extensive periventricular leukomalacia. CONCLUSION: Congenital candidiasis in these four very preterm neonates has several features in common: intrauterine contraceptive device during pregnancy, characteristic chorioamnionitis and funisitis, high WBC count, infectious alveolitis. Fluconazole as alternative to amphotericine B therapy is proposed.

Adult↗
PubMed1997

Umbilical cord coagulation by operative microendoscopy at 16 weeks' gestation in an acardiac twin.

Twin reversed arterial perfusion (TRAP) sequence carries high mortality and morbidity in the normal twin due to a hemodynamic imbalance through the feto-fetal vascular anastomosis. This report describes the ultrasound features of TRAP in the first trimester and a new technique for selective fetocide in the early second trimester in monochorionic twin pregnancies complicated by the TRAP sequence. Laser coagulation of the umbilical cord of the acardiac twin was performed under sonoendoscopic control. The blood flow in the umbilical cord of the acardiac twin was successfully arrested and the survivor developed normally. TRAP sequence can be recognized in the first trimester and successfully arrested by microendoscopic surgery.

Adult↗
PubMed1997

[Surgical treatment of twin-to-twin transfusion syndrome: coagulation of anastomoses with a Nd:YAG laser, under endosonographic control. Forty four cases].

Twin to twin transfusion syndrome occurs in 15% of monozygotic twin pregnancies and is characterized by a hemodynamic imbalance between the two fetuses. Survival is about 10% with expectant management. Our aim is to coagulate the placental vascular anastomoses joining the two fetal circulations on the placenta in order to prevent the consequences on the survivor when one dies in utero. Between November 1993 and April 1996, 44 patients were referred with severe twin to twin transfusion syndrome at less than 28 weeks' gestation. Nd:YAG laser coagulation of the placental vessels crossing the interamniotic membrane was performed under sono-endoscopic control. Forty-one patients have completed their pregnancy and 3 are continuing uneventfully in the third trimester. Fifteen patients (36.5%) delivered 2 healthy infants who survived the neonatal period and are developing normally. Sixteen patients (41.5%) delivered one infant developing, normally after the death of the co-twin in the perinatal period. In ten cases (22%) both twins died in the perinatal period. Among the survivors, 3 (9%) present with neurological handicap at a median age of 9 months. Around 75% (31/41) pregnancies complicated by twin to twin transfusion and treated by fetoscopy delivered at least one healthy baby. These data confirm the feasibility of the technique and that morbidity in-the survivors is relatively low.

Endosonography↗
PubMed1996

Mother-to-child transmission of human T-cell lymphotropic virus types I and II (HTLV-I/II) in Gabon: a prospective follow-up of 4 years.

SUMMARY: For 4 years. we determined the mode and risk of mother-to-child transmission of HTLV-I in a prospective cohort of 34 children born to seropositive mothers in Franceville, Gabon. We also determined the prevalence of antibodies to HTLV-I/II in siblings born to seropositive mothers. Antibodies to HTLV-I/II were detected by Western blot, and the proviral DNA was detected by the polymerase chain reaction (PCR). The risk of seroconversion to anti-HTLV-I for the 4 years of follow-up was 17.5 percent. Anti-HTLV-I/II and proviral DNA were only detected after age 18 months. We observed a seroprevalence rate of 15 percent among the siblings born to HTLV-I/II seropositive mothers. Furthermore, we report a case of mother-to-child transmission of HTLV-II infection in a population of HTLV-II-infected pregnant women that is emerging in Gabon. The lack of detection of HTLV-I/II proviral DNA in cord blood and amniotic fluid and, furthermore, the late seroconversion observed in the children indirectly indicate that mother-to-child transmission occurred postnatally, probably through breast milk.

Amniotic Fluid↗
PubMed1996

[Management of HELLP syndrome before 32 weeks of amenorrhea. 22 cases].

OBJECTIVES: Assess expression and management of HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) occurring before 32 weeks gestation. METHODS: Among 50 patients presenting HELLP syndrome from 1990 to 1994, 22 (44%) who developed the syndrome before 32 weeks gestation were evaluated retrospectively. RESULTS: Most of the patients were primiparous and HELLP syndrome recurred in 2 during a second gestation before 32 weeks gestation. Only three cases began during the post partum period. All patients had severe pre-eclampsia before discovery of the HELLP syndrome. Episodes of eclampsia also occurred in 6. The most frequent clinical manifestation was epigastric pain. Ten patients had acute severe renal failure. The 3 post partum patients had severe complications (eclampsia, renal failure, subcapsular hepatic hematoma). Obstetrical intervention was required in all cases. Cesarean section was performed within 48 hours of diagnosis. Pregnancy had to be terminated in 3 cases between 24 and 29 weeks gestation. There was one fetal death in utero and one during the neonatal period. Seventeen live infants were delivered. In the group of 11 infants born after 30 weeks gestation, only 1 had hyalin membrane disease which developed in all those born before 30 weeks, including 2 with broncho-pulmonary dysplasia. CONCLUSION: Based on the physiological mechanisms involved in HELLP syndrome, criteria for obstetrical extraction and the possibilities for conservative management in very premature pregnancies, we propose a management protocol for HELLP syndrome developing before 32 weeks gestation. Corticosteroid therapy may be given for 48 hours in cases without maternal or fetal complications in order to accelerate fetal maturation before extraction.

Abortion, Therapeutic↗
PubMed1996

[Does asymptomatic amniotic infection in the second trimester really exist?].

OBJECTIVE: Our purpose was to evaluate the incidence of asymptomatic amniotic fluid infection. STUDY DESIGN: One hundred fifty-four amniotic fluid samples obtained at the second trimester between 14 and 27 weeks gestation were studied by Gram stain with bacteriological cultures and detection of mycoplasm species and Chlamydiae trachomatis. Transabdominal amniocentesis for caryotyping were carried out in 151 health patients with intact membranes and without preterm labor or signs of infectious (3 dizygotic twin pregnancies). RESULTS: One hundred forty-seven complete microbiologic examinations were performed (Gram stain examination white-cell count, quantitative aerobic and anaerobic cultures). Commercial texts for Mycoplasma hominis, Ureaplasma urealyticum and Chlamydiae trachomatis were negative. Three patients had rare microorganisms, coagulase negative staphylococcus (30 and 50 bacteria per ml) and alpha-hemolytic streptococcus (5 x 10(2) bacteria per ml). White cell count on amniotic fluids in 50 cases (32%) was less than 30 per ml. CONCLUSION: These findings appear to be in contradiction with recent data, suggesting the existence of intraamniotic infection in the early phase of the second trimester. Our data confirm the need for a cut-off level for white cell count to improve test sensibility.

Adult↗
PubMed1996

[Maternal and fetal retinoid assay. Two case reports of isotretinoin (Roaccutane) exposure].

We report on 2 women who were treated with retinoids (Roaccutan, isotretinoin) during the first trimester of their pregnancies. Therapeutic abortions were carried out. The interest in these case reports lies in the determination of concentration of isotretinoin and its metabolites (4-oxo-isotretinoin, and tretinoin) in foetal tissues, using high performance liquid chromatography. The findings show the significant transplacental passage of isotretinoin, an accumulation of 4-oxo-isotretinoin in the liver, and a low concentration of retinoids in the brain of these foetuses. Contraception must be used with retinoid treatment and for 4 weeks after retinoid withdrawal.

Abortion, Therapeutic↗
PubMed1996

[Anomalies of umbilical vein in the fetus. A case report and review of the literature].

Abnormal connexion of the umbilical vein in the inferior vena cava was diagnosed in a fetus at 18 weeks' gestation. Associated anomalies included nuchal and axillary lymphangiectasia, hypertrophic cardiomyopathy and hepatomegaly. Neonatal death occurred after spontaneous vaginal delivery at 25 weeks. A review of the literature summarizes the diagnostic criteria and associated anomalies.

Abnormalities, Multiple↗
PubMed1995

Preliminary experience with endoscopic laser surgery for severe twin-twin transfusion syndrome.

BACKGROUND: In monozygotic twin pregnancies, there are placental vascular communications between the two fetuses. In 15 percent of such pregnancies there is an imbalance in net blood flow between the twins, resulting in the twin-twin transfusion syndrome. The recipient twin may have severe hydramnios during the second trimester of pregnancy, and there is a high risk of perinatal death and cerebral palsy in survivors. This condition can now be treated by endoscopic coagulation of the vascular anastomoses responsible for fetofetal transfusion with a neodymium:yttrium-aluminum-garnet (Nd: YAG) laser. METHODS: We performed intrauterine surgery in 45 pregnant women carrying twins at 15 to 28 weeks of gestation (median, 21); in each case there was severe hydramnios in one fetus due to the twin-twin transfusion syndrome. With the use of local anesthesia and continuous ultrasound visualization, a rigid fetoscope 2 mm in diameter, housed in a 2.7-mm cannula, was introduced transabdominally into the amniotic cavity of the recipient twin. A systematic search was made for all vessels approaching or crossing the membrane between the twins, and these were coagulated with an Nd:YAG laser by means of a fiber in the side arm of the cannula. RESULTS: Coagulation of the communicating vessels was successful in all cases. The total number of fetuses who survived to delivery was 48 (53 percent), and the number of pregnancies with at least 1 survivor was 32 (71 percent). Among the live-born infants, the median gestational age at delivery was 35 weeks (range, 25 to 40), and the median birth weight was 2098 g (range, 550 to 4252). The median interval between the endoscopic laser procedure and delivery was 14 weeks (range, 0 to 21). All the survivors were developing normally at a median age of 12 months (range, 2 to 24). CONCLUSIONS: Our preliminary experience suggests that the twin-twin transfusion syndrome can be treated effectively by endoscopic laser coagulation of the communicating placental vessels.

Endoscopy↗
PubMed1995

Development of a training model for ultrasound-guided invasive procedures in fetal medicine.

Training in ultrasound-guided procedures in fetal medicine is currently available in a few major fetal medicine units. Unlike elective surgical procedures, cordocentesis is usually performed without sedation as an outpatient procedure and active supervision of the trainee intensifies the anxiety already felt by the patient. In addition, the complication rate is higher in the initial few procedures or when the procedure is not regularly practiced. We have developed a comprehensive method of training for transabdominal invasive procedures using a medical model that simulates the in vivo situation.

Cordocentesis↗
PubMed1995

Ultrasound evaluation of the length of the fetal nasal bones throughout gestation.

Subtle facial abnormalities, including smallness of the nose, are common findings in trisomy 21 and numerous other genetic conditions. The aim of this study was to construct a normal range for the length of the fetal nasal bones with gestation in a Caucasian population. Ultrasound measurements were performed on a strictly mid-sagittal profile in 376 normal singleton fetuses at 14-34 (mean 24) weeks' gestation. It was found that the length of the nasal bones increased from 4 mm at 14 weeks to 12 mm at 35 weeks' gestation, and that there was a linear relationship between the length of these bones and biparietal diameter and femur length. We conclude that the length of nasal bones can easily be measured in fetuses at 14-34 weeks' gestation and that such measurements might prove useful in the evaluation of pregnancies at high risk for associated fetal abnormalities.

Embryonic and Fetal Development↗
PubMed1995

Doppler studies of the fetal circulation in twin-twin transfusion syndrome.

This cross-sectional study investigated the circulatory profile of the donor and recipient fetuses in 20 pregnancies with twin-twin transfusion syndrome presenting with acute polyhydramnios at 17-27 (mean, 22) weeks' gestation. Doppler investigations of the arterial vessels and ductus venosus, inferior vena cava, right hepatic vein, tricuspid and mitral ventricular inflow were performed in both fetuses. Mean values of most blood flow velocities on the venous side showed a significant decrease in both groups of fetuses, and a significant increase in mean values for indices describing waveform pulsatility was found in all three venous vessels in the group of recipients, whereas in the donor group this was only the case in the ductus venosus. Mean values of atrioventricular flow velocities showed a significant decrease in the donor group. The most significant findings on the arterial side were an increased mean umbilical artery pulsatility index and a decreased mean value for aortic blood flow velocity in both groups of fetuses. Five recipients and four donors had absence or reversal of blood flow during atrial contraction in the ductus venosus. All these fetuses showed pulsations in the umbilical vein. Tricuspid regurgitation was present in eight recipients. Absence or reversal of end-diastolic velocities in the umbilical artery was found in four donors.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1995

Preterm prelabour amniorrhexis: intrauterine infection and interval between membrane rupture and delivery.

This study aimed to determine if fetal bacteraemia and amniotic fluid infection at the time of membrane rupture reduces the interval between membrane rupture and the onset of labour in pregnancies complicated by preterm prelabour amniorrhexis. Sixty nine pregnancies with preterm prelabour amniorrhexis at 12-36 weeks' gestation that were managed expectantly had spontaneous onset of labour. In all cases cordocentesis and amniocentesis were performed and fetal blood and amniotic fluid were cultured for aerobic and anaerobic bacteria. In the group with negative fetal blood and amniotic fluid cultures (group 1) the median interval from amniorrhexis to delivery was 41 days (range 1-161) and there was an inverse correlation between gestational age at amniorrhexis and delivery interval. In the group with negative fetal blood but positive amniotic fluid cultures (group 2) the median amniorrhexis to delivery interval was nine days (range 1-37), and in the group with positive fetal blood cultures (group 3) the interval was two days (range 1-5). These findings suggest that pregnancies complicated by preterm prelabour amniorrhexis and fetal bacteraemia undergo spontaneous labour within five days of membrane rupture, and if labour does not occur then infection is unlikely.

Amniotic Fluid↗
PubMed1995

Concentration of fetal plasma and amniotic fluid interleukin-1 in pregnancies complicated by preterm prelabour amniorrhexis.

AIMS: To determine interleukin-1 beta (IL-1 beta) concentration in fetal and maternal plasma and amniotic fluid from pregnancies complicated by preterm prelabour amniorrhexis and to define the relation of this cytokine to intrauterine infection and the onset of labour. METHODS: Cross-sectional study of 23 pregnancies complicated by preterm prelabour amniorrhexis. Enzyme linked immunoassay was used to measure IL-1 beta concentration in fetal and maternal plasma and amniotic fluid. In each case, fetal blood and amniotic fluid were cultured for micro-organisms. RESULTS: In pregnancies with positive fetal blood and/or amniotic fluid cultures, plasma and amniotic fluid concentrations of IL-1 beta were higher and the interval between amniorrhexis and onset of labour was shorter than in the non-infected group. There were no significant associations between fetal plasma IL-1 beta and maternal plasma or amniotic fluid IL-1 beta concentrations, fetal leucocyte count or the interval between amniorrhexis and the onset of labour. CONCLUSIONS: These findings suggest that although intrauterine infection is associated with increased IL-1 beta concentrations in fetal plasma and amniotic fluid, there is no significant association between the concentration of IL-1 beta and the interval between amniorrhexis and the onset of labour.

Amniotic Fluid↗