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Background: Lower limb neurologic deficit after vaginal delivery remains poorly understood. The objective of this study was to describe the incidence, characteristics and prognosis associated with nerve injury occurring to women during vaginal delivery.Methods: A single-center observational study of women who complained about a lower limb neurologic deficit that appeared immediately after vaginal delivery. The follow-up period was up to four years.Results: Among the 10 569 women with a singleton vaginal delivery during the 30-month study period, 31 (0.3%) reported a neurologic deficit. Most women were nulliparous (71%) and the mean duration of the second stage of labor was 94 min [range 13-224 min]. In two-thirds of cases, delivery required instrumental assistance. Most neurologic deficits were sensory (67.7%) and primarily involved femoral nerve territory (83.9%). Most women recovered within six weeks (69.2%). In one case (a sensory deficit of the entire right leg), recovery only occurred after 3.5 years.Conclusion: Neurologic deficit was identified in 0.3% of our vaginal delivery population. Recovery from neurologic deficit may take many weeks and may occasionally be disabling. [ABSTRACT FROM AUTHOR]

Background: Most pregnant women who self-report penicillin allergy are not truly penicillin-allergic and this misunderstanding often leads to administration of inappropriate antibiotic therapy. Decision algorithms have been developed to guide antibiotic selection but major discrepancies have been reported between guidelines and clinical practice. We aimed to optimize the prescription of antibiotics for pregnant women who self-reported penicillin allergy, using an educational intervention about the classification of penicillin allergies that targeted gynecologists, anesthesiologists and midwives.Methods: This quasi-experimental study assessed the effect of an educational intervention about the classification of penicillin allergy. For six months, a combination of two strategies was used, namely dissemination of printed educational materials and group education. The principal study endpoint was the appropriateness of the antibiotic therapy, defined in advance for each level of allergic risk.Results: The pre-intervention phase included 903 women; one year after its conclusion, the post-intervention phase began and included 892 women. The prevalence of self-reported penicillin allergy was stable over the two periods (6.8% before vs 5.4% after, P=0.24). The clinical classification of penicillin allergies was more often used after the educational intervention (68% vs 100%, P<0.001). The appropriateness of the antibiotic therapy prescribed to self-reported penicillin allergic-women increased significantly between the two periods, from 5/29 (17.2%) to 18/27 (66.7%, P<0.001).Conclusion: An educational intervention about penicillin allergy classification was associated with an improvement in the choice of appropriate antibiotic therapy among women who had reported penicillin allergy. [ABSTRACT FROM AUTHOR]

Introduction: Chronic histiocytic intervillositis (CHI) is a placental disease that has been associated with unfavorable obstetric outcomes in small, noncomparative series. The objective was to measure the excess risk of adverse obstetric outcomes associated with the discovery of CHI after birth.Methods: Retrospective single-center case-control study from 2000 through 2016. The case patients had a CHI diagnosis after a pathology analysis of the placenta. Two types of controls were defined for each case: low-risk control women were those who gave birth in our hospital immediately before each case patient, and the high-risk controls were the next women after each case for whom microscopic examination of the placenta was indicated.Results: We observed 111 cases of CHI during the study period. Compared with the 111 low-risk controls, the cases had a significantly higher frequency of late miscarriages (5.4 vs 0.0%, p < .03), small for gestational age (SGA) babies <3rd centile (70.4 vs 0.9%, p < .001, OR 140, 95% CI, 19.9-2800), and in utero deaths (35.1 vs 0.9%, p < .001, OR 59.6, 95% CI 8.5-1192), with significantly fewer children surviving to discharge (54.9 vs 99.1%, p < .001, OR 0.01, 95% CI, 0.00-0.08). All of these factors also differed significantly compared with the high-risk women (severe SGA: OR 3.7, 95% CI 1.9-7.0; in utero death: OR 4.1, 95% CI 1.9-8.7; children surviving to discharge: OR 0.27, 95% CI, 0.14-0.52).Discussion: Even compared with high-risk pregnancies, CHI is a severe placental disease associated with a substantial excess rate of late miscarriages, severe SGA and in utero death. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the conditions and way of delivery in women with congenital uterine malformations. Patients and methods: This retrospective study included a cohort of patients with malformed uterus giving birth in Lille University Hospital between 2000 and 2010, features such as way of delivery, labour, foetal presentation were compared with those patients without uterine malformation. Results: Patients with uterine anomalies had significantly higher rates of breech présentation (36.51% vs 4.52%; P < 0.01) and cesarean section (55.26% vs 18.70%; P < 0.01) compared to the group of women with a normal uterus. Discussion and conclusion: Our results suggest that women with uterine malformation should be informed that they have an increased risk of caesarean section due to more frequent malpresentations. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Chronic histiocytic intervillositis of unknown etiology (CIUE) is a rare placental inflammatory disease, associated with severe obstetric complications. Its pathophysiologic mechanism remains to be elucidated. Aim: To establish anatomical–clinical correlations to improve our understanding of CIUE pathophysiology. Material and methods: Retrospective study of all cases of CIUE occurring during a 9-year period in a university tertiary hospital center. Results: CIUE was diagnosed in 69 pregnancies in 50 different women, after early spontaneous abortions (30.4%), late spontaneous abortions (13.0%), in utero deaths (26.1%), and live births (30.4%). Of 39 fetuses surviving to at least 22 weeks, 24 had severe intrauterine growth restriction (61.5%) and 18 died in utero (46.2%). Twelve in utero deaths occurred before 32 weeks of gestation (66.7%). Substantially elevated alkaline phosphatase levels (>600 IU/L) were observed in 55.6% of cases. Microscopic examination of placentas showed that both spontaneous early abortions and intrauterine growth restriction were significantly associated with more intense fibrin deposits. Conclusion: A diagnosis of CIUE must be considered in cases of severe obstetric complications. We hypothesize that the elevated alkaline phosphatases (ALP) observed during the pregnancy demonstrate the presence of syncytiotrophoblastic lesions due to histiocytosis in the intervillous space, before fibrin deposits cover them. [Copyright &y& Elsevier]

Abstract: Background: Little is known about the influence of anaesthesia for caesarean section on outcome in very preterm infants. Methods: A prospective, population-based, cohort study (the EPIPAGE cohort) included all births before 33 weeks in nine French regions in 1997. Of 2360 infants live-born between 27 and 32 weeks, 1338 were delivered by caesarean section with general anaesthesia (n=711, 53.1%), spinal anaesthesia (n=419, 31.3%), or epidural anaesthesia (n=208, 15.6%). Neonatal mortality was compared among these three groups using bi- (according to gestational age and to anaesthetic technique) and multivariate analyses. Results: Neonatal mortality was 10.1% with general anaesthesia, 12.2% with spinal anaesthesia and 7.7% with epidural anaesthesia. After adjustment for gestational age and characteristics of pregnancy, delivery and neonate, spinal anaesthesia was associated with a higher risk of neonatal death than general anaesthesia (adjusted odds ratio, 1.7; 95% confidence interval 1.1 to 2.6). Conclusion: In this population-based study, spinal anaesthesia was associated with an increased risk of neonatal mortality in very preterm infants compared to general anaesthesia (and epidural anaesthesia), independently from gestational age and characteristics of the pregnancies, deliveries and neonates. Although this multivariate analysis does not prove a causal relationship, the results suggest it could exist, particularly if maternal haemodynamics are poorly controlled. With recent significant change in the conduct of spinal anaesthesia, further studies are needed to investigate potential harmful effects of anaesthesia on very preterm infants delivered by caesarean section. [Copyright &y& Elsevier]

Cytomegalovirus (CMV) screening during pregnancy has been widely discussed for several years, but still no consensus has been agreed. With a number of live births of 750,000 per year in France, we would expect 7500 infected infants at birth per year (rate of congenital infection of 1%). Among infected infants at birth, the number of severely infected foetuses would be approximately 75, the number of infants with severe sequelae would be 480, 675 approximately would present with hearing loss and the number of asymptomatic infants would be 6270. Five different preventive methods for congenital CMV infection are possible: (1) Routine CMV screening at the beginning of pregnancy for primary prevention. (2) Secondary prevention by antenatal diagnosis of congenital CMV infection complications. (3) Tertiary prevention by serological testing during pregnancy. (4) Tertiary prevention by serological screening at birth. (5) Tertiary prevention: Hearing loss screening at birth. The aims of this review are to define the advantages and disadvantages of these different methods of CMV screening during pregnancy and to determine if the current available information would make systematic testing acceptable. [Copyright &y& Elsevier]

The aims of this work were the evaluation of the reproductive outcome after ectopic pregnancy, and the assessment of the role of infertility risk factors and treatment’s strategy. All patients in the population-based register of the urban area around Lille, Northern France, were followed-up. 345 women treated between April 1994 and March 1997, who were trying to become pregnant were interviewed by telephone every 6 months and then every year. The cumulative pregnancy rates were calculated by the Kaplan-Meier estimation. Associations between infertility risk factors and intrauterine pregnancy were tested by the logrank test, and by a Cox model for multivariate analysis. The mean duration of follow-up was 22 months, and 228 (66%) women had obtained a new pregnancy at the time of the analysis. 23 (10%) of the first pregnancies were recurrences. For women for whom EP occured with an IUCD (17 patients), the 1 year intrauterine pregnancy (IUP) reached 67%. For the others, the 1 year IUP rate was 56%, and reached 67% after 2 years. After adjusting factors associated with fertility with a Cox regression, 3 factors seemed to lower reproductive performances: age > 35 years, previous history of infertility, and anterior tubal damage. More than half the women treated for EP obtained spontaneously a normally progressive pregnancy after 1 year. Reproductive performances are associated with characteristics of the patients, but do not depend on radical or conservative treatment. [Copyright &y& Elsevier]

Abstract: Objectives: The purpose of this study was to describe outcome of subsequent pregnancy after preeclampsia or HELLP syndrome during the first pregnancy and to evaluate potential risk factors for gestational vascular complications. Patients and methods: Follow-up data were obtained from 445 women who were delivered between March 1996 and December 2006. Medical records of the index pregnancy and subsequent outcomes were available for review. To have adequate time to study subsequent pregnancy outcome, only patients who were delivered>2years before the analysis were included. Results: There were 151 subsequent pregnancies of which 142 pregnancies progressed beyond 20 weeks of gestation. The median duration of follow-up was 6years (range: 2–9years). Thirty-nine (27.5%) had a gestational vascular complication. Preeclampsia reoccurred in the second pregnancy in 20 women (51.3%), HELLP syndrome developed in three of these pregnancies. Gestational hypertension occurred in 14 patients (35.9%) and abruptio placentae in one (2.6%). Four of the newborn infants (10.3%) were small for gestational age (<3rd percentile). Obesity, delivery<32weeks of gestation and small for gestational age newborns at index pregnancy were related to a higher incidence of gestational vascular complication during the subsequent pregnancy. Discussion and conclusion: Patients with a history of preeclampsia or HELLP syndrome during the index pregnancy are at increased risk for obstetric complications in subsequent pregnancies. [Copyright &y& Elsevier]

Fifty percent of young women are not immunized against Parvovirus B19 and may be infected during their pregnancy. Because of the scarcity of the foetal complications, the behaviour to be held in case of Parvovirus B19 exposure is badly known. In this view, we realized a review of the literature to answer the questions put by Parvovirus B19 during pregnancy, in particular in case of maternal exposure. About 33% of Parvovirus B19 infections of the pregnant women are complicated by foetal contamination. This foetal infection does not always result in foetal complications. The foetal complications are more frequent before 20 weeks of gestation (11 to 15% of spontaneous abortion and foetal death, 3% of foetal hydrops). After 20 weeks of gestation, it remains 1% of foetal hydrops. Without treatment, they may sometimes lead to foetal death. In the case of Parvovirus B19 exposure, it is advisable to control the maternal serology to know its initial status. According to the result, a weekly ultrasonographic supervision will be proposed to detect foetal anaemia (ascites, pericardial effusion). In the case of foetal hydrops, an in utero transfusion reduce the risk of foetal loss. The long-term outcome of infected foetuses is mostly good. Authors describe a survival without after-effect in 90% of the cases. More ample studies are necessary to evaluate long-term neurodevelopmental outcome of hydropic foetuses. [Copyright &y& Elsevier]

Objectives. Our objectives were to link hyperemesis gravidarum with biochemical hyperthyroidism and hormonal modification (HCG and estradiol) and to test the hypothesis that biological abnormalities (ionogram and liver enzyme) are more often report in hyperemesis gravidarum with biochemical hyperthyroidism.Study design. Thirty three patients admitted in « Hoˆpital Jeanne de Flandre » with hyperemesis gravidarum were studied prospectively.Results. Twenty-two patients (66.7%) had biochemical hyperthyroi¨dsm (suppressed thyroid stimulating hormone or increased triiodothyronin index or tetraiodothyronin index). Hyperthyroid patients were more likely than euthyroid patients to have abnormal electrolyte levels (16/22 [72.7%] vs 3/1 [27.3%], P<0.02) or increased liver enzyme levels (8/22 [36.4%] vs 3/11 [27.3%]). The severity of hyperemesis was found to vary directly with the degree of hyperthyroidism. We report a female predominance among the offspring of mothers with hyperemesis gravidarum.Conclusion. Our results are suggestive of the involvement of hyperthyroidism and fetal sex in the pathogenesis of hyperemesis gravidarum. Also these hypothesis are not clearly understood, human chorionic gonadotrophin occur in the two mechanisms. [Copyright &y& Elsevier]

• Infant vaccines protecting against 11 diseases have changed from recommended to mandatory status in France for all children born from first of January 2018. • Vaccinoscopie is an annual French web-based survey targeting mothers, monitoring vaccine coverages (VCRs) in children as well as mothers' opinion regarding vaccination. • This study shows a positive impact of mandatory vaccination extension on VCRs and opinion of infants' mothers for the second consecutive year. • Among infants born after mandatory vaccination extension, VCRs for vaccines that did not achieve Public Health objectives increased further in 2018 and 2019 (especially MenC and HepB VCRs). Infant vaccines protecting against 11 diseases have changed from recommended to mandatory status in France for all children born from first of January 2018. Through Vaccinoscopie survey, we measured for the second consecutive year the impact of this new policy on vaccine coverage rates (VCRs) and mothers' perception regarding vaccination. Web-based survey on a representative sample of 1500 mothers of 0 to 17-month-old infants. Non-optimal VCRs continued to increase in 2019 versus 2017 (according to age, + 7 to 8 points VCR for Hepatitis B and + 36 to 68 points for Meningococcus C). After a progressive decrease between 2012 and 2017, the rate of favorable mothers' opinion towards vaccination continued to progress in 2018 and 2019. These results confirmed the positive impact of this new law on infant VCRs and mothers' favorable opinion regarding vaccination. [ABSTRACT FROM AUTHOR]

Highlights • In France the vaccination of all infants born on or after January 1, 2018 against 11 diseases has changed from a recommended to a mandatory status. • Vaccinoscopie is an annual French web-based survey targeting mothers, monitoring vaccine coverage rates (VCRs) in children as well as mothers' opinion regarding vaccination. • This study reports the positive impact of mandatory vaccination extension on VCRs and on the opinion of mothers of infants. • Among infants born after the extension of mandatory vaccination, VCRs for at least one dose at six months of age greatly increased for vaccines that previously did not meet Public Health objectives (MenC and HepB). Abstract Objective In France infant vaccines protecting against 11 diseases have changed from a recommended to a mandatory status for all children born on or after January 1, 2018. Using the Vaccinoscopie survey, we measured the impact of this new vaccination policy on vaccine coverage rates (VCRs) and on mothers' perception of vaccination. Methods Online survey with 1000 mothers of 0- to 11-month-old infants. Results VCRs for at least one dose at the age of 6 months strongly progressed for diseases that previously did not meet Public Health objectives (+8 points for Hepatitis B and +31 points for meningococcal C vaccines). Mothers were more favorable to mandatory vaccination and better informed in 2018 than in 2017. Conclusion These first results showed a positive impact of the extension of mandatory vaccination on mothers' opinion regarding vaccination and on infant VCRs. [ABSTRACT FROM AUTHOR]

In intrauterine pregnancies of uncertain viability with a gestational sac without a yolk sac (with a mean of three orthogonal transvaginal ultrasound measurements <25mm), the suspected pregnancy loss should only be confirmed after a follow-up scan at least 14 days later shows no embryo with cardiac activity (Grade C). In intrauterine pregnancies of uncertain viability with an embryo <7mm on transvaginal ultrasound, the suspected pregnancy loss should only be confirmed after a follow-up scan at least 7 days later (Grade C). In pregnancies of unknown location after transvaginal ultrasound (i.e. not visible in the uterus), a threshold of at least 3510IU/l for the serum human chorionic gonadotrophin assay is recommended; above that level, a viable intrauterine pregnancy can be ruled out (Grade C). Postponing conception after an early miscarriage in women who want a new pregnancy is not recommended (Grade A). A work-up for women with recurrent pregnancy loss should include the following: diabetes (Grade A), antiphospholipid syndrome (Grade A), hypothyroidism with anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies (Grade A), vitamin deficiencies (B9, B12) (Grade C), hyperhomocysteinaemia (Grade C), hyperprolactinaemia (Grade B), diminished ovarian reserve (Grade C), and a uterine malformation or an acquired uterine abnormality amenable to surgical treatment (Grade C). The treatment options recommended for women with a missed early miscarriage are vacuum aspiration (Grade A) or misoprostol (Grade B); and the treatment options recommended for women with an incomplete early miscarriage are vacuum aspiration (Grade A) or expectant management (Grade A). In the absence of both chorioamnionitis and rupture of the membranes, women with a threatened late miscarriage and an open cervix, with or without protrusion of the amniotic sac into the vagina, should receive McDonald cerclage, tocolysis with indomethacin, and antibiotics (Grade C). Among women with a threatened late miscarriage and an isolated undilated shortened cervix (<25mm on ultrasound), cerclage is only indicated for those with a history of either late miscarriage or preterm delivery (Grade A). Among women with a threatened late miscarriage, an isolated undilated shortened cervix (<25mm on ultrasound) and no uterine contractions, daily treatment with vaginal progesterone up to 34 weeks of gestation is recommended (Grade A). Hysteroscopic section of the septum is recommended for women with a uterine septum and a history of late miscarriage (Grade C). Correction of acquired abnormalities of the uterine cavity (e.g. polyps, myomas, synechiae) is recommended after three early or late miscarriages (Grade C). Prophylactic cerclage is recommended for women with a history of three late miscarriages or preterm deliveries (Grade B). Low-dose aspirin and low-molecular-weight heparin at a preventive dose are recommended for women with obstetric antiphospholipid syndrome (Grade A). Glycaemic levels should be controlled before conception in women with diabetes (Grade A). [ABSTRACT FROM AUTHOR]

Objective Doppler measurement of peak velocity of systolic blood flow in the middle cerebral artery (PVS-MCA) can safely replace invasive testing in the diagnosis of fetal anemia in Rh-alloimmunized pregnancies and PSV-MCA is now the reference technique. However, no study has evaluated its impact in antenatal care and in survival rate. Our objective was to evaluate the impact of the measurement of PVS-MCA in antenatal management and neonatal outcome in maternal red cell alloimmunization requiring in utero transfusion (IUT). Study design Retrospective study between January 1999 and January 2013. We excluded all cases of hydrops without follow-up before first IUT. From 1999 to 2006, an IUT was indicated on the optical index at 450 nm (Period 1) and was then replaced by the use of PVS-MCA (Period 2). Results 77 patients were included, 39 in Period 1 (104 IUT) and 38 in Period 2 (89 IUT). 5 cases of hydrops fetalis (12.8%) were diagnosed during the follow up in Period 1 and none during Period 2. The average number of IUT, the delays between 2 IUT and between last IUET and birth were comparable. The total rate of complication per IUT during the first period was 9.6% vs 1.1% during the second one ( p = 0.01). The overall survival rate in our population was 34/39 (86.8%) during Period 1 vs 38/38 (100%) during Period 2. Conclusion PSV-ACM allowed an improved monitoring with fewer occurrences of hydrops. Conversely, it did not modify antenatal management and timing of delivery. [ABSTRACT FROM AUTHOR]

Résumé Durant la grossesse, la survenue d’une dissection aortique est un événement rare qui menace immédiatement le pronostic vital fœtal et maternel. Sa survenue est plus fréquente en cas de maladie du tissu conjonctif mais l’absence de facteur de risque ne doit ni exclure ni retarder le diagnostic. Il faut donc savoir y penser, car son pronostic dépend fortement du délai de prise en charge. La présentation clinique de cette urgence médico-chirurgicale est hétérogène – ce d’autant que la grossesse ajoute sa propre symptomatologie – mais il faut y penser devant toute douleur thoracique et demander sans hésiter la réalisation d’une échocardiographie ou d’un angioscanner thoracique qui sont des méthodes diagnostiques à la fois fiables et accessibles. During pregnancy, the occurrence of aortic dissection is a rare event immediately threatening fetal and maternal prognosis. Its occurrence is more common in cases of connective tissue disease. But the absence risk factor shall not exclude or delay diagnosis. We must learn to think about it, because the prognosis is highly dependent on time management. The clinical presentation of this medical and surgical emergency varies, and pregnancy adds its own symptoms. We have to ask without hesitation that echocardiography or chest CT be performed since these diagnostic methods are both reliable and available. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Après vérification des critères d’acceptabilité et en présence d’un obstétricien connaissant les manœuvres spécifiques à appliquer, l’accouchement en présentation du siège est possible par voie basse. En cas de difficulté précoce au dégagement, l’application d’une ventouse obstétricale est théoriquement possible mais cette manœuvre est à la fois peu réalisée et peu évaluée. Le but de cette étude est d’évaluer rétrospectivement notre pratique de la ventouse obstétricale sur 6 fœtus en siège décomplété. Patientes et méthodes Étude rétrospective comparative des tentatives d’accouchement par voie basse des fœtus en présentation du siège après 37 SA, selon qu’elles ont fait appel ou non à la réalisation d’une ventouse obstétricale. Résultats Pendant une période de deux ans, 83 patientes ont débuté les efforts expulsifs avec un fœtus unique à terme en présentation du siège. Pour six d’entre elles, une ventouse a été appliquée sur le siège fœtal (7,2 %). Le taux d’échecs de voie basse était significativement plus élevé dans le groupe « ventouse » que dans le groupe « sans ventouse » (33,3 % versus 6,5 % ; p < 0,05). De plus, le pH à la naissance était en moyenne significativement plus bas dans le groupe « ventouse » (7,12 ± 0,11 versus 7,20 ± 0,08 ; p < 0,05) et les nouveau-nés de ce groupe présentaient plus fréquemment des lésions cutanées profondes (66,7 % versus 26,0 % ; p < 0,05) : en outre, l’un d’entre eux présentait des lésions sévères. Discussion et conclusion En cas de présentation du siège, la tentative d’extraction par ventouse obstétricale est liée à un excès de morbidité fœtale. Objectives After verification of the eligibility criteria and with an obstetrician familiar with the specific maneuvers likely to be needed, vaginal delivery of breech presentations is possible. If problems arise during the active pushing phase of labor, vacuum extraction has been described in the literature for this uncommon condition with limited series. The aim of this study is to assess retrospectively vacuum extraction in frank breech presentation in our center. Patients and methods This retrospective study of trials of vaginal delivery of fetuses in breech presentation at term compares cases according to whether they did or did not use a vacuum extraction. Results During a two-year period, 83 patients, whom had trials of vaginal delivery in breech presentations, reached the active pushing/bearing down stage after complete cervical dilatation. Vacuum assistance was applied in six of these (7.2 %). The failure rate for vaginal delivery was significantly higher in the group with compared to without vacuum extraction (33.3 % versus 6.5 %, P < 0.05). Moreover, the mean pH at birth was significantly lower in the group with vacuum extraction (7.12 ± 0.11 versus 7.20 ± 0.08, P < 0.05), and these infants more frequently had deep cutaneous injuries (66.7 % versus 26.0 %, P < 0.05). Discussion and conclusion In fetuses in breech presentation, when vaginal delivery failed, it seems to be safer for the fetuses to perform caesarean section rather than attempt vacuum extraction. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Un déséquilibre entre coagulation et fibrinolyse participe aux mécanismes physiopathologiques de la prééclampsie. Le HELLP syndrome est associé à un état d’hypercoagulabilité et entraîne des complications maternelle et périnatales. L’objectif de notre étude était d’évaluer l’intérêt des d-dimères comme marqueurs de sévérité en cas de prééclampsie. Patientes et méthodes: Il s’agit d’une étude rétrospective de 129 patientes avec prééclampsie ou HELLP syndrome réalisée du 1er janvier 2001 au 31 décembre 2009. Les taux plasmatiques de d-dimères ont été mesurés à l’aide d’une technique enzyme-linked immunosorbent assay (ELISA). Nous avons étudié l’association entre les taux de d-dimères et les principales caractéristiques cliniques et biologiques des grossesses compliquées de prééclampsie. Résultats: Les taux de d-dimères augmentaient avec l’âge gestationnel. Les patientes avec un HELLP syndrome avaient des valeurs moyennes de d-dimères significativement plus élevées que les patientes avec une prééclamspie seule (3848±2551 versus 1578±1077, p <0,001). Néanmoins, les taux de d-dimères à l’admission étaient peu prédictifs de la survenue d’un HELLP syndrome. L’aire sous la courbe ROC était mesurée à 0,69 (IC 95 % : 0,59–0,79). Le meilleur seuil était de 2170ng/mL avec une sensibilité à 0,91 et une spécificité à 0,40. Les autres critères de sévérité de la prééclampsie n’étaient pas associés à des taux plus élevés de d-dimères. Discussion et conclusion: Nous avons montré qu’en cas de prééclampsie, les taux de d-dimères sont influencés par l’âge gestationnel et l’existence d’un HELLP syndrome. Cependant, la capacité de ce test à prédire la survenue d’un HELLP syndrome ou une prééclampsie sévère est trop faible pour le recommander en routine. [Copyright &y& Elsevier]

Résumé: Objectifs: La prééclampsie est l’une des plus fréquentes et plus sévères complications de la grossesse. Elle survient dans environ 5 % des cas. Sa physiopathologie est complexe et implique plusieurs mécanismes. La prééclampsie est associée de façon inconstante à un retard de croissance intra-utérin (RCIU). Les éléments expliquant la variabilité de cette association sont mal connus. L’objectif de notre étude était d’identifier, dans une population de patientes françaises ayant présentées une prééclampsie et/ou un HELLP syndrome, l’incidence et les facteurs de risque de survenue d’un RCIU afin d’isoler d’éventuelles caractéristiques particulières chez ces femmes. Patientes et méthodes: Étude rétrospective incluant 578 patientes prises en charge pour prééclampsie et/ou HELLP syndrome selon la présence ou l’absence d’un RCIU (base de données constituée depuis 1996). Les comparaisons entre les groupes ont été réalisées par le test des rangs de Wilcoxon (données quantitatives) ou le test exact de Fisher (données qualitatives). Résultats: Entre les groupes eutrophes et RCIU, la prééclampsie survenait plus tôt et était plus grave cliniquement sur le plan maternel dans le groupe RCIU. De même, les issues fœtales étaient plus défavorables dans le groupe RCIU. Discussion et conclusion: La présence d’un RCIU associé à une prééclampsie ou à un HELLP syndrome constitue un critère pronostique de sévérité de la pathologie tant sur le plan fœtal que maternel. Nos données ne permettent pas de distinguer des éléments physiopathologiques expliquant ses différences. [ABSTRACT FROM AUTHOR]

Résumé: Le syndrome des ovaires polymicrokystiques (SOPMK) est le désordre endocrinien le plus fréquent chez la femme en âge de procréer et la première cause d’infertilité féminine. Cette pathologie est très fréquemment associée à l’obésité et à d’importants troubles métaboliques, notamment l’hyperinsulinisme. Par conséquent, il est légitime de s’intéresser aux grossesses de ces patientes. De nombreuses études suggèrent en effet une augmentation des risques obstétricaux dans cette pathologie. Le SOPMK semble en rapport avec une fréquence accrue des fausses couches spontanées précoces, de l’hypertension artérielle gravidique, de la pré-éclampsie, du diabète gestationnel diagnostiqué dès le premier trimestre de la grossesse, de la prématurité, de l’hypotrophie néonatale ou de la macrosomie, des complications néonatales et des césariennes. Néanmoins, il est difficile de conclure de façon claire à ce sujet, du fait de la grande hétérogénéité de définition du SOPMK dans les différentes études. De plus, les nombreux facteurs confondants inhérents au SOPMK et notamment l’obésité ne sont pas toujours pris en compte ce qui engendre un réel problème d’interprétation. Toutefois, il semble possible de conclure que le SOPMK ne majore pas le risque d’hématome rétroplacentaire, de HELLP syndrome, d’hépatopathie gravidique, d’hémorragie du post-partum, de fausse couche tardive et de mort fœtale in utero. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Assessment of pregnancy outcomes after bariatric surgery and analysis of follow-up particularities of such pregnancies. Patients and methods: A retrospective study of 63 post-bariatric surgery pregnancies compared to 259 pregnancies of obese un-operated patients. Pregnancy outcomes, neonatal datas, delay influence between surgery and pregnancy beginning, bariatric surgery type and gastric banding (GB) loosening consequences were analysed. Results: In the surgical brand were developed less gestational diabetes (DG) (P =0,05), deliveries were more often normal (P =0,004) and births shown less macrosomias and small for gestational age newborns (P =0,04). Neonatal state was improved among operated patients: less Apgar scores less than 7 at 1minute (P =0,05) and less cord blood pH less than 7,2 (P =0,03). They gained more weight during the pregnancy (P =0,0003) and only 53% had a nutritional management and assessment. Patients with GB loosening gained more weight (P =0,0003). Lastly, there were no difference due to the different bariatric surgery techniques or nutritional follow-up in the pregnancy course and neonatal state. Discussion and conclusion: Bariatric surgery improves obstetric and neonatal prognosis. Improvements have to be developed in the multidisciplinary follow-up in order to avoid nutritional deficiencies or important weight gain pregnancy in case of GB. [Copyright &y& Elsevier]

Abstract: Gyration abnormalities often reflect severe neurological diseases. Their diagnosis is impeded by our limited knowledge about normal sulci anatomy throughout fetal brain development. Primary sulci appears in a specific chronology which is unchanged among all fetuses. We think it is interesting to remind of sulci anatomy and then to depict sulci MRI and ultrasonography appearance at 22, 27 and 32 weeks of gestation. We pay particular attention to the lateral sulcus, also called Sylvian fissure. [Copyright &y& Elsevier]

Abstract: Objectives: Bacterial vaginosis is a risk factor for preterm delivery. Its prevalence and risk factors in Europe are not well known. Our objective was to assess both in early pregnancy. Study design: As part of the PREMEVA randomized controlled trial, this population-based study included 14,193 women screened before 14 weeks’ gestation for bacterial vaginosis in the 160 laboratories of the Nord-Pas-de-Calais region in France. Bacterial vaginosis was defined by a Nugent score≥7. Data were collected about maternal tobacco use, age, education, and history of preterm birth. We estimated the prevalence of bacterial vaginosis and used a multilevel logistic regression model to identify significant risk factors for it. Results: Among the 14,193 women assessed before 14 weeks’ gestation, the prevalence of bacterial vaginosis was 7.1% (95% CI: 6.6–7.5%). In the multivariate analysis, smoking during pregnancy tobacco (adjusted OR: 1.38; 95% CI: 1.19–1.60), maternal age 18–19 years (adjusted OR: 1.40; 95% CI: 1.01–1.93), and educational level (completed only primary school: adjusted OR: 1.77; 95% CI: 1.35–2.31; completed only secondary school: adjusted OR: 1.27; 95% CI: 1.10–1.48) were independent risk factors for bacterial vaginosis. History of preterm delivery was not an independent risk factor of bacterial vaginosis: adjusted OR: 1.15; 95% CI: 0.90–1.47. Conclusion: In a large sample of women in their first trimester of pregnancy in France, the prevalence of bacterial vaginosis was lower than rates reported in other countries, but risk factors were similar: young age, low level of education, and tobacco use during pregnancy. These results should be considered in future strategies to reduce preterm delivery. [Copyright &y& Elsevier]

Abstract: Objectives: To assess the safety of a decision protocol for type of delivery of breech presentations after 37 weeks of gestation. This protocol was based on a comparison of fetal head and maternal pelvic measurements. Study design: Retrospective before-and-after study of 1133 breech infants born between 2000 and 2008 in a tertiary centre, analysing neonatal condition and percentage of vaginal deliveries by study period. Results: Application of the protocol was accompanied by an increase in the percentage of vaginal deliveries of breech presentations from 24.0% in 2000–2004 to 38.5% in 2004–2008 (p <0.001), without impairment of neonatal condition [composite mortality/morbidity variable: 3/567 (0.5%) vs 4/566 (0.7%), respectively; p >0.99; neonatal arterial pH<7.0: 8/521 (1.5%) vs 4/529 (0.8%), respectively; p =0.23]. Conclusion: The use of a protocol based on objective criteria at the authors’ centre made it possible to increase the percentage of vaginal deliveries of breech presentations without impairing neonatal condition. [Copyright &y& Elsevier]

Abstract: Objective: To assess the risk of severe postpartum haemorrhage (PPH) according to the durations of the passive and active phases of the second stage of labour. Study design: Secondary analysis from the PREMODA prospective observational study in 138 French maternity units; 3330 low-risk nulliparous women with vaginal deliveries of cephalic singletons were included. Prospective analysis of the recorded durations of the active first stage of labour and the passive and active phases of the second stage of labour was undertaken, and their association with severe PPH, defined by estimated blood loss >1000ml or blood transfusion. Factors associated with severe PPH were analysed by uni and multivariate analyses with logistic regression models. Results: The frequency of severe PPH was 2.1% (n =69). In the univariate analysis, the frequency of severe PPH increased with the duration of the active second stage but not the passive second stage: 1.2% for active second stage <10min, 1.6% for 10–19min, 2.1% for 20–29min, 2.6% for 30–39min, 4.5% for 40–49min and 14.3% for ≥50min (p <0.001). After adjustment for confounding factors, the risk of severe PPH was found to be statistically significant when the active first stage exceeded 6h [adjusted odds ratio (OR) 2.5, 95% confidence interval (CI) 1.0–6.1)] and when the active second stage exceeded 40min (40–49min: adjusted OR 3.5, 95% CI 1.0–12.3; ≥50min: adjusted OR 10.6, 95% CI 2.8–40.3; reference: <10min). The duration of the active second stage was not associated with other maternal or neonatal complications. Conclusions: A prolonged active, but not passive, second stage of labour is associated with the risk of severe PPH in nulliparas. The optimal duration of these phases remains to be defined. [Copyright &y& Elsevier]

Abstract: Oculo-dento-digital dysplasia (ODDD) is an autosomal dominant disorder with complete penetrance and high intra- and interfamilial phenotypic variability. The key features in this syndrome are microphthalmia, enamel hypoplasia and syndactyly of the 4th–5th fingers. ODDD is caused by mutations in the connexin 43 gene (GJA1). We report here four patients from three families with GJA1 mutations, one of them diagnosed prenatally. The three mutations (c.52T > C/p.Ser18Pro, c.689_690delTA/p.Tyr230CysfsX6, c.442C > G/p.Arg148Gly) have been reported once before. Two patients had white matter hypersignal anomalies, associated in one case with mental retardation, but asymptomatic in the other one, an observation that leads us to discuss systematic neuroradiological imaging for ODDD. One case has optic atrophy, another has hypospadias. The patient carrying a truncating mutation of Cx43 did not have palmoplantar keratoderma, in contradiction with the previously suggested genotype–phenotype correlation between truncating mutation and skin involvement. [Copyright &y& Elsevier]

Abstract: Isolated congenital heart block is linked to transplacental passage of maternal anti-SSA/Ro and/or anti-SSB/La antibodies that may be related to a connective tissue disease. Ultrasonography and Doppler are essential to screen fetus at risk. They allow the diagnosis of first- and second-degree blocks which are probably preliminary stages in conducting tissue''s injury. In these situations, a maternal treatment by fluorinated steroids can be proposed because of its possible effect on partial blocks. However, these early signs of nodal injury can be lacking: some fetus present a complete heart block without previously detected less advanced block. Moreover, the significance of first-degree block is unclear since it could reverse spontaneously. Other markers of nodal injury would be valuable. In case of complete congenital heart block, ultrasonography is useful to detect congestive heart failure and help the obstetrical management when unfavorable prognostic signs occur. [Copyright &y& Elsevier]

Every year, in France, about 70 women die during their pregnancy or the delivery. Any maternal death during labour is a traumatic event for the medical team and the family. The medical team has to face many “new” problems. We try to identify all the problems which the medical team has to face in front of a maternal death and try to solve them by a medical literature and French laws review. The medical team often feels powerless when a maternal death occurs. This work was made to be a guideline. [Copyright &y& Elsevier]

The French legislation strictly controls the organization of assisted reproductive techniques (ART). The menopaused women are not allowed access to this kind of medical care. For women who still want to be pregnant, oocyte donation in a foreign country may offer a solution. The mortality and morbidity rates are higher for these women compared to the general population. We report two cases of pregnancy after oocyte donation in women around 45 years of age. The first one was complicated by preeclampsia and gestational diabetes. The second patient suffered from severe postpartum complications that needed intensive care during three weeks. The clinical consequences are discussed, together with legislative and ethical issues. [Copyright &y& Elsevier]

Objectives: To assess the effect of the twin-to-twin delivery interval on the umbilical cord blood gas status and the neonatal outcome of the second twin following vaginal delivery. Patients and methods: Retrospective study of twin deliveries at or beyond 34 weeks of gestation over a period of five years. The correlation between the twin-to-twin delivery interval, and the umbilical arterial blood gas parameters of the second twin, including pH, PO2, PCO2, HCO3- and base excess, was studied. A second analysis was performed after exclusion of non-vertex presentation, need for general anesthesia, growth restriction and weight difference between the twin>30%. Results: Two hundred and thirty-nine patients were studied. The mean twin-to-twin delivery interval was 11.3±6.4 minutes (between 6 and 14 minutes in 56.1% of cases). The second twin had more Apgar score<7 at 1 minute (P <0.02) and more arterial ombilical pH<7.20 (P <0.01) than the first twin. Over 15 minutes, the mean arterial pH was lower (P <0.01) and the number of arterial pH<7.20 increased (P <0.03). In contrast, the mean Apgar score and the rate of neonatal transfer did not differ significantly. There were significant negative correlations between arterial pH, base excess and bicarbonates and the twin-to-twin delivery interval (P <0.05). Similar results were found in the homogenised population. The reduction in the second twin arterial pH was expressed as pH=7.282–0.003×time. Discussion and conclusion: Umbilical cord arterial blood gas parameters deteriorate with increasing twin-to-twin delivery interval. Our results suggest that this interval should be less than 15 minutes, but obstetrician should adapt to every clinic situation. [Copyright &y& Elsevier]

With a review of the current literature, a clarification on screening and management of gestational diabetes is hereby set out, within the frame of a Clinical Expert Series. According to the ethnic group, the prevalence varies from 1 to 14%. The treatment is based on dietary advice, insulin. The ACHOIS study demonstrates that the treatment of gestational diabetes significantly decreases perinatal complications (4 to 1%). The place of the oral treatment (glyburide) remains to be defined. In most countries, diagnosis rests on oral glucose test tolerance: Sullivan 50 g glucose test (1 hour) and 100 g test of glucose if positive (3 hours); WHO 75 g test (2 hours). The screening can be systematic or only on risk factors (wide variations between studies). Screening of gestational diabetes is required because its management improves pregnancy outcomes. Despite this, there is no consensus on the strategy of screening and diagnosis. [Copyright &y& Elsevier]

Abstract: The vacuum extractor Kiwi OmniCup™ (Clinical Innovations, Muray, Utah, USA) has been developed to provide several advantages. This is a complete system with an integral hand-held vacuum operated by the obstetrician. This is also a single use instrument, which may reduce the risk of potential transmission of infections and the logistic of sterilization process. Further potential benefits of this system include the smaller overall equipment size and the ability to measure traction force. However, the data about its efficiency remain conflicting. The first works demonstrated very high successful rate of vaginal delivery, whereas two recent randomized studies showed that the Kiwi Omnicup™ was less efficient than currently used vacuum extractor. It appears to be as safe as conventional a device for both mother and newborn. However, further additional data remain necessary needed to complete its evaluation. [Copyright &y& Elsevier]

Abstract: Objectives: Our purpose was to study a non-invasive management of fetomaternal alloimmune thrombocytopenia (FMAIT). Patients and methods: Between 1996 and 2005, 18 women were treated. The population was divided into 2 groups: patients with a history of intracranial haemorrhage (ICH) in the older sibling received weekly intravenous immunoglobulin (IVIG) therapy to the mother (1 g/kg per week) without initial cordocentesis whereas patients with a history of neonatal thrombocytopenia did not undergo any treatment. Results: All pregnancies with a previous FMAIT were monitored with serial ultrasound scans without cordecentesis. 15 patients had HPA-1, 2 HPA-3 and 1 HPA-5 immunizations. Weekly intravenous immunoglobulin therapy was administered in 5 patients with a history of ICH in the older sibling. Two of these delivered thrombocytopenic children; one had a platelet count<50×109/l. For the 13 women (one twin) who had a sibling with neonatal thrombocytopenia, 11/14 newborns had a platelet count<50×109/l. Predelivery fetal blood sampling were performed in 8/18 pregnancies. The neonatal periods of the 19 children were uncomplicated and no ICHs were observed. Discussion and conclusion: Our results suggest that a non-invasive strategy avoiding serial cordocentesis may be an effective therapy in patients who are at risk of fetal and neonatal alloimmune thrombocytopenia. [Copyright &y& Elsevier]

Abstract: Objective: To study the feasibility of a screening for bacterial vaginosis by a self-collected vaginal swab during pregnancy. To measure bacterial vaginosis prevalence in a non-representative sample of women. Patients and methods: A self-collected swab was suggested to 398 women who consulted between 15 and 33 weeks of gestation in three different centres. Gram stain evaluation using Nugent criteria was used for the diagnosis of bacterial vaginosis. Results: Three hundred and forty-one women agreed to take part in the study (86%). The quality of the swabs was satisfactory in 93% of the cases. Concerning the 15 non-interpretable slides, the cellular and bacterial density was too poor, owing to a poor quality or a low vaginal flora. Thirty-one women (9%) had a bacterial vaginosis — Nugent score included between 7 and 10 — and this frequency did not vary according to the centre. Thirty-five women (10%) had an intermediate flora — score between 4 and 6 — and this result varied from 2 to 12% depending on the centre, but the difference was not significant. Discussion and conclusion: Self-collected swabs to detect bacterial vaginosis are well accepted by most of pregnant women, and the quality of the swabs seems to be satisfactory. In case vaginal flora is intermediate — between 4 and 6 — the interpretation of the slides could be difficult. [Copyright &y& Elsevier]