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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: 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]

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: 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]

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]

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: 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]

Abstract: Management of HELLP syndrome is still controversial. In order to improve maternal and foetal prognosis, 2 approaches are usually considered: immediate termination of pregnancy (risk of foetal complications related to prematurity) or conservative treatment (maternal risk of complications related to hematologic disorders). Choice of treatment needs to be taken after evaluation of the maternal and fetal risk/benefit ratio. [Copyright &y& Elsevier]

Abstract: Polycythemia vera is a myeloproliferative syndrome. This clonal disorder involves a pluripotent stem cell capable of differentiating into red blood cells, granulocytes, and platelets. Polycythemia vera is characterized by the overproduction of mature red blood cells in the bone marrow. Myeloid and megakaryocytic elements are also often increased. Polycythemia vera (PV) is rarely associated with pregnancy. About 20 cases have been reported. Prognosis of PV is not influenced by pregnancy. Conversely, pregnancy outcome is poor, due to the occurrence of gestational hypertension, stillbirth and induced prematurity. During pregnancy, clinical management needs to be close including a collaborative approach between obstetricians, hematologists and anesthesists. The risk of poor outcome may be reduced by the association of antiaggregant and anticoagulant therapy. Phlebotomy can be provided in order to maintain hemoglobin level under 42%. [Copyright &y& Elsevier]

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 ≥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 ≥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. [Copyright &y& Elsevier]

Nous rapportons cinq cas d’élévation très importante de l’uricémie (> 595 mmol/l, 100 mg/l) survenus dans le cadre de vomissements observés au troisième trimestre de la grossesse. Dans tous ces cas, cette élévation fut transitoire et totalement régressive sous réhydratation, permettant de mener la grossesse jusqu’à terme. Une élévation importante de l’uricémie au cours de la grossesse peut accompagner l’existence d’anomalies sévères (HELLP syndrome, stéatose aiguë gravidique, pré-éclampsie) mais également des troubles digestifs bénins et transitoires. Le mécanisme supposé de cette élévation est une insuffisance rénale modérée et passagère dont le pronostic a été excellent dans chacun de nos cas. [Copyright 2004 Elsevier]