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Background: The risk of vertical transmission of hepatitis B virus (HBV) increases as maternal HBV DNA increase, despite serovaccination to newborns., Methods: From 1 July 2012 to 1 January 2016, all pregnant women in Lariboisiere Hospital, Paris, France, with HBV DNA of 5 log10 IU/ml and above were administered tenofovir from week 28 of pregnancy until delivery. HBV DNA was measured at months 1, 2 of tenofovir and at delivery. The newborns were serovaccinated, tested for hepatitis B surface antigen, hepatitis B core antibody (HBcAb)±HBV DNA, and hepatitis B surface antibody (HBsAb) when aged 9 months, and then 24 months. This study was registered in http://www.ClinicalTrials.gov (NCT02039362)., Results: Thirty-one women gave birth to 37 newborns. Maternal HBV DNA at baseline was 8.23 log10 IU/ml and above in 12 pregnancies. The mean (median) HBV DNA were 4.4±1.2 (4.8), 3.3±1.7 (3.8), and 2.1±1.9 (2.0) log10 IU/ml at months 1, 2 of tenofovir and at delivery, respectively. Twenty-seven newborns were followed up: none of the 19 children aged 9 months or older was positive for hepatitis B surface antigen when aged 9 months; 14 children tested positive for HBcAb (probably transferred maternal antibodies, not found when aged 24 months) and for HBsAb without HBV DNA. Four of the 19 children showed HBsAb without HBcAb, the last being doubtful for HBcAb and HBsAb without HBV DNA. Eight newborns aged less than 9 months were not tested., Conclusion: Tenofovir from week 28 of pregnancy to highly viremic HBV women plus serovaccination to newborns could prevent chronic and past infection.

Hydrops fetalis related to homozygous α-thalassemia is a rare condition in Western Europe. We report a case of fetal cardiac failure that occurred after a second-trimester diagnosis of fetal umbilical vein aneurysm that was postnatally related to α-thalassemia., (Copyright © 2013 S. Karger AG, Basel.)

Adhesions are the most frequent complications of abdominopelvic surgery, causing important short- and long-term problems, including infertility, chronic pelvic pain and a lifetime risk of small bowel obstruction. They also complicate future surgery with increased morbidity and mortality risk. They pose serious quality of life issues for many patients with associated social and healthcare costs. Despite advances in surgical techniques, including laparoscopy, the healthcare burden of adhesion-related complications has not changed in recent years. Adhesiolysis remains the main treatment although adhesions reform in many patients. The extent of the problem of adhesions has been underestimated by surgeons and the health authorities. There is rising evidence however that surgeons can take important steps to reduce the impact of adhesions. As well as improvements in surgical technique, developments in adhesion-reduction strategies and new agents offer a realistic possibility of reducing adhesion formation and improving outcomes for patients. This paper is the first of a two-part publication providing a comprehensive overview of the evidence on adhesions to allow gynaecological surgeons to be best informed on adhesions, their development, impact on patients, health systems and surgical outcomes. In the second paper we review the various strategies to reduce the impact of adhesions and improve surgical outcomes to assist fellow surgeons in France to consider the adoption of adhesion reduction strategies in their own practice., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Background: Ovarian teratoma (OT) is the most common ovarian neoplasm in children. Oophorectomy has been the standard treatment but may impair fertility. The aim of this study was to investigate the feasibility and outcome of ovarian-sparing surgery (OSS) for OT., Procedure: We retrospectively studied all children treated for OT at a pediatric teaching hospital in Paris, France, between March 1992 and July 2006. OSS was performed when deemed technically feasible in patients who had no lymphadenopathy by preoperative imaging or surgical exploration, normal tumor marker levels, and calcifications on radiographs., Results: We identified 30 patients, including 29 with unilateral OT and 1 with synchronous bilateral OT. Emergent surgery was performed in five patients, among whom four had ovarian torsion requiring oophorectomy and one underwent OSS. Of the 26 OTs in the 25 remaining patients, 10 were managed with OSS and 16 with oophorectomy. Subsequently, ultrasound monitoring detected OT development in the contralateral ovary in 4 (14%) patients, after a median of 3 years (range, 1-14 years); OSS was performed in all four cases. The patient with bilateral synchronous OT, managed by OSS initially, underwent unilateral oophorectomy 3 years later for a recurrence. Overall OSS was performed for 15 (42%) OTs., Conclusions: Our results suggest recommendations for preserving fertility whenever possible without compromising the oncological prognosis. In particular, OSS should be reserved for patients who meet all criteria for localized mature teratoma. Long-term follow-up is crucial., (Copyright © 2011 Wiley-Liss, Inc.)

We report a posterior urethral valves case diagnosed at 33 week's gestation on a fetus presenting with anamnios and urinary ascites. In this fetus, the serum beta2 microglobuline rate was high, suggesting a very poor renal prognosis. At 1-year-old, the creatinine rate is nearly normal. In case of urinary ascites, the serum beta2 microglobuline rate could be improved in relation with the transperitoneal reabsorption of this protein., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)

Background: The results from preliminary studies on fetal pacing preclude an application to the human fetus. The purpose of this study was to evaluate the feasibility of acute fetal cardiac pacing following ultrasound-guided epicardial anchorage of a new pacing lead dedicated to the fetal heart., Methods: In 12 pregnant ewes, a needle was placed in contact with cardiac chambers under echo-guidance. Using the lumen of the needle, a 3-Fr pacing lead was advanced and fixed on the cardiac wall using a built-in screw. Pacing was attempted using an external pacing system., Results: Lead insertion was successful in all but one. In the first fetus, the needle was advanced too far into the right ventricle leading to pericardial bleeding. The fetal heart rate was overdriven in all at 220/ min. After assessment, pacing lead was unscrewed and retrieved without any complication. Pregnancy was electively interrupted in six animals. The other six fetuses were delivered vaginally after uneventful pregnancy and autopsy at day 3 did not show any significant injury., Conclusions: Transcutaneous echo-guided fetal acute pacing is feasible using a specially designed lead. Additional refinement of both the equipments and the operative technique are needed before considering permanent pacing in the human fetus., ((c) 2009 John Wiley & Sons, Ltd.)

Objectives: To evaluate the frequency of ovarian torsion in neonates with ovarian cysts (OCs) and to analyze the outcome after surgical treatment., Methods: A retrospective review of all infants with OCs managed in our institution during 20 years, was conducted. Our management included a follow-up (FU) of prenatal serial ultrasound (US) scan without prenatal cyst aspiration and early postnatal US scan. Neonatal surgery was indicated for cysts that appeared complex regardless of size and for simple cysts larger than 20 mm., Results: Sixty-seven OCs detected through prenatal diagnosis were identified. Cysts were detected at a median gestational age (GA) of 33 weeks. At diagnosis, median size of the OCs was 40 mm, and 18% were complex. On the postnatal US scan, 55% were complex. Neonatal surgery was performed for 64 OCs : 56% were torsed, 6% were hemorrhagic, and 38% were uncomplicated. Proportions of complex- and simple-appearing cysts on prenatal or postnatal US scan were the only significantly different parameters found between infants with torsed or not torsed OC., Conclusion: Our study demonstrated that OC bears a high risk of ovarian loss. These findings have implications regarding information and treatment offered to pregnant women bearing an affected fetus.

Coelocentesis may represent the ideal technique for early prenatal diagnosis. This study aimed to quantify the number of cells in coelomic fluid and to investigate the feasibility of interphase fluorescence in-situ hybridization (FISH) in uncultured coelomic cells for chromosomes X and Y in 12 samples of 0.4-0.8 ml of coelomic fluid obtained by transvaginal puncture at 8-9 weeks of gestation. It was found that the density of cells in the coelomic fluid was low and variable ranging from 0 to 10,600 cells/ml. The FISH analysis failed in three cases because of the absence or remarkably low number of cells. Among the remaining nine cases, FISH analysis led to an unambiguous result in all the samples except two in whom the FISH analysis clearly demonstrated a high count of maternal cells whereas the fluid was apparently not blood stained. The presence of such maternal cells, while their source and nature remaining unexplained, stressed the question of the absolute necessity to prove the fetal origin of the cells analysed. Whatever the cytogenetic analysis performed on coelomic fluid, combining a systematic exclusion of significant maternal contamination is recommended, using multiplex polymerase chain reaction for short tandem repeat analysis to cytogenetic analyses.

Hydrocolpos may be associated with a lower urinary tract obstruction in a spectrum of urorectal malformations ranging from persistent urogenital sinus to cloacal dysgenesis. As cloacal dysgenesis carries the worst postnatal prognosis, detailed prenatal ultrasound should focus on the fetal pelvic anatomy to provide the parents with appropriate prenatal counseling. We report three cases of fetal hydrocolpos associated with low urinary tract obstructions, including two with a normal appearance of the anal canal and rectum on prenatal ultrasound and one with a complex cloacal malformation which contributed to the precise prenatal assignment of the malformation in each case within the spectrum of urogenital sequence malformations.

Background: Coelocentesis may represent the ideal technique for very early prenatal diagnosis. Although cell density in coelomic fluid (CF) is very low, the results of analyses on the cellular compartment have been proposed for prenatal diagnosis., Methods and Results: We aimed to evaluate the amount of total DNA (i.e. cellular and cell-free) in 14 samples (0.4-0.8 ml) of CF, taken from women at 8- to 9-week gestation, who are about to undergo termination of pregnancy, and to assess the feasibility of multiple single-gene analyses using multiplex real-time PCR. We found that the amount of total DNA in the CF was very low and varied widely. Genetic testing using multiplex real-time PCR was successfully achieved in 10 of 14 samples (71%). However, when considering samples that could provide a reliable prenatal diagnosis (i.e. successful PCR analysis and no marked maternal contamination), reliable CF-DNA-based prenatal diagnoses were obtained in only 8 of the 14 (58%) samples., Conclusion: The development of highly reliable procedures adapted to pauci-cellular CF is crucially needed before coelocentesis could be proposed for early prenatal diagnosis of genetic diseases before 10 weeks.

Hydrops fetalis is associated with a wide variety of fetal and maternal disorders. Among these disorders, cases with anemia may benefit from a specific treatment. The authors report on two cases of hydrops fetalis with increased middle cerebral artery peak systolic velocity and discussed the contribution of this finding in the management of fetuses with hydrops.

We report a case of fetal hyperechogenic bowel diagnosed at midgestation that was associated with fetal parvovirus B19 infection. Isolated hyperechogenic bowel was detected at 25 weeks. Cystic fibrosis, chromosomal abnormalities and cytomegalovirus infection were excluded, whereas polymerase chain reaction DNA for parvovirus B 19 was found positive on amniotic fluid. The hyperechogenic bowel decreased with complete resolution by 32 weeks of gestation. No other signs of fetal B19 infection were detected prenatally and the baby had normal postnatal outcome. This case provides additional arguments in favor of a possible intestinal tropism of parvovirus B19 during fetal life. Fetal B19 infection should be systematically incorporated in the prenatal evaluation of isolated fetal hyperechogenic bowel., (Copyright (c) 2005 S. Karger AG, Basel.)

Background: Our aim was to estimate the prevalence of stress urinary incontinence 4 years after the first delivery and analyze its risk factors., Methods: A retrospective cohort survey was conducted in a French university hospital. The 669 primiparous women who delivered in our department in 1996 a singleton in a vertex position between 37 and 41 weeks of amenorrhea were included. A mailed questionnaire was sent 4 years after the indexed delivery. The main outcome measure was stress urinary incontinence 4 years after the first delivery., Results: Three hundred and seven women replied, 274 had moved and 88 did not respond. Four years after the first delivery, prevalence of stress urinary incontinence was 29% (89/307). According to multiple logistic regression analysis, the independent risk factors were urine leakage before the first pregnancy [odds ratio (OR) 18.7; 95% confidence interval (CI) 3.6-96.4], urine leakage during the first pregnancy (OR 2.5; 95% CI 1.3-4.8), duration of first labor > or = 8 h (OR 3.1; 95% CI 1.7-5.7), mother's age > 30 years at the first delivery (OR 2.4; 95% CI 1.4-4.2) and cesarean section at the first delivery (OR 0.3; 95% CI 0.1-0.9)., Conclusion: Our results suggest that stress urinary incontinence after pregnancy arises from a multifactorial condition. The main risk factors are: age, previous incontinence (before or during the first pregnancy), prolonged labor and vaginal delivery.

Objective: The possibility of offering assisted reproductive technologies (ART) to HIV-positive couples has revived questions concerning the safety of the gametes and embryos cryopreservation in liquid nitrogen tanks., Patients and Methods: We evaluated the safety of three types of straws - polyvinyl chloride (PVC), polyethylene terephthalate glycol (PETG) and so-called 'high-security' ionomeric resin (IR) - containing HIV-1 under standard conditions of cryopreservation. Potential HIV contamination was assessed by RT-PCR and then nested PCR., Results: Under cryopreservation conditions, the sealed open ends of PVC and PETG straws were not safe. The ultrasound sealing system seems to be the weak link in obtaining total imperviousness of the straws. In contrast, both ends of the IR straws were safe for HIV in the framework of their use for ART., Conclusion: Sealing cryopreservation straws ultrasonically could incur the risk of not assuring their impermeability. Under standard cryopreservation conditions thermosealing of IR straws appears to be safe for HIV.

The rate of mother-to-infant transmission for hepatitis C virus is estimated to be around 5% of viraemic mothers and represents an important route of HCV infection among children. Transmission is possible in utero but the highest risk of infection is at or near the time of delivery because of an important blood transmission of hepatitis C virus. Mothers with high levels of HCV-RNA and co-infected for human immunodeficiency virus are documented to have risk factors for vertical transmission of HCV. Thus, for these, the mode of delivery must be discussed even if there are no precise recommendations. Among obstetrical risk factors, the results of literature fail to prove a benefit of elective caesarean delivery in the aim to reduce the vertical transmission of HCV. However, obstetrical situations with a high risk of blood contact between mother and foetus must be considered and if possible evicted.

Inclusion of HIV+, HCV+ or HBV+ couples in medically assisted procreation has been allowed by the French law since the publication of some legal texts dates January 12th 1999 and May 2001. This article tries to identify the viral risks of such inclusion and to analyse the answers given by the French law to eliminate these risks.

Objective: The aim of this study was to investigate the relationship between induced apoptosis of human luteinized granulosa cells (GCs) and in vitro fertilization (IVF) outcome., Study Design: We induced apoptosis with interferon gamma and an anti-human Fas antibody in cultured GCs isolated from follicular fluids coming from 25 different women undergoing 25 consecutive IVF cycles. After examination of 1000 GCs stained by DAPI with a fluorescent microscope, we determined the percentages of apoptotic GCs. Ovarian, endometrial and IVF parameters were recorded for every woman., Results: We classified the women according to their induced GCs apoptosis percentages in two groups. Group 1 with a low percentage of apoptotic GCs (11.6+/-4.8%) had a significantly higher pregnancy rate (P<0.05) than group 2 with a high percentage of apoptotic GCs (59.5+/-14.8%). No other statistically significant differences were observed., Conclusion: Resistance of human GCs to apoptosis might be implicated in IVF outcome.

Objective: To study the perinatal management of fetal macrosomia (FM) and the obstetrical and neonatal results related to FM in the Ile de France area., Materials and Methods: Case-control study from the fifteenth of July to the fifteenth of September 1999 in fifteen maternity in Paris and the Ile de France area. All singletons, without malformation, weighing more than 4,000 grams, born after 37 weeks of pregnancy during the study were included. The control group had the same inclusion and exclusion criteria (except the birth-weight) and was defined by the next delivery of same parity., Results: 384 FM and 384 controls have been included. Usual risk factors of macrosomia have been found. The screening of gestational diabetes was realised in 56.8% and FM was suspected before delivery in 59.3% in the FM group. In cases of FM, the midwife was alone at the time of delivery in 53.4% of spontaneous vaginal delivery. FM was associated with a longer labour and a more frequent use of oxytocin. There was six times more severe perineal tears (1.7 vs 0.3%; p = 0.05) for women with FM whereas the rate of haemorrhage at delivery was the same in both groups. Cesarean section' rate before and during labor was higher in the FM group whereas instrumental extraction was not different. In this study, FM was not associated with an excess of fetal morbidity (injury, Apgar score, pH cord) even if we found ten times more shoulder dystocia., Conclusion: Complications related to FM were mainly maternal in this study. Some recommendations accounting fetal macrosomia were not widely adopted as screening of gestational diabetes or necessity to have a whole obstetric team at the time of delivery.

Endometrioma is one of the most frequent localisations of endometriosis. The diagnosis is based mainly on the intravaginal ultrasonography which has a good predictive value, even if there are a lot of atypical echographic aspects. Endoscopic surgery remains the standard treatment for endometriosis, the goal being the complete removal of the lesions. Three surgical options are possible: intraperitoneal cystectomy, the three-phase "Donnez technique" in three time, and ovariectomy. Treatment of recurrences of endometriosis must be based on a precise diagnosis, and also on the type of patient being treated: patient wishing to be pregnant, patient under medically-assisted reproductive programs, and patients close to menopause. The ultrasound-guided puncture could be an interesting option for multioperated patients or patients under assisted reproductive programs, yet these patients should be informed of the high risk of further episodes of endometriosis after such a puncture.

Uterus septus is the most frequent congenital uterine anomalies caused by insufficient resorption of the müllerian ducts. Retrospective statistical analysis shows that the uterine septa have the worst reproductive outcome with a high incidence of early abortions. It is well recognized that it increased the incidence of recurrent (> or = 3) miscarriages (79% among 1,601 pregnancies), reproductive failure and obstetric complications. A septate uterus does not seem to be an infertility factor. On the other hand, the incidence of unexplained infertility was significantly higher (40%) in the patients with secondary infertility; thus, a contribution from the uterine septum in delayed conception of these patients cannot be excluded. Hysteroscopic surgery has replaced conventional abdominal route. Hysteroscopic metroplasty improves obstetrical prognosis in women with septate uterus, and it's advantages are easiness, low morbidity rate, without the hysterotomy's consequences like adnexial adhesions. Metroplasty is indicated in women with a history of miscarriages (2 or more), which decreased to 15%, in patients with an unexplained infertility, and in women in whom assisted reproductive treatment is being contemplated. Combined with laparoscopy, the hysteroscopic metroplasty is the gold standard for assessing uterine septa, especially in these infertile women. Laparoscopy also is required to complete the diagnostic work up of infertility, and provides an opportunity to treat any coexisting pelvic pathology.

Context: Zidovudine reduces maternal-infant transmission of human immunodeficiency virus 1 (HIV-1) infection by two thirds. Combination antiretroviral therapies are potentially more effective prevention., Objectives: To assess the safety of perinatal lamivudine-zidovudine therapy, especially in children, and its effects on viral load, acquisition of drug resistance, and maternal-infant transmission of HIV-1 in a nonbreastfeeding population., Design and Setting: The Agence Nationale de Recherches sur le SIDA (ANRS) 075 Study, an open-label, nonrandomized intervention trial conducted in the context of an ongoing observational cohort study in 48 sites in France., Patients: A total of 445 HIV-1-infected pregnant women were enrolled as the study cohort from February 1997 to September 1998; controls consisted of 899 pregnant women who had received zidovudine monotherapy in May 1994 to February 1997 as standard care., Intervention: The study cohort received lamivudine in addition to the standard Pediatric AIDS Clinical Trial Group 076 Study zidovudine prophylaxis regimen. Lamivudine was initiated in women at 32 weeks' gestation through delivery at 150 mg twice per day orally; children received lamivudine, 2 mg/kg twice per day for 6 weeks., Main Outcome Measures: HIV-1 infection status and tolerance of therapy in children through age 18 months; maternal plasma HIV-1 RNA levels through 6 weeks after delivery., Results: The transmission rate in the study group was 1.6% (7/437; 95% confidence interval [CI], 0.7%-3.3%). In a multivariable analysis, transmission in the study group was 5-fold lower than in controls. In the study group, maternal plasma HIV-1 RNA level was less than 500 copies/mL at delivery in 74%; the median decrease was 1.24 (range, -1.63 to 3.40) log(10) copies/mL. The M184V lamivudine resistance mutation was detected at 6 weeks after delivery in specimens from 52 of 132 women. The most frequent serious adverse events in children were neutropenia and anemia, requiring blood transfusion in 9 children and premature treatment discontinuation in 19. Two uninfected children died at age 1 year from neurologic complications related to mitochondrial dysfunction., Conclusions: Lamivudine-zidovudine may be effective in preventing maternal-infant HIV transmission. However, severe adverse effects and emergence of resistance to lamivudine occurred. Thus, the role of this combination therapy in this setting is as yet unclear, and further research involving a variety of strategies is needed to definitively ascertain its utility for preventing maternal-infant HIV transmission.

Aims: We aimed to compare the expression patterns of E-cadherin and CD44 isoforms in cervical intraepithelial neoplasia (CIN) between patients with or without infection by the human immunodeficiency virus (HIV)., Methods: An immunohistochemical analysis using the monoclonal antibody HECD-1 against E-cadherin and the monoclonal antibodies 2C5, binding to CD44s and all the variants encoded by exons 3 to 10, 3G5, specific for CD44v3 and 2F10, and specific for CD44v6, was performed in formalin-fixed, paraffin-embedded samples of 138 CIN (74 from HIV-negative and 64 from HIV-positive patients)., Results: In HIV-negative patients, the mean percentages (+/-SD) of E-cadherin-positive cells in CIN of grades I, II, and III were, respectively, 33% +/- 4, 63% +/- 5, and 91% +/- 9. The difference was statistically significant between the three groups of tumors (P < 0.0001). In HIV-negative patients, the mean percentages (+/-SD) of CD44-positive cells in CIN of grades I, II, and III were, respectively, 37% +/- 7, 57% +/- 8, and 90% +/- 11. The difference was statistically significant between the three groups of tumors (P < 0.0001). No difference in E-cadherin and CD44 expressions was noted between HIV+ and HIV- women. Further analysis showed no relation between E-cadherin or CD44 expression and the HPV status and CD4 T cell serum levels., Conclusion: Our study confirms that alterations in E-cadherin and CD44 expression in CIN depend on the histological grade but suggest nondirect involvement and are not related to HIV and immune status., (Copyright 2000 Academic Press.)

Objective: To evaluate the frequency and correlates of oral route exposure of infants born to HIV-1-infected women., Methods: A multicenter study was performed within the prospective French Perinatal Cohort Study of mother-to-child HIV transmission. Oropharyngeal and gastric aspirates from 122 neonates were studied by reverse transcriptase (RT) polymerase chain reaction (PCR) for the presence of HIV-1, as well as for standard microbiology (Gram staining and culture)., Results: Aspirates from 101 neonates were analyzed by RT-PCR; 28% of these were positive for HIV RNA. Another 21 aspirates could not be tested because of PCR inhibition. The median concentration of HIV RNA in the positive aspirates was 126 copies/ml (range: 8-1270). Detection of HIV-1 in the aspirate was significantly related to high maternal plasma-viral load, presence of blood in the aspirate, positive Gram stain or culture, episiotomy or perineal lesions, and sexually transmitted infections during the pregnancy. Most of the mothers received zidovudine prophylaxis during pregnancy and delivery. Among the six infants who were infected with HIV, three had positive aspirates. Of the three assumed to have acquired the infection intrapartum, only one had an HIV RNA-positive aspirate., Conclusion: Exposure of the fetus to HIV via the oral route occurs frequently, even in the presence of zidovudine prophylaxis, and is likely to be one of the mechanisms of intrapartum transmission, but not the only one.

Investigations are performed in women with external endometriosis to confirm the diagnosis and to evaluate extension of the disease before treatment. Elevated serum CA 125 level is correlated with the severity of the disease. CA 125 may be a helpful to assess the efficacy of the treatment or to detect recurrences. Imaging diagnosis of endometriosis have a good sensitivity to detect cysts and nodes forms of the disease. Magnetic resonance imaging is more sensitive than ultrasonography to detect small nodular lesion and is able to made the diagnosis of deeply infiltrating endometriosis (sometimes not visualised by laparoscopy). Rectal endosonography, barium enema or excretion urography can be usefull if an involvement of the rectosigmoid or the bladder is suspected. Hysterosalpingography is an integral part of the initial fertility survey, but shows only indirect signs of endometriosis. Laparoscopy is the definitive diagnosis procedure for endometriosis, and permit to classify the lesions and to draw-up a therapeutic strategy.

Context: It is unclear whether elective cesarean delivery may have a protective effect against the transmission of human immunodeficiency virus 1 (HIV-1)., Objective: To investigate whether mode of delivery has an impact on perinatal HIV-1 transmission in the presence of zidovudine prophylaxis., Design: A prospective cohort study., Setting: The 85 perinatal centers in the French Perinatal Cohort, from 1985 to 1996., Patients: A total of 2834 singleton children born to mothers with HIV-1 infection., Main Outcome Measure: Human immunodeficiency virus 1 infection of the infant., Results: No zidovudine was used in 1917 pregnancies and zidovudine prophylaxis was used in 902 pregnancies. Cesarean deliveries were performed in 10.9% on an emergent basis and in 8.3% electively, prior to labor or membrane rupture. In 1917 mothers who did not receive zidovudine, of 1877 with information on mode of delivery, 17.2% transmitted HIV-1 to their child. Risk factors statistically significantly associated with transmission were maternal p24 antigenemia, cervicovaginal infections during pregnancy, amniotic fluid color, and rupture of membranes 4 hours or more before delivery. Mode of delivery was not related to transmission. In 902 mothers receiving zidovudine, transmission was 6.4% in 872 with information on mode of delivery, and elective cesarean delivery (n = 133) was associated with a lower transmission rate than emergent cesarean or vaginal delivery (0.8%, 11.4%, and 6.6%, respectively; P=.002). In a multivariate analysis of all mother-child pairs, including obstetrical risk factors, maternal p24 antigenemia, and zidovudine prophylaxis, interaction between mode of delivery and zidovudine prophylaxis was significant (P=.007). In the multivariate analysis of pregnancies with zidovudine prophylaxis, factors related to transmission rate were maternal p24 antigenemia, amniotic fluid color, and mode of delivery. Adjusted odds ratios (95% confidence intervals) were 1.6 (0.7-3.6) for emergent cesarean delivery and 0.2 (0.0-0.9) for elective cesarean delivery (P = .04) in comparison with vaginal delivery., Conclusions: We observed an interaction between zidovudine prophylaxis and elective cesarean delivery in decreasing transmission of HIV-1 from mother to child. This observation may have clinical implications for prevention.

Our objective was to determine the limits of laparoscopic-assisted vaginal hysterectomy (LAVH) and the value of a preoperative scoring system to determine the operative approach to hysterectomy. Between January 1991 and December 1996, 152 out of 177 patients had LAVH and 25 had laparoconversion. The mean operating time was 163 min. The overall postoperative complication rate was 8.4%. The hospital stay was 4.8 days for LAVH versus 6.2 days for laparoconversion (p < 0.01). For each patient, a preoperative scoring system was established according to uterine size, previous laparotomy, uterine mobility, pelvic adhesions and endometriosis stage. The laparoconversion rate increased according to the score, as it was 7.8% for a score < or = 7 and 80% for a score > 7. LAVH offers a technique to convert some abdominal hysterectomies into vaginal hysterectomies. The use of the preoperative scoring system may help to determine patients who may benefit from the laparoscopic route and those with a high risk of laparoconversion.

Our objective was to evaluate the sonographic features, serum tumor markers in a series of 43 patients with borderline ovarian tumors. At sonographic examination, the majority of borderline tumors were multilocular. Serum CA-125 levels were elevated in 32.1%, CA-19-9 in 17.4%. In contrast, ACE levels were constantly normal. Twenty-four out of 43 patients (55.8%) had serous tumors, 18 (41.9%) had mucinous tumors and 1 (2.3%) had endometrioid tumor. Among, the 43 patients, 9 (20.9%) had first laparotomic approach and 34 had first laparoscopic treatment. Seven out of 34 patients treated by first laparoscopic approach had a laparoconversion (2 for presumption of invasive carcinoma and 5 for failure of laparoscopic procedure). Therefore, 27 had exclusive laparoscopic management. Among the 43 patients, 22 had conservative treatment and 21 radical surgery. The mean follow-up of patients was 41 months. Thirty-seven patients (86.1%) were alive without recurrence, 4 had a recurrence (9.3%), 1 patient (2.3%) was lost to follow-up and the last died of intercurrent disease. The mean delay of recurrence was 22 months (range 6 to 36). Three out of 4 recurrences occurred after cystectomy (2 ipsilateral and 1 controlateral). The fourth recurrence occurred after unilateral salpingo-oophorectomy. All 10 second look procedures were negative. Our results point out about the feasibility of laparoscopic management of borderline tumors. However, cystectomy is associated with a high risk of recurrence.

Objective: We attempted to determine whether the risk of mother-to-child transmission of human immunodeficiency virus type 1 is related to events in pregnancy, labor, and delivery., Study Design: In a prospective multicenter cohort study of human immunodeficiency virus type 1-infected mothers and their children, we studied pregnancy histories, labor (including gestational age, induction, membrane rupture, length of labor, intrapartum procedures, bleeding, infection, antiseptic technique, and antiretroviral therapy), and conditions of delivery., Results: Among 1632 singleton infants, 310 were confirmed infected with human immunodeficiency virus type 1 at age 18 months (19.0% +/- 1.9%). Procedures (in particular, amniocentesis and amnioscopy) and sexually transmitted diseases during pregnancy, preterm delivery, premature membrane rupture, hemorrhage in labor, and bloody amniotic fluid were associated with increased transmission. Transmission was not related to mode of delivery or to the conditions of labor and delivery., Conclusions: Transmission was not decreased after emergency or elective cesarean section. Most risk factors either were rare or appeared poorly amenable to obstetric management, with the exception of invasive procedures, which should be avoided.

External version was successful after initial failure in 6 cases after transabdominal amnio-infusion. Filling the uterine cavity by amnio-infusion with 700 to 900 ml saline solution at 37 degrees C facilitated cephalic presentation in these 6 cases. In each case, a prior version attempt had been unsuccessful. Amnio-infusion was performed under continuous sonographic monitoring before a second attempt the next day. The clinical situation was different in the 6 cases which all terminated by normal cephalic delivery. Two patients were first parity, another has a single uterine scar, 3 had a normal pelvis (Magnin > 23), one a narrow pelvis (Magnin = 22.7) and 2 had a pelvis considered pathological (Magnin < 22). The main goal of this preliminary study was to evaluate the feasibility and safety of this new indication for transabdominal amnio-infusion. This new indication should be evaluated by several clinical trials, but it would new appear reasonable to propose transabdominal amnio-infusion in patients with a pathological pelvis and/or a single cicatricial uterus.

Early trophoblastic cells share several features with neoplastic cells. Based on that observation, we attempted to identify genes overexpressed in tumors by analyzing genes preferentially expressed in trophoblasts. A subtracted library enriched in complementary DNA from early cytotrophoblasts was constructed, and the expression level of selected recombinants was analyzed on a large panel of normal and tumor tissues. The library was prepared using a polymerase chain reaction-based complementary DNA subtraction method with 6-week amenorrhea cytotrophoblast endoplasmic reticulum-bound RNA as target, and a mixture of complementary DNA prepared from terminal placenta and activated T-lymphocytes as driver. Two rounds of screening were performed to isolate clones preferentially expressed in early placenta. From a total number of recombinant clones estimated at 32,000 in the subtracted library, 594 inserts were analyzed by Southern blot and 21 sequences were isolated as corresponding to genes highly expressed in early placenta. Eleven encoded known molecules, such as carcinoembryonic antigen, human chorionic gonadotropin, and mitochondrial rRNAs. Ten sequences represented novel genes. Northern blot analysis confirmed that most of these genes were preferentially expressed in early trophoblast in comparison to terminal placenta. Three clones that gave detectable hybridization signals on total RNA were extensively studied and were found to be overexpressed in various tumors. Two of these clones, designated B9 and E4, were later identified as corresponding to genes coding for the putative ribosomal protein S18 and the bifunctional enzyme ADE2H1 involved in purine biosynthesis, respectively. Expression of the third clone, E9, was increased up to 10-fold in breast cancer tissues in comparison with normal counterparts. Present results confirm that many genes expressed in the trophoblast are overexpressed in malignant cells. This approach could provide a general targeted method for the identification of genes overexpressed in various neoplastic cell types.

Thrombosis of the internal jugular vein was associated with a severe syndrome of ovarian hyperstimulation. After in vitro fertilization, a twin pregnancy was obtained in a 31-year-old patient with severe endometriosis. On the day of follicle collection, plasma oestradiol was 3050 mg/ml. Ten ovocytes were collected and 3 embryos were implanted. A syndrome of severe ovarian hyperstimulation (ascites, pleural effusion) developed 3 weeks later and symptomatic treatment was given. Phlebitis of the upper left limb was diagnosed at 9 weeks amenorrhoea and echo-Doppler confirmed the diagnosis of subclavian and internal jugular venous thrombosis. Search for a cause was negative excepting a frank drop in protein S activity to 35%. Post-partum assay and assay in family members confirmed that the deficiency was acquired during pregnancy. The clinical course was favourable with anticoagulant therapy (heparin, then low-molecular weight heparin). Intra-uterine death of one of the fetuses occurred at 21 weeks amenorrhoea and a 2,550 g girl was born by vaginal delivery at 36 weeks. The Apgar score at birth was 10/10. In a review of the literature on vascular events in fertilization, programmes showed that severe syndromes of ovarian hyperstimulation, endogenous hyperestrogenism, multiple pregnancy and predominance of upper limb are the most frequently observed criteria. We emphasize the importance of preventing these thromboembolic events with subcutaneous heparin during the first trimester of pregnancy followed by low-molecular weight heparin, particularly in patients with a history of thromboembolism and/or patients with severe ovarian hyperstimulation.