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We present the clinical case of a 42-year-old pregnant woman whom fetal death was confirmed with a delay of up to 11 weeks. At the time of the confirmation of the death, the patient undergone a medically-motivated abortion in a context of congenital heart disease associated with a trisomy 21. Major ambivalence to proceed to medically-motivated abortion resulted in important care discontinuity with potentially severe consequences for the mother health. To better understand the psychological aspects underlying it resistance to care, a qualitative analysis of series of semi-structured interviews conducted with varied professionals involved in the care were conducted. The patient's obstetrical medical history (including several unfinished pregnancy and medical complications) was worth considering to better understand the patient's stress reactions and her low level of compliance and trust in medical team. This clinical case illustrates how psycho-trauma related to perinatal bereavements could be reactivated during a new pregnancy. This situation also illustrates the function and the limits of a psychological perinatal team which aims to foster adaptive strategies and mentalizing abilities at the patient-but also the professional-level. [ABSTRACT FROM AUTHOR]

Intrauterine fetal death is a frequent problem in obstetric practice with a high prevalence in developing countries, and particularly in Africa. The objectives of this study were to calculate the frequency, describe the sociodemographic characteristics, describe the management and the prognosis of women with intra uterine fetal death at the Gyneco-Obstetrics and Pediatrics Hospital in Yaounde. This was a descriptive prospective study from January 1st to April 30th, 2021 concerning 42 cases at the maternity of the the Yaounde Gyneco-Obstetrics and Pediatrics Hospital. A pretested questionnaire was used. Our main variables of study were the sociodemographic data, the obstetrical history and the management of the situation as well as the maternal prognosis. We included 42 patients. The frequency of intrauterine fetal death was 5.9%, It mainly concerned young aged from 20 to 30 years old (57.1%) with a mean age of 29 ± 6.4 years, single (85,7%), nulliparous in almost half of cases (42.9%), living in urban areas (73.8%) and having a higher level of education (47.6%). Vaginal delivery (78.6 %) was the most common following spontaneous induction of labor (57.1%). The frequency of cesarean sections was 21.4% mainly indicated for maternal emergency. All of the women had received antibiotic therapy. However, none received psychological counseling. The frequency of maternal complications was 21.4%, dominated by disseminated intravascular coagulation (11.9%). No case of maternal death has been recorded. Intrauterine foetal death is common in our series and its management is dominated by induction of labor, antibiotic propylaxis and vaginal delivery. Disseminated intravascular coagulation is the main complication observed. [ABSTRACT FROM AUTHOR]

Objective: To identify strategies for reducing neonatal and maternal morbidity associated with intrahepatic cholestasis pregnancy (ICP)., Material and Methods: The quality of evidence of the literature was assessed following the GRADE methodology with questions formulated in the PICO format (Patients, Intervention, Comparison, Outcome) and outcomes defined a priori and classified according to their importance. An extensive bibliographic search was performed on PubMed, Cochrane, EMBASE and Google Scholar databases. The quality of the evidence was assessed (high, moderate, low, very low) and a (i) strong or (ii) weak recommendations or (iii) no recommendation were formulated. The recommendations were reviewed in two rounds with external reviewers (Delphi survey) to select the consensus recommendations., Results: Of the 14 questions (from 12 PICO questions and one definition question outside the PICO format), there was agreement between the working group and the external reviewers on 14 (100%). The level of evidence of the literature was insufficient to provide a recommendation on two questions. ICP is defined by the occurrence of suggestive pruritus (palmoplantar, nocturnal) associated with a total bile acid level>10μmol/L or an alanine transaminase level above 2N after ruling out differential diagnoses. In the absence of suggestive symptoms of a differential diagnosis, it is recommended not to carry out additional biological or ultrasound tests. In women with CIP, ursodeoxycholic acid is recommended to reduce the intensity of maternal pruritus (Strong recommendation. Quality of the evidence moderate) and to decrease the level of total bile acids and alanine transaminases. (Strong recommendation. Quality of the evidence moderate). S-adenosyl-methionine, dexamethasone, guar gum or activated charcoal should not be used to reduce the intensity of maternal pruritus (Strong recommendation. Quality of evidence low), and there is insufficient data to recommend the use of antihistamines (No recommendation. Quality of evidence low). Rifampicin (Weak recommendation. Very low quality of evidence) or plasma exchange (Strong recommendation. Very low quality of evidence) should not be used to reduce maternal pruritus and perinatal morbidity. Serum monitoring of bile acids is recommended to reduce perinatal morbidity and mortality (stillbirth, prematurity) (Low recommendation. Quality of the evidence low). The level of evidence is insufficient to determine whether fetal heart rate or fetal ultrasound monitoring are useful to reduce perinatal morbidity (No recommendation). Birth is recommended when bile acid level is above 99μmol/L from 36 weeks gestation to reduce perinatal morbidity, in particular stillbirth. When bile acid level is above 99μmol/L is below 100μmol/L, women should be informed that induction of labor could be considered 37 and 39 weeks gestation to reduce perinatal morbidity. (Strong recommendation. Quality of evidence low). In postpartum, total bile acids and alanine transaminases level should be checked and normalized before prescribing estrogen-progestin contraception, ideally with a low estrogen dose (risk of recurrence of pruritus and cytolysis) (Low recommendation. Quality of evidence very low)., Conclusion: Although the quality of evidence regarding ICP gestational cholestasis remains low, there is a strong consensus in France, as shown by our Delphi study, on how to manage women with ICP. The reference first-line treatment is ursodeoxycholic acid., (Copyright © 2023 CNGOF. Published by Elsevier Masson SAS.. All rights reserved.)

We here report a case of hydrops fetalis diagnosed and treated at the University Clinics of Lubumbashi in the Democratic Republic of the Congo. Fetal death in utero with feto-placental anasarca was diagnosed via ultrasound and etiologic evaluation showed maternal toxoplasmosis. This clinical case highlights the impact of fetal morbi-mortality due to toxoplasmosis during pregnancy and calls for the implementation of a systematic screening among Congolese pregnant women. [ABSTRACT FROM AUTHOR]

Introduction: Fetal intrauterine death constitutes a frequent problem in obstetric practice. The objectives of this study were to determine the frequency and to identify risk factors of fetal death at Reference General Hospital of Kamina. Methods: The study was done in two times. First, a cross-sectional descriptive study of 379 deliveries which allowed to determine the frequency of fetal death. Then, the determination of risk factors was made using a case-control study in which the characteristics of 53 fetal death were compared to 106 controls constituted of alive borns. Results: The fetal intrauterine deaht's frequency at Reference General Hospital of Kamina was at 13,98%. After adjustment, maternal age over 35 years (OR=6,23 ; IC= (1,30-29,80)), antecedent of fetal intrauterine death (OR=3,13 ; IC= (1,06-9,27)) and diseases during pregnancy (OR=31,6, IC= [7,66-130,71]) have been identified as factors significantly associated with increased occurrence fetal death. The high maternal education (OR=0,11 ; IC= (0,03-0,42)) and Kamina's residency (OR=0,23 ; IC= (0,08-0,62)) decreased this risk. Conclusion: The frequency of fetal death was 13,9%. The advanced maternal age, the history of fetal death and disease during pregnancy was associated with fetal intra uterin death but the high maternal instruction and the Kamina residence reduced the risk. The monitoring of at-risk pregnant, screening and the treatment of diseases during pregnancy are necessary in view of reducing prevalence of fetal death in our midst. [ABSTRACT FROM AUTHOR]

Résumé La perte de grossesse formule généraliste correspondant à une interruption de la grossesse quel qu’en soit le terme, regroupe des entités nosologiques bien distinctes fausse couche précoce, fausse couche tardive, mort fœtale in utero. Analyser précisément les circonstances de cette perte fœtale permet d’orienter au mieux le bilan étiologique. De plus, selon le mécanisme et la cause de la perte fœtale, les modalités de prise en charge thérapeutique sont très différentes. Enfin, elle permet d’expliquer au couple, très affecté par l’accident, la raison qui a conduit à l’arrêt de la grossesse, le risque éventuel de récidive lors d’une prochaine grossesse et les possibilités thérapeutiques. Il est important de noter que les recommandations en matière de bilan étiologique ont considérablement évolué ces dix dernières années. Ce changement touche notamment les thrombophilies héréditaires, dont la recherche ne semble plus être pertinente en cas de fausses couches spontanées à répétition et n’est donc plus recommandée dans ce contexte. Le rendu des résultats s’effectuera préférentiellement au sein d’une consultation préconceptionnelle pour un accompagnement optimal aussi bien thérapeutique que psychologique de ces couples. Pregnancy loss is a general term including distinct well-defined entities: early miscarriage, late miscarriage, and stillbirth. It is important to clarify fetal loss circumstances to guide the diagnostic assessment of this issue. Etiological considerations in the presence of a fetal loss are very important to find the causes where a treatment exists and is efficient. The aim is also to explain to the couple, very affected by the event, the reason of the fetal loss and the potential risk of recurrence in a future pregnancy. In recent years, international guidelines changed and assessment of familial thrombophilia seems to be useless in this context. Feedback of the investigations will be better in a preconception consultation and multidisciplinary management of these couples is important for both therapeutic and psychological cares. [ABSTRACT FROM AUTHOR]

Abstract: Giving birth to a stillbirth baby is part of perinatal loss. This event has been considered for a long time as being of little or of no significance. But for more than 20 years now, taking care of these losses has much evolved and now they’re recognized as tragic life events like the loss of any other family members. We know now that it psychologically affects parents on a long-term basis. Stillbirths occur in about 8.7 births out of 1000, 20 times more frequent than sudden infant death syndrome. Two stillbirth situations can occur: either a fetal death or elective and therapeutic abortion. Following these deaths the same grief stages as in other losses are described (shock and numbness, bargaining, depression, acceptance). Gestational age at the time of the loss does not alone explain pain intensity, which is probably more linked to pregnancy investment. Attachment theory is of great contribution in understanding grief process. Finding a meaning to the lost and having secured attachment both help. What seems particularly specific in this bereavement is the lack of social support leading to a strong feeling of loneliness. No souvenirs can be shared with close relations and if short-term support is effective during the maternity stay, it often doesn’t last much longer. A solution to the sorrow is given by the couple''s relationships or the couple itself: having another baby. Social pressure is strong and the social message could be resumed as this: don’t think about it, forget quickly, it''s not as terrible as if it was an older living baby, get pregnant again is the solution. Couple often react differently, father being affected during a shorter time and felling ready earlier for the next pregnancy. Understanding and supporting these families is essential for the couple and the family''s future as well as for the subsequent children. Different types of interventions exist: during hospital stay and after discharge. Self-help groups are of good support as the feeling of being misunderstood and lonely is important. Professional support should always be proposed. Specific questionnaires to assess perinatal grief exist, one is translated in French. Interpersonal psychotherapy is well indicated in case of death and well developed during the perinatal period. It is of great importance to train (or continue training) health professionals in general as perinatal grieving starts being recognized but also to provide support to maternity professionals. [Copyright &y& Elsevier]

Taking into account the pain of antenatal bereavement is relatively recent. If the stages of elaboration of this mourning are identical compared to those of other close persons, nevertheless it has some particularities. The status of the fetus is singular, an integral part of the mother's body, but without legal existence. The psychological context in which the mourning takes place is marked by a profound psychic transformation. Finally, the impact on parental narcissism must be taken into account., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Abstract: Objectives: Indications for fetal blood sampling (FBS) are getting more limited. In this context, we aimed to evaluate fetal loss and morbidity associated with FBS and to precise the predictive parameters for fetal complications. More than a retrospective evaluation of our practices, the final end point of our study was to better inform the patients coming to our centre. Patients and methods: Retrospective monocentric cohort (Canadian Task Force classification II-2) of the 99 FBS performed between April 2004 and June 2010 on 80 fetuses, after excluding the procedures done for termination of pregnancy. The main clinical outcome was a composite outcome criteria for fetal tolerance including cesarean section for abnormal non stress test within the 24hours, or any event responsible of a modified obstetrical management during the 14day following FBS. Results: Mean maternal age at FBS was 30years±5.13 SD and parity was 2.49±1.38SD. FBS was performed by an experienced operator in 86.5% of cases (CI 95%, 78–92.6); with a single insertion in 83.3% of circumstances (CI 95%, 74.4–90.2). The mean duration was 11min±6.37 SD. The total rate of intrauterine death, in our series, was 7.1% (CI 95%, 2.9–14), including all reported fetal demise within the 14 days after FBS, whatever the relation with the procedure. Our study demonstrated a 9.1% occurrence of post-FBS altered CTG fetal testing (CI 95%, 4.2–16.6), half of it with spontaneous resolution. The rate of severe complications (main clinical outcome) was 11.1% (CI 95%, 5.7–19) including one fetal death liable to FBS and 10 emergency caesarean sections: 5.1% for fetal bradycardia (CI 95%, 1.7–11.4), 2% for placental abruption (CI 95%, 0.2–7.1), 2% for premature preterm rupture of membranes (CI 95%, 0.2–7.1) and 1% for significative umbilical cord bleeding (CI 95%, 0–5.5). Univariate factor analysis highlights 4 parameters for impaired fetal tolerance; a prolonged procedure, presence of low fetal platelets (<30.109/L); and FBS performed for fetal anaemia during Parvovirus B19 infection or allo-immune thrombocytopenia. Discussion and conclusion: FBS remains a tricky procedure with a substantial risk of fetal loss or complications especially when performed on high-risk fœtuses. The length of the procedure should be shortened as much as possible (trained operator, postponed procedure when all favourable condition are not available). Fetal thrombocytopenia is a meaningful risk factor encouraging carefulness when exploring allo-immune fetal thrombocytopenia. [Copyright &y& Elsevier]

Abstract: Acute fatty liver of pregnancy is a rare clinical syndrome of pregnancy that occurs during the third trimester. Clinicians must have a high index of suspicion for this condition when a woman has nausea or vomiting during the last trimester. Early diagnosis and prompt delivery improve foetal and maternal prognosis. We report a case of a previously healthy 23-year-old woman who presented an acute fatty liver of pregnancy with intrauterine fetal death. Based on this experience as well as on medical literature, characteristics of this uncommon pathology are discussed. [Copyright &y& Elsevier]

We report the case of a 30-year-old woman with a post-partum haemorrhage and foetal death caused by a leptospirosis infection. This disease could induce a coagulopathy associated with foetal death and potential hazard for epidural analgesia. [Copyright &y& Elsevier]

Parents can be faced with a situation of bereavement during pregnancy or birth. It is often during a later pregnancy, an ultrasound scan or a subsequent birth, that some will talk about the loss of a child. These situations resulting in bereavement during pregnancy or perinatal bereavement are specific and all perinatal caregivers must be aware of them., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Enteroviruses are responsible for about one billion infections every year in the world. The clinical expression is in the vast majority asymptomatic cases (90%). Its consequences during pregnancy are rarely described. From the Medline database, we selected and analyzed 34 articles ranging from 1965 to 2015, to analyse the current knowledge of enterovirus infection consequences during pregnancy. We found that enterovirus infections may be the cause of fetal loss. The enterovirus infections during the 2nd and 3rd trimester may also lead to in utero fetal anomalies and death, but also to severe neonatal infections. PCR enterovirus detection should be performed during pregnancy and the peripartum in case of unexplained fever, specific fetal anomalies or unexplained fetal demise., (Copyright © 2017. Published by Elsevier Masson SAS.)

Objective: To describe the epidemiological, clinical and prognostic factors of placental abruption and fetal death in utero and to investigate possible risk factors for their occurrence., Patients and Methods: Observational retrospective study including the women having presented a placental abruption between January 2001 and January 2012, in a IIB maternity. Women's sociodemographic characteristics, clinical symptoms and the method used to detect placental abruption were collected. Patient data of those whose pregnancy resulted in fetal death were compared to those with more favorable outcomes., Results: There were 171 cases of placental abruption among 21,913 patients having delivered, which represents a 0.78% incidence. Diagnosis was rarely based on clinical data (30%). The rate of fetal death in utero represented 25% of the pregnancy's outcomes. A history of fetal death in utero increased the risk of placental abruption (P<0.001). This complication was more frequent for patients who did not have pregnancy monitoring (P=0.054) and before 37 weeks of amenorrhoea (P=0.005)., Conclusion: Placental abruption is an important cause of perinatal mortality and maternal morbidity. Among the observed risk factors, only regular pregnancy monitoring can be an easy way to prevent these complications., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Pregnancy loss is a general term including distinct well-defined entities: early miscarriage, late miscarriage, and stillbirth. It is important to clarify fetal loss circumstances to guide the diagnostic assessment of this issue. Etiological considerations in the presence of a fetal loss are very important to find the causes where a treatment exists and is efficient. The aim is also to explain to the couple, very affected by the event, the reason of the fetal loss and the potential risk of recurrence in a future pregnancy. In recent years, international guidelines changed and assessment of familial thrombophilia seems to be useless in this context. Feedback of the investigations will be better in a preconception consultation and multidisciplinary management of these couples is important for both therapeutic and psychological cares., (Copyright © 2015. Published by Elsevier SAS.)

Objectives: To give consistent data of the prevalence of intrauterine fetal death (IUFD), to assess risk factors and causes related to IUFD, to evaluate prevention of IUFD, to evaluate fetal autopsy and MRI and to determine the management of inhibition of lactation., Methods: French and English publications were searched using PubMed, Cochrane Library., Results: Intrauterine fetal death occurs in 2% of the pregnancies worldwide, and in around 0,5% of pregnancies in France (NP1). Major risk factors related to IUFD are maternal overweight, maternal age, and smoking, small for gestational age fetuses or placental abruption, and pre-gestational maternal diseases such as hypertension and diabetes (NP1). The most relevant causes of IUFD are placental anomalies, followed by abnormal karyotypes and congenital malformations (NP3). Data are insufficient to recommend a classification for causes of IUFD. Data concerning primary and secondary prevention do not recommend a specific management for the following of pregnancy. Fetal autopsy is still the gold standard of fetal examination, but fetal post-mortem MRI can be offered when fetal autopsy is refused (NP4). Inhibition of lactation should be started within 24hours postpartum with cabergoline, if the patient demands a treatment (NP4)., (Copyright © 2014. Published by Elsevier Masson SAS.)

Aim: To review the available data on maternal chronic diseases and pregnancy losses., Material and Methods: We searched PubMed and the Cochrane library with pregnancy loss, stillbirth, intrauterine fetal demise, intrauterine fetal death, miscarriage and each maternal diseases of this paper., Results: Antiphospholipid antibodies (anticardiolipin, anti-beta-2-glycoprotein, lupus anticoagulant) should be measured in case of miscarriage after 10WG confirmed by ultrasound (grade B) and an antiphospholipid syndrome should be treated by a combination of aspirin and low-molecular-weight heparin during a subsequent pregnancy (grade A). We do not recommend testing for genetic thrombophilia in case of first trimester miscarriage (grade B) or stillbirth (grade C). Glycemic control should be a goal before pregnancy for women with pregestational diabetes to limit the risks of pregnancy loss (grade A) with a goal of prepregnancy HbA1c<7%. Overt and subclinical hypothyroidisms should be treated by L-thyroxin during pregnancy to reduce the risks of pregnancy loss (grade A). Women who are positive for TPOAb should have TSH concentrations follow-up during pregnancy and subsequently treated by L-thyroxin if they develop subclinical hypothyroidism (grade B)., Conclusions: Prepregnancy management of most chronic maternal diseases, ideally through prepregnancy multidisciplinary counseling, reduces the risks of pregnancy loss., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Objectives: Study of epidemiology of pregnancy loss., Materials and Method: A systematic review of the literature was performed using Pubmed and the Cochrane library databases and the guidelines from main international societies., Results: The occurrence of first trimester miscarriage is 12% of pregnancies and 25% of women. Miscarriage risk factors are ages of woman and man, body mass index greater than or equal to 25kg/m(2), excessive coffee drinking, smoking and alcohol consumption, exposure to magnetic fields and ionizing radiation, history of abortion, some fertility disorders and impaired ovarian reserve. Late miscarriage (LM) complicates less than 1% of pregnancies. Identified risk factors are maternal age, low level of education, living alone, history of previous miscarriage, of premature delivery and of previous termination of pregnancy, any uterine malformation, trachelectomy, existing bacterial vaginosis, amniocentesis, a shortened cervix and a dilated cervical os with prolapsed membranes. Fetal death in utero has a prevalence of 2% in the world and 5/1000 in France. Its main risk factors are detailed in the chapter., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Objective: The objective of this study was to evaluate the relationship between psychology and pregnancy loss., Methods: A literature review was conducted by consulting Medline until April 2014., Results: Psychological factors appear to be significantly associated with the risk of recurrent miscarriage. Depression and anxiety are common symptoms after miscarriage. A return to normal scores of depression and anxiety is frequently found in one year. A systematic psychological treatment after an episode of miscarriage seems to not bring obvious benefits, one year after a miscarriage, in terms of anxiety and depression. After a stillbirth, psychological impacts on the couple, such as anxiety and depressive symptoms, are common. An empathetic and respectful attitude of all medical and paramedical team at the support is associated with better psychological experience., Conclusion: After a pregnancy loss, psychological consequences are common and usually reversible. An attitude of empathy is desirable in order to accompany patients and to consider a future pregnancy., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)