[Prenatal ultrasound prognostic of myelomeningocele at the era of fetal surgery]. / Évaluation pronostique prénatale échographique de la myéloméningocèle à l'ère de la chirurgie fœtale.

Myelomeningocele (MMC) is a severe congenital condition responsible for motor and sensory impairments of the lower limbs, incontinence and cognitive impairment. Its screening, sometimes as early as the first trimester, is one of the major goals of modern prenatal care, supported by the emergence of prenatal surgery that results in a significant improvement in motor function, ambulation and ventriculoperitoneal shunt rate in patients undergoing in-utero surgery. From screening to pre- and post-operative prognostic evaluation, prenatal ultrasound is now an essential tool in the antenatal management of this condition. Using the multi planar and three-dimensional modes, it can be used to assess the vertebral level of MMC, which remains the key antenatal prognostic marker for motor function and ambulation, incontinence and the need for a ventriculo-peritoneal shunt. A careful and systematic ultrasound examination also makes it possible to assess the severity and progression of ventriculomegaly, to search for associated cerebral, spinal cord or vertebral anomalies, or to rule out exclusion criteria for in-utero surgery such as severe kyphosis or serious cortical anomalies. New tools from post-natal evaluation, such as the "metameric" ultrasound assessment of lower limb mobility, appear to be promising either for the initial examination or after in-utero surgery. Ultrasonography, associated with fetal MRI, cytogenetic and next generation sequencing, now allows a highly customized prognostic evaluation of these fetuses affected by MMC and provides the parents with the best possible information on the expected benefits and limitations of fetal surgery.

Increased incidence of obstetric complications in women carrying mitochondrial DNA mutations: a retrospective cohort study in a single tertiary centre.

OBJECTIVE: To investigate the obstetric outcome of women carriers of the oxidative phosphorylation (OXPHOS) disorder mutation. DESIGN: A retrospective cohort study in a single tertiary centre. SETTING: A review of the obstetric history of women referred for prenatal screening of a mitochondrial disorder was performed. POPULATION: Women were divided into three groups: (1) women carrying mitochondrial DNA (mtDNA) mutations; (2) healthy women with a family history of mtDNA-related OXPHOS disorder; and (3) healthy women carrying heterozygote nuclear DNA mutations. METHODS: Obstetric history and pregnancy complications were evaluated separately in the three groups and compared with the control group. MAIN OUTCOME MEASURES PREGNANCY COMPLICATIONS. RESULTS: Seventy-five women were included with 287 cumulative pregnancies. Groups 1 and 3 had a significantly greater proportion of terminations of pregnancy (20 and 13% versus 0.8%, P < 0.001), and a lower percentage of live births (52 and 72% versus 87%, P = 0.001), compared with controls. Apart from this, the rate of obstetric complications in group 3 did not differ from the controls. The obstetric history of women in group 1 was marked by higher rates of early miscarriages (26 versus 11%, P = 0.004), gestational diabetes (14 versus 3%, P = 0.02), intrauterine growth restriction (IUGR, 10 versus 1%, P = 0.008), and postpartum haemorrhage than were reported for controls (12 versus 2%, P = 0.01). CONCLUSION: Women who are heteroplasmic for OXPHOS mutations have a higher incidence of pregnancy losses, gestational diabetes, IUGR, and post postpartum haemorrhage. TWEETABLE ABSTRACT: Women heteroplasmic for mitochondrial DNA mutations have a higher incidence of obstetric complications, compared with the control group.

A viability analysis of fishery controlled by investment rate.

This work presents a stock/effort model describing both harvested fish population and fishing effort dynamics. The fishing effort dynamic is controlled by investment which corresponds to the revenue proportion generated by the activity. The dynamics are subject to a set of economic and biological state constraints. The analytical study focuses on the compatibility between state constraints and controlled dynamics. By using the mathematical concept of viability kernel, we reveal situations and management options that guarantee a sustainable system.

Viability analysis of multi-fishery.

This work is about the viability domain corresponding to a model of fisheries management. The dynamic is subject of two constraints. The biological constraint ensures the stock perennity where as the economic one ensures a minimum income for the fleets. Using the mathematical concept of viability kernel, we find out a viability domain which simultaneously enables the fleets to exploit the resource, to ensure a minimum income and stock perennity.

Effects of density dependent sex allocation on the dynamics of a simultaneous hermaphroditic population: modelling and analysis.

In this work we present a mathematical model describing the dynamics of a population where sex allocation remains flexible throughout adult life and so can be adjusted to current environmental conditions. We consider that the fractions of immature individuals acquiring male and female sexual roles are density dependent through nonlinear functions of a weighted total population size. The main goal of this work is to understand the role of life-history parameters on the stabilization or destabilization of the population dynamics. The model turns out to be a nonlinear discrete model which is analysed by studying the existence of fixed points as well as their stability conditions in terms of model parameters. The existence of more complex asymptotic behaviours of system solutions is shown by means of numerical simulations. Females have larger fertility rate than males. On the other hand, increasing population density favours immature individuals adopting the male role. A positive equilibrium of the system exists whenever fertility and survival rates of one of the sexual roles, if shared by all adults, allow population growing while the opposite happens with the other sexual role. In terms of the female inherent net reproductive number, eta(F), it is shown that the positive equilibria are stable when eta(F) is larger and closed to 1 while for larger values of eta(F) a certain asymptotic assumption on the investment rate in the female function implies that the population density is permanent. Depending on the other parameters values, the asymptotic behaviour of solutions becomes more complex, even chaotic. In this setting the stabilization/destabilization effects of the abruptness rate in density dependence, of the survival rates and of the competition coefficients are analysed.

Iron stocks and risk of anemia in twins.

This study aims to compare the risk of anemia by iron deficiency in mothers and infants of twin and single pregnancy. It concerned 33 couples of twins and 31 control, all 97 being term newborns. At birth, ferritinemia is significantly lower in twins, and reticulocytes count is significantly higher; their mothers have a significantly lower hemoglobin level and higher reticulocytes percentage and count. At 3 and 6 months, hemoglobin level and mean corpuscular hemoglobin are significantly lower in twins, as at 6 months ferritinemia is significantly lower in twins. Iron stocks constituted in utero are significantly lower in twin pregnancy, and this study support the early preventive iron treatment in twins.

[Twin pregnancies: incidence, fetal development and perinatal mortality]. / Les grossesses gémellaires: fréquence, développement foetal et mortalité périnatale.

The authors study 233 pairs of twins in a big maternity of Tunis, they analyse the frequency, the intra-uterine growth and the perinatal mortality. The frequency of twinning was 1.56%, the occurrence of preterm delivery was 45.92% and foetal hypotrophy was observed in 9.84% of the cases. The perinatal mortality rate was 143.77%: still born = 55.79% and neonatal deaths = 87.98%; the ratio of still born to neonatal deaths was 1.6. 29.3% of the neonatal twin deaths were due to hyaline membrane disease, 24.5% to immaturity, 14.6% to perinatal asphyxia and 12.4% to infection. The authors compare their findings to other studies on twin pregnancies.