Repellent effectiveness of seven plant essential oils, sunflower oil and natural insecticides against horn flies on pastured dairy cows and heifers.

Plant essential oils (basil, geranium, balsam fir, lavender, lemongrass, peppermint, pine and tea tree), mixed with either sunflower oil or ethyl alcohol, were applied at 5% concentrations to the sides of Holstein cattle. Pastured cattle treated with essential oils diluted in sunflower oil had less flies than the untreated control for a 24-h period. However, the essential oil treatments were not significantly different than the carrier oil alone. Barn-held heifers treated with essential oils and sunflower oil alone had significantly less flies than the untreated control for up to 8 h after treatment. Basil, geranium, lavender, lemongrass and peppermint repelled more flies than sunflower oil alone for a period ranging from 1.5 to 4 h after treatments applied to heifers. All essential oils repelled > 75% of the flies on the treated area for 6 and 8 h on pastured cows and indoor heifers, respectively. Geranium, lemongrass and peppermint stayed effective for a longer duration. Essential oils mixed with ethyl alcohol demonstrated less repellence than when mixed with the carrier oil. Safer's soap, natural pyrethrins without piperonyl butoxide and ethyl alcohol alone were not efficient at repelling flies. Essential oils could be formulated for use as fly repellents in livestock production.

Semi-automated adjusted measurement of nuchal translucency: feasibility and reproducibility.

OBJECTIVE: The variability of nuchal translucency thickness (NT) measurements in the first trimester appears to be associated in part with caliper placement. Methods for obtaining semi-automated adjusted measurements (SAAMs) can provide several NT values (maximum, minimum, mean and median) automatically within a manually set frame in the zone of interest. This study sought to assess the feasibility and reproducibility of these SAAM-NTs. METHODS: Three readers, two experts and one less experienced, examined archive images of 160 patients and obtained SAAM-NTs from them, on two separate occasions. The intra- and interobserver reproducibility were assessed by calculating the intraclass correlation coefficients (ICCs) for maximum, mean and median SAAM-NTs, and Bland-Altman plots were constructed. RESULTS: SAAM-NTs were technically feasible for all 160 images. The range of ICCs for intraobserver reproducibility was 0.76-0.93 for mean SAAM-NT, 0.76-0.95 for median SAAM-NT and 0.74-0.95 for maximum SAAM-NT. Interobserver ICCs were 0.85, 0.85 and 0.84 for mean SAAM-NT, median SAAM-NT and maximum SAAM-NT, respectively. There were no significant differences for intra- and interobserver reproducibility of median, mean and maximum SAAM-NTs. CONCLUSIONS: SAAM-NT is feasible with a high level of intra- and interobserver reproducibility. This easy-to-use method has the potential to simplify screening during the first trimester. It should be evaluated further and compared with the manual measurement method.

Fetal tumors of the choroid plexus: is differential diagnosis between papilloma and carcinoma possible?

Fetal choroid plexus tumors are uncommon. The prognosis is widely variable and depends on the histological findings: papilloma or carcinoma. We report a case of prenatal diagnosis of choroid plexus mass detected by ultrasound at 33 weeks of gestation. Prenatal (T1, T2, T2* and diffusion weighted sequences) magnetic resonance imaging (MRI) was used to rule out a hematoma. Follow-up examination by ultrasound and MRI revealed a significant increase in the volume of the mass, suggesting a diagnosis of malignant tumor. A healthy neonate was delivered by Cesarean section at 38 weeks of gestation. Full surgical excision of the tumor was performed at 20 days after delivery and histological analysis revealed a papilloma.

[CNGOF-SFT Expert Report and Guidelines for Smoking Management during Pregnancy-Short Text]. / Rapport d'experts et recommandations CNGOF-SFT sur la prise en charge du tabagisme en cours de grossesse­texte court.

OBJECTIVES: To provide up-to-date evidence-based guidelines for the management of smoking cessation during pregnancy. METHODS: Systematic review of the international literature. We identified papers published between January 2003 and April 2019 in Cochrane PubMed, and Embase databases with predefined keywords. All reports published in French and English relevant to the areas of focus were included and classified according the level of evidence ranging from 1 (highest) to 4 (lowest). The strength of the recommendations was classified according to the Haute Autorité de santé, France (ranging from A, highest to C, lowest). RESULTS: "Counseling", involving globally all kind of non-pharmacological interventions, has a modest benefit on smoking cessation, birth weight and prematurity. Moderate physical activity did not show a significant effect on smoking cessation. The systematic use of feedback by measuring the expired air carbon monoxide concentration do not influence smoking abstinence but it may be used in establishing a therapeutic alliance. The use of self-help interventions and health education are recommended in helping pregnant smokers quit. The prescription of nicotine replacement therapies (NRT) may be offered to any pregnant woman who has failed stopping smoking without medication This prescription can be initiated by the health care professional taking care of the pregnant woman in early pregnancy. There is no scientific evidence to propose the electronic cigarette for smoking cessation to pregnant smokers; it is recommended to provide the same advice and to use methods that have already been evaluated. The use of waterpipe (shisha/narghile) during pregnancy is associated with decreased fetal growth. It is recommended not to use waterpipe during pregnancy. Breastfeeding is possible in smokers, but less often initiated by them. Although its benefit for the child's development is not demonstrated to date, breastfeeding allows the mother to reduce or stop smoking. The risk of postpartum relapse is high (up to 82% at 1 year). The main factors associated with postpartum abstinence are breastfeeding, not having a smoker at home, and having no symptoms of postpartum depression. CONCLUSIONS: Smoking during pregnancy concerns more than hundred thousand women and their children per year in France. It is a major public health burden. Health care professionals should be mobilized for reducing or even eradicating it.

Smoking and smoking cessation in pregnancy. Synthesis of a systematic review.

OBJECTIVES: To provide up-to-date evidence-based guidelines for the management of smoking cessation during pregnancy and the post-partum period. STUDY DESIGN: A systematic review of the international literature was undertaken between January 2003 and April 2019. MEDLINE, EMBASE databases and the Cochrane library were searched for a range of predefined key words. All relevant reports in English and French were classified according to their level of evidence ranging from 1(highest) to 4(lowest). The strength of each recommendation was classified according to the Haute Autorité de Santé (French National Authority for Health) ranging from A (highest) to C (lowest). RESULTS: "Counselling", including all types of non-pharmacological interventions, has a moderate benefit on smoking cessation, birth weight and prematurity. The systematic use of measuring expired air CO concentration does not influence smoking abstinence, however, it may be useful in assessing smoked tobacco exposure prior to and after quitting. The use of self-help therapies and health education are recommended in helping pregnant smokers quit and should be advised by healthcare professionals. Nicotine replacement therapies (NRT) may be prescribed to pregnant women who have failed to stop smoking after trying non-pharmacological interventions. Different modes of delivery and dosages can be used in optimizing their efficacy. Smoking in the postpartum period is essential to consider. The same treatment options as during pregnancy can be used. CONCLUSION: Smoking during pregnancy concerns more than a hundred thousand women each year in France resulting in a major public health burden. Healthcare professionals should be mobilised to employ a range of methods to reduce or even eradicate it.

Comparison of fundal height measurement and sonographically measured fetal abdominal circumference in the prediction of high and low birth weight at term.

OBJECTIVES: To compare the diagnostic value of fundal height and sonographically measured fetal abdominal circumference in the prediction of high and low birth weight in routine practice between 37 and 41 weeks' gestation. METHODS: Data were obtained from a multicenter study of 19 415 women in France and Belgium. In this study we included 7138 low-risk women from that population who underwent fundal height measurements no more than 8 days before delivery (Population A). We also included another 1689 women with both fundal height measurements and fetal ultrasound measurements obtained no more than 8 days before delivery (Population B). Population A was used to calculate the parameters of equations for estimating fetal weight according to fundal height alone (EFW(FH)) or fundal height in combination with other clinical indicators (EFW(FH+)). The ultrasound fetal weight estimation was based on fetal abdominal circumference (EFW(AC)) using Campbell and Wilkins' equation. The correlation between the estimated fetal weight calculated using each of the formulae and the birth weight was then evaluated in Population B, and the diagnostic value of each of the methods for predicting birth weight or=4000 g was also compared. RESULTS: EFW(AC) was better correlated with birth weight than was either EFW(FH) or EFW(FH+). With specificity set at 95%, the sensitivity of EFW(AC) in screening for neonates weighing or=4000 g was significantly higher than that of EFW(FH) (54.0% vs. 37.1%, P < 0.05) or EFW(FH+) (54.0% vs. 45.1%, P < 0.05). CONCLUSIONS: Sonographic measurement of fetal abdominal circumference predicts high and low birth weight better than does clinical examination based on fundal height in routine practice between 37 and 41 weeks' gestation.

Is rapid aneuploidy screening used alone acceptable in prenatal diagnosis? An evaluation of the possible role of ultrasound examination.

OBJECTIVE: The objectives of this study were to use a factual basis to: (1) determine the number, nature, and probable phenotypic consequences of karyotype anomalies that would probably be missed (structural anomalies, uncommon aneuploidies and mosaic aneuploidies) by rapid aneuploidy screening (RAS), and (2) appraise whether RAS can replace traditional karyotyping when amniocenteses are performed for increased risk of Down's syndrome by maternal serum screening or advanced maternal age in the absence of ultrasound abnormality. METHODS: This retrospective cohort study analysed the indications, results and outcomes of 5,713 consecutive amniocenteses over a 5-year period at a single prenatal diagnosis centre in Paris. RESULTS: Advanced maternal age and increased Down's risk with maternal serum marker were the most common indications. Chromosome abnormalities were detected in 3.64% of the pregnancies tested, and unexpected structural anomalies in 0.63% (n = 36). Translocations were more likely to be reciprocal, balanced and of parental origin. There were 6 mosaic gonosomal aneuploidies. Overall, 4 mosaic autosomal aneuploidies and 36 structural aberrations would not have been recognised by RAS alone. Of the 4 mosaic autosomal aneuploidies, all were terminated, one had major malformations and the others had discrete signs that a good quality ultrasound examination would probably not detect. Of the 36 structural aberrations, 24 would be undetected by ultrasound scan, from which 6 would be associated with a significant risk of an abnormal phenotype outcome. CONCLUSION: In conclusion, our data do not provide evidence that RAS can replace the traditional karyotype. It is probably impossible to arrive in a universal conclusion of which approach (karyotype or RAS) is definitely better than the other. Each prenatal centre could have its own approach depending on the local data analysis, including quality control of ultrasounds.

[Early diagnosis of omphalocele: Prognostic value of the herniated viscera for associated anomalies]. / Omphalocèle au premier trimestre : valeur pronostique du contenu extériorisé pour le risque d'anomalie associée.

OBJECTIVES: Prognosis of infants with omphalocele depends on many factors, including associated anomalies. "Small" omphaloceles are believed to have more often WB syndrome, but so far no prenatal criterion has been demonstrated to predict associated anomalies. The aim of this study was to assess the outcomes of omphaloceles with prenatal diagnosis, and to seek for any correlation between the herniated viscera in the first trimester and the risk of associated anomalies. METHODS: We conducted a retrospective study at the Necker Enfants Malades Hospital between 2008 and 2018. Pregnancy outcomes and post natal data were collected and compared to the omphalocele content in the first trimester. RESULTS: One hundred and ninety-one women with antenatal diagnosis of omphalocele were included. Twenty-eight percent were isolated at birth, 32% had a polymalformative syndrome with chromosomal anomaly, 13% had a polymalformative syndrome without genetic anomaly, 9% had a Wiedemann-Beckwith syndrome, 7% had an association with cardiopathy, 6% had a limb body wall complex, 3% had OEIS complex and one case had a Cantrell pentalogy. The presence of the liver in the omphalocele during the first trimester was a predictive factor of heart disease (85.7% vs 48.6% P=0.01). The presence of bowel in the omphalocele during the first trimester was a predictor of chromosomal abnormalities (69.6% vs 37.2% P<0.001). Omphalocele content in the first trimester was not predictive of Wiedemann-Beckwith syndrome. CONCLUSION: Ultrasound analysis in the first trimester of omphalocele content is a valuable clue for prenatal counseling and diagnosis of associated abnormalities.

Should parity be included in customised fetal weight standards for identifying small-for-gestational-age babies? Results from a French multicentre study.

OBJECTIVE: Parity is one of several parameters used to customise fetal growth norms. However, it is uncertain whether the lower birthweight of babies born to primiparous women reflects physiological or pathological variation. Our aim was to assess the impact of adjusting for parity in identification of small-for-gestational-age (SGA) births. DESIGN: Comparison of two customised definitions of SGA with and without parity. SETTING: Routinely collected data in five tertiary maternity hospitals in France. POPULATION: A total of 51 126 singleton births without malformations from 1997 to 2002. METHODS: Characteristics of mothers and babies and adverse pregnancy outcomes for SGA and non-SGA births were compared using customised definitions with and without parity. MAIN OUTCOME MEASURES: Neonatal morbidity and mortality. RESULTS: SGA births among primiparas increased from 14.9 to 18.0% when parity was excluded. Overall rates of SGA rose from 14.4 to 15.0%. Newly defined cases of SGA were babies of primiparas. They had higher rates of admission to a neonatal unit and caesarean section than babies reclassified as non-SGA. Perinatal mortality was 9.1 per thousand (parity included) and 9.7 per thousand (parity excluded) and did not differ significantly from babies classified as non-SGA by both standards (5.4 per thousand). CONCLUSIONS: Adjustment for parity markedly decreased the proportion of primiparas diagnosed with SGA babies but did not appear to improve the identification of high-risk babies. Removing parity would simplify the customised definition of SGA and would eliminate the need for the assumption that lower birthweight for primiparous women is normal.

Fetal loss after amniocentesis in a series of 5,780 procedures.

OBJECTIVES: Counseling on prenatal diagnosis requires accurate knowledge of the associated risks, including fetal loss. The objective of our study was to assess this risk of amniocentesis in a single center with several operators. METHODS: This retrospective analysis concerns only women with singleton pregnancies who underwent amniocentesis between 14(+0) and 23(+6) weeks' gestation. RESULTS: During this 4.5-year period, 5,780 amniocenteses were performed, of which we analyzed 5,319. The rate of fetal loss was 70 in 4,858 tests (1.4%), with a lost-to-follow-up rate of 3.8%. CONCLUSION: Our results for fetal loss are comparable to those in the largest series with fewer operators already published.

Estimation of fetal weight: accuracy of regression models versus accuracy of ultrasound data.

OBJECTIVES: To determine the respective importance of equation accuracy and variability in interexaminer measurements in estimation of fetal weight (EFW). METHODS: The study included 3 samples from three different French maternity hospitals. Sample 1 (6,508 fetuses) was used to compute a new linear regression model estimating fetal weight (FW) from ultrasound measurements. Sample 2, with 705 fetuses, was used to compare the accuracy of the new equation with Hadlock's equation. Sample 3 (1,461 fetuses) was used to assess - from our equation and from Hadlock's - the estimation errors due to the variability of ultrasound measurements recorded by 11 distinct examiners. Accuracy was determined by the signed percent difference (%Diff). Statistical analysis included the F test for correlated variances and comparisons of correlated variances. RESULTS: The random error of our model is 6.8%, significantly lower (p < 0.01) than Hadlock's which is around 7.4% (8.9% for low FW and 7.4% for high FW). The variability of ultrasound measurements among the different examiners in sample 3 generated a significant variation (p < 0.01) in the random error, ranging from 6.7 to 12.5%. This significant variation was also observed using Hadlock's equation for the same sample (from 7.2 to 12%). CONCLUSION: The accuracy of EFW depends much more on the quality of ultrasound measurements than on the choice of equation. Nevertheless, optimizing the accuracy of EFW (about 6.7-6.8%) imperatively requires standardized data collecting.

Artificial intelligence assistance for fetal head biometry: Assessment of automated measurement software.

PURPOSE: To evaluate the feasibility and reproducibility of artificial intelligence software (Smartplanes®) to automatically identify the transthalamic plane from 3D ultrasound volumes and to measure the biparietal diameter (BPD) and head circumference (HC) in fetus. MATERIAL AND METHODS: Thirty fetuses were evaluated at 17-30 weeks' gestation. For each fetus two three-dimensional (3D) volumes of the fetal head along with one conventional two-dimensional (2D) image of the transthalamic plane were prospectively acquired. The Smartplanes® software identified the transthalamic plane from the 3D volumes and performed BPD and HC measurements automatically (3D auto). Two experienced sonographers also measured BPD and HC from 2D images and from the 3D volumes. Measurements were compared using Bland-Altman plots. Interclass correlation coefficient (ICC) was used to evaluate intra- and interobserver reproducibility. RESULTS: For each series of measurements, intra- and interobserver reproducibility rates were high with ICC values>0.98. The 95% confidence intervals between the BPD measurements were 2mm (3D versus 2D) and 4mm (3D auto versus 2D) and the HC measurements were 7.5mm (3D versus 2D) and 11mm (3D auto versus 2D). CONCLUSION: Fetal head measurements obtained automatically by Smartplanes® software from 3D volumes show good agreement with those obtained by two experienced sonographers from conventional 2D images and 3D volumes. The reproducibility of these measurements is similar to that observed by experienced sonographers.

[Management of placenta accreta]. / Prise en charge du placenta accreta.

Placenta accreta occurs when a defect of the decidua basalis results in abnormally invasive placental implantation. Main risk factors include placenta previa and previous caesarean section. The conventional sonographic criteria for abnormally adherent placenta have a good diagnostic value that has to be assessed. MRI should improve the diagnosis when sonography is inconclusive. The choice of the treatment results of medical staff and the women's choice. It implies centers with adequate equipment and resources. Radical strategy consists in caesarean hysterectomy according to American recommendations or in an attempt of complete placental delivery associated with trial haemostasis and hysterectomy if this fails. A conservative approach whereby the placenta is left in place may however be proposed in selected cases if the woman wishes to continue to be fertile. This strategy needs a rigorous follow-up until complete resorption of the placenta. In case of major hemorrhage, hysterectomy should not be delayed to prevent major maternal complications or even maternal death.

Improving students' ability to perform a standardized foetal biometry plane using ultrasound simulators.

OBJECTIVE: The objective of this study is to assess progress made in the ultrasound (US) measurement of femur length (FL) by students after one hour of training on US obstetric simulators. MATERIALS AND METHODS: Medical residents and midwives registered for the 2016 French national foetal US diploma were invited to a 1-hour US training course with simulators. The time to acquire the FL plane with changing foetal presentation was prospectively measured before and after the training. Every image was recorded, and quality criteria were assessed. RESULTS: Thirty new learners trained in foetal US were evaluated. The time needed to measure the FL was significantly shorter in the post-test versus the pre-test (86s versus 125, P=0.015). The quality criteria were statistically similar before and after training regarding the angle to horizontal (10.0° versus 9.6°, P=0.84) and FL (31.3mm versus 32.0mm, P=0.15). CONCLUSION: The time needed to obtain the FL plane was reduced by 30% after a 1-hour US simulation training session.

[Prevalence of smoking cessation during pregnancy according to trimester]. / Taux de sevrage tabagique chez la femme enceinte en fonction des trimestres.

OBJECTIVE: To investigate the smoking cessation period during pregnancy. PATIENTS AND METHODS: Questionnaire-based, descriptive study of 979 pregnant women in four regions of France. The variables analysed included the characteristics of the mother and neonate at delivery, the smoking habits of the mother before and during pregnancy, the perception of risk linked to smoking, and the reasons for giving up smoking. RESULTS: Eighteen percent of women smoked until delivery. Forty-five percent of women gave up smoking during pregnancy, usually in the first trimester. More precisely, about one woman who smoked out of 50 gives up in order to prepare pregnancy. The proportion of women who stop smoking in each of the three trimesters of pregnancy is 84,1, 8,8 and 7,1% respectively. DISCUSSION AND CONCLUSION: Most women appear to stop smoking before any intervention therapy is possible. The first contact with a midwife or an obstetrician takes place whereas smoking cessation is already successful.

[Autopsy findings related to Down's syndrome: 101 cases]. / Fréquence des malformations associées à la trisomie 21: à propos de 101 cas foetopathologiques.

OBJECTIVES: To analyze the spectrum of congenital malformations among fetuses with Down's syndrome sent for necropsy. Materials and methods. Necropsies following medical termination of pregnancy during the second and third trimester were performed during a 4 year period. RESULTS: The incidence of each malformation was determined. Talipes equinovarus and aberrant lobation of the lung were present in 6% of cases. We are able to state precisely the incidence of 11 pairs of ribs: 11%. CONCLUSION: A precise knowledge about Down's syndrome associated malformations is essential for genetic counselling. The exact incidence of each sign is important to lead ultrasound examination when this syndrome is revealed.

[Is the stomach a main landmark on the abdominal circumference? Audit of 3 operators]. / L'estomac est-il un critère de qualité majeur dans la coupe du périmètre abdominal ? Audit auprès de 3 opérateurs.

OBJECTIVES: The fetal weight estimation depends largely on the accuracy of abdominal circumference. The quality criteria are standardized to minimize variability and include visualization of the stomach. The objective of this study is to investigate the presence or absence of the stomach on the abdominal circumference for 3 different operators. MATERIAL AND METHODS: We conducted re-reading of 204 ultrasound images in the second and third trimester of pregnancy, performed by three operators, at the maternity Port Royal in Paris in 2013. On these images, the presence of the stomach was sought and other quality criteria were verified. RESULTS: Among the 204 images, 166 included the stomach (81%). When studying for each of the three operators, there were 79%, 72% and 98% of the stomach into the abdominal circumference, a significant difference between operators (P=0.0029). Regarding the secondary criteria, the quality criteria found most often were the calipers and well placed ellipse (89%). CONCLUSION: According to the previous studies, the stomach seems to be a reference to search. Our study shows variability depending on the different operators. If a hierarchy of quality criteria is to be considered, the stomach does not seem to be the first criterion to search.

[The noninvasive prenatal testing for Down's Syndrome. Retrospective study of 8821 patients]. / Le dépistage prénatal non invasif de la trisomie 21. Étude rétrospective à propos de 8821 patientes.

OBJECTIVE: To demonstrate the decrease in intrauterine invasive procedures through analysis of DNA fetoplacental free circulating in maternal blood: Non Invasive Prenatal Test (NIPT), in Prenatal Diagnosis Center of American Hospital of Paris (AHP). MATERIALS AND METHODS: Retrospective descriptive study of 8821 patients in Prenatal Diagnosis Center at the AHP between 01/01/2012 and 09/25/2014. The NIPT is available to patients since 1st January 2013. RESULTS: The number of invasive procedures decreased significantly (P<0.0001) between 2012 (n=1177, i.e. 42 % of the global activity of the Prenatal Diagnosis Center at the AHP in 2012) and 2013 (n=987 or 28.5 %) and between 2013 and 2014 (n=599 or 23.4 %). The NIPT calculated performance statistics are: sensitivity≥99.9 %; specificity=99.8 %; Positive Predictive Value=90.4 %; Negative Predictive Value≥99.9 %; False Positives=3. While the actual screening statistic values are: sensitivity≥95.4 %; specificity=82.5 %; Positive Predictive Value=6.5 %; Negative Predictive Value=99.9 %; False Positives=1197. The NIPT has reduced the number of invasive procedures at the Prenatal Diagnosis Center at the AHP. The NIPT performances are superior to those of the actual screening.