Sinusoidal fetal heart rate pattern in severe fetal anemia from feto-maternal transfusion.

A case is reported where a sinusoidal fetal heart rate pattern was found in a fetus at 34 weeks. This pattern, at first isolated and later persistent for several hours, during a normal pregnancy became progressively transformed into a silent pattern. Cesarean delivery then performed resulted in the birth of an infant affected by a severe anemia due to a major feto-maternal transfusion and it died aged 36 h. The authors enquire into the significance of this pattern when found in apparently normal pregnancies, not involving rhesus iso-immunization, and they suggest a possible management when confronted with a sinusoidal fetal heart pattern.

Fetal tachycardia and meconium staining: a sign of fetal infection.

A retrospective study was carried out on 72 liveborn babies in whom perinatal infection was suspected. Twenty-nine of the 72 neonates were effectively infected. Analysis of intrapartum FHR recordings showed that tachycardia (base line FHR above 160 beats/min) during labor, occurred more often among infected babies (P less than 0.001). When fetal tachycardia is associated with meconium stained amniotic fluid (MSAF), the relative risk of fetal infection is 51 times as great as in babies without MSAF. Fetal tachycardia is not related to maternal fever nor to prematurity. It is not a sign of limited placental or amniotic fluid infection, but implies infection of the fetus itself. Since most infected babies displayed infectious diarrhea immediately at birth, it is suggested that MSAF may eventually be due to antenatal intestinal infection and intrauterine emission of infected stools. Although great caution is advocated for the management of labor in the presence of fetal tachycardia, MSAF should not be always regarded as a sign of acute fetal distress when antenatal infection of the fetus is suspected.

[Operable cancers of the rectum: preoperative radiotherapy. Retrospective study of 192 cases treated at the Curie Institute]. / Cancers opérables du rectum: radiothérapie pré-opératoire. Etude rétrospective de 192 cas traités à l'Institut Curie.

Pre-operative irradiation in operable cancer of the rectum remains controversial. This is a report of a retrospective study about 192 patients treated between 1958 and 1980 at the Institut Curie (Paris) for a rectal cancer. An abdomino-perineal resection was done in 144 patients, 83 as a primary procedure and 61 after a pre-operative irradiation. During the same period 48 patients had an anterior resection. We put in this study the only patients who underwent curative surgery. Irradiation was given with high voltage by a four field "box technique". The tumour received 40 to 50 grays in 5 to 6 weeks. The operation was done at least 6 weeks after the end of the irradiation. There was no difference for the sex, and age of the patients, and in the size of the tumour before treatment, between the patients irradiated and those operated on as a primary procedure. There was no difference in the operative mortality as well as the 3, 5, and 10 year survival in the two groups. Pre-operative irradiation did not change the number of perineal recurrences or the number of visceral metastases. The healing of the perineum was significantly longer in the irradiated patients (p less than 0.001). The survival was closely related to the Dukes classification. The number of Dukes A patients was significantly higher (p = 0.02) after irradiation: 26/61 (43%) vs 19/83 (23%) when the patients were not irradiated. In our experience pre-operative irradiation can shrink some large tumours helping the surgical act.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ovarian abscess. Report of 2 cases]. / Abcès de l'ovaire. A propos de deux observations.

Ovarian abscess is very rare and is usually a complication of acute purulent salpingitis. It can however rarely be isolated. Wilson and Black found 28 cases of 75,262 women who were admitted to the Department of Gynaecology and Obstetrics in Philadelphia between 1948 and 1963. There are only 120 cases in the literature. We report here two cases of abscess of the ovary which were operated in our department at an interval of one month.

[A new prostaglandin E1 analog in late interruption of pregnancy, in utero deaths and very premature ruptures of the membranes. Apropos of 117 cases]. / Un nouvel analogue de prostaglandine E1 dans les interruptions de grossesses tardives, les morts in-utero et les ruptures très prématurées des membranes. A propos de 117 cas.

The authors have used suppositories containing 1 mg of an analogue of PGE1 in 117 cases. The indication was fetal abnormality or fetal disease in 85 cases, fetal death in utero in 24 cases and very premature rupture of the membranes in 8 cases. The pessaries have a number of advantages over the techniques that were employed previously; intra-amniotic injection and intra-cervical perfusion of PGF2. The method is very efficacious: 98.3% successes. There was no failure in the series of intra-uterine fetal deaths. Placing the pessaries in the posterior vaginal fornix is easy and the technique does not consist of any manipulation. Not having to put any laminary tents in and no early rupture of the membranes has made it possible to avoid infection except in 1.7% of cases. The incidence of heavy bleeding was exceptionally low: 0.8%. As far as the dangers of rupture of the uterus or of tears in the cervix, this was minimal. Picking cases for correct indications, using doses adapted to each patient and careful observation by a team who are used to dealing with terminations of pregnancy and their techniques should lower the risk. The time spent in hospital is lessened: on an average 3 days. The fetus that is expelled is never macerated, which is important in order to be able to find out all the facts necessary to give good genetic counselling to a couple who have been profoundly traumatised.(ABSTRACT TRUNCATED AT 250 WORDS)

[Late postpartum eclampsia, myth or reality?]. / Eclampsie tardive du post-partum, mythe ou réalité?

It has never been formally established whether eclampsia can come on more than 48 hours after delivery. We report a case of a patient who had convulsions together with transitory raised blood pressure coming on 14 days after her delivery. MRI was carried out 24 hours after the attack and showed pathological sub-cortical images and there was a hyper signal at T2. This is now a well known feature and has been described in the course of typical eclampsia fits. On the other hand MRI is able to eliminate a certain number of differential diagnoses such as cerebral thrombophlebitis, cerebral vascular accidents and tumours. A cerebral blood flow study and a trans-cranial Doppler flow study showed (as far as we know for the first time) a lessening in perfusion and in speed of flow giving rise to lowered blood circulation in that part of the brain and suggestive of vascular spasm. This observation makes it very likely that eclamptic crises can occur two weeks after delivery and favours a vascular spasm being the origin of these crises.

[Study of amniotic fluid bacterial colonization sampled by amniocentesis in cases with premature rupture of membranes. Prospective multicenter study]. / Etude de la colonisation bactérienne du liquide amniotique prélevé par amniocentèse en cas de rupture prématurée des membranes. Etude prospective multicentrique.

OBJECTIVE: To determine the relationship between bacterial colonization of the amniotic fluid sampled by amniocentesis and premature rupture of the membranes. METHODS: A prospective multicentric study conducted over a one year period in 6 maternity wards in the suburban area of Paris. Thirty-six women with premature rupture of the membranes were studied. RESULTS: There were 11 patients (30%) with contaminated fluid at the first amniocentesis. Twenty-five patients had sterile fluid. In 7 patients with prolonged rupture for more than one week, repeated amniocentesis. Twenty-five patients had sterile fluid. In 7 patients with prolonged rupture for more than one week, repeated amniocenteses were used to follow bacterial colonization. In one patient, Proteus mirabilis in the amniotic fluid was eradicated by adapted antibiotic therapy. In patients with sterile amniotic fluid, there was no secondary colonization. In the 11 cases with colonized liquid, the vaginal swab could only be considered as positive in 4 cases. Amniocentesis was able to discover 7 bacterial colonizations of the amniotic fluid in patients with an indeterminant vaginal swab. Likewise, C-reactive protein levels were raised only in 26% of the cases with a colonized amniotic fluid.

[Significance of the diamine-oxidase test in the diagnosis of spontaneous rupture of fetal membranes]. / Intérêt du test à la diamine-oxydase (DAO) dans le diagnostic de la rupture spontanée des membranes ovulaires.

The authors report on their experience collected over a year of the use of the diamine-oxydase activity test after having collected the vaginal secretions on strips of Whatman paper placed in the vagina when they were trying to recognise premature rupture of the membranes. They studied: a control series of 90 patients (30 where the rupture was certain, 60 where it was definite that there was no rupture). They point out how reliable the method is at all stages of pregnancy and how simple and easy it is to carry out; a series of 89 consecutive patients whose clinical picture suggested premature rupture of the membranes; the diagnosis was shown to be wrong 48 times and confirmed 41 times (either immediately in 38 tests using DAO, or 48 hours after carrying out the first test in 3 cases). If this test is used to confirm that the membranes have really ruptured and to say when they have ruptured diamine-oxydase can be a very valuable factor when it is associated with the clinical picture and the ultrasound picture in leading to a rational handling of the case.

[Cutaneous lesions during the 1st week of life in 306 consecutive newborn infants]. / Lésions cutanées au cours de la première semaine de vie chez 306 nouveau-nés consécutifs.

The authors report the results of a systematic study of the skin conducted during three months in 306 neonates born in a hospital maternity unit in the Hauts-de-Seine departement, France. Two hundred and ninety-nine infants could be examined: 91 (30.5 p. 100) developed erythema toxicum neonatorum; 102 (34 p. 100) had port wine naevus; 42 (14 p. 100) mongolian spot, and 10 (3.5 p. 100) pigmented epidermal naevus. Various other abnormalities were found. These findings are compared with those of previous French (5, 14) and foreign (1, 3, 7-11, 13, 16, 17-19) studies.

Thiamphenicol for treatment of salpingitis.

During a six-month period, 27 women with acute salpingitis diagnosed by laparoscopy were treated with thiamphenicol. Bacterial cultures and serologic tests for syphilis and Chlamydia trachomatis infection were systematically performed before treatment. Patients were assigned to one of two treatment groups. Treatment on the day of surgery was the same for both groups: 1.5 g of iv thiamphenicol immediately after laparoscopy and 0.75 g im 12 hr later. The first group received 0.75 g im twice daily thereafter for six days, while the second group received 0.5 g orally three times daily during the same period. Treatment with 0.5 g orally every 8 hr was initiated for an additional 14 days in the 13 patients in whom C. trachomatis was identified. Follow-up examination included clinical and laboratory tests and laparoscopy. Therapy was successful in 20 of the 27 patients, and there were no significant differences between the two treatment groups. Thiamphenicol is well tolerated at this dosage and appears to be an excellent treatment for acute salpingitis.