Knowledge of surgeons and practical stances of healthcare institutions in the Ile-de-France region toward sustainable development: A cross-sectional study.

PURPOSE OF THE STUDY: Climate change represents one of the gravest threats to health. Surgical activities mobilize a large number of resources which contribute to increased emission of CO2 and anesthetic gases in the environment. The objective of this study was to assess the level of knowledge of surgeons and the practical stances of healthcare establishments toward sustainable development. METHODS: This was a descriptive cross-sectional study, lasting 2 months. From 1 May 2021 to 30 June 2021, surgeons were asked via an online questionnaire to participate. RESULTS: A total of 131 out of the 457 contacted surgeons responded. A majority practiced in the private sector, 48.9% knew little about the rules of sustainable development in operating theaters, and 43.5% had an average level. The sustainable development charter was available in only 23% of establishments, while 19% had a sustainable development committee, and specific sustainable development actions were carried out in 27%. CONCLUSION: The level of knowledge of surgeons in Île-de-France on sustainable development was low. In general, surgical units were not complying with the rules of good practice on CO2 reduction. It is necessary to find strategies to reduce the impact of operating theaters on the environment.

Electrocardiographic findings in women with a recent history of pre-eclampsia.

OBJECTIVE: To assess the prevalence of electrocardiographic (ECG) abnormalities after a pregnancy complicated by pre-eclampsia and/or syndrome of hemolysis, elevated liver enzymes and low platelets (PE) and to compare the ECG characteristics, at least six months after pregnancy, between primiparous early-onset PE women with and without recurrent PE. DESIGN: Longitudinal observational study. SETTING: Tertiary referral centre in The Netherlands from 1996 to 2008. SAMPLE: Six hundred and fifty-eight formerly pre-eclamptic women. For our second objective, we used a subgroup of 79 primiparae with a history of early-onset PE. METHODS: Data were obtained during a postpartum screening program for women with hypertensive disorders during pregnancy. MAIN OUTCOME MEASURES: Electrocardiographic abnormalities in PE women and characteristics of the ECG in women with recurrent PE after a first pregnancy complicated by early-onset PE. RESULTS: The ECG of 13 (2.0%), two (0.3%) and two (0.3%) former patients suggested ischemia, left ventricular hypertrophy and left atrial enlargement, respectively. Primiparae with recurrent PE in their second pregnancy differed from their counterparts with an uneventful second pregnancy by a leftward deviation of both the P- and the R-axes of 11° (p= 0.022) and 12° (p= 0.021), respectively, with a prolonged QT interval (p= 0.025). CONCLUSIONS: The prevalence of ECG abnormalities in women with a recent history of PE was low and did not differ appreciably from that in a large population of healthy women of comparable age. The ECGs in primiparae with a history of early-onset PE who developed recurrent PE in their second pregnancy differed slightly from women with an uneventful second pregnancy, probably related to potential confounders.

The efficacy and safety of a nicotine conjugate vaccine (NicVAX®) or placebo co-administered with varenicline (Champix®) for smoking cessation: study protocol of a phase IIb, double blind, randomized, placebo controlled trial.

BACKGROUND: A potential new treatment in smoking cessation and relapse prevention is nicotine vaccination which is based on active immunization against the nicotine molecule. This immunization will elicit the immune system to produce nicotine-specific antibodies that sequester nicotine in the blood stream, after inhaling tobacco products. The resulting antibody-antigen is too large to cross the blood-brain barrier and is therefore postulated to attenuate the rewarding effect of nicotine by preventing the latter from reaching its receptors in the brain and causing the release of dopamine. The aim of this paper is to describe the design of a phase IIb, multi-center, double blind, randomized, placebo controlled trial to assess the efficacy of the nicotine vaccine NicVAX® co-administered with varenicline (Champix®) and intensive counseling as an aid in smoking cessation and relapse prevention. METHODS/DESIGN: Two centers will include a total of 600 smokers who are motivated to quit smoking. At week -2 these smokers will be randomized, in a 1:1 ratio, to either 6 injections of NicVAX® or placebo, both co-administered with 12-weeks of varenicline treatment, starting at week 0. The target quit day will be set after 7 days of varenicline treatment at week 1. Smokers will be followed up for 54 weeks. The primary outcome is defined as biochemically validated prolonged smoking abstinence from week 9 to 52. Secondary outcomes include safety, immunogenicity, smoking abstinence from week 37 to 52, abstinence from week 9 to 24, abstinence in the subset of subjects with the highest antibody response, and lapse/relapse rate. DISCUSSION: This is the first study to assess the efficacy of a nicotine conjugate vaccine in combination with an evidence-based smoking cessation pharmacotherapy (varenicline) to quit smoking. Although NicVAX® is primarily designed as an aid to smoking cessation, our study is designed to explore its potential to maintain abstinence and prevent relapse. The results of this trial will give a unique insight in the potential of nicotine vaccination for relapse prevention. TRIAL REGISTRATION: ClinicalTrials.gov: (NCT00995033).

Contribution of three-dimensional ultrasonography in depicting perineal features in cloacal malformation.

Cloacal anomaly is a rare malformation with an incidence of 1 in 50,000 births. The definitive prenatal diagnosis of cloacal dysgenesis sequence is difficult. The use of three-dimensional (3-D) ultrasonography helps to describe the perineum and change diagnosis. In our case report, a large median genital structure was visualized, which was initially considered a penis-like structure, but the 3-D technique showed an enlarged bud. The urethral meatus was at the tip of this smooth structure. The lack of anal structure was clearly demonstrated.

[Hysteroscopic sterilization among women older than forty years: what motivated the women?]. / Stérilisation tubaire par voie hystéroscopique chez les femmes de plus de quarante ans : quelle motivation pour ces femmes ?

OBJECTIVES: The aim of the study was to check the motivations of the patients over 40 years old who want to be sterilized by the Essure system (hysteroscopic sterilization). The simplicity of the technique raises the question of the choice between contraception and sterilization among women over 40. PATIENTS AND METHODS: It is a prospective study concerning 168 women. We report their past history and their motivations. We have checked also the satisfaction and tolerance of the procedure. RESULTS: The medium number of children by woman was 2.6. The middle age of the last child was 11.5. Twenty-eight percent of the patients underwent at least one abortion. They tried 2.3 methods of contraception before accept sterilization. The reasons of their choice were, for 45.9% of them the side effects of the contraceptions; in 22% of cases, they were fed up of their contraception; in 12% of cases, it was a contraindication to the contraceptions, in 10% of cases, a failure of the contraception and in 2% of cases, they had have a contraindication to the pregnancy. Ninety-three percent of them were satisfied. It is a fast procedure with bearable pain. DISCUSSION AND CONCLUSION: Essure system is a good alternative to the contraception in patients who present, from 40 years old, some increased risks. It is an easy technique with high satisfaction rate.

[Acute pulmonary edema occurred during tocolytic treatment using nicardipine in a twin pregnancy. Report of three cases]. / OEdème aigu du poumon lors d'une tocolyse par nicardipine chez une grossesse gémellaire. A propos de trois observations.

We report three cases of acute pulmonary edema that occurred during treatment by intravenous tocolysis using nicardipine in twin pregnancy patients with no previous heart problems. The three patients were admitted into our unit on account of the risk of premature birth after 29 to 32 weeks of amenorrhea. The treatment by intravenous tocolysis using nicardipine combined with glucocorticoids therapy had been undertaken in the previous maternity ward. The three patients presented symptoms of acute dyspnea 48 hours after the beginning of the treatment. Paraclinical examinations eliminated the diagnosis of pulmonary embolism. The patients'condition improved rapidly with appropriate diuretic treatment and by modifying the tocolysis. There are currently few studies proving the benefits of nicardipine in tocolysis treatment. Few similar cases of acute pulmonary edema have been noted in twin pregnancy patients treated with nicardipine. Haemodynamic modifications specific to twin pregnancy, intravenous hydratation and glucocorticoid maturation may explain a part of this complication. Therefore, it is appropriated to limit the use of intravenous nicardipine in the sole indication of tocolysis in twin pregnancy, and to prefer the use of nifedipine and atosiban, that have proven their effectiveness in this indication.

A systematic review of surgical site infections following day surgery: a frequentist and a Bayesian meta-analysis of prevalence.

BACKGROUND: Since 1990, several studies have focused on safety and patient satisfaction in connection with day surgery. However, to date, no meta-analysis has investigated the overall prevalence of surgical site infections (SSI). AIM: To estimate the overall prevalence of SSI following day surgery, regardless of the type of surgery. METHOD: A systematic review and a meta-analysis of the prevalence of SSI following day surgery, regardless of the type of surgery, was conducted, seeking all studies before June 2016. A pooled random effects model using the DerSimonian and Laird approach was used to estimate overall prevalence. A double arcsine transformation was used to stabilize the variance of proportions. After performing a sensitivity analysis to validate the robustness of the method, univariate and multi-variate meta-regressions were used to test the effect of date of publication, country of study, study population, type of specialty, contamination class, time of postoperative patient visit after day surgery, and duration of hospital care. FINDINGS: Ninety articles, both observational and randomized, were analysed. The estimated overall prevalence of SSI among patients who underwent day surgery was 1.36% (95% confidence interval 1.1-1.6), with a Bayesian probability between 1 and 2% of 96.5%. The date of publication was associated with the prevalence of SSI (coefficient -0.001, P = 0.04), and the specialty (digestive vs non-digestive surgery) tended to be associated with the prevalence of SSI (coefficient 0.03, P = 0.064). CONCLUSION: The meta-analysis showed a low prevalence of SSI following day surgery, regardless of the surgical procedure.

[Premature rupture of membranes before 32 weeks of gestation: prenatal prognosis factors]. / Rupture prématurée des membranes avant 32 semaines d'aménorrhée: facteurs pronostiques prénatals.

OBJECTIVE: Premature preterm rupture of membranes (PPROM) accounts for a significant part of overall perinatal mortality and morbidity. This study aims to define potential prognostic factors for neonatal outcome. PATIENTS AND METHODS: One hundred and thirty-one pregnancies complicated with PPROM at between 26 and 32 weeks were retrospectively reviewed over a three-year period. The influence of chorioamnionitis on perinatal morbidity and mortality was assessed using a composite outcome. RESULTS: On admission, gestational age (GA) at diagnosis, fetal heart rate anomalies and increasing severity of clinical features of chorioamnionitis were significantly related with an adverse outcome. Significant factors associated with a favourable outcome were an administration of steroids for lung maturation, prophylactic antibiotics and tocolytic therapies. Stratifying according to GA at PPROM, the survival rates were 43 and 52% at before 22 weeks and between 22 and 26 weeks respectively. The prognosis dramatically improved after 26 weeks with an 84.6% rate of survival without impairment. Although this rate reached 97.5% after 30 weeks, there was no statistical evidence supporting any benefit to prolong pregnancies beyond this point. The complete expression of chorioamnionitis independently increased the mortality rate by 41% (OR=1.41; 95% CI [0.99-2.01]. Overall, the most relevant factor was GA at delivery, levelling the prognostic value of GA at diagnosis. DISCUSSION AND CONCLUSION: If no consensus rules PPROM at the moment, the most efficient prognosis factor before 34 weeks is mostly determined by GA at delivery.

[Is the bronchial atresia prenatal diagnosis possible?]. / Le diagnostic anténatal d'atrésie bronchique est-il possible ?

Bronchial atresia is a rare congenital malformation of the lung. The main-stem segmental or lobar bronchus fails to construct normally, which can lead to accumulation of mucus within the distal bronchi or lung hyperinflation of the obstructed lobe. The prenatal diagnosis is rare and difficult. We report two cases of fetuses who presented pathological examination of the lung on the ultrasonography, at 22 weeks of gestation, suspect of prenatal bronchial atresia diagnosis. We analysed this malformation through a literature review in order to discuss differential diagnosis to be evoked, as well as appropriate perinatal management.

[Maternal virilization due to mucinous ovarian tumour: a case report]. / Tumeur ovarienne mucineuse virilisante et grossesse: à propos d'un cas.

Virilization in pregnancy is rare and mostly due to luteoma or to hyper-reactio luteinalis. We present a rare case of a virilization borderline mucinous ovarian tumour on a gravida 1 patient. The tumour was responsible for a clinical hyperandrogenism and for an increased level of testosterone. This patient was treated by ovariectomy at 31 weeks of gestation. The surgery was completed one month after delivery. There was no fetal consequence and the clinical and biological signs of virilization totally disappeared after surgery.

[Superfetation: case report and review of the literature]. / Superfoetation: à propos d'un cas et revue de la littérature.

We report the case of a dichorionic-diamniotic pregnancy in which a discordance in the size of the fetuses was observed as early as the first trimester. This discordance in size was maintained over time and the two fetuses continued their respective growths. We suggest the very rare phenomenon of superfetation as a diagnosis because less than 10 cases are described in the literature. Even though a formal proof of the diagnosis is difficult to obtain, the elements described in this article rally in favor of this hypothesis. Superfetation is defined by the fertilization and the implantation of a second oocyte in a uterus already containing the product of a previous conception. After a description of the case, a review of the literature enables us to describe the frequency, the possible risk factors and the existing case reports on the subject. The rarity of this case justifies its publication for the information of clinicians.

Fat grafting of hairy areas of head and neck - comparison between lipofilling and nanofat grafting procedures in a cadaveric study.

AIM: Fat grafting has well-recognized effects in terms of volume gain, skin trophicity, relieving of post-wound nevralgia. Recent publications suggest a regenerative action on hair follicles. The objective of our study was to compare lipofilling and nanofat grafting in hairy areas of head and neck so as to determine a convenient fat injection technique for those areas in the prospect of treating alopecia. MATERIAL AND METHODS: Our study compared lipofilling and nanofat grafting, in a cadaveric study involving one body. RESULTS: Lipofilling was found easy to perform in the face, avoiding classical pitfalls, but was more difficult in the scalp areas. Nanofat grafting seemed particularly convenient to inject into the scalp, especially in Merkel's space, and hairy areas that required high precision injections. CONCLUSION: After having compared lipofilling and nanofat grafting in hairy areas of the head and neck, we propose a combination of lipofilling (in hairy areas where a durable gain of volume is acceptable, in case of burn or scar) and nanofat grafting (in all hairy areas and in Merkel's space in scalp areas). This technique may be used either as a complement of hair follicle grafting or as a regenerative treatment of alopecia.

[Pleuropulmonary blastoma: a case of early neonatal diagnosis through antenatal scan screening]. / Pleuropneumoblastome: un cas de découverte néonatale précoce grâce au dépistage échographique prénatal.

We report a case of pleuropulmonary blastoma (PPB) prenatally diagnosed at 32 weeks of gestation. The suspected diagnoses was a congenital cystic adenomatoid malformation of the lung (CCAM). The excision of the malformation was performed through a thoracotomy at 4 months of age. On pathological examination, the presence of focal stromal hypercellularity (cambium layer) in the cyst wall was consistent with both the diagnosis of type IV CCAM or grade I PPB. The presence of nodules of immature cartilage and the positivity of particular immunohistochemical staining (indicate which staining came positive) confirmed the diagnosis of grade I PPB. Pleuropulmonary blastoma is a rare malignant tumour in children, sometimes difficult to differentiate from the type IV CCAM as they share similar circumstances of diagnosis, radiological and macroscopic features. The pathological examination does not always allow to differentiate them clearly, implying the necessity of an extended medical supervision for the children carrying those border lesions. Because of the risks of malignancy and of the risks of septic complications, surgical resection during the first year of life is often advocated. Therefore, prenatal detection is essential to allow adequate early management and complete resection of these lesions.

[Evaluation of the instruction and the instructors by the students during a clinical training period in a gynecology and obstetrics unit]. / Evaluation des enseignements et des enseignants par les externes lors d'un stage clinique dans un service de gynécologie-obstétrique.

OBJECTIVES: The evaluation of an educational system is part of the essential process to get high-quality teaching. We wanted to assess the teaching and the teachers in a gynaecological unit with a view to improve the education of the trainees within a dynamic educational system. MATERIALS AND METHODS: It is a prospective study which took place in the gynecology-obstetric unit of the University of Nantes. Thanks to a questionnaire called "Evaluation of the teaching during a gynecologic-obstetric training course", we evaluated the feelings of 21 medical students about their two-month training course. This questionnaire of 27 items is divided in several parts. The first one is about the quality of the teaching, the second about planification, the third about the quality of the learning resources, and the fourth is about the educational quality of each teacher (interaction teacher-student). The fifth one evaluates the perception of this work experience by the student, notably his clinical activity and his personal implication in the unity. There are also some open questions which point out the positive aspects of the teaching but also its failings and the parts that must be improved. We give here the details of the different stages of this assessment from the questionnaire up to the results, mentioning their limits considering the conceptual orientations and the methodological orientations chosen. RESULTS: Analysis of the data was done determining the percentage of agreement and disagreement to a statement of the questionnaire. All the students find the teachings interesting and stimulating, objectives were gone through thoroughly. Courses were well organised. Their integration in the medical team was good. They feel responsible especially when they are on call (88.3%). On the other hand, for a quarter of them, educational supports are not adapted, teaching documents are not clear and adapted to the National Test. Half of them (45%) are not satisfied by the numerical campus which does not facilitate understanding. Staffs are not an opportunity to learn for 37% of them. Management by senior doctors is insufficient. CONCLUSION: Students are completely integrated into the process of evaluation but concrete actions to improve the teaching have to be realised in the hospital departments. Questionnaire is an informative and adapted tool. It permits to highlight the flaws in the learning process and to remedy them.

[Extra-uterine pelvic leiomyoma: diagnosis and practical management]. / Léiomyome pelvien extra-utérin: diagnostic et prise en charge.

OBJECTIVES: To analyze the possibilities of setting up a therapy for extra-uterine pelvic leiomyomas. METHODS: Three cases of leiomyomas of the broad ligament, of the round ligament and of the ovary, and literature review. RESULTS: Little is known about physiopathology of extra-uterine leiomyoma. The diagnosis of extra-uterine leiomyoma is based on histopathological analysis, using standard histology, and immunohistochemistry with anti-desmin and anti smooth muscle actin antibodies. The main differential diagnoses are fibroma, fibrothecoma, ovarian fibrosarcoma, and gastrointestinal stromal tumors. To define criteria of malignancy, we use Bell's classification without being sure that the uterine and extra-uterine models are comparable. So there is a risk of ignoring a low grade leiomyosarcoma. Providing therapy depends on the clinicopathologic features: the so called "parasitic leiomyoma", a tumor developed at the expense of local smooth muscle cells, metastasis of a benign metastasizing leiomyoma or leiomyomatosis peritonealis disseminata. CONCLUSION: The extra-uterine leiomyoma has no precise nosologic status and no specific criteria of benignity; thus no precise evolution can be predicted. We must be extremely careful, and the issue of the monitoring and long-term therapy of patients must come up.

[Cervical cancer screening in rural Madagascar: Feasibility, coverage and incidence]. / Dépistage du cancer du col utérin en milieu rural à Madagascar : faisabilité, couverture et incidence.

OBJECTIVES: To assess the implementation of a cervical cancer screening strategy in rural Madagascar. MATERIALS AND METHODS: A mobile unit, equipped with a cold-coagulator, visited every six months the main health care centers in the Atsinanana area between 2013 and 2015. Cervical cancer screening was based on visual inspection with acetic acid (VIA). The lesions suggestive of intraepithelial neoplasia and limited to the cervix were coagulated on the same day. Non-eligible patients for immediate treatment were referred for appropriate investigations. We assessed the feasibility and the coverage of the screening strategy and estimated the incidence of cervical cancer in the targeted population. RESULTS: One thousand five hundred and sixty-nine (18%) of 8959 women aged between 25 and 65 years old were screened. Three hundred and fifty-seven (23%) were VIA positive and 322 (21%) were eligible for immediate treatment. No serious adverse effects were observed among patients treated on the same day. Among the 35 patients not eligible for immediate treatment and referred to the hospital, 16 (46%) were lost to follow up. CONCLUSION: When a cervical cancer screening by HPV or cytology is not possible, VIA remains a feasible and acceptable option in a disadvantaged environment. The effectiveness of this approach is still limited by the problems of access to care for patients who are not eligible for immediate treatment.

[Interest of selective lymphadenectomy in patients with vulvar cancer]. / Intérêt de la technique de lymphadénectomie sélective dans les cancers de vulve.

Vulvar cancer represents approximately 4% of all gynecologic malignancies and the most important prognosis factor in this cancer is the status of the regional lymph nodes. The radical inguinal lymphadenectomy, associated or not with radiotherapy, is accompanied by high morbidity, which can affect 50% of the patients. The sentinel node detection appears now to be feasible in patients with vulvar carcinoma, in order to reduce the morbidity of inguinal lymphadenectomy. But contrary to breast cancer, the learning curve is not easy to obtain because of the low number of cases. That is why we have described the procedure of selective lymphadenectomy. The aim of this technique is to remove the blue and/or marked inguinal lymph node and any other palpable lymph node, without a real radical inguinal lymphadenectomy. Thus, since November 2003, 4 procedures have been performed in total. With the lymphoscintigraphy, we identified 17 marked lymph node and we finally obtained 28 lymph nodes after surgery, with only one metastatic lymph node. There was no complication after our procedure. Selective lymphadenectomy appears to be a new procedure which may reduce the morbidity of usual inguinal lymphadenectomy.

[Hysteroscopic fallopian tube sterilization procedure: feasibility and one-year follow-up]. / Stérilisation tubaire par voie hystéroscopique: faisabilité et évaluation à un an.

OBJECTIVES: Hysteroscopic flexible micro-insert (Essure) is an ambulatory improvement of fallopian tube sterilization, which is a deliberated suppression of fertility. The aim of this study was an evaluation of feasibility (learning curve) and the first year outcome of this method. PATIENTS AND METHODS: This prospective study, carried out between February 2002 and March 2003, included patients who were matching with manufacturer recommendations. One surgeon only realized all the device placements. RESULTS: Fifty patients were included (one year follow-up). Mean age was 41 (+/-3.3), mean parity was 2.7 (+/-0.8). Mean time needed for device placement was 26 minutes (+/-6.5) and was reduced with increased experience. Six failures of placement (12%) were related, because of submucus leiomyomas, proximal tubal stenotic disease or too retroverted uterus. Only 5 patients (11,4%) described intensive pelvic pain during the placement. The only case of device expulsion benefited from a successful second placement. The one-year follow-up showed no significant difference of body weight increasing, duration or quantity of menstruation, neither significant pelvic pain nor vaginal bleeding. Tolerance was rated at least at "somewhat satisfied". There have been no pregnancies reported in 670 woman-months of effectiveness. DISCUSSION AND CONCLUSION: Our results agree in any point with those of larger studies. We think that hysteroscopy micro-insert placement is not only reserved to specialized centers but also to any gynecologist who is used to performing hysteroscopy because of its feasibility.

[Abdominal trauma during pregnancy: Pertinence of monitoring elements]. / Traumatisme au cours de la grossesse: pertinence des éléments de surveillance dans l'évaluation des suites obstétricales. A propos d'une série de 98 patientes.

OBJECTIVE: The objective of this study is to evaluate current means of monitoring of pregnant women victims of abdominal trauma and to determine whether systematic hospitalization is warranted. MATERIAL: and methods. This was a retrospective study of pregnant women who consulted the Nantes hospital during a three-year period for abdominal trauma during pregnancy. Four principal means of monitoring (examination, fetal heart rate or ERCF, ulstrasonography, Kleihauer test) were evaluated according to the fetal outcomes. RESULTS: Ninety-five patients were including in the study. The abdominal trauma resulted from a traffic accident for 49 patients (51%), a fall for 39 patients (41%) and high-energy trauma for 7 patients (8%). Three patients (3%) presented fetal complications: one fetal death, one fetal porencephaly, one premature birth at 34 weeks gestation for premature rupture of the membranes and abruptio placentae. These three women were traffic accident victims who also suffered extra-abdominal trauma. Ultrasonographic signs (npv=99%) and anomalies foetal monitoring (npv=98%) were also observed in two cases (fetal death and premature birth). The porencephaly was fortuitously discovered 3 weeks after trauma at a routine ultrasound. The Kleihauer test remained negative in all patients. The other traumas did not give lead to fetal complications. The incidence of premature births did not increase after trauma. Fetal outcome was good when monitoring parameters were normal at admission. CONCLUSION: Ultrasonography and fetal heart rate monitoring enable proper assessment of fetal well-being but only have predictive value if they are negative. A negative Kleihauer test, useful for Rh negative patients to determine the amount of anti-D antibody to inject, does not provide any information about fetal outcome when it is negative. The complications observed were related only to traffic accidents. Hospitalization is probably not very useful when monitoring elements are normal at admission and when the women has suffered mild trauma.

[Mirror pre-eclampsia: Ballantyne's syndrome. Two cases]. / Une pré-éclampsie en miroir: le syndrome de Ballantyne: à propos de deux cas.

We report two cases of Ballantyne's syndrome which was first described in association with foeto-placental hydrops caused by rhesus isoimmunization. Our two cases occurred in association with materno-fetal parvovirus infection. Although the pathogenic mechanism remains to be fully elucidated, fluid retention and hyperplacentation are the main features. Together with these two case reports, a literature review confirmed the diverse nonimmunological etiologies associated with Ballantyne's syndrome. Clinicians should be aware of this particular presentation of hydrops fetalis resulting from a mechanism different from hypotrophic placentation because specific etiological treatment can avoid unnecessary pregnancy termination. Pre-conception counselling is also different.