Evolution of the prematurity before the 32nd week from 1980 to 1985 in a tertiary perinatal center in Lille, France.

127 infants were born alive before the 32nd week of gestation in the H. Salengro obstetrical unit from the University Hospital of Lille from January 1980 to December 1985. During this period the annual number of deliveries was constant, 2700. Two periods were considered, 1980-1982 and 1983-1985. The number of such premature infants increased slightly: from 56 to 71. The most striking feature was the dramatic increase in infants born after induction of delivery for fetal reasons. Another finding is the statistically significant lowering of gestational age and birthweight of the spontaneously born infants. These trends counterweight the efficacy of the policy of prevention. When considering the morbidity and the mortality, hyaline membrane disease still plays a preeminent role in this population.

[Long-term development in treated cervical dysplasias]. / Evolution à long terme des dysplasies cervicales traitées.

The study of 324 cervical dysplasia treated and followed from 1 to 15 years allows to draw three major risks from conservative treatment: micro invasions or invasions, non seen at diagnosis time; risk of residual lesion whatever the used treatment; risk of recurrence from 7 months to 7 years after the last treatment. The ratio of cure (actuarial analysis) is about 92% at 3 years and 88% at 6 years. Whatever the patient's age, the lesion's degree or the treatment used, the risk of recurrence can be fixed up to 6.17%. Only the concordance of diagnostical means and the long term follow up should decrease consequences of medical therapeutic failures.

[Does genital tuberculosis still exist? Current review]. / La tuberculose génitale existe-t-elle encore? Revue récente.

The diagnosis of female pelvic tuberculosis is seldom thought of although it is still an entity. The reason why it is so seldom considered is partly because it has greatly diminished in incidence and also because the population who suffer from it and who are becoming much older move about. Another reason is that the symptomatology has changed, and now most often shows in pure haemorrhagic forms. The authors therefore go over the system of diagnosis and show that treatment is reverting to surgery.

[The unruptured luteinized follicle. Determination of estradiol and progesterone in peritoneal fluid]. / Le follicule lutéinisé non rompu. Dosage de l'estradiol et de la progestérone dans le liquide péritonéal.

The finding of more luteinized unruptured follicles in women who are under investigation for unexplained infertility compared with fertile women suggests that the syndrome does exist and probably plays a causative role in the infertility of these patients. The levels of oestradiol 17-beta and progesterone found in the peritoneum in the early luteal phase showed a much higher figure when there has been rupture of the follicle with a haemorrhagic corpus luteum and a stigma as compared with luteinized unruptured follicles. It does seem to us worth while to obtain some of the peritoneal fluid in order to estimate the levels of hormones and to diagnose more often the unruptured follicle syndrome whenever laparoscopy in undertaken in the early luteal phase.

[The use of prostaglandins to perform terminations of pregnancy in the second trimester (author's transl)]. / Utilisation des prostaglandines pour les interruptions de grossesse au second trimestre.

The authors report 48 cases of termination of pregnancy between the 12th and the 20th week using prostaglandins. Two methods were used: An injection of 40 mg of Prostaglandin F2 alpha (1) intra-amniotically: used on 38 women in group i. 10 patients had 5 mg of 15 (S) 15 methylprostaglandin F2 alpha administered vaginally in group ii. In the first group all women aborted with a mean induction expulsion time of 16 hours and 20 minutes. In the second group 9 women aborted with a mean time of 14 hours and 2 minutes. Side effects were very marked in the second group, whereas they seemed to be acceptable in the first group.

[Cardiovascular complications due to naftidrofuryl]. / Les accidents cardiovasculaires dus au naftidrofuryl.

The authors report the case of a serious cardiovascular complication due to naftidrofuryl overdosage following its intravenous administration. Other similar complications have already been reported in the literature and in experimental animal studies (particularly involving the conduction system of the heart). Since naftidrofuryl belongs to the class of local anesthetics and is pharmacologically related to procainamide, certain precautions must be closely followed if it is administered intravenously: avoidance of rapid injection directly into the vein, limiting the infusion to 200 to 400 mg given over a 3 hour period using preferably a constant infusion syringe pump or an infusion pump, and using caution when associated with other medications, particularly antiarrhythmic agents which could affect atrioventricular or intraventricular conduction.

[Echography of the corpus luteum]. / Echographie du corps jaune.

The authors analyse the ultrasound aspects of normal and abnormal corpora lutea after reviewing the techniques for studying ovaries. The abnormalities include unruptured luteal follicles, cystic corpora lutea, haemorrhage into corpora lutea and ovarian hyperstimulation.

[Small oscillations in fetal cardiac rhythm: a sign of well-being? A new approach to the diagnostic value of spontaneous recordings of fetal cardiac rhythm in pregnancy]. / Le rythme cardiaque foetal à petites oscillations: signe de bien-être? Nouvelle approche de la valeur diagnostique des enregistrements spontanés du rythme cardiaque foetal au cours de la grossesse.

The authors suggest an indirect evaluation of the electrocortical activity of the fetus by looking at evidence of cyclical variations in fetal cardiac rhythm. These are shown up by periodic changes in the variability of the rhythm. The narrow association that has been established between small changes in episodes of cardiac rhythm and deep sleep--which is itself evidence of satisfactory cortical development--make this type of tracing, under certain conditions, an excellent sign of fetal wellbeing. This means that the value of small variabilities in fetal heart rhythm takes on greater importance as a prognostic feature.

[Assessment of the inflammatory evolution of the sequelae of salpingitis]. / Appréciation de l'évolutivité inflammatoire des séquelles de salpingites.

Fifty-four patients who had consulted because of their sterility had a laparoscopy carried out with bacteriological, cytological and biochemical studies of the peritoneal fluid as well as a histological assessment of the peritoneal adhesions. The purpose of this prospective study was to show the usefulness of laparoscopy in pre-operative assessment of tubal sterility and to look for objective criteria of the progress of inflammation. To do the study, two groups of women in different clinical stages (29 patients with no pelvic infection and 25 patients who had salpingitis) were divided into three sub-groups: 25 free of disease, 4 subsiding salpingitis patients and 25 with tubo-peritoneal sequellae. Different samples taken with the laparoscope made it possible to decide whether the inflammatory process was carrying on or not in these 25 cases. Using swabs for bacteriological examinations we had to employ transport medium and this showed bacteria in 7 cases. We found a significant correlation between the serum and peritoneal levels of anti chlamydia antibodies and the levels of AC antibodies when there was a tubal lesion. There was little value in carrying out cytology on the peritoneal fluid except when the histology showed that this was necessary. The level of serum and peritoneal orosomucoid was found to be different in the two groups of patients. This study shows that it is necessary to assess several different parameters to exclude pelvic inflammatory disease before resorting to reparative tubal surgery.

[Loco-regional analgesia by electronic stimulation during labor]. / Analgésie loco-régionale au cours du travail par stimulation électronique

This is a preliminary report on an original method of local regional electronic analgesia. From it the first results can be deduced. The threshold for pain which was appreciated at 25 mmHg without electronic stimulation was raised to 48 mm Hg under electronic stimulation. Fetal ill-effects are nil.

[Thrombo-embolic disease of pregnancy. Methods and indications for surgical prevention]. / Maladie thrombo-embolique de la grossesse. Méthodes et indications de la prévention chirurgicale.

Thrombo-embolic disease can generally benefit from anticoagulant treatment. Nevertheless, there are circumstances that require surgical prevention of pulmonary embolism. The vena caval circulation can be interrupted using clips, which necessitates a general anaesthetic and laparotomy, or intravenous procedures such as Mobin-Udin or Greenfield filters may be inserted. The indications for these procedures depend on how advanced the pregnancy is. The authors point out the indications for interruption of the vena caval flow during pregnancy in the light of four recent case histories. The main one is failure of medical treatment. Interruption of the vena caval flow is to be recommended when there is impaired circulation or when a thrombus is threatening. The diagnosis of this condition does require invasive tests; and whether these are toxic for the fetus is discussed.

[Prolonged fetal monitoring, ultrasonic telemetric registering. Methodology. Applications]. / La surveillance foetale prolongée, enregistrement télémétrique par ultra-sons. Méthodologie. Applications.

Studying the fetal heart rate is the method of choice for monitoring fetal wellbeing. All the same, when repeated records are made, but only over a short time, no permanent control is carried out and this means that some very high risk fetuses are not monitored properly. but all these involved using electrocardiograms to record the fetal heart rate and this was not a practical proposition because of the number of artifacts that were produced. the authors suggest using a new method of observing the fetal heart rate over a long period of time based on telemetric transmission of the rate using an ultrasound machine. They show the results and also the difficulties of using this apparatus as well as the prospects for studying fetal physiology in this way.

[Problem in echographic diagnosis: intrauterine pseudo-sac]. / Une difficulté de diagnostic échographique: le pseudo-sac intra-utérin.

The authors report eight cases of an intra-uterine pseudo-sac giving a wrong diagnosis of intra-uterine pregnancy. In two cases there was hypertrophy of the uterine mucosa and in six cases there was decidual change. The pseudo-sac corresponds to: either a blood clot held by the uterine mucosa; or a marked hypertrophy of the endometrium with intense decidualization and massive oedema. Certain characteristic criteria suggest that a pseudo-sac may be in the uterus; the oblong shape, dimensions which do not accord with the period of amenorrhoea, absence of peripheral and linear thickening, the variety of sites in which the picture is seen and in particular its disappearance, which makes it difficult to localise it in all sections. On the other hand it is not possible to diagnose between an intra-uterine pseudo-gestational sac and an early intra-uterine pregnancy which is not growing, in our present state of knowledge.

[The level of glycohaemoglobin (Hb A1c) in connection with diabetes and pregnancy (author's transl)]. / Dosage de l'hémoglobine glycosylée (Hb A1c) dans l'association "diabète et grossesse".

The authors worked out a normal curve using 379 levels obtained over 9 months in 180 normal pregnancies. 6% (with a confidence level between 4.4% and 7.6%) was usual for haemoglobin A1c. Then they compared 42 levels of glycohaemoglobin obtained from 14 pregnant diabetic patients where the mean value was 8.34%. Glycohaemoglobin A1c therefore is a good indicator or the level of stabilisation in diabetic pregnancies in the two months before the estimation is taken. It is therefore possible to think that it does indicate chronic hyperglycaemia and does seem to have a future in screening diabetic pregnancies. On the other hand it does not seem to be of any supplementary value in monitoring the fetus of the diabetic mother in the third trimester of pregnancy because of the small variations in the levels that are obtained as compared with the suddenness of fetal complications.

[The prognostic value of raised uric acid in the blood in arterial hypertension in pregnancy. 58 cases (author's transl)]. / Valeur pronostique de l'hyperuricémie dans les hypertensions artérielles de la grossesse. A propos de 58 observations.

The authors have carried out research in 58 cases to see whether the findings of high uric acid levels in the blood are of prognostic value in all cases of arterial hypertension in pregnancy whatever the aetiology. The material studied consisted of 30 true cases of toxaemia of pregnancy, 13 cases of recurrent toxaemia and 15 cases of the vasculo-renal syndrome on top of the pre-existing pathological condition. In 37 cases where the blood uric acid level was lower than 300 micromoles there were only 4 minor complications. Serious complications were found in 6 cases in which the patients had a blood uric acid level highthan 480 micromoles. This study confirms the prognostic value of blood uric acid levels. The estimation of these levels, however, seems to be of less value in making a differential diagnosis between the various kinds of toxaemia and hypertension found in pregnant women due to different aetiologies.

[Ultrasonic size of fetal crump-rump length in first trimester of pregnancy. Accuracy of gestational age assessment (author's transl)]. / La mesure échographique de l'embryon. Une détermination précise de l'âge gestationnel.

The fetal crown rump length was measureed by means of pulsed ultrasound. The normal values between 49 and 94 days from the onset of the last menstrual period were determined in 72 patients. Statistical analysis showed a good correlation between gestationnal age and fetal crown rump length. The usefulness of this measure is so demonstrated: assessment of gestational age, within few days.

[Postpartum renal cortical necrosis]. / La nécrose corticale rénale du post-partum.

The authors report two cases of post-partum cortical renal necrosis. The diagnosis was made on clinical and biological criteria (severe, prolonged oliguria, the signs of intra-vascular coagulation defects, a rise in L.D.H. and anaemia with micro-angiopathy. It is confirmed by selective renal arteriography and renal punch-biopsy. There is a threefold method of treatment: --of the kidney condition by repeated haemodialysis and diuretics; --antihypertensive treatment; --treatment aimed at the aetiological pathology (heparin, anti-platelet aggregation and fresh plasma). Functional recovery of the kidney was obtained in both cases (after an interval of 1 year and an interval of 1 1/2 year). The authors review the diagnostic, physiopathological, morphological and therapeutic elements in the condition of cortical renal necrosis.

[The value of estimating the levels of amniotic insulin which come from the fetus in looking after diabetic pregnancies in the last trimester (author's transl)]. / Intérêt du dosage de l'insuline amniotique d'origine foetale dans la surveillance des grossesses de diabétique au dernier trimestre.

The authors carried out 49 estimations of amniotic fluid levels of insulin in 41 patients. 25 of these patients were non-diabetic and they were a control group, and 16 patients were diabetic (24 estimations). The liquor was collected by amniocentesis between the 32nd and the 42nd week of amenorrhoea. The mean of the control levels was 3.17 micro-units per ml. The mean of the values in diabetic pregnancies was 9.97 micro-units per ml. The difference between the two groups is statistically significant. We have studied this insulinaemia in relationship to the duration of the diabetes, the maternal weight increase, the levels of insulin used therapeutically, the blood glucose level, the rise in arterial blood pressure, the weight of the infant, the date of delivery, the presence of fetal distress and the control of blood sugar. There is a statistically significant difference between the insulinaemia of patients in whom the diabetes is well controlled (mean level of 7.08 micro-units per ml) and the patients in whom the diabetes is badly controlled (31.7 micro-units per ml). This new parameter for supervision of the third trimester of pregnancy in diabetics gives rise to the possibilities of a better approach to materno-fetal blood sugar regulation and to an adjustment of the therapeutic doses of insulin that are given which will result in lengthening of the duration of pregnancy, with the aim of achieving a spontaneous vaginal delivery at term.

[The influence of present therapeutic methods and especially of beta-blockers on fetal and maternal prognosis in hypertensive syndromes in pregnancy. 43 case records (author's transl)]. / Influence des thérapeutiques actuelles et notamment des bêta-bloquants sur le pronostic foetal et maternel des syndromes hypertensifs de la grossesse. A propos de 43 observations.

The authors studied 43 cases of arterial hypertension in pregnancy in an attempt to determine the efficiency and safety of different anti-hypertensive drugs. The patients were divided into two major groups: arterial hypertension which revealed itself during pregnancy (true toxaemias of pregnancy and relapsing toxaemias), and arterial hypertensions which were added on to a pre-existing pathology (arterial hypertension, diabetes, chronic nephritis). The cases in these different classes were then divided into two definite groups according to the need for therapy: the first group was treated by rest and hydrallazine as a single therapeutic agent. In the second group multiple agents were needed because of the arterial hypertension, and one was a beta-blocker. Complications were found particularly in the second group of true toxaemias of pregnancy where unfortunately 5 fetal deaths occurred that were attributable to the severity of the hypertension more than to the beta-blockers, which were administered for longer and in higher doses without major complications in recurrent toxaemias and pre-existing arterial hypertension cases.

[Meadows syndrome. A case history (author's transl)]. / Le syndrome de Meadows. A propos d'une observation.

The authors, having studied a case of Meadows syndrome, confirm that this cardiomyopathy is a specific entity in pregnancy and the puerperium. They point out the difficulties in diagnosis, as Meadows syndrome seems to be diagnosis of elimination. They point out that a paraclinical balance has to be drawn up very fully on the biological and haemodynamic planes to confirm this condition. Finally, after a short discussion about the therapy, they tackle the problem of the prognosis for life and for future childbearing in these patients, which is determined by the persistence or absence of cardiac enlargement.