[Prenatal path of care following the diagnosis of a malformation for which a novel prenatal therapy is available]. / Parcours prénatal devant une malformation pour laquelle un traitement in utero émergent est disponible.

OBJECTIVES: Fetal therapy is part of the available care offer for several severe malformations. The place of these emergent prenatal interventions in the prenatal path of care is poorly known. The objective of this study is to describe the decision-making process of patients facing the option of an emergent in utero intervention. METHODS: We have conducted a retrospective monocentric descriptive study in the department of maternal-fetal medicine of Necker Hospital. We collected data regarding eligibility or not for fetal surgery and the pregnancy outcomes of patients referred for myelomeningocele, diaphragmatic hernia, aortic stenosis and low obstructive uropathies. RESULTS: All indications combined, 70% of patients opted for fetal surgery. This rate was lower in the case of myelomeningocele with 21% consent, than in the other pathologies: 69% for diaphragmatic hernias, 90% for aortic stenoses and 76% for uropathy. When fetal intervention was declined, the vast majority of patients opted for termination of pregnancy: 86%. In 14% of the considering fetal surgery, the patient was referred too far. CONCLUSION: The acceptance rate for fetal surgeries depends on condition. It offers an additional option and is an alternative for couples for which termination of pregnancy (TOP) is not an option. Timely referral to an expert center allows to discuss the place of a fetal intervention and not to deprive couples of this possibility.

[Wounds of the flexor tendons of the fingers at the level of the hand. Results of primary sutures]. / Les plaies des tendons fléchisseurs des doigts au niveau de la main. Résultats des sutures primaires

The authors review in 100 patients, 182 wounds of flexor tendons of the fingers at the level of the hand emphasize the definite preponderance in young workers, their frequency which is all the greater as one moves away from the thumb, and approches the area of the fibrous pulleys, their common misdiagnosis, especially at the level of the thumb, their prognosis which is all the worse as one approaches the fifth finger and the areas of the pulleys. The poor results simply confirm their reputation of seriousness from an economic and social point of view. The technical problems raised by stiffening of the proximal interphalangeal joints and, above all, the formation of adhesions, are far from solved, it seems that an improvement in the results might be obtained if these wounds were repaired by specialised surgeons in a unit dealing exclusively with surgery of the hand which, under present conditions, is not always the case.