Normal serum concentrations of anti-Mullerian hormone in a population of fertile women in their first trimester of pregnancy.

BACKGROUND: Anti-Müllerian hormone (AMH) levels are used to evaluate the ovarian reserve. AMH serum concentrations have recently been studied among women attending fertility centers, and among women with regular menstrual cycles but normative values have not been established among fertile women: the objective of this study was to establish those values. METHODS: This prospective cross-sectional study included 340 healthy fertile women attending a single centre, aged between 15 and 50 years. The women were all in the first trimester of pregnancy, had no serious medical history and attended the abortion service of the University Hospital of Nice, France. Serum AMH was measured using a second-generation AMH enzyme-linked immunosorbent assay. RESULTS: Median AMH concentration was 2.42 ng/ml (25-75 percentiles 1.19-4.12). The relationship between AMH concentration and age was best fitted by a polynomial function. Serum AMH values rose until age 29 years and then showed a significant decline (R(2)= 0.289, P < 0.001). Normative values for serum AMH were established in different age groups between 15 and 50 years. CONCLUSIONS: We established the normative values for serum AMH in a population of French fertile women in their first trimester of pregnancy.

Prospective study on the prevalence and associated risk factors of cryptorchidism in 6246 newborn boys from Nice area, France.

To assess the incidence and risk factors of cryptorchidism in Nice area. A 3-year prospective study was conducted at two maternity wards involving neonatal screening of boys born ≥34weeks of amenorrhoea. Methodology was strict with examination at birth, 3 and 12months by the same paediatrician. Two strictly matched controls were included for each case. Information on child and parents (medical history, pregnancy, lifestyle) was recorded using medical chart and self-administered questionnaires. A total of 102 of 6246 boys were born with cryptorchidism (prevalence 1.6%, 95 included). Half of them were still cryptorchid at three and 12months with, however, 10% of secondary re-ascent (recurrent cryptorchidism) at 12months, justifying long-term follow-up. Cryptorchidism at birth was associated with instrumental delivery, inguinal hernia and urogenital malformations, particularly micropenis and paternal history of cryptorchidism. Our results suggest that maternal exposure to anti-rust or phthalates could be a risk factor, whereas eating fruits daily seemed somewhat protective. Prevalence of cryptorchidism in our area is on the lower bracket compared with other countries, and is associated with both familial and environmental risk factors.

Utility of vaginal and rectal contrast medium in MRI for the detection of deep pelvic endometriosis.

OBJECTIVE: To study the sensitivity of MRI performed utilising vaginal and rectal opacification with ultrasound gel in the detection of deep pelvic endometriosis. MATERIAL AND METHODS: This was a prospective monocentric study. All patients evaluated by the gynaecologist for pelvic pain, endometriosis or infertility were included. Axial and sagittal T2-weighted images were performed both with and without vaginal and rectal opacification with ultrasound gel. Three radiologists, all blinded, interpreted the images with a minimum of 15 days between the two readings. MRI performance with and without vaginal and rectal opacification was evaluated by calculating sensitivity, specificity and both positive and negative predictive values. RESULTS: Seventy-eight patients were included. Among these, 31 patients had deep pelvic endometriosis of which 24 were confirmed by laparoscopy. Seventy-six locations of deep pelvic endometriosis were discovered on MRI. For the three reviewers there was a significant improvement in sensitivity between pre- and post-contrast MRI (p < 0.0002). CONCLUSION: Opacification of the vagina and rectum significantly improved the sensitivity of MRI for the detection of deep pelvic endometriosis by expanding the vagina and rectum, thus allowing better delineation of the pelvic organs. This was especially apparent for lesions localised to the vagina and rectovaginal septum.

[Anatomy of the female pelvis on MRI: value of intravaginal contrast]. / Anatomie pelvienne en IRM: apport du contraste vaginal.

PURPOSE: Prospective monocentric study to determine the feasibility, tolerability and diagnostic value of intravaginal contrast to assess female pelvic anatomy on MRI. MATERIALS AND METHODS: Forty-nine consecutive women referred for MRI evaluation of the pelvis, irrespective of the indication, were included in this study. The MR imaging protocol consisted of axial and sagittal T2W images before and after intravaginal instillation of sterile US gel. Eight anatomical regions were analyzed and their visibility graded from 1 to 4 (1=excellent; 4=non-visualized) by 3 radiologists without and with intravaginal gel. The value of intravaginal gel was determined by calculating the difference in the visibility index for each anatomical region by the Wilcoxon and khi2 tests. Inter-observer agreement was also determined using the kappa test. RESULTS: Two women declined vaginal opacification resulting in an acceptance rate of 96%. The gel instillation procedure had a duration of less than 3 minutes on average and was well tolerated by all patients. Intravaginal gel allowed significantly improved visualization of all anatomical regions (p<0.001); improvement between 0.5 and 2.5 points on average per anatomical region. Inter-observer agreement significantly improved after gel instillation increasing from 72% to 92%. CONCLUSION: Intravaginal instillation of US gel is simple, noninvasive, well-accepted and well-tolerated by patients. It increases visibility of pelvic anatomical structures with improved inter-observer agreement.

[Evaluation of two classifications systems for pelvic prolapse on dynamic MRI]. / Evaluation de deux systèmes de cotation des prolapsus pelviens en IRM dynamique.

PURPOSE: To determine the usefulness of two classification systems for pelvic prolapse on MRI. MATERIALS AND METHODS: Prospective study of 30 patients with symptoms of pelvic prolapse performed in a single center. All patients underwent clinical evaluation followed by dynamic pelvic MRI within 15 days. All MR examinations were reviewed by three readers using both classification systems based on different anatomical landmarks. The first used the pubococcygeal line and the second used the midpubic line. RESULTS: For prolapse detection, the correlation between clinical examination and MRI was good to very good, ranging between 74 and 89%. For prolapse staging, the correlation was poor to moderate. Inter-observer agreement was good to very good (kappa between 0.67 and 0.95). It was slightly better at the mid stage, with both systems (kappa between 0.83 and 0.97). Comparison of the inter-observer agreement between both MRI classification systems showed better results for the system using the pubococcygeal line (p<0.005). CONCLUSION: The classification system based on the pubococcygeal line appeared more reliable and simple for th eevaluation of pelvic prolapse on MRI.

[Transvaginal repair of genital prolapse with Prolift: evaluation of safety and learning curve]. / Cure de prolapsus par voie vaginale selon la technique du Prolift: évaluation du caractère minimal invasif et de sa courbe d'apprentissage.

AIMS: Evaluation of the mini invasiveness and the learning curve of the Prolift technique. MATERIALS AND METHODS: Prospective study. All patients were operated on by the same surgeon. The mini-invasiveness of the procedure was estimated through the evaluation of the intraoperative and immediate postoperative complications. The learning curve was evaluated through the analysis of the operative time. RESULTS: Between January and December 2007. Forty-seven patients were included in the study. Mean follow-up was: 11,8 months. Two cases of bladder injury and two cases of intraoperative bleeding (>500 ml) were reported. One case of vaginal erosion and one case of recurrence of the prolapse occurred during the follow-up. The mean operative time was 62+/-18 min. The mean operative time of the posterior step of the Prolift was 24+/-min and remained stable after the 18th procedure. DISCUSSION: The learning cure of the posterior of the procedure is longer because of the passage of the needles through the ischiorectal foramens. The technique is mini-invasive considered the low rate of intra and immediate postoperative complication and the learning curve short. CONCLUSIONS: Longer follow-up is needed to evaluate the efficacy of the procedure in the long term.

[Oocyte donation in patients with Turner syndrome: A high-risk pregnancy]. / Procréation par don d'ovocytes dans le syndrome de Turner : une situation à haut risque.

Turner's syndrome is characterized by an ovarian failure, which occurs in most cases before puberty and leads to infertility. In vitro fertilization with oocyte donation has dramatically transformed the prognosis of infertility of these women. However, in the same time, it has become obvious that pregnancies in Turner's syndrome are at very high risk of possible sudden death because of a specific risk for cardiovascular complications involving aortic root dissection. We report the case of a serious cardiac failure occurred during a twin pregnancy obtained by oocyte donation in a 39-year-old patient with Turner's syndrome. Pregnancy outcome was hopefully favourable thanks to a foetal extraction at 27 weeks of amenorrhoea. If the most reported cases of maternal deaths in patients with Turner's syndrome are associated with an aortic root dissection, our observation is characterized by a full normal cardiologic assessment before the pregnancy and by the absence of aortic root dilatation during pregnancy. This case also illustrates the very high risk of pregnancy in women with Turner's syndrome and the importance of a multidisciplinary care by professionals informed and been used to this obstetric practice.

[Anorexia nervosa during pregnancy: an unusual association]. / Grossesse et anorexie mentale évolutive : une observation inhabituelle.

We report the case of a pregnancy associated with severe restricting anorexia nervosa in a 33-year-old patient who weighed 41kg for 1.61m at conception. She continued to lose weight during pregnancy and she gave birth to an eutrophic child by cesarean section at 34 weeks of amenorrhea. Because of complications induced by the chronic food restriction, anorectic pregnant women should be viewed as being at high risk and also monitored closely both during and after pregnancy to optimize maternal and fetal outcomes.

[Delivery of emergency contraception to minors in French pharmacies]. / Délivrance de la contraception d'urgence aux mineures dans les pharmacies françaises.

OBJECTIVE: The goal of this work was to evaluate the application in French pharmacies of the decree n 2002-39 relating to the delivery of the emergency contraception to minors. PATIENTS AND METHODS: Four selected minors carried out an anonymous investigation in 53 randomised pharmacies in the town of Nice (south of France). RESULTS: The cost-free delivery of the emergency oral contraception was refused to minors by 37.7% of pharmacies. DISCUSSION AND CONCLUSION: Our article highlights the remaining problems, five years after the decree, with the delivery of the emergency contraception. It seems necessary to explain to all the professionals of information, drugs delivery and treatments relating to the contraception or abortive methods the importance of their roles and the respect of their legal obligations.

[Second pregnancies in HIV-1-infected women. A prospective monocentric study]. / Secondes grossesses chez les femmes VIH-1 séropositives. Etude prospective monocentrique.

OBJECTIVES: To evaluate the influence of successive pregnancies on the materno-foetal prognosis in a population of HIV-infected women. Clinical, biological data and treatment strategies were compared during iterative pregnancies. PATIENTS AND METHODS: We conducted a monocentric prospective study between August 1995 and January 2007 in a French university hospital (Nice). RESULTS: Twenty-six HIV-infected women had two consecutive pregnancies during our study. We noticed an increase in CD4 cell count between the two pregnancies. Viral load variations were non significant. The maternal's prophylaxis changed. Percentage of HAART increased from 26 to 54%. Modes of delivery, HIV or treatments side-effects remained the same between the successive pregnancies. DISCUSSION AND CONCLUSION: Successive pregnancies do not seem to influence the materno-foetal prognosis related to HIV infection.

[Environmental pollutants in maternal milk and cryptorchidism]. / Polluants environnementaux dans le lait maternel et cryptorchidie.

OBJECTIVE: Numerous maternal lipophilic compounds are eliminated into milk during lactation, their concentrations reflecting fetal in utero exposure. Some of them are endocrine disruptors. Their role in the occurrence of genital malformation, dysfunction or cancer has been suggested. We wanted to study the exposure of our population and its potential association with cryptorchidism, as few clinical studies are available. PATIENTS AND METHODS: Over three years, we screened for cryptorchidism all boys born alive at or above 34 weeks of gestational age, in two maternity wards (CHU Nice, CHG Grasse). Cryptorchid boys were matched with two controls. Nursing mothers provided a colostrum sample that was screened for 15 compounds known for their antiandrogenic and/or anti estrogenic properties, including dichloro-diphenyl-trichloro-ethylene (DDE), polychlorinated biphenyls (PCBs), dibutylphthalate (DBP) (& metabolite monobutylphthalate-mBP) and hexachlorobenzene (HCB). RESULTS: Out of 6246 boys, 102 were cryptorchid (1.6%). All available colostrums (56 for cryptorchid and 69 for controls) were contaminated. Median concentrations of DDE, PCBs, HCB and phthalates were higher though not significantly in cryptorchid versus controls. Cryptorchid boys were more likely to be classified in the most contaminated groups for DDE and SigmaPCBs, with a trend for mBP. Odds ratio (OR) for cryptorchidism was increased for the highest score of SigmaPCB, with a trend only for DDE versus the lowest score of those components. Our results are similar to those of a Scandinavian study with comparable design. DISCUSSION AND CONCLUSIONS: Our results show the universal contamination of milk with endocrine disruptors in our area, and support the association between congenital cryptorchidism and fetal exposure to PCBs and possibly DDE, alone or in association with other chemicals.

[MR imaging evaluation of endometrial carcinoma]. / Evaluation en imagerie par résonance magnétique des carcinomes de l'endomètre.

Prognosis for endometrial carcinoma is closely related to cell type and tumor grade but also to local staging using the FIGO classification. MRI, under specific technical conditions, allows excellent depiction of the degree of myometrial tumor extension. It also has an excellent specificity for the detection of cervical extension. In addition, it allows evaluation of regional nodes, but with sensitivity values that are not perfect. The purpose of this paper is to review the MR imaging features of endometrial carcinoma along with its limitations and pitfalls.

[Deep pelvic endometriosis: MRI features]. / Endométriose pelvienne profonde en IRM.

Endometriosis is a frequent pathology of adult women. Clinical examination and US are poorly sensitive for detection of deep pelvic implants and MRI is superior for presurgical mapping of disease extent. This is important to optimize complete surgical excision, the only proven treatment to achieve symptomatic relief. The purpose of this pictorial essay is to describe the imaging features of deep pelvic endometriosis and the technical means to optimize its detection.

[Influence of mode of delivery in term breech presentation on the Apgar score and transfer in neonatal care unit. Results of the management of 568 singleton pregnancies in a level III French maternity]. / Influence de la voie d'accouchement dans la présentation du siège à terme sur le score d'Apgar et les transferts en néonatologie. Résultats de la prise en charge de 568 grossesses singleton dans une maternité française de niveau III.

OBJECTIVES: The aim of our study was to define the influence of mode of delivery in term breech presentation on the Apgar score and transfert in neonatal care unit using our university hospital protocol. MATERIAL AND METHOD: We conducted a retrospective study. The study included 568 singleton term pregnancies during the period January 1996 to December 2005. The main selection criteria were Apgar score and transfert in neonatal care unit. RESULTS: Analysis of the Apgar scores at 1.5 and 10min and transfer in neonatal care unit do not show any statistical difference. CONCLUSION: The absence of a difference in neonatal prognosis is to allow vaginal delivery to be carried out. To carry on with the teaching of obstetrical manoeuvres makes it possible to avoid pointless surgical intervention and a bad maternofoetal prognosis in the event of an unexpected breech presentation.

[Feasibility and preliminary experiment of a routine use of Da-VinciS in fertility surgery]. / Faisabilité et expérience préliminaire de l'utilisation du robot Da-VinciS dans la chirurgie de l'infertilité féminine.

OBJECTIVES: The goal of our study is to evaluate the use of Da-Vinci S in the field of fertility laparoscopic surgery. MATERIALS AND METHODS: Ten successive patients were included for a laparoscopic fertility surgery using the Da-Vinci S. Surgical feasibility, operating time, length of hospital stay and postoperative complications have been analyzed. RESULTS: All procedures have been completed using Da-Vinci S. CONCLUSION: In our preliminary surgical experience, the Da-Vinci S can be technically used in the field of fertility surgery.

[Medical information and patients' choices. Influences on term singleton breech deliveries]. / Information médicale et choix des patientes. Influences sur la pratique de l'accouchement du siège à terme par voie basse.

OBJECTIVE: The mode of delivery of term singleton breech presentation has been argued for decades. Many elements are responsible for the current increase in the rate of elective cesarean delivery. Among these elements, the influence of medical information and patients' choices are unknown. PATIENTS AND METHODS: We studied retrospectively, between January 1996 and December 2005, the mode of term breech delivery in a French maternity. RESULTS: Medical information relates primarily to the complications of vaginal birth. Patient's request for an elective Cesarean has been in constant increase since 1996. DISCUSSION AND CONCLUSION: Medical information and patients' choices strongly influence the practice of breech delivery.

[Minors' request for voluntary termination of pregnancy. A study of their motivations and influences at the CHU of Nice]. / Demandes d'IVG des mineures. Etude de leurs motivations et influences menée au CHU de Nice.

OBJECTIVE: The goal of this work was to determine the influences exerted on minors during a request for voluntary termination of pregnancy (TOP). PATIENTS AND METHODS: We made a retrospective descriptive study at the Centre Hospitalier Universitaire (CHU) of Nice. Two hundred (and) four minor patients were included, from January 1st 2003 to December 31st 2004. RESULTS: In the majority of cases, the entourage (sexual partner or parents) who are informed of the request for TOP support the patient in her choice. In more than 56% of cases, the parents are not informed of the request for TOP. DISCUSSION AND CONCLUSION: It seems, for minors, that it is the need for conforming to the existing social model which motivates the majority of the requests for TOP.

[Pregnant woman and road safety: a numerical approach. Application to a restrained third trimester pregnant woman in frontal impact]. / Femme enceinte et accidentologie routière: intérêt de l'approche numérique. Application à un choc frontal au troisième trimestre de la grossesse avec analyse de l'effet de la ceinture de sécurité

OBJECTIVES: The goal of our work is the development of a numerical model of pregnant woman in driving position. We present an application to the study of injury mechanisms during a frontal car crash for a seat belt restrained pregnant woman in driving position. MATERIALS AND METHODS: We integrated a digital representation of a pregnant uterus, foetus and placenta in a previous existing numerical model of non pregnant Human body in driving position, the Humos model. The realization of a numerical simulation of a frontal car crash enabled us to analyze the part played by the safety belt in the organic traumatisms. RESULTS: Three phases were highlighted. The first phase consists of a translation forwards of the pregnant uterus during the impact. The second phase is a rotation forwards in the sagittal plan of the pregnant uterus with for axis of rotation the posterior wall of the pubis. The third phase is a vertical adjustment coupled to a translation of the uterus towards the back. This translation leads the uterus to impact the spine. CONCLUSION: The development of a pregnant numerical model in the field of accidentology allows the analysis of organic traumatisms. That makes it possible to study the role played by the existing safety systems. This model might make it possible to develop safety systems specific to the pregnant woman.

Impact of walking epidural analgesia on obstetric outcome of nulliparous women in spontaneous labour.

BACKGROUND: To explore the effects of walking epidural analgesia on obstetric and neonatal outcomes, we performed a case-control study. METHOD: Each nulliparous woman receiving walking epidural analgesia using 0.0625% bupivacaine (n = 44) was matched to two nulliparous historical controls receiving 0.125% or 0.25% bupivacaine (n = 88 each) for epidural analgesia while recumbent. RESULTS: Maternal and obstetric parameters, fetal status and presentation, and oxytocin use were comparable among groups. Those receiving walking epidural analgesia walked for a mean of 60 min (range: 20-75 min). In the control groups the mean total durations of labour were shorter (58 min in the 0.125% group and 99 min in the 0.25% group, P < 0.05). Significantly fewer walking epidural analgesia cases than controls required instrumental vaginal delivery (P < 0.05). No other differences in obstetric or fetal outcome were observed and no mother fell or stumbled while walking. CONCLUSION: Although it was associated with a prolonged first stage of labour, walking epidural analgesia appeared safe for nulliparous women and their babies.