Modified Delphi study of ultrasound signs associated with placenta accreta spectrum.

OBJECTIVE: To determine, by expert consensus through a modified Delphi process, the role of standardized and new ultrasound signs in the prenatal evaluation of patients at high risk of placenta accreta spectrum (PAS). METHODS: A systematic review of articles providing information on ultrasound imaging signs or markers associated with PAS was performed before the development of questionnaires for the first round of the Delphi process. Only peer-reviewed original research studies in the English language describing one or more new ultrasound sign(s) for the prenatal evaluation of PAS were included. A three-round consensus-building Delphi method was then conducted under the guidance of a steering group, which included nine experts who invited an international panel of experts in obstetric ultrasound imaging in the evaluation of patients at high risk for PAS. Consensus was defined as agreement of ≥ 70% between participants. RESULTS: The systematic review identified 15 articles describing eight new ultrasound signs for the prenatal evaluation of PAS. A total of 35 external experts were approached, of whom 31 agreed and participated in the first round. Thirty external experts (97%) and seven experts from the steering group completed all three Delphi rounds. A consensus was reached that a prior history of at least one Cesarean delivery, myomectomy or PAS should be an indication for detailed PAS ultrasound assessment. The panelists also reached a consensus that seven of the 11 conventional signs of PAS should be included in the examination of high-risk patients and the routine mid-gestation scan report: (1) loss of the 'clear zone', (2) myometrial thinning, (3) bladder-wall interruption, (4) placental bulge, (5) uterovesical hypervascularity, (6) placental lacunae and (7) bridging vessels. A consensus was not reached for any of the eight new signs identified by the systematic review. With respect to other ultrasound features that are not specific to PAS but increase the probability of PAS at birth, the panelists reached a consensus for the finding of anterior placenta previa or placenta previa with cervical involvement. The experts were also asked to determine which PAS signs should be quantified and consensus was reached only for the quantification of placental lacunae using an existing score. For predicting surgical outcome in patients with a high probability of PAS at delivery, a consensus was obtained for loss of the clear zone, bladder-wall interruption, presence of placental lacunae and presence of placenta previa involving the cervix. CONCLUSIONS: We have confirmed the continued importance of seven established standardized ultrasound signs of PAS, highlighted the role of transvaginal ultrasound in evaluating the placental position and anatomy of the cervix, and identified new ultrasound signs that may become useful in the future prenatal evaluation and management of patients at high risk for PAS at birth. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

[Uterine rupture in a patient with a cesarean scar pregnancy]. / Cas clinique. Rupture utérine en début de grossesse sur cicatrice de césarienne.

Caesarean scar pregnancy is a rare form of ectopic pregnancy, but it is increasingly common due to the increasing number of caesarean sections and advances in medical imaging. There are two types of cesarean scar pregnancy depending on the depth of the implantation : endogenous type I and exogenous type II. In the case of a pregnancy resulting from a type II caesarean scar, the main complication is uterine rupture, which could be life-threatening for the patient. Early diagnosis and treatment are therefore essential for the woman. We report the case of a patient in early pregnancy with a history of cesarean section who presented with severe pelvic pain due to uterine rupture.

La grossesse sur cicatrice de césarienne est une forme rare de grossesse extra-utérine mais dont la fréquence augmente en raison du nombre croissant de césariennes et du progrès de l'imagerie médicale. Il en existe deux types en fonction de la profondeur d'implantation : le type I endogène et le type II exogène. Dans les cas d'une grossesse sur cicatrice de césarienne de type II, la complication principale est la rupture utérine qui pourrait engager le pronostic vital de la patiente. Un diagnostic et un traitement précoce sont donc primordiaux pour la patiente. Nous rapportons le cas d'une patiente en début de grossesse avec un antécédent de césarienne qui se présente pour des douleurs abdominales aiguës dues à une rupture utérine.

[Twin pregnancy and polymalformative syndrome by Enterovirus]. / Grossesse gémellaire et syndrome polymalformatif infectieux à Entérovirus.

Prenatal diagnosed congenital infection by Enterovirus is rarely described in the literature. A few casereports describe severe abnormalities observed by ultrasound that have led to spontaneous intrauterine demise or early death of the newborn. We report the case of a dichorionic diamniotic twin pregnancy. At 24 weeks of gestation, the second trimester ultrasound examination shows cardiac, brain and abdominal abnormalities in one of the fetuses. The other fetus has a normal appearance. "Standard" serological tests conducted on the mother are negative and amniocentesis reveals no genetic abnormality. After birth, Reverse Transcription Polymerase Chain Reaction (PCR) on samples of blood, ascites and stool reveals to be positive for Enterovirus in both newborns. Both are viable and exhibit severe brain abnormalities with severe neurological sequelae such as cerebral palsy, visual and hearing impairment. This case report illustrates the difficulty of prenatal diagnosis of congenital Enterovirus infection and informs about its possible neurological sequelae.

L'infection foetale précoce à Entérovirus (EV) est peu décrite dans la littérature. De rares cas rapportent de sévères anomalies vues à l'échographie qui conduisent à la mort foetale in utero ou au décès postnatal précoce. Nous présentons le cas d'une patiente présentant une grossesse gémellaire bichoriale biamniotique. L'échographie morphologique réalisée à 24 semaines d'aménorrhée révèle chez l'un des foetus des anomalies cardiaques, cérébrales et abdominales. Le second foetus présente un développement organique normal. Les sérologies «standards¼ réalisées chez la mère sont négatives et la ponction de liquide amniotique ne met pas en évidence d'anomalie génétique. A la naissance, une recherche d'Entérovirus par «Reverse Transcription Polymerase Chain Reaction¼ (RTPCR) se révèle positive pour les deux enfants. Ces derniers sont viables, mais présentent de sévères anomalies cérébrales causant des lourdes séquelles neurologiques. Ce cas clinique illustre la difficulté du diagnostic de l'infection congénitale à Entérovirus ainsi que ses conséquences potentielles.

Soluble fms-like tyrosine kinase-1 to placental growth factor ratio: ruling out pre-eclampsia for up to 4 weeks and value of retesting.

OBJECTIVES: The soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) ratio is generally elevated some time before and at the clinical onset of pre-eclampsia. The PROGNOSIS study validated a sFlt-1/PlGF ratio cut-off of ≤ 38 to rule out the onset of pre-eclampsia within 1 week of testing in women with suspected disease. The aim of this study was to assess the predictive value of the sFlt-1/PlGF ratio to rule out the onset of pre-eclampsia for up to 4 weeks, and to assess the value of repeat measurements. METHODS: This was an exploratory post-hoc analysis of data from the PROGNOSIS study performed in pregnant women aged ≥ 18 years with suspected pre-eclampsia, who were at 24 + 0 to 36 + 6 weeks' gestation at their first clinic visit. Serum samples were collected at the first visit and weekly thereafter. sFlt-1 and PlGF levels were measured using Elecsys® sFlt-1 and PlGF immunoassays. Whether the sFlt-1/PlGF ratio cut-off of ≤ 38 used to rule out the onset of pre-eclampsia within 1 week could predict the absence of pre-eclampsia 2, 3, and 4 weeks post-baseline was assessed. The value of repeat sFlt-1/PlGF testing was assessed by examining the difference in sFlt-1/PlGF ratio 2 and 3 weeks after the first measurement in women with, and those without, pre-eclampsia or adverse fetal outcome. RESULTS: On analysis of 550 women, sFlt-1/PlGF ratio ≤ 38 ruled out the onset of pre-eclampsia 2 and 3 weeks post-baseline with high negative predictive values (NPV) of 97.9% and 95.7%, respectively. The onset of pre-eclampsia within 4 weeks was ruled out with a high NPV (94.3%) and high sensitivity and specificity (66.2% and 83.1%, respectively). Compared with women who did not develop pre-eclampsia, those who developed pre-eclampsia had significantly larger median increases in sFlt-1/PlGF ratio at 2 weeks (∆, 31.22 vs 1.45; P < 0.001) and at 3 weeks (∆, 48.97 vs 2.39; P < 0.001) after their initial visit. Women who developed pre-eclampsia and/or adverse fetal outcome compared with those who did not had a significantly greater median increase in sFlt-1/PlGF ratio over the same period (∆, 21.22 vs 1.40; P < 0.001 at 2 weeks; ∆, 34.95 vs 2.30; P < 0.001 at 3 weeks). CONCLUSION: The Elecsys® immunoassay sFlt-1/PlGF ratio can help to rule out the onset of pre-eclampsia for 4 weeks in women with suspected pre-eclampsia. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

[Use of sFlt-1/PlGF ratio in preeclampsia : a monocentric retrospective analysis]. / L'utilisation du ratio sFlt-1/PlGF dans la prééclampsie : une analyse rétrospective monocentrique.

Soluble Fms-like tyrosine kinase 1 (sFlt-1) is an anti-angiogenic factor released in higher amounts in preeclampsia and implicated in endothelial dysfunction. sFlt-1/PlGF ratio is used in the prediction of preeclampsia. An sFlt-1/PlGF ratio inferior to 38 predicts the short-term absence of preeclampsia. A ratio ? 85 (early-onset PE) or ? 110 (late-onset of PE) could diagnose preeclampsia. In this study, sFlt-1/PlGF ratio has been measured in 183 patients. Sixty-seven preeclampsia have been diagnosed preeclamptic at delivery. The median sFlt-1/PlGF ratio was 100.3. The median ratio among women with preeclampsia (N=67) versus no preeclampsia (N=116) was 212.7 versus 35.4. In accordance with this analysis, an sFlt-1/PlGF ratio ? 38 has a sensibility of 95,5 % and a specificity of 73.3 %. The positive predictive value and the negative predictive value were 67.4 % and 96.6 %, respectively. These results suggest that sFlt-1/PlGF ratio is helpful in the diagnosis of preeclampsia.

La Fms-like tyrosine kinase 1 soluble (sFlt-1) est un facteur anti-angiogénique libéré en quantité excessive dans la prééclampsie (PE) et impliqué dans la dysfonction endothéliale. Il est comparé au facteur de croissance placentaire pro-angiogénique (PlGF) qui diminue dans la PE. Le ratio sFlt-1/PlGF est présenté dans la littérature comme outil dans la prédiction de la prééclampsie. Un ratio inf�rieur a 38 confirme l'absence de prééclampsie à court terme. Un ratio ? 85 dans la PE précoce (avant 34 semaines d'aménorrhée (SA)) et ? 110 dans la PE tardive (après 34 SA) peut poser le diagnostic de prééclampsie. Dans cette étude rétrospective monocentrique, le ratio sFlt-1/PlGF a été dosé chez 183 patientes à risque de PE dont 67 ont présenté une prééclampsie. Le ratio sFlt-1/PlGF médian pour toutes les patientes évaluées est 100,3. Le ratio médian pour les patientes ayant déclaré une prééclampsie (N=67) est 212,7 alors que celui des femmes sans prééclampsie (N=116) est de 35,4. En accord avec ces analyses, un ratio sFlt-1/PlGF ? 38 possède une sensibilité égale à 95,5 % et une spécificité égale à 73,3 % dans la mise au point de la PE. Les valeurs prédictives positive (VPP) et négative (VPN) sont, respectivement, 67,4 % et 96,6 %. Ces résultats suggèrent que le ratio sFlt-1/PlGF peut être une aide dans le diagnostic de la prééclampsie.

Low-dose aspirin prophylaxis to prevent hypertensive disorders of pregnancy after in vitro fertilisation: a scoping review protocol.

INTRODUCTION: Pregnancies resulting from in vitro fertilisation are associated with an increased risk of developing hypertensive disorders of pregnancy, such as preeclampsia, when compared with naturally conceived pregnancies. OBJECTIVE: The efficacy of aspirin prophylaxis to reduce the incidence of preeclampsia is well established in naturally conceived pregnancies identified as high risk for developing preeclampsia. However, the efficacy of aspirin to reduce the rate of preeclampsia for all pregnancies resulting from in vitro fertilisation remains uncertain, although in vitro fertilisation conception is a well-known risk factor for preeclampsia. Therefore, the purpose of this scoping review is to provide a comprehensive overview of the current literature regarding the use of low-dose aspirin to prevent hypertensive disorders of pregnancy after in vitro fertilisation. INCLUSION CRITERIA: This review will identify all peer-reviewed published articles including pregnant women who underwent embryo transfer after in vitro fertilisation and were prescribed low-dose aspirin to reduce the risk of hypertensive disorders of pregnancy. METHODS: We have devised a comprehensive search strategy to systematically identify pertinent studies published from January 2000 until May 2024, within the Medline (PubMed interface), Embase and Scopus databases. The search strategy is based on the keywords 'aspirin,' 'pregnancy-induced hypertension,' and ('in vitro fertilization' OR 'oocyte donation' OR 'embryo transfer' OR 'donor conception'). Two reviewers will independently screen the titles, abstracts and full-text articles to select the relevant articles, using the Covidence software. ETHICS AND DISSEMINATION: No patients are involved in this study. This study aims to be published in a peer-reviewed journal and could be presented at a conference.

[Adenomyosis]. / Le cas clinique du mois. L'adénomyose.

Adenomyosis is a medical benign condition of the endometrium-myometrium interface that is histopathologically characterized by the presence of ectopic tissue (endometrial glands and stroma) in myometrium. The diagnosis is complicated by the low specificity of its symptoms and the frequent associations with others gynaecologic pathologies. Consequently, paraclinic investigations are essential to make the diagnosis.

[Addictions and pregnancy : how to ruin a pregnancy]. / Assuétudes et grossesse: comment détruire un projet de naissance.

Pregnant women are well aware that any addiction during pregnancy can be harmful to the child. In spite of this knowledge, many continue to smoke, to drink alcohol, to consume illicit drugs or to absorb medicines because these dependences are particularly strong. Tobacco, alcohol, cocaine and ecstasy represent the most dangerous substances as regards foetal damage. The period of pregnancy is the optimal moment to stop these addictions. It is therefore essential to raise awareness among the general public, policy makers, and physicians of the fact that addictions during pregnancy cause a disparity in terms of future health and life expectancy of the unborn child.

[Mirror syndrome: a case report in fetal medicine]. / Le syndrome miroir: a propos d'un cas.

Mirror syndrome is a rare entity describing the association of foetal hydrops and maternal symptoms as general oedema and excessive weight gain mimicking preeclampsia. We report the case of a patient who developed symptoms of oedema, weight gain, headache and biological hemodilution associated with foetal hydrops due to a complex congenital heart defect. This symptomatology spontaneously resolved after foetal expulsion. Mirror or Ballantyne's syndrome needs to be identified on time and well differentiated from preeclampsia. Its consequences may involve the maternal and foetal prognosis.

A study of progress of labour using intrapartum translabial ultrasound, assessing head station, direction, and angle of descent.

OBJECTIVE: Intrapartum translabial ultrasound (ITU) has the potential to objectively and quantitatively assess the progress of labour. The relationships between the different ITU parameters and their development during normal term labour have not been studied. DESIGN: Observational study. SETTING: University teaching hospital. POPULATION: Labouring women with normal term fetuses in cephalic presentation. METHODS: Intrapartum translabial ultrasound measurements for 'head station', 'head direction', and 'angle of descent' (AoD) were taken in 50 labouring women, compared, studied for repeatability, and correlated with the progress of labour. MAIN OUTCOME MEASURES: Reproducibility and correlation of ITU parameters and their pattern of changes during labour. RESULTS: All three ITU parameters were clinically well reproducible. AoD and head station were interchangeable, and could be calculated from each other. Head station and head direction changed in a typical pattern along the birth canal. Time to delivery correlated with ITU head station. CONCLUSIONS: Intrapartum translabial ultrasound is a simple technique that improves the understanding of normal and abnormal labour, enables the objective measurement of birth progress and provides a more scientific basis for assessing labour.

[X-linked hydrocephaly. A case report in fetal medicine]. / Le cas clinique du mois. Hydrocéphalie liée à i'X: à spropos d'un cas en médecine foetale.

X-linked hydrocephaly (Li Syndrome) is a rare cause of hydrocephaly. It is, however, the most common genetic form of congenital hydrocephaly and consists of the association of hydrocephaly, mental retardation, leg spasticity and adducted thumbs. The phenotype is variable. A mutation of the LICAM gene is known to be the aetiology of the syndrome. We present an antenatal case managed in our department.

Maternal plasma soluble endoglin at 11-13 weeks' gestation in pre-eclampsia.

OBJECTIVES: To examine the performance of screening for pre-eclampsia (PE) by a combination of maternal factors, soluble endoglin (sEng), pregnancy associated plasma protein-A (PAPP-A), placental growth factor (PlGF) and uterine artery lowest pulsatility index (L-PI) at 11-13 weeks' gestation. METHODS: Uterine artery L-PI, sEng, PAPP-A and PlGF were measured at 11-13 weeks in 90 singleton pregnancies that subsequently developed PE, including 30 that required delivery before 34 weeks (early PE) and 60 with late PE, and 180 unaffected controls. Screening performance for PE by maternal factors, sEng, PAPP-A, PlGF and uterine artery L-PI and their combinations was determined. RESULTS: In early PE, compared to controls, plasma sEng and uterine L-PI were significantly increased and serum PAPP-A and PlGF were decreased. In late PE, compared to controls, serum PlGF was decreased and uterine L-PI was increased but plasma sEng and serum PAPP-A were not significantly different. In screening for early PE, the detection rate for a 10% false-positive rate was 46.7% for sEng alone and 96.3% for a combination of maternal factors, sEng, PlGF and uterine artery L-PI. CONCLUSIONS: Effective screening for early PE can be provided by a combination of maternal factors, sEng, PlGF and uterine artery L-PI at 11-13 weeks' gestation.

[A rare case of placental chorioangioma associated with neonatal disseminated hemangiomatosis]. / Association rare d'un choriangiome et d'une hémangiomatose néonatale diffuse.

Placental chorioangioma is a benign vascular tumor. Lesions larger than 4 cm may cause fetal and maternal complications. Its association with disseminated neonatal hemangiomatosis is rarely described. We report a case of a large chorioangioma associated with an hydrops foetalis and disseminated neonatal hemangiomatosis. The relationship between placental chorioangioma and hemangioma is briefly discussed.