Antenatal exposure to atenolol and retroperitoneal fibromatosis.

We present a case of retroperitoneal fibromatosis in a fetus whose mother took atenolol during pregnancy. A 25-year-old obese woman was treated for hypertension with 100 mg atenolol daily from the second month until the end of pregnancy. At 29 weeks, echography disclosed a retroperitoneal mass and at 37 weeks, a boy was delivered. A biopsy of the tumor showed a fibromatosis with medullary compression, treated by antimitotics until 3 months of age. At the age of 4, the mass had disappeared but severe scoliosis was present. This in utero exposure to atenolol drew our attention because the retroperitoneal localization of the tumor is similar to that of fibroses reported in adults after exposure to atenolol and for other reasons: transplacental carcinogenesis has been demonstrated in humans, at least for diethylstilboestrol, atenolol crosses the placental barrier, the drug was taken during nearly the whole pregnancy, and retroperitoneal fibromatosis is exceptional as a neonatal tumour.

[Fetal bradycardia caused by arrhythmia. Apropos of a case of blocked staggered atrial extrasystole]. / Les bradycardies foetales par arythmie. A propos d'un cas d'extrasystolie atriale bloquée décalante.

The author reports a case of fetal bradycardia with a rate of 75 beats per minute, with atrial extrasystoles and an intermittent auriculo-ventricular functional block. Cases have rarely been described because the condition is often not recognized. Bradycardia can be diagnosed as a sign of fetal distress and may lead to procedures which are not helpful. Ultrasound has become the mainstay of diagnosis. The arrhythmia is usually an isolated feature without causing any trouble, and it usually disappears by itself before or soon after delivery. This does not mean that the cause of the arrhythmia should not be sought carefully and that the fetus should not have careful monitoring during pregnancy and in labour (including fetal pH sampling); in general arrangements should be made for a paediatrician to take over the case after birth. This article reviews the different types of fetal bradycardia and classifies them into three groups: sinus bradycardias and sino-auricular dysfunctions auriculo-ventricular blocks which may or may not be associated with a congenital malformation and often occur if the mother has a collagen disease with the presence of anti-Ro antibodies, and paradoxal bradycardias. A system of management of these cases is suggested.

[Fibromatosis found during prenatal ultrasonography]. / Fibromatose à révélation échographique anténatale.

During an antenatal echography, we observed a here to unreported fetal tumour which was diagnosed after birth as aggressive fibromatosis. The infant was treated with chemotherapy and, at the age of 27 months, still had a sclerous mass on the trunk which cause major scoliosis. Fibromatosis is a locally malignant fibrous tumour. During the unpredictable clinical course, recurrence after treatment as well as spontaneous regression is observed. Therapeutic management decisions (surgery, radiotherapy, chemotherapy) must be made on a case by case basis. Hormone factors and inappropriate oncogene expression are pathogenic factor.

[Delivery in France of patients born in Black Africa]. / L'accouchement en France des patientes nées en Afrique Noire.

171 cases of African women who delivered at the Maternity Hospital in Le Havre were analyzed. A few specific points are worth mentioning. During the pregnancy, serology is often positive for treponema, and many women are not immunized against toxoplasmosis and rubella (German measles), and anemia is so frequent that its prevention must be systematic. The pelvis may seem narrowed transversally at the upper strait. However, delivery is usually easy with a high rate of episiotomies and perineal tears, representing the obstetrical cost of the ritual excision procedure. It is not necessary to perform caesarean sections more often in African than in other women, more especially as caesarean section is poorly tolerated and exposes the patient to the risk of rupture of the uterus when they deliver again in their own country. The newborn is rather small, more in weight than size or cranial circumference, without the possibility of incriminating only the ethnic factor. Perinatal morbidity and mortality do not appear to be higher than in the general population.

Does ultrasound examination when the cervix is unfavorable improve the prediction of failed labor induction?

OBJECTIVE: To compare the Bishop score, ultrasound cervical parameters and fetal fibronectin assessment for predicting failed labor induction when the cervix is unfavorable. METHOD: A prospective observational study was performed in 106 consecutive pregnant women with a Bishop score < or =5 undergoing labor induction. Assessment of fetal fibronectin and ultrasound measurement of cervical length, cervical wedging and cervical lip areas were performed. The relationship between these parameters and failure of labor induction was determined. RESULTS: Failure of labor induction was defined as failure to reach a cervical dilatation of > or =5 cm, and it occurred in 16 patients (15.1%). Induction failure was associated with low Bishop scores before (P = 0.004) and 6 h after the start of induction (P = 0.007), increased clinical cervical length (P = 0.02) and increased ultrasound anterior cervical lip area (P = 0.04). The logistic regression model identified the Bishop score before induction (odds ratio = 2.25; 95% CI, 1.30-3.91; P = 0.003) and the clinical cervical length (odds ratio = 3.95; 95% CI, 1.3-11.7; P = 0.01) as being independent predictors of failed induction. To predict an induction failure, the best Bishop score cut-off value was 4, with a sensitivity of 87.5%, a specificity of 45.6%, a likelihood ratio of 1.58, a positive predictive value of 22.2% and a negative predictive value of 95.4%. CONCLUSION: Compared with the Bishop score, cervical length by ultrasound is not a better predictor for the outcome of labor induction in an unfavorable cervix. Nevertheless, the Bishop score appears to be of poor predictive value for failed induction of labor.

The role of ultrasound and fetal fibronectin in predicting the length of induced labor when the cervix is unfavorable.

OBJECTIVE: To compare cervical clinical data, ultrasound parameters and fetal fibronectin assessment in the prediction of the duration of induced labor when the cervix is unfavorable. METHODS: This was a prospective study of 90 pregnant women with a Bishop score /= 27 mm (P = 0.002 and P = 0.005). CONCLUSION: Cervical dilatation as assessed by digital examination is the best predictor of the duration of the latent phase and of that of the whole of labor. Ultrasound measurement of cervical length is not more accurate at predicting the duration of labor than are clinical data.

Screening of the C677T mutation on the methylenetetrahydrofolate reductase gene in French patients with neural tube defects.

We report the analysis of the distribution of the C677T mutation on the methylenetetrahydrofolate reductase (MTHFR) gene in prenatally diagnosed neural tube defects (NTD) cases and controls. In contrast to previous reports, we found the same distribution in fetuses with NTD and controls, which suggests that the MTHFR C677T mutation cannot be regarded as a genetic risk factor for NTD.