[Cranial osteopathy as a complementary treatment of postural plagiocephaly]. / Place de l'ostéopathie dans la correction des déformations crâniennes du nouveau-né et du jeune enfant.

For the majority of neonates and young infants, appropriate postures and standard physiotherapy succeed in preventing or correcting acquired cranial deformations (fetal due to restricted mobility in utero or postnatal secondary to exclusive dorsal decubitus). However in some cases, when postural management is not efficient, pediatricians will be asked by the parents about the potential benefits of osteopathy. What is osteopathic treatment? At first, diagnostic palpation will identify which suture is normally mobile with the respiratory cycle, and which has limited or absent mobility secondary to abnormal postures. Later on, the goal of the therapeutic phase is to mobilise impaired sutures, by various gentle maneuvers depending on the topography of the impairment. The treatment is not restricted to the skull but extended to the spine, pelvis and lower extremities which contribute to the deformative sequence. Osteopathic treatment belongs to complementary medicine, therefore demonstration of its scientific value and favorable results have to be provided. Based on randomized studies, the answer is yes, it significantly decreases the degree of asymmetry. Do postural deformations matter to the development of an healthy infant? It seems that the prejudice is not only esthetic but also functional, however more research is necessary. In conclusion, pediatricians should be more aware of the method and expectations: major deformative sequence since birth and increasing deformations despite preventive postures and standard physiotherapy are reasonable indications for such complementary treatment. "Preventive" osteopathy in maternity is not justified. Moreover osteopathy has no place in the treatment of craniosynostosis ; the latter belong to malformations, completely distinct from postural deformations.

[When the pregnant woman risks iodine deficiency]. / Quand la femme enceinte risque d'être en manque d'iode.

There may be situations in France were women do not have sufficient iodine intake during pregnancy. The nutritional needs for iodine are increased during pregnancy, mostly during the first trimester, for the use of the mother and the embryo and fetus. In France, a deficiency in available iodine has been demonstrated in the general population and in a population of pregnant women. Iodine deficiency may affect the mother (goiter, high TSH, low thyroxin levels) and new information points to a risk of retarded development in children born to women with low thyroxin levels during the first and second trimesters of pregnancy. Iodine deficiency can also induce transient high TSH levels in the newborn. The question raised by these new established facts is whether iodine supplementation should be proposed for all pregnant women, and this before the second trimester of pregnancy. Systematic screening for thyroid deficiency might also be useful at the end of the first trimester of pregnancy.

Preliminary report of an identification mission for safe motherhood, Senegal: putting the M back in M.C.H.

The Government of Senegal, in keeping with the priority given to women and children in its health programs, requested the assistance of the United Nations Development Program (UNDP) in identifying and executing a program to diminish maternal mortality in that country. A UNDP "Mission of Identification" was carried out in response to this initiative. The preliminary results of this mission confirm that the issue of maternal safety is of primary concern not only to the government but also to women in the Republic of Senegal. The methodology employed during this mission allowed the team of national and international experts to confirm the level of this concern and to identify four major potential areas of intervention. Quantitative goals for the program have been set and estimates for the efficacy of each of the intervention areas indicate that intervention through the timely provision of access to emergency surgical services and appropriate prenatal care will yield the largest reduction. The feasibility of providing interventions in each of the four areas was also addressed during the mission. This methodology will be applicable to other settings as Third World countries begin to address the problem of excessive maternal mortality.

PIP: The government of Senegal, in March of 1986, requested assistance from the UN Development Program (UNDP) to formulate and execute a program for safe motherhood. Senegal, with an estimated maternal mortality rate of 580-760/100,000, was the 1st country to initiate a concrete national program to address the problem of maternal mortality. Despite the existence of a well-developed health infrastructure, data showed that the majority of Senegalese women deliver at home and that only 20% of maternal mortality is reported. Causes of mortality include endemic diseases (malaria and hepatitis), and abrupted placenta as a complication of hypertension. To identify the target areas of intervention, a "Mission of Identification" was organized by the UNDP in collaboration with the government of Senegal. 4 levels of the health infrastructure--village or rural maternity, the health post, the health center, and regional and national hospitals--were assessed as to existing and potential capacity to prevent maternal deaths. Epidemiology, social barriers to care, service delivery problems, and management issues were addressed. Results revealed a minimal knowledge of family planning, an expressed desire to solve the problems, and the strong influence of traditional beliefs in health care intervention, all of which contribute to maternal mortality. Interventions to reduce mortality were outlined based on identified causes of death and capabilities to address a specific problem. Over 50% of maternal deaths could be prevented by improved access and optimization of health care delivery and timely medical/surgical intervention. Adequate prenatal coverage and reducing pregnancy rates at the extremes of maternal age and parity were also cited as methods to reduce mortality. Estimates of the efficacy of these interventions were based on universal access, which does not now exist. A significant investment must be made to assure such access and to emphasize the priority given to maternal/child health by the government of Senegal.

[Marchiafava-Micheli syndrome and pregnancy]. / Maladie de Marchiafava-Micheli et grossesse.

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal disorder characterized by sensitive populations of erythrocytes, granulocytes and platelets. PNH is a disease of young adults with a slight female predominance. Several complications of PNH during pregnancy, could be prevented; chronic anemia, folate and iron deficiency, deep vein thrombosis. We report seven pregnancies, six of which were successful in four patients. One pregnancy was terminated after 25 weeks by a fetal death during an acute hemolytic crisis. Diagnosis of PNH was made in the four patients before the pregnancy by the acidified serum lysis assay and the sucrose lysis assay. During puerperium, acute hemolytic crisis, most probably triggered by delivery, were observed in two patients. Thrombotic complications could be prevented by early initiation of an anticoagulant therapy after delivery. The only neonatal complication, observed in two cases was iso immune hemolytic anemia related to the multiple blood transfusions received before and during pregnancy. These results show that successful pregnancies are possible in PNH women when monitoring is especially close. To allow optimal fetal development, patients were transfused with saline-washed or frozen-thawed packed red-cells to prevent the precipitation of hemolysis, so that the hemoglobin level remained higher than 10 g/dl. During the whole pregnancy, patients had to be given dietary supplementation with folic acid and iron therapy whenever deficiency was demonstrated, under close surveillance of hemolysis. To prevent thrombotic complications during pregnancy, anticoagulant therapy was used if the patients had to be bedridden, or within 8 hours following delivery.

The prevention of preterm delivery through prenatal care: an intervention study in Martinique.

During 1976-1978, improvements were made in the free prenatal care provided by the maternal and child health authority (PMI) of Martinique. Central to these changes was implementation of a program of preventive prenatal care developed in France by one of the authors (EP). Data on all births during 1980-1982 show no significant difference in pregnancy outcomes between women receiving free prenatal care from the government and women receiving private care from obstetricians.

PIP: This paper reports the results of a prenatal care program in Martinique aimed at preventing preterm deliveries among women of low socioeconomic status. It was based on the assumption that high-quality preventive care during pregnancy can substantially improve pregnancy outcomes among disadvantaged women. During 1976-78, the government's maternal and child health department (PMI) took steps to ensure easy access to prenatal care for all women in Martinique. New service sites were established, existing sites were improved, and health personnel were given special training on the recognition of high-risk pregnancies. The mean number of prenatal visits/woman to government clinics increased from 4.9 in 1978 to 6.2 in 1982. During this period, the percentage of women attending a free clinic in the 1st trimester of pregnancy rose from 39% to 64%. In 1981, 42% of all births were to women who received prenatal care through the PMI and delivered in public facilities. 22% were to women who received prenatal care and delivered within the private health care system, and the remaining 36% were to women to delivered in public facilities but did not received prenatal care through the PMI system. To evaluate the impact of the government prenatal care program, the outcomes of all births in Martinique in 1980, 1981, and 1982 were compared by type of prenatal care. Although women who received private prenatal care belonged to a higher socioeconomic class, there were no significant differences between women receiving private or public prenatal care in terms of preterm deliveries, low birthweight, or perinatal mortality. This finding suggests that the social class effect on pregnancy outcome can be eliminated through preventive prenatal care. It is further noted that the Martinique program did not involve an emphasis on expensive equipment or the services of specialists; rather, patient education and upgrading the skills of midwwives were central features.

[Transcutaneous cerebral electric stimulation by Limoge current during labor]. / Electrostimulation cérébrale transcutanée par les courants de Limoge au cours de l'accouchement.

In order to test the analgesic efficacy of Anesthelec (transcutaneous cranial electrical stimulation with Limoge currents) during labour and delivery, a double blind study was performed in 20 cases for whom analgesia was necessary. In 10 cases Anesthelec was used with the Limoge currents on and in 10 cases as a sham. Labour and delivery were carried out by a medical team different from that which set up the Anesthelec. The results showed that this method, with or without nitrous oxide inhalation, decreased by 80% the number of epidural and general anaesthesias that would otherwise have been unavoidable. To define the effects of this new method, maternal and foetal parameters of 50 deliveries carried out under Anesthelec were compared with 50 deliveries carried out under epidural analgesia. Anesthelec was used only if analgesia was required. This study was a retrospective comparison between two similar non paired series. Despite the fact that analgesia obtained with Anesthelec was less powerful than with epidural analgesia, this method showed many advantages: total safety for the child and the mother, easy utilization, shorter labour time, decreased number of instrumental extractions and potentially reduced costs. Good acceptance and satisfaction for the mother should allow a rapid evolution of this new method.

Iron supplements versus placebo during pregnancy: its effects on iron and folate status on mothers and newborns.

Iron and folate status of 203 pregnant women have been evaluated at 6 months gestation and on the same women and their newborn infants at delivery. The women who had, at 6 months gestation, a Hb level below 11 g/dl were systematically given iron supplements. Iron or placebo were randomly allocated to the other women. At 6 months of pregnancy, one quarter of the women had a Hb level under 11 g/dl but one third had a serum ferritin level below 12 micrograms/l and more than half had low levels of serum and red cell folate. Iron supplements induced an increase both in Hb levels and in serum ferritin values; however, no significant differences were observed in serum ferritin of the newborn infants, whether their mothers had received iron supplements or not. These results have led us to reconsider the value of ferritin levels at birth as an index of iron stores in the infant. Iron supplements had no effect on the folate status in mothers or infants or on the frequency of obstetrical complications. A significant relationship was found between maternal folate levels and length of gestation. Folate supplementation may reduce the incidence of premature delivery.

Folate and iron deficiencies in mothers and their newborn children.

Iron and folate status was assessed in 79 multiparous French women and 21 immigrant parturient women, previously defined as belonging to a high risk population for nutritional deficiencies, and their newborn infants. Maternal hemoglobin was correlated with ferritinemia and with serum folate values; weight gain during pregnancy appeared to be correlated with mother's iron status at start of labour and gestation duration with folate status. The need of iron and folic supplementation is emphasized for such groups. While a correlation appeared between maternal and newborn values for serum and red blood cell folates and for the RBC indices, no statistical difference was found between the infants born to iron or folate deficient mothers when compared with others.

Influence of routine administration of folic acid and iron during pregnancy.

Haematological and folic acid status were assessed in 200 women in the 6th month of pregnancy. Folic acid deficiencies with no or little haematological impairment were found in one third of the cases, and their occurrence increased when the socioeconomic level was low. During the last trimester of pregnancy, the women were given either iron alone or iron and folic acid supplementation. In the mothers, the rise of folate values in serum and red blood cells, in the folic acid-supplemented group, had no obvious haematological consequences, showing that iron therapy alone can, in developed countries, prevent the anaemia in pregnancy. In the infants, there was no difference in the haematological indices, whatever the mothers' treatment had been. However, a significant difference appeared for the gestational age and, therefore, the height and weight. Folic acid supplementation during pregnancy increased its duration by virtually 1 week.

[The antibacterial activity of amniotic fluid with a correlation between zinc phosphorus concentrations (author's transl)]. / Activité antibactérienne du liquide amniotique corrélation avec la zincamnie et la phosphoramnie.

Antibacterial activity of 22 amniotic fluids collected at different stage of pregnancy have been tested against different types of staphylococci: 209 P, 2961 and Escherichia Coli OMS and 83. At the same time zinc and phosphorus concentration in these fluids have been measured. 77 p. 100 of those fluids present an antibacterial activity, but no correlation has been found with their concentration in zinc and phosphorus. Probably this activity is multifactorial and further studies need to be done to identify the factor or factors responsible for that antibacterial activity.