[Prospective evaluation of our protocol for screening gestational diabetes by O'Sullivan's test]. / Evaluation prospective de notre protocole de dépistage du diabète gestationnel avec le test de O'Sullivan.

OBJECTIVES: We evaluated prospectively our protocol for screening diabetes during pregnancy. PATIENTS AND METHODS: We applied recommendations of the French National College for Obstetricians and Gynecologists with screening by O'Sullivan's test and HGPO with 100g when the result was greater than 1.40 g/l. This protocol was discussed and approved by our team including a neonatalogist. RESULTS: We included 780 patients delivered between the 1(st) January and the 1(st) October 2005. Between them, 628 were screened (80.5%) and 39 presented gestational diabetes (39/628=6.2%). Fetal ultrasound at 38 weeks of amenorrhea was included in our protocol but applied only for 25.8% of our patients. In the subgroup with gestational diabetes, the rate of induction of labor was 38.4% (15/39), with a cesarean delivery for 23% (9/39) and macrosomia for 20.5% (8/39) of the newborn. CONCLUSIONS: This study showed us that we have to improve the application of our protocol and to try to obtain a shorter time between the two test, O'Sullivan and HGPO, when performed.

[Risk factors of preeclampsia in single pregnancy]. / Facteurs de risque de la prééclampsie en cas de grossesse unique.

OBJECTIVES: Study of the clinical risk factors of preeclampsia during a single pregnancy. MATERIALS AND METHODS: Retrospective case-control study during five years. RESULTS: One hundred and eighty-eight cases of preeclampsia have been studied, with 147 called severe (78.2%). We find as risk factors: first pregnancy (OR=2.11; IC 95% [1.30-3.35]), primiparity (OR=2.67; IC 95% [1.67-4.29]), primipaternity (OR=3.55; IC 95% [2.13-5.83], maternal overweight (OR=2.50; IC 95% [1.55-4.05]), personal history of preeclampsia (OR=8.12; IC 95% [2.37-45.65]), personal history of hypertension (OR=2.77; IC 95% [1.01-7.99]), familial history of preeclampsia (OR=1.04; IC 95% [1.01-1.08]), familial history of hypertension at the first step (OR=2.61; IC 95% [1.32-5.47]). Two elements have been found as protected: tobacco before pregnancy (OR=0.51; IC 95% [0.36-0.85]), tobacco during pregnancy (OR=0.52; IC 95% [0.30-0.92]). CONCLUSION: Preeclampsia is responsible of a high maternal and fetal morbidity. The risk factors are widespread, the only use of them is not enough to determine the individual risk. A second step could be to determine if biological markers are better than clinical factors.

[Early diagnosis of traumatic extra-pericardial luxation of the heart. Value of tomodensitometry. Apropos of a case]. / Diagnostic précoce de la luxation extrapéricardique du coeur d'origine traumatique. Intérêt de la tomodensitométrie. A propos d'un cas.

Heart luxation is a rare complication of chest trauma. The rupture of pericardium must be diagnosed as soon as possible, particularly before prolonged orthopaedic surgery for multitrauma, as a cardiac arrest may occur during anaesthesia. This report underlines the difficulties of diagnosis in a 40-year-old patient with head trauma, chest trauma and multiple fractures. The diagnosis was suspected on unstable blood pressure and left lung atelectasis. The computed tomography showed herniation of the left ventricle. Emergency thoracotomy showed the left rupture of pericardium with complete left heart dislocation. Orthopaedic operation was carried out three days later. Computed tomography in multitrauma patients, seems to be decisive for early diagnosis of heart luxation. Emergency thoracotomy is essential.