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1.
Ultrasound Obstet Gynecol ; 52(6): 769-775, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29363850

RESUMEN

OBJECTIVE: The quality of ultrasound images is impaired in obese patients. All ultrasound scanners are calibrated for an ultrasound propagation velocity of 1540 m/s, but the propagation in fatty tissue is slower (in the order of 1450 m/s). The main objective of this study was to evaluate the quality of images obtained with different ultrasound propagation velocity settings during the mid-trimester fetal ultrasound examination in obese patients. METHODS: This was a cross-sectional study using image sets of four recommended scanning planes collected from 32 obese pregnant women during their mid-trimester fetal scan. Each image set comprised three images obtained successively at three different propagation velocity settings (1540 m/s, 1480 m/s and 1420 m/s). A panel of 114 experts assessed the quality of 100 image sets, grading them from A (most acceptable) to C (least acceptable). Scanning-plane-specific indicators of adiposity (fatty layer thickness, probe-to-organ distance) were analyzed for each scanning plane. RESULTS: The experts had a mean of 18.1 ± 10.2 years of experience. The grade distribution (A, B, C) differed significantly (P < 0.0001) between the three propagation velocity settings tested; at the lower speed of 1480 m/s, images were most often graded A, while at the conventional speed of 1540 m/s, they were most often graded C. Regardless of the scanning plane, the thicker the fatty layer of the abdominal wall in a given plane, the lower the preferred speed (P < 0.0001). CONCLUSION: The construction of images taking into account ultrasound propagation velocities lower than 1540 m/s can improve significantly the quality of images obtained during mid-trimester fetal ultrasonography in obese women. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.


Asunto(s)
Aumento de la Imagen/normas , Obesidad/complicaciones , Ultrasonografía Prenatal/métodos , Estudios Transversales , Femenino , Humanos , Aumento de la Imagen/métodos , Obesidad/diagnóstico por imagen , Embarazo , Complicaciones del Embarazo/diagnóstico por imagen , Trimestres del Embarazo
2.
J Prev Med Hyg ; 56(2): E95-E101, 2015 Aug 05.
Artículo en Inglés | MEDLINE | ID: mdl-26789995

RESUMEN

INTRODUCTION: French national health programmes take into account social deprivation in their implementation, those targeting perinatal outcomes, especially. The main aim of the present work was to assess the association between individual social deprivation and adverse perinatal outcomes. METHODS: A multicentre cross-sectional population-based survey was performed between October and December 2007. Eligible women delivered a baby in one of the three maternity hospitals of Clermont-Ferrand area, and read and spoke French fluently. Women who had undergone voluntary termination of pregnancy were excluded. Individual social deprivation was measured by the EPICES score. Standard prenatal follow-up defined by having less than 7 consultations and quality of prenatal care defined by having at least four consultations were measured. Adverse perinatal outcomes were measured by a composite criterion defined by women who had the occurrence of the three main causes of pregnancy-related disorders: preterm delivery, and/or diabetes, and/or obstetrical hypertension. RESULTS: Of the 471 eligible women, 464 were finally included. One hundred and fifteen (24.78%) women were socially deprived. The most deprived women had poor standard prenatal follow-up (p = 0.003) and poor quality of prenatal care (0.03). Nationality was the sole confounding factor identified. Deprived women had a two-fold greater risk of adverse perinatal outcomes, adjusted odds ratio 1.95 [1.15; 3.29]. DISCUSSION: Social deprivation was associated with adverse perinatal outcomes. Social deprivation should be systematically screened in pregnant women standard follow-up, among migrant women, especially.

4.
Morphologie ; 97(317): 65-7, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23473874

RESUMEN

The 48,XXYY syndrome is a rare uncommon gonosome aneuploidy and its incidence is estimated to be 1:18,000-1:40,000. The phenotype associated with this syndrome, classically described as Klinefelter variant, is extremely variable but developmental abnormalities are always present. Ultrasound signs during pregnancy are inconsistent, and only three prenatal cases have been described in the literature. Here, we report a case of 48,XXYY syndrome identified in prenatal period because of the presence of polyhydramnios and bilateral clubfeet on second trimester ultrasound. This observation shows the importance of chromosomal prenatal diagnosis in cases with bilateral clubfeet on morphologic ultrasound. This diagnosis is essential for further characterization of the prenatal phenotype and to improving genetic counselling.


Asunto(s)
Síndrome de Klinefelter/diagnóstico por imagen , Ultrasonografía Prenatal , Aborto Eugénico , Amniocentesis , Bandeo Cromosómico , Pie Equinovaro/diagnóstico por imagen , Pie Equinovaro/embriología , Femenino , Humanos , Cariotipificación , Síndrome de Klinefelter/diagnóstico , Síndrome de Klinefelter/embriología , Síndrome de Klinefelter/genética , Masculino , Fenotipo , Polihidramnios/etiología , Embarazo , Segundo Trimestre del Embarazo , Adulto Joven
5.
Ultrasound Obstet Gynecol ; 37(1): 110-2, 2011 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-20878667

RESUMEN

We report three cases of fetal lobar bronchial atresia referred to our Fetal Medicine Center during the mid-trimester of pregnancy over the last 15 years. Lobar bronchial atresia can mimic a main stem bronchial atresia on mid-trimester ultrasound examination as it induces extensive lobar enlargement, major mediastinal shift and eversion of the diaphragm. It was associated with severe pulmonary hypoplasia in all three cases, even though polyhydramnios and ascites were absent in two. Termination of pregnancy was performed at parental request after extensive counseling in each of the cases and necropsy confirmed one or two enlarged lung lobes leading to major compression of the remaining lobe(s) of the ipsilateral lung, the contralateral lung and the heart. No other anomalies were observed and the karyotype was normal in all cases.


Asunto(s)
Bronquios/anomalías , Bronquios/diagnóstico por imagen , Autopsia , Bronquios/patología , Resultado Fatal , Femenino , Humanos , Embarazo , Diagnóstico Prenatal , Ultrasonografía , Adulto Joven
6.
Diagn Interv Imaging ; 102(2): 109-113, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32819887

RESUMEN

PURPOSE: The purpose of this study was to assess the impact of the free choice of ultrasound propagation velocity on ultrasound image construction to improve the completion rate and anatomical quality of fetal second-trimester ultrasound examination in obese women. MATERIALS AND METHODS: This repeated cross-sectional single-center study retrospectively collected second-trimester ultrasound images of 88 obese women. During the first period, ultrasound examinations were performed in 44 women (mean age, 31.4±5.9 [SD] years; range: 21.1 - 45.3 years) applying only the standard 1540m/s tissue ultrasound velocity (group 1). During the second period, ultrasound examinations were performed in other 44 women (mean age, 31.4±5.1 [SD] years; range: 20.6 - 41.6 years) with the operator free to choose among three available velocity settings (1420m/s, 1480m/s or 1540m/s) for the scanning planes for the morphological images (group 2). All women underwent mid-trimester ultrasound examination at 20 to 24 gestational weeks. Two observers assessed the examinations in both groups for completeness, quality, and duration of fetal ultrasound examinations. RESULTS: No differences in age (P>0.99), body mass index (P=0.67), prevalence of previous cesarean delivery (P=0.30) or gestational age at the second-trimester scan (P=0.20) were found between the two groups. The mean cumulative duration of these ultrasound examinations was longer in group 1 than in group 2 (for both the complete (P=0.04) and incomplete (P=0.03) examinations). The quality of the anatomic images according to Salomon's criteria was less often acceptable in group 1 (5/44, 11.4%) than in group 2 (15/44, 34.1%) (P=0.02). CONCLUSION: Free choice of ultrasound velocity improves the overall performance of fetal second-trimester ultrasound examinations in obese women.


Asunto(s)
Obesidad , Ultrasonografía Prenatal , Adulto , Estudios Transversales , Femenino , Humanos , Obesidad/diagnóstico por imagen , Embarazo , Segundo Trimestre del Embarazo , Estudios Retrospectivos
7.
Gynecol Obstet Fertil ; 37(7-8): 598-603, 2009.
Artículo en Francés | MEDLINE | ID: mdl-19577945

RESUMEN

OBJECTIVE: To describe perioperative management and perinatal outcome for patients undergoing laparoscopy during pregnancy. PATIENTS AND METHODS: We conducted a retrospective study of all cases of laparoscopy during pregnancy performed in our university hospital over a period of six years (from February 2000 to February 2006). RESULTS: We observed 34 cases managed from five to 30 weeks of gestation (11 cases of adnexal torsion, ten adnexal masses, eight appendicitis, one cholecystitis, one sigmoid volvulus, one pelvic peritonitis, two heterotopic pregnancies). Open laparoscopy was used in 12 cases. Conversion was required in two cases mainly due to adherences (one borderline lesion at 16 weeks and one tubal cyst torsion at 24 weeks). No maternal complication was observed. One miscarriage occurred at Day 1 (peritonitis, five weeks of gestation) and one patient opted for abortion. No threatened preterm labour occurred after the perioperative course and no neonate required admission in neonatology unit. DISCUSSION AND CONCLUSION: This study illustrates safety and efficacy of laparoscopy in management of surgical diseases in the gravid patient. Emergent indications are the most common, highlighting the need for all physicians to know specific recommendations related to laparoscopy during pregnancy.


Asunto(s)
Laparoscopía/métodos , Complicaciones del Embarazo/cirugía , Resultado del Embarazo , Enfermedades de los Anexos/cirugía , Adulto , Apendicitis/cirugía , Femenino , Cálculos Biliares/cirugía , Humanos , Laparoscopía/efectos adversos , Atención Perinatal , Atención Perioperativa , Embarazo , Primer Trimestre del Embarazo , Segundo Trimestre del Embarazo , Estudios Retrospectivos , Anomalía Torsional/cirugía , Resultado del Tratamiento , Adulto Joven
8.
J Gynecol Obstet Biol Reprod (Paris) ; 38(7): 559-73, 2009 Nov.
Artículo en Francés | MEDLINE | ID: mdl-19819647

RESUMEN

OBJECTIVES: Our goal was to evaluate the level of integration of general practitioners within the perinatal network in the Auvergne. MATERIALS AND METHODS: A cross-sectional study was realized. The questionnaire was sent by post to the 1346 general practitioners who were members of the "Union régionale des médecins libéraux" (Regional association of private doctors in the Auvergne). Follow-up phone calls were also made. RESULTS: The overall response to the questionnaire was 29.8%. Of those who replied, 76.3% were involved in the care of pregnant women or newly born babies. Among them, 51.2% had a consultation with a pregnant woman less than once a week and 53,5% had a consultation with a newly born more than once a week. A third were aware of the network and 25.7% had knowledge of the medical record provided by the network. Among them, 91.3% thought that a common medical record was necessary to improve the coordination of care. The answers differed according to age, area of responsibility, the administrative geographic position in the Auvergne, type of practise (hospital, private), and the sex of those who replied. CONCLUSION: Despite a high a priori agreement, we must improve the level of information and training given to general practitioners within our perinatal network.


Asunto(s)
Redes Comunitarias , Atención Perinatal/estadística & datos numéricos , Médicos de Familia/estadística & datos numéricos , Estudios Transversales , Femenino , Francia , Humanos , Recién Nacido , Persona de Mediana Edad , Pautas de la Práctica en Medicina/estadística & datos numéricos , Embarazo , Encuestas y Cuestionarios
9.
J Gynecol Obstet Biol Reprod (Paris) ; 38(1): 61-71, 2009 Feb.
Artículo en Francés | MEDLINE | ID: mdl-19046827

RESUMEN

OBJECTIVES: The objective of this work was to determine the principal axes for measuring the satisfaction of women transferred within a perinatal network. MATERIAL AND METHODS: We began with two successive qualitative sociological approaches (18 semi-structured interviews of women and of couples in 2004 and 2006-2007) and one quantitative approach (questionnaire survey of 583 women hospitalized in 15 of the 16 maternity units in the Auvergne network during a two-week period in 2004). RESULTS: The qualitative surveys show that the procedures at arrival at the new establishment and the feeling of consistency that they did or did not induce, the identification of the participants, an understanding of their role, and the objectives of the new examinations were all important dimensions. During hospitalization, explanations of who does what and the consistency of the information provided also played a role in this satisfaction. The quantitative survey (participation rate=89%) showed that 77% of the women were aware of the possibility of an in utero transfer. Nonetheless, most of them had very little information about the network. CONCLUSION: It is possible to identify specific themes associated with women's satisfaction about in utero transfers that are useful for constructing a questionnaire that must, in turn, be validated.


Asunto(s)
Encuestas de Atención de la Salud/métodos , Servicios de Salud Materna/normas , Madres/psicología , Satisfacción del Paciente , Atención Perinatal/normas , Femenino , Humanos , Recién Nacido , Entrevistas como Asunto , Satisfacción del Paciente/estadística & datos numéricos , Embarazo , Psicometría , Encuestas y Cuestionarios
10.
Ultrasound Obstet Gynecol ; 32(2): 188-98, 2008 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-18512853

RESUMEN

OBJECTIVES: To describe and assess the sonographic findings, evolution and clinical implications of thrombosis of the fetal dural sinuses. METHODS: We compiled a multicenter report of the outcomes of five cases with a prenatal diagnosis of thrombosis of the dural sinuses, and one case in which thrombosis of the dural sinus was diagnosed at necroscopy after termination of pregnancy. Prognostic factors are discussed, and suggestions made for prenatal and postnatal management. RESULTS: The mean (range) gestational age at diagnosis of thrombosis of the dural sinuses in the five cases in which it was made prenatally was 25.2 (22-31) weeks. In these five cases, diagnosis was made by sonography and confirmed by magnetic resonance imaging (MRI), which showed a blood clot in the region of the torcular herophili. Three of the six cases delivered vaginally with favorable sonographic findings, and normal clinical neurological development. Two pregnancies were terminated at the request of the parents. In one of these cases the prognosis was poor, with signs of fetal decompensation or cardiac failure; the pregnancy was terminated and necropsy revealed thrombosis of the occipital dural sinuses associated with a hemangioma. One infant, in whom the thrombosis developed in conjunction with a dural sinus malformation, died at 4 months of age. CONCLUSIONS: Thrombosis of the cerebral venous circulation can occur antenatally and is detectable by fetal real-time and color Doppler ultrasound examination. A review of the literature supports targeted evaluation of the fetus by serial ultrasound imaging and MRI to help guide the diagnosis, and to improve the counseling and management of such cases. Partial or total regression, isolated abnormality, absence of fetal decompensation or signs of cardiac failure and favorable clinical evolution are suggestive of favorable prognosis. In such cases, non-interventional neonatal management is recommended.


Asunto(s)
Senos Craneales/anomalías , Angiografía por Resonancia Magnética/métodos , Diagnóstico Prenatal/métodos , Trombosis de los Senos Intracraneales/diagnóstico , Ultrasonografía Prenatal/métodos , Adulto , Consejo , Senos Craneales/cirugía , Femenino , Edad Gestacional , Humanos , Recién Nacido , Padres/psicología , Embarazo , Resultado del Embarazo , Segundo Trimestre del Embarazo , Trombosis de los Senos Intracraneales/cirugía , Trombosis de los Senos Intracraneales/terapia
11.
Gynecol Obstet Fertil ; 36(5): 529-31, 2008 May.
Artículo en Francés | MEDLINE | ID: mdl-18462976

RESUMEN

Lobar congenital emphysema is a rare pulmonary malformation corresponding to progressive overinflation of a pulmonary lobe secondary to partial bronchial obstruction. Prenatal diagnosis is mainly based on lung hyperechoic area. Sonographic features are not specific highlighting the interest of fetal MRI or postnatal tomodensitometry. This case report describes prenatal detection including pitfalls and postnatal management.


Asunto(s)
Enfermedades Fetales/diagnóstico , Diagnóstico Prenatal/métodos , Enfisema Pulmonar/diagnóstico , Ultrasonografía Prenatal/métodos , Adulto , Femenino , Edad Gestacional , Humanos , Recién Nacido , Imagen por Resonancia Magnética , Neumonectomía , Embarazo , Resultado del Embarazo
12.
J Gynecol Obstet Biol Reprod (Paris) ; 37(3): 237-45, 2008 May.
Artículo en Francés | MEDLINE | ID: mdl-18329186

RESUMEN

OBJECTIVES: Postpartum haemorrhage (PPH) constitutes the leading cause of maternal deaths in France, and the majority of these deaths are preventable. The objective of this study was to ascertain policies for prevention and early management of PPH in maternity units, and to compare the results with scientific evidence. The survey was part of the Euphrates European project, and was conducted in France in 2003 before national recommendations for clinical practice related to PPH were launched. MATERIALS AND METHODS: A cross-sectional declarative survey was conducted in six perinatal networks representing 132 maternity units. A postal questionnaire was sent to all units. Main outcomes measured were stated policies for prevention, diagnosis and management of PPH. RESULTS: There was no definition of PPH in one out of four units, and no written protocol for PPH management in one out of six. Policies of using preventive uterotonics were widespread, but variation was observed concerning the timing of administration, and association with the other components of active management of the third stage of labour. Policies about drugs used for management of PPH also varied. CONCLUSION: Variations in policies show firstly that evidence-based improvement in practice is possible, and secondly that further research is needed on poorly documented aspects of PPH management.


Asunto(s)
Protocolos Clínicos , Hemorragia Posparto/terapia , Estudios Transversales , Femenino , Francia , Unidades Hospitalarias , Humanos , Embarazo , Encuestas y Cuestionarios
13.
J Gynecol Obstet Hum Reprod ; 47(3): 107-111, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29223928

RESUMEN

INTRODUCTION: In a population-based study, we found an overall false-positive rate of 8.8% for the second and third trimester ultrasounds. Although numerous studies have been performed to examine factors which lead to false negatives, the same is not true for the factors associated with false positives. The principal objective of this study was to look for risk factors for false-positive diagnoses of fetal malformations on obstetric ultrasound scans. MATERIAL AND METHODS: In this nested case-control study, the case infants were those whose mother had a false-positive antenatal ultrasound diagnosis of a malformation during the second or third trimester (ultrasound false-positives) and who were live - or stillborn in Auvergne in 2006-2010. The control group comprised all children who were ultrasound true-negatives in 2005 and 2007. The study included 46 cases and 184 controls, matched according to the level of the maternity unit in which they were born. RESULTS: Most false-positive diagnoses were minor malformations. The mean term at this false-positive diagnosis was 27.7±5.4 weeks; in 46.8% of cases, the diagnosis was made during the second-trimester ultrasound. A single malformation was suspected in 95.7% of the cases. In 97.9% of cases, only one anatomical system was affected. In all, 49 malformations were identified among the 46 cases and their distribution differed according to anatomical system. The only risk factor identified was a body mass index (BMI)<25 (ORa=1.7; 95%CI: 1.2-2.4). DISCUSSION: A maternal BMI<25 was the only risk factor identified for a false-positive ultrasound diagnosis of a fetal malformation.


Asunto(s)
Anomalías Congénitas/diagnóstico por imagen , Errores Diagnósticos , Ultrasonografía Prenatal/normas , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Recién Nacido , Embarazo , Segundo Trimestre del Embarazo , Tercer Trimestre del Embarazo , Factores de Riesgo
14.
Diagn Interv Imaging ; 99(9): 519-524, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-29934239

RESUMEN

PURPOSE: To identify the effects of shear wave elastography in the fetus for evaluation in widespread use. MATERIALS AND METHODS: The Health Risk Assessment method proposed by the National Research Council was used with literature to evaluate the safety of shear wave elastography for the fetus regarding its potential effects in human tissues. RESULTS: The experimental and epidemiologic data from 25 articles showed that shear wave elastography maintained the same thermal effect as pulsed Doppler ultrasound already authorized in obstetrics, and that cavitation effect on fetal tissue is improbable. Nonetheless, the vibratory character of shear waves could induce displacement of fetal tissue while potential effects of very short duration energy peaks of the radiation force focused wave front remain unknown. CONCLUSION: The actual knowledge does not provide enough information to assess the effects of shear wave elastography on fetal tissues, thus these points have to be explored by further experimental studies.


Asunto(s)
Diagnóstico por Imagen de Elasticidad , Feto/diagnóstico por imagen , Medición de Riesgo , Animales , Femenino , Humanos , Embarazo , Ultrasonografía Doppler , Ultrasonografía Prenatal
15.
Gynecol Obstet Fertil ; 35(11): 1133-5, 2007 Nov.
Artículo en Francés | MEDLINE | ID: mdl-17977046

RESUMEN

We report a case of unexpected severe hypertriglyceridemia (140N) diagnosed at 33 weeks during a second gestation. The risk of acute pancreatitis indicated plasmapheresis (three procedures) with reduction of hypertriglyceridemia (6N) and no impact on fetal well-being. Immediate recurrence led to induction of labour at 34 weeks. Spontaneous regression occurred after delivery. We demonstrated reduced lipoprotein lipase activity with no mutation for apolipoprotein E, nor lipoprotein lipase in favour of a potential pregnancy-induced inhibitor of lipoprotein degradation.


Asunto(s)
Hipertrigliceridemia/terapia , Plasmaféresis/métodos , Complicaciones del Embarazo/terapia , Adulto , Femenino , Humanos , Recién Nacido , Lípidos/sangre , Masculino , Pancreatitis/prevención & control , Embarazo , Resultado del Embarazo , Tercer Trimestre del Embarazo/sangre
16.
Gynecol Obstet Fertil ; 35(9): 757-63, 2007 Sep.
Artículo en Francés | MEDLINE | ID: mdl-17707672

RESUMEN

OBJECTIVE: To investigate the influence of obstetrician and patient respectively on mode of delivery in case of breech presentation at term. PATIENTS AND METHODS: This retrospective study included all women with a singleton pregnancy in a breech presentation delivered at term in a tertiary care maternity unit from January 1998 to December 2004. Mode of delivery was suggested by a score based on maternal age, parity, obstetrical past history, radiopelvimetry and cephalopelvic confrontation. The obstetrician was free to follow or not the score indication and patient's informed consent was required concerning the mode of delivery. Our main outcome measurements were mode of delivery and neonatal parameters. RESULTS: Two hundred cases were identified. Elective cesarean section increased progressively (from 52% in 1998 to 80% in 2004 [P=0,002]). Neonatal status and proportion of score in favour of vaginal birth remained stable during the study period. The rise in cesarean section rate was mainly due to patient's request (P=0,001) whereas the trend of obstetrician in favour of cesarean did not reach significance (P=0,3). DISCUSSION AND CONCLUSION: The rise of elective cesarean section for term breech delivery in a maternity unit using a predefinite score is mainly induced by patient's request. This evolution has no effect on neonatal status.


Asunto(s)
Presentación de Nalgas , Parto Obstétrico , Presentación de Nalgas/psicología , Parto Obstétrico/psicología , Femenino , Humanos , Aceptación de la Atención de Salud , Relaciones Médico-Paciente , Embarazo
17.
J Gynecol Obstet Hum Reprod ; 46(4): 373-377, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28643667

RESUMEN

INTRODUCTION: Vasa previa (VP) is defined as a condition in which the fetal blood vessels, unsupported by the placenta or the umbilical cord, run through the membranes of the lower uterine segment. It is associated with a high risk of stillbirth by exsanguination. This study aimed to assess the clinical context of diagnosis of VP in order to elaborate a strategy for its prenatal diagnosis and to improve its obstetrical and neonatal outcomes. MATERIAL AND METHODS: This historical cohort study covered the period from January 1, 2011 to December 31, 2015. All women who gave birth at our obstetrics and gynecology department (level 3 university hospital) and who had a VP were included. RESULTS: Eight cases of VP among 18,152 deliveries were observed (0.04%). Transvaginal sonography (TVS) with color Doppler allowed a prenatal diagnosis of VP in all cases. The mean gestational age at diagnosis was 26 weeks. Placental abnormalities were noted in 7 cases (87.5%) as bipartita or low-lying placenta. In one case (12.5%), the placenta appeared normal while umbilical cord insertion was velamentous. In 2 cases (25%), concomitant placental and cord abnormalities were objectified. The mean gestational age at delivery was 37±2.1 weeks. Seven deliveries (87.5%) had been by caesarean sections, except one, which occurred by vaginal route at 33 weeks of gestation (twin pregnancy). No case of perinatal death was observed. DISCUSSION: Prenatal diagnosis of VP during screening ultrasounds appears easy to perform and can improve obstetrical and neonatal outcomes. For this purpose, TVS with color and pulsed Doppler remains essential, particularly when an anomaly of the umbilical cord insertion and/or placental location is diagnosed.


Asunto(s)
Resultado del Embarazo/epidemiología , Ultrasonografía Prenatal , Vasa Previa/diagnóstico , Vasa Previa/epidemiología , Adulto , Estudios de Cohortes , Femenino , Edad Gestacional , Humanos , Recién Nacido , Pautas de la Práctica en Medicina/estadística & datos numéricos , Embarazo , Pronóstico , Conducta de Reducción del Riesgo , Ultrasonografía Doppler en Color/estadística & datos numéricos , Ultrasonografía Prenatal/estadística & datos numéricos
18.
Gynecol Obstet Fertil Senol ; 45(6): 348-352, 2017 Jun.
Artículo en Francés | MEDLINE | ID: mdl-28552753

RESUMEN

OBJECTIVES: To identify predictive criteria for a positive expectation in the context of rupture of membranes after 37 WG. METHODS: Single-center retrospective study including ROM≥37 WG. The primary outcome was labour onset within 24hours. We compared predictive factors for occurrence of spontaneous labour and described obstetrical and neonatal outcomes according to initial Bishop score<6 or ≥6. RESULTS: From January 2013 to December 2014, 520 patients were included. The predictive factors in case of unfavorable cervix were clinical leakage (P<0.001) and a cervical dilatation≥2cm (P<0.001) according to multivariate analysis. When the expectancy failed, there was a higher rate of cesarean section (24.3% vs. 9.6% P<0.001) but no more proven maternal-fetal infection. In case of Bishop≥6, we identified no predictive factor for labour onset but Apgar<7 at 5minutes (18.7% vs. 3.2% P=0.01) and admission to neonatal unit (18.8% vs. 3.2% P=0.04) were more frequent without majoration of maternal-fetal infection. CONCLUSION: The favorable expectation was the outcome for 70.8% of ROM at term. Clinical leakage and dilated cervix appeared as the main predictors in case of Bishop<6. Majoration of low Apgar score and admission to neonatal unit could be increased when no labour onset occurred despite Bishop≥6.


Asunto(s)
Rotura Prematura de Membranas Fetales , Edad Gestacional , Inicio del Trabajo de Parto , Adulto , Puntaje de Apgar , Femenino , Humanos , Recién Nacido , Cuidado Intensivo Neonatal , Primer Periodo del Trabajo de Parto , Embarazo , Resultado del Embarazo , Estudios Retrospectivos , Factores de Tiempo
19.
J Pregnancy ; 2017: 4168541, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29082043

RESUMEN

The aim is to compare the prevalence of maternal deficiencies in micronutrients, the obstetrical and neonatal complications after bariatric surgery according to surgical techniques, the time between surgery and conception, and BMI at the onset of pregnancy. A retrospective cohort study concerned 57 singleton pregnancies between 2011 and 2016 of 48 adult women who have undergone bariatric surgery. Small-for-gestational-age neonates were identified in 36.0% of pregnancies. With supplements intake (periconceptional period: 56.8%, trimester 1 (T1): 77.8%, T2: 96.3%, and T3: 100.0%), nutritional deficiencies involved vitamins A (T1: 36.4%, T2: 21.1%, and T3: 40.0%), D (T1: 33.3%, T2: 26.3%, and T3: 8.3%), C (T1: 66.7%, T2: 41.2%, and T3: 83.3%), B1 (T1: 45.5%, T2: 15.4%, and T3: 20.0%), and B9 (T1: 14.3%, T2: 0%, and T3: 9.1%) and selenium (T1: 77.8%, T2: 22.2%, and T3: 50.0%). There was no significant difference in the prevalence of nutritional deficiencies and complications according to surgery procedures and in the prevalence of pregnancy issues according to BMI at the beginning of the pregnancy and time between surgery and pregnancy. Prevalence of micronutritional deficiencies and small-for-gestational-age neonates is high in pregnant women following bariatric surgery. Specific nutritional programmes should be recommended for these women.


Asunto(s)
Avitaminosis/epidemiología , Cirugía Bariátrica/efectos adversos , Recién Nacido Pequeño para la Edad Gestacional , Estado Nutricional/fisiología , Complicaciones del Embarazo/epidemiología , Adulto , Índice de Masa Corporal , Femenino , Humanos , Recién Nacido , Obesidad , Embarazo , Resultado del Embarazo , Atención Prenatal/métodos , Estudios Retrospectivos
20.
Eur J Obstet Gynecol Reprod Biol ; 125(2): 176-84, 2006 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-16099580

RESUMEN

OBJECTIVE: Compare neonatal complications according to the planned mode of delivery and according to whether the women gave birth at a maternity unit that applied "consensus" guidelines. STUDY DESIGN: The study used the database of the AUDIPOG Sentinel Network (n=71,919 pregnancies between 1994 and 2000). The principal outcome was a composite variable that included neonatal morbidity and mortality. A survey of obstetric practices was sent to 175 maternity units belonging to the network. Consensus guidelines were defined from the survey responses and taken into account in the database analysis. RESULTS: Neonatal complications did not differ between the group of women with term babies in breech presentation for whom vaginal delivery was planned and those for whom an elective caesarean was planned (adjusted OR=1.33; 95% CI: 0.63-2.80). The survey allowed us to define a set of six criteria for deciding on mode of delivery; it established a consensus, followed by 42% of the maternity units in the study. The rate of neonatal complications among the women with planned vaginal delivery was lower for those giving birth in units that applied the consensus guidelines than among those in the other units: adjusted OR=0.27 (95% CI: 0.09-0.85). CONCLUSION: The risk of neonatal morbidity according to planned mode of delivery for term breech babies was lower for those giving birth in units that applied the consensus guidelines than among those in the other units.


Asunto(s)
Traumatismos del Nacimiento/etiología , Presentación de Nalgas , Parto Obstétrico , Guías de Práctica Clínica como Asunto , Adulto , Presentación de Nalgas/mortalidad , Presentación de Nalgas/terapia , Parto Obstétrico/efectos adversos , Parto Obstétrico/métodos , Parto Obstétrico/normas , Femenino , Muerte Fetal/epidemiología , Francia/epidemiología , Humanos , Recién Nacido , Embarazo , Estudios Retrospectivos , Encuestas y Cuestionarios , Resultado del Tratamiento
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