[Predictive index for preeclampsia before conception and primary prevention]. / Détermination d'un index prédictif de la prééclampsie en préconceptionnel et propositions thérapeutiques de prévention primaire.

OBJECTIVE: To derive a prediction index based on the most salient history, laboratory and clinical parameters for identifying women at high risk of developing preeclampsia (PE) and to suggest a primary prevention. MATERIAL AND METHOD: Non-pregnant women with a history of PE (n=101) were compared to non-pregnant parous women with a history of one or more successful normotensive pregnancies (n=50) but with comparable age, gestation and parity profiles. The parameters included history and clinical examination; laboratory studies (hemostasis, coagulation, vitamins); and morphological and functional tests (cardiovascular and renal functions). Stepwise logistic regression analysis was applied to develop a three step PE prediction index based on the most discriminant parameters. Strategies to prevent PE in the high-risk group are described. RESULTS: Identification of women at high risk of PE can be done efficiently (88% sensitivity and specificity) using a predictive index based on a simple history, laboratory, clinical and functional information. Strategies to prevent PE in our high-risk group have given encouraging results during next pregnancy. CONCLUSION: Our study gives a predictive index of PE outside of pregnancy and possibilities to do a primary prevention.

[To give birth: in the past and today]. / Accoucher et naître: de jadis à aujourd'hui.

Nowadays in industrialized regions, the majority of childbirths take place in a hospital under high medical and paramedical supervision; this renders the rate of perinatal events very low. This obstetrical safety progressively developped through a practice that, at times, was studded with strange recommendations as well as ingenious concepts. The progress of Medicine and the emancipation of Woman deeply modified the approach to child delivery and influence the importance of its different actors. The current tendency towards a "more natural delivery" may be stepping away from the security of childbirth in a hospital setting.

[Sports and pregnancy]. / Sport et grossesse.

Pregnant women consult often their obstetricians for counselling about their way of living. Particularly answering questions concerning physical activity and sports during pregnancy require a profound knowledge on the physiological adaptations of pregnancy and, on the other hand, on performance and sports physiology. On the basis of the current state of research, physical exercise and sport are to be recommended during pregnancy so long as women are aware of potential dangers and contraindications. Maternal benefits and fetal benefits have today been demonstrated.

[Prevention of prematurity in the French community at the approach of the year 2000]. / La prévention de la prématurité en Communauté française à l'approche de l'an 2000.

The actual results confirm the dominating influence of psychosocial factors on prematurity and low birth weight. The study performed in Liège indicates that these factors must be taken into account for better care of the future mother. The systematic use of a prenatal questionnaire on psychosocial factors draws attention towards the personal situation of the future mother. Detection of some organic or psychosocial risk factors must prompt prophylactic measures even in the absence of any sign of pathologies. Prevention of prematurity has, over the last 30 years, been the primary objective of prenatal follow-up. Its importance must be further emphasized.

[HELLP syndrome]. / HELLP syndrome.

The HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelet count) is a clinical expression of a multilayered disease whose central pathophysiology is abnormal placentation. Clinical research aims logically to search for new predictive and specific markers for the early identification of pregnant women at risk of developing a HELLP syndrome, the most common cause of feto-maternal mortality and morbidity.

[Psychosocial environment and premature birth]. / Environnement psychosocial et naissance prématurée.

For about twenty years, prematurity has been the subject of many preventive actions. In spite of the elaboration of different screening programmes, preterm deliveries rate doesn't decrease. Some somatic risk factors are now known and are the subject of an unconditional screening in prenatal consultation. However we consider that the etiology of many preterm deliveries remain unknown and 55% of preterm cases could be idiopathic without any explanation of pathological order. The clinical observation suggests the existence of a link between preterm delivery and the psychosocial environment of the pregnant woman. According to that suggestion, they are now making a study in the university obstetrical service of the CHR Citadelle (Liège). The first part of the research has enabled to identify different risk factors such as: illegitimate pregnancy, future mother living alone, unemployed husband, no wage, stress, earlier miscarriage, social isolation, less than 2 years between 2 babies, bad satisfying pregnancy on a psychological and/or physical point of view. According to the study and literature results, a psychosocial risk screening overview has been elaborated. It would permit to identify the cases leading surely to a preterm delivery. That study is financed by a convention between the "Ministère de la Culture et des Affaires sociales de la Communauté française".

[Medical disorders which interfere with pregnancy]. / Les affections mèdicales qui interfèrent avec la grossesse.

During pregnancy, the future mother can develop several different diseases. Most of them have a benign prognosis. Cyanotic heart disease, at least when it is accompanied by significant pulmonary hypertension or induces a functional class IV represents a contra-indication to pregnancy. Pregnancy cardiomyopathy generally carries a poor prognosis and may be responsible for the mother's death. Herpes virus pneumopathy can also be extremely dangerous. Lupus erythematosus represents a factor of guarded prognosis for the outcome of pregnancy; discontinuation of the latter should be seriously considered. Hepatic steatosis which is a rare diagnosis must be distinguished from Hellp syndrome in which the maternal prognosis is much better. In this review, we shall briefly discuss various medical diseases which may have a deleterious influence on the evolution of pregnancy or on the foetus. These deleterious influences can be direct, i.e. due to the disease, or indirect, i.e. due to the therapy. We shall successively consider several neurological, cardiological, pulmonary, dermatological and digestive diseases. We shall not take into account viral infections or infections in general, diabetes mellitus or the various vasculo-renal syndromes.

[The effects of labor induction on the progress of childbirth]. / Les effets de l'induction du travail sur le déroulement de l'accouchement.

Labour induction has become a common practice. Given the significant number of induced deliveries carried out each year, it is important to know the consequences of this induction policy. The effects of labour induction on the childbirth are still the subject of considerable controversy. The increase of the caesarean and instrumental extraction rates has already been emphasized in previous studies. This article is based on an analysis of 10,045 deliveries carried out in the CHR Obstetrical Clinic of La Citadelle, between 1991 and 1997. The conclusions are instructive. Thus a departmental policy of setting an induction level of 35% will allocate 2/3 of the workload between 8:00 AM and 8:00 PM during the week, with a preponderance on Friday. The Caesarean rate is not increased but peridurals and recourse to instrumental extraction are more frequent.

[Spontaneous cervical extradural hematoma in a pregnant woman]. / Hématome extradural cervical spontané de la femme enceinte.

Spontaneous spinal extradural hematomas are rare entities, especially during pregnancy. The authors report a case of a 26 years old women who developed as Brown-Sequard syndrome during pregnancy. The patient underwent first a caesarean and thereafter a prompt spinal surgical decompression. Complete sensory-motor recovery occurred after 48 hours. Differential diagnosis of cord compression, etiology of bleeding, conditions of recovery after surgery are discussed.

[Lower urinary tract infections in women. Recent data]. / L'infection des voies urinaires basses chez la femme. Données récentes.

Lower urinary tract infection (LUTI) is a common disease of young women. It usually has a favourable prognosis, but it must not be neglected in view of its frequent recurrences and of the important morbidity it creates leading to social and sexual discomfort. LUTI, therefore, must be diagnosed, and this is done essentially by bacteriological examination of midstream urine. As regards detection of asymptomatic bacteriuria, notably in pregnant or elderly women, the sensitivity of screening is distinctly enhanced by the nitrite and leucocyte esterase tests. Recent publications concerning treatment are in favour of single dose therapy. In uncomplicated urinary tract infections, single doses of antibacterial agents are as effective as the conventional 5 to 7 days administration, and they constitute the treatment of choice of LUTI. In pregnant women, this therapeutic method has the advantage of lesser toxicity and lower frequency of vaginal candidiasis. In patients with frequent recurrences of LUTI, several options are possible: low dose continuous treatment, prophylactic treatment after situations of high risk for reinfection, or self administered single dose as soon as the symptoms reappear. However, the last two methods need to be further evaluated by additional clinical trials.

[Contribution of magnesium gluconate in intravenous tocolysis with ritodrine]. / Apport du gluconate de magnésium dans la tocolyse parentérale par la ritodrine.

The purpose of this randomized study was to compare the efficacy of ritodrine alone (51) versus ritodrine plus magnesium gluconate (56). We concluded that high oral doses of magnesium therapy (4 x 3 gr) potentiate the effects of intravenous beta-agonists, allowing a reduction of the dosage needed and a better "tolerance". Considering the low side effects, it seems reasonable to consider using magnesium in the treatment of premature labour.

Blunted erythropoietin production and decreased erythropoiesis in early pregnancy.

After decreasing in the first trimester of pregnancy, the total red blood cell mass increases in the second and third trimesters to peak at term at about 120% to 125% of nonpregnant values, but how this is brought about by changes in the rate of erythropoiesis is not known. We evaluated erythropoiesis by measuring serum transferrin receptor (TfR) levels in 406 women during normal pregnancy (N = 317), at delivery (N = 63), or in the early postpartum (N = 27). Despite the presence of the placenta and the frequent occurrence of iron deficiency, TfR levels remained low in the first two trimesters and increased in the third trimester and at delivery. To explain why erythropoiesic activity was relatively low in early pregnancy, we also measured serum immunoreactive erythropoietin (Epo) in relation to the degree of anemia. There was a very strong correlation between serum TfR and Epo levels in the entire group (r = .59, P less than .0001) as well as in each period of pregnancy. Epo levels remained low for the degree of anemia and did not correlate with hematocrit in the first two trimesters, but recovered afterwards. In the early postpartum, Epo production and erythropoiesis were normal. We conclude that: (1) erythropoiesis is decreased in the first part of pregnancy but increases afterwards; and (2) blunted Epo production in early pregnancy could be responsible for that observation.

Serum immunoreactive erythropoietin during pregnancy and in the early postpartum.

We studied 209 women during normal pregnancy, at delivery, or in the early postpartum, to determine whether erythropoietin (EPO) response was appropriate for the degree of anaemia. Serum immunoreactive EPO was measured in 74 nonpregnant women, including 33 normal subjects (16.4 +/- 4.1 mU/ml) and 41 women with hypoplastic, haemolytic, dyserythropoietic, or iron-deficient anaemia. An inverse linear relationship (R = -0.88, P less than 0.0001) between log(EPO) and Hct was observed. Predicted EPO values were derived for each Hct and an O/P ratio of observed/predicted log(EPO) was calculated for each sample (1.00 +/- 0.10, range 0.80-1.20). Serum EPO levels (mU/ml) were significantly higher during pregnancy (30 +/- 16, n = 142), at delivery (31 +/- 16, n = 41), and on day 7 postpartum (37 +/- 35, n = 26) than in normal women (P less than 0.001). EPO levels increased steadily from 18 +/- 6 mU/ml in the first, to 26 +/- 14 mU/ml in the second, and to 35 +/- 18 mU/ml in the third trimester (P less than 0.0001). The O/P ratio was normal on day 7 postpartum (1.01 +/- 0.16), at delivery (1.03 +/- 0.16), and in the third trimester (0.96 +/- 0.15), but was significantly reduced in the first two trimesters (0.88 +/- 0.15, P less than 0.001). A significant negative correlation between log(EPO) and Hct was lacking in the first two trimesters, was present but with a reduced slope during the third trimester and at delivery, and was normal postpartum. We conclude that EPO response to anaemia is impaired in early pregnancy, recovers in late pregnancy, and normalizes rapidly in the postpartum.