[Contribution of 3D-ultrasound in the heterotaxy syndromes: about four cases and review of the literature]. / L'apport de l'échographie 3D dans les syndromes d'hétérotaxie : à propos de quatre cas et revue de la littérature.

The position or location of the organs and vessels is usually classified into three types: situs solitus, situs inversus, and situs ambigus. Situs solitus is the usual arrangement of organs and vessels within the body. Only 0.6 to 0.8% of patients with situs solitus and levocardia have associated congenital heart diseases. Situs inversus refers to an anatomic arrangement that is the mirror image of situs solitus. The incidence of congenital heart disease is increased to 3 to 5% in the patients with situs inversus. The patients with heterotaxy have congenital heart disease in high incidence, ranging from 50 to nearly 100%. We present four cases diagnosed in our department in a period of 18 months. With these four cases and a review in the literature, we explore the definitions and characteristics of heterotaxy syndromes and we study the role of 3D ultrasound.

[Syphilis and pregnancy]. / Syphilis et grossesse. Etude de 85 cas en Guyane française.

OBJECTIVE: The aim of our study was to assess the impact of maternal syphilis on pregnancy and foetal/neonatal outcomes. STUDY DESIGN: A retrospective study, conducted from 1 June 1992 to 31 December 2004, involved 85 seropositive pregnant women at the West Guyanese hospital in French Guyana. Inclusion criterias were a positive treponemal pallidum hemagglutination assay (TPHA) with a titre greater or equal to than 1/2560 and a positive Venereal Disease Research Laboratory (VDRL) with a titre greater or equal to than 1/16 for a pregnant woman with different stages of pregnancy. We evaluated maternal characteristics, antenatal care, type of treatment, the presence of coinfections, fetal ultrasound characteristics, outcome of pregnancy, umbilical cord biological diagnosis and neonatal clinical exams. We evaluated the efficiency of early and complete syphilis treatment in the prevention of vertical infection. RESULTS: The proportion of seropositive pregnant women with lack or inadequate antenatal care was high (40%), hence, the diagnosis and treatment were performed late in pregnancy. The incidences of adverse obstetric outcomes were the following: perinatal deaths (20%), stillbirths (12,9%), preterm deliveries (18,8%) and low birth weight (28,2%). Specific ultrasound findings of congenital syphilis (stillbirth excluded) were found in six cases out of 61 (9,8%) and specific neonatal clinical features of early congenital syphilis were found in four cases. There is a high correlation demonstrated between vertical infections and late or inadequate syphilis treatment in a pregnant woman. CONCLUSION: Antepartum syphilis represents a health problem in developing countries and tends to reappear in developed countries. All pregnant women should receive an adequate prenatal care including obligatory screening test for syphilis, we should keep in mind the possibility of syphilitic infection in case of maternal clinical features or foetal signs especially hepatosplenomegaly, hydrops fetalis or intestinal hyperechogenicity.

[Pregnancy and delivery among adolescents under 15: a study of 181 cases in French Guiana]. / Grossesses et accouchement chez les adolescentes de moins de 15 ans: étude de 181 cas en Guyane française.

OBJECTIVE: The purpose of this study were to determine the effects and consequences of premature pregnancy and childbirth among adolescents under 15 years of age in French Guyana. MATERIAL AND METHODS: A retrospective field-case study between the 1(st) and the 31(st) December 2001 identified 181 births among adolescents aged 14 years and under. Comparisons were made with 181 births among 18-year-old first-time mothers taking place over the same period. RESULTS: 1.55% of all births in the maternity ward at St Laurent-du-Maroni Hospital involved adolescents under the age of 15. 24.6% of these young mothers were enrolled in secondary school, 21% were beneficiaries of the national social security health insurance and 61% of them were born outside Guyana. Pre-natal monitoring was less frequent among the group of teenage mothers, and preterm labor (0.04 < p < 0.05), anemia (0.02 < p < 0.03) and Chlamydiae trachomatis infections (0.03 < p < 0.04) are more frequent. There is no significant difference regarding high blood pressure, diabetes, or infectious diseases (except from Chlamydiae) or regarding labor and delivery. Mean birth weight was lower (p = 0.01) and the Apgar score was more often less than 7 at the first minute (p < 0.05) among newborn of teenage mothers. CONCLUSION: While pregnancies among younger teenagers appear to indicate a higher level of associated medical problems, a more thorough pre-natal check-up program would certainly reduce the number of problem related cases. The extremely high proportion of teenage pregnancies in the West of French Guiana has become a major public health issue for the entire region.

[Medical termination of pregnancy at 9-14 weeks gestation. Prospective study of 105 cases in Saint-Laurent-du-Maroni (French Guyana)]. / L'interruption volontaire de grossesse médicamenteuse de 9 à 14 semaines d'aménorrhée: étude prospective de 105 cas à Saint-Laurent-du-Maroni (Guyane française).

OBJECTIVES: To demonstrate the effectiveness and safety of mifepristone 600mg with misoprostol 800 mg, for termination of pregnancy at 9-14 weeks gestation. PATIENTS AND METHODS: This prospective study included 105 women at 9 to 14 weeks gestation given 800 mg of vaginal misoprostol, 2 or 3 days after a single dose of 600 mg of mifepristone for pregnancy termination. Outcomes measures included mean expulsion time, the interval between fotal and placental expulsion, adverse effects, vaginal bleeding, requirement for analgesia, and hospital stay, analyzed by parity and gestational age. RESULTS: Pregnancy termination was successful in 92.4% of the patients without requirement for surgery. The mean time to expulsion was 6 hours. The fetus and placenta were expelled together in 79% of the cases. In 15% the conception products were retained in the cervical canal, and removed with a ring forceps. Additional misoprostol doses were necessary in 33% and analgesia (nalbuphine sublingually, mean dose was 10mg) in 56%. Significant bleeding was observed in 7.5%, leading to curettage in 2 patients. No statistically significant differences were found between the rate of success and term (9-12 versus 12-14) or parity. CONCLUSION: Combining oral mifepristone and vaginal misoprostol is a successful alternative to surgical termination of pregnancy, even after 9 weeks' gestation. The use of nalbuphine for analgesia improves acceptability; sublingual administration helps avoid invasive procedures. Before 14 weeks gestation, the legal limit for termination of pregnancy in France, the choice between the surgical and medical alternatives should be left to the patient.

[HTLV1 infection and pregnancy]. / Infection par le rétrovirus HTLV-1 et grossesse.

OBJECTIVE: We report an epidemiological study with an analysis of the risk factors of the HTLV-1 seroprevalence in pregnant women and their children in the town of St Laurent du Maroni, French Guyana. MATERIAL AND METHOD: HTLV-1 seroprevalence and risk associated factors were first studied in all the pregnant women having delivered at St. Laurent between July 1991 and June 1993. Then, a retrospective analysis was performed in the children, aged between 18 months and 12 years old, born from HTLV-1 infected mothers, focusing especially on the duration of breast feeding and the level of HTLV-1 anti body titers and proviral load. RESULTS: The global HTLV-1 seroprevalence was 4.4% (75/1727) but it was more prevalent among ethnic groups of African origin such as the Noir Marron population (5.5%) and Haitians (6.3%). In the Noir-Marron population, which represents 70% of the studied population, HTLV-1 seropositivity was associated with a maternal age of>35 years, prior miscarriage, prior cesarean section, parity>4, gravidity>6 and negative rhesus factor. After logistic regression, HTLV-1 seropositivity remained associated with gravidity>6 and negative rhesus factor. Out of the 216 children born from 81 HTLV-1 infected mothers, only 21 were found to be HTLV-1 seropositive, giving a crude HTLV-1 transmission rate of 9.7% while among the 180 breast-fed children 10.6% were HTLV-1 seropositive. HTLV-1 seropositivity in children was associated with elevated maternal anti HTLV-1 antibody titer, high maternal HTLV-1 proviral load and child's gender, girls being more frequently HTLV-1 infected than boys. CONCLUSION: HTLV-1 infection, which can be responsible for severe pathologies in adults (adult T cell leukemia and tropical spastic paraparesis/HTLV-1 associated myelopathy) should be screened during pregnancy in women originating from high HTLV-1 endemic areas, as for France, mainly the French West Indies, French Guyana and Intertropical Africa. In case of HTLV-1 seropositivity, mothers should be informed on the risk of transmission and promotion of bottle feeding of their children should be strongly proposed.