[A new case of hydatidiform mole occurring on one of the ova of a twin pregnancy]. / Un nouveau cas de môle hydatiforme survenant dans l'un des oeufs d'une grossesse gémellaire.

The authors report here a new case of hydatid mole in one of the eggs of a mole pregnancy. 48 other cases have been reported in 13 publications. The birth of a viable, well-developed fetus is described in 13 instances (27%), fetal death in utero in 22 instances (46%), birth of a non-viable fetus 11 times (23%) and malignant degeneration twice (4%). Medical interruption of the pregnancy is indicated for the slightest sign of fetal anomaly or maternal complication. Prostaglandins may be used for that purpose. However, it is possible to let such a pregnancy follow its course.

[Evaluation of the economic burden in the respective indications of in vitro fertilization and tubal microsurgery at a regional hospital center]. / Evaluation du poids économique dans les indications respectives de la fécondation in vitro et de la microchirurgie tubaire dans un Centre Hospitalier Régional.

The authors have calculated the cost of obtaining and maintaining an intrauterine pregnancy to term by IVF and by tubal surgery according to the four classical indications. They have worked this out from local experience. The indications are: reversal of sterilization, surgery on proximal lesions, surgery on distal lesions and multifocal lesions. IVF is superior to surgery where the lesions are multifocal and possibly also in proximal blocks. But surgery is indicated in a large number of distal blocks and particularly in reversal of sterilization. The authors point out how difficult it is to extrapolate from national or international statistics. The choice must depend particularly on the experience of the local teams.

[Triploidy]. / La triploïdie.

Using their own experience which they described in 1984 and reviewing as well the literature of the condition since that time has led the authors to suggest that triploidy should be considered as a pathological entity with three clinical forms: early abortion, mid-trimester termination and the birth of triploidy fetuses either alive or dead. They discuss the clinical features, the ultrasound appearances, the pathological and anatomical details and the cytogenetics of triploidy. They differentiate this condition from trophoblast disease and from the central hydropic conditions which occur with normal caryotypes. They emphasize that there is a difference in the way classical molar pregnancy evolves and repeat again that the term "embryonic mole" should be avoided.

[A review of six years use of a computerised case history in obstetrics (author's transl)]. / Bilan de six ans d'exploitation d'un dossier informatisé en obstétrique.

The University Centre for Gynaecology and Obstetrics in Toulouse have been using a computerised record system for obstetrics since 1974. This makes it possible for a review for a review to be undertaken each year of the work carried out in the Service and has made it possible to study over six years the evolution of the characteristics of the population who have been followed, as well as the changes in attitudes and techniques adopted during pregnancy and labour. A study has been carried out on the factors associated with perinatal mortality and prematurity. Computerisation of 13,500 records has made it possible to draw curves of birth weights, according to the duration of the pregnancy, and characterising the service given. Finally the adoption of a prospective record system used in common by several teams and checked by people specialised in this work has improved the quality and quantity of retrieval and has made it possible to foresee cooperative studies between different departments.

[Home care by hospital midwives in the prevention of premature labor]. / La surveillance à domicile par les sages-femmes hospitalières dans la prévention de l'accouchement prématuré.

The authors analyse the results of 4 years home supervision of high-risk pregnancies by hospital midwives. The inquiry concerns 813 women out of a total of 12,643 deliveries in the same period of time (1978-1981). This supervision deals with the people who were selected by patient consultation or after hospitalisation. It is particularly concerned with patients with threatened premature labour. The role of the midwife is at once medical in that she undertakes a constant review of the state of the pregnancy, and social and psychological. Domiciliary visiting can often take the place of admission to hospital. Even though has not been a great decrease in the number of premature labours it does seen certain that patients who have been followed in this way have had pregnancies that have lasted longer. Over the 4 years when the experience has been gained the number of deliveries occurring before the 34th week has dropped from 2.8 to 1%. Finally, it is an extremely efficient way of lowering hospital expenses.

Factor VIII complex in normal pregnancy, pre-eclampsia and fetal growth retardation.

The levels of the three components of factor VIII complex (VIII R:AG, VIII R:WF, VIII:C) were measured during normal late pregnancy, in pre-eclampsia and in pregnancies complicated by fetal growth retardation. In late normal pregnancy, there was a steady increase in factor VIII complex and the highest level was reached at delivery; in primary fetal growth retardation, the values were similar. In pregnancies complicated by pre-eclampsia, with or without fetal growth retardation, there was a significant increase of VIII R:AG VIII R:WF; the more severe the course of the disease, the greater the increase. The level of VIII R:AG-VIII R:WF appears to be an indicator of vascular pathology and it is suggested that this assessment may be of value in monitoring high risk pregnancies.

[Epstein-Barr virus infections in pregnancy. The serological profile of active infections in pregnant women. Their possible relationship with perinatal mortality (author's transl)]. / Les infections à virus Epstein-Barr (EBV) au cours de la grossesse. Profil sérologique des infections actives chez la femme enceinte. Ses relations possibles avec la pathologie périnatale.

A significant number of cases of deaths and of perinatal misfortunes are still of unknown origin. The role of pathological infection is probably important in these cases and particularly those in the Torch group of viruses, and among these, as has been shown by epidemiological and virological tests, the Epstein-Barr virus (E.B.V.). The authors have undertaken a prospective study based on serology, looking for E.B.V. antibodies in pregnancy. 1,164 women were studied and 74 of these had perinatal abnormalities. There is a significant relationship between active E.B.V. infection and mishaps in pregnancy.

[Obstetrical anaesthesia. Their place in the conduct of labour (author's transl)]. / Les anesthésies obstétricales; leur place dans la direction de l'accouchement.

After having made an historical study of the principal works coming from the School in Toulouse concerning obstetrical anaesthesia, one can make an account of the criteria for fetal risk. These have been established by comparing with a standard that determines the physical and biological parameters found in normal labour. The fetal risk has been studied for four types of anaesthesia progressively. These are : general anaesthesia with Pentothal, general anaesthesia with Gamma OH, neuroleptanalgesia and finally epidural anaesthesia. By comparison with a normal standard, the evolution of the parameters concerning uterine contraction, the changes in the fetal heart rate the, acid-base balance of the fetal blood and how it changes, and the Apgar score have been studied for each type of anaesthesia. The same has been done for maternal risk. After having completed this study we have come to the conclusion that there is no single anaesthetic that should particularly be recommended, and that for every phase of labour : before labour starts and after labour has been confirmed, and at the end of the first stage of labour, a different form of anaesthesia may well be indicated. Above all, the skill of the anaesthetist and of the obstetrician influence the efficiency of the anaesthetic.

[Hepatic adenoma and oral contraception]. / Adénome hépatique et contraception orale

The authors report 2 new cases of adenoma of the liver in women who had been taking oral contraceptives. They review the world literature and analyse 18 of the 31 cases so far described. They consider the theoretical and practical problems posed by liver adenomata. As far as the theory goes, they think that uninterrupted taking of the pill for several years may cause the liver to become hyperactive in order to neutralise the excessive and permanent oestro-progesterone hormones brought to it. Following this, the liver gland responds with hypertrophy. As far as the practical aspect goes, the clinician is faced with the problem of supervision and clinical examination of the abdomen of women who take the pill for a ling time. Gynaecologist and the general surgeon have to know that there are complications with this tumour and in particular acute intraperitoneal bleeding.

Endometrial progesterone concentrations during the menstrual cycle.

Endometrial progesterone concentrations have been determined during the menstrual cycle and compared to plasma progesterone and estradiol-17 beta concentration. There is a good relationship between endometrial and plasma progesterone concentrations but none between endometrial progesterone and estradiol-17 beta concentration.

[The evolution of ideas about therapeutic interruption of pregnancy]. / L'évolution des idées dans l'interruption thérapeutique de la grossesse

The author has analysed 77 therapeutic terminations of pregnancy carried out at the C.H.U. in Toulouse between 1959 and 1973. He concludes that ideas about the indications for therapeutic termination of pregnancy should be completely revised under the pressure of change in medical knowledge and in philosophical attitudes. He points out the danger of becoming tied up in this matter in too rigid a framework. He emphasizes that therapeutic abortion is just another variety of induced abortion and like the latter it carries many immediate and late risks.

PIP: 77 therapeutic terminations of pregnancy carried out at the C.H.U. in Toulouse between 1959 and 1973 were analyzed. There were none in the years 1959-1962, then between 1 and 3 a year until 1970. The number jumped to 8 in 1971, 20 in 1972, and 36 in 1973. Before 1970 most of the women were over 30 years of age and the indications were grave medical risk to the life of the mother. From 1970 and 1973 most of the women were under 20 and psychiatric and fetal indications increased dramatically. Ideas about the indications for therapeutic termination of pregnancy should be completely revised under the pressure of change in medical knowledge and in philosophical attitudes. Therapeutic abortion is just another variety of induced abortion and, like the latter, carries many immediate and later risks.