[Study of transplacental transmission of beta-lactam antibiotics (author's transl)]. / Etude du passage transplacentaire des bêta-lactamines.

The authors present the results of the study of transplacental transfer of 3 recent beta lactam antibiotics: amoxicillin, cephradin and cefoxitin. The experiment was carried out in 37 pregnant women who had a premature rupture of membranes or who were undergoing a cesarean section. In these patients antibiotherapy was indicated in view of a possible superinfection. The results of the study show a worthwhile transplacental penetration of the 3 drugs tested. The concentrations achieved in umbilical cord blood and amniotic fluid increase with time and finally exceed the levels measured in maternal blood, after a period of time varying from 2 to 4 hours according to the drug and the route of administration.

[Early amniocentesis, 1061 punctures and 1000 pregnancies]. / L'amniocentèse précoce. 1061 ponctions et 1000 grossesses.

The authors analysed 1061 early amniocentesis carried out during 1000 pregnancies. The indications were as follows: chromosomal abnormalities (79,6 p. 100), fetal karyotypes for X-linked diseases (4,7 p. 100), metabolic disorders (5,9 p. 100), amniotic fluid alpha-foetoprotein (9,8 p. 100) in neural tube defect or congenital nephrosis. Amniotic fluid was obtained on the first attempt in 98.2 p. 100 and on the second attempt in 100 p. 100. The fluid was heavily blood-stained in 1,7 p. 100, sanguinolent in 3,8 p. 100 and brownish in 2,40 p. 100. Cells were grown on the first attempt in 98 p. 100 and on the second attempt in 100 p. 100. The outcome of pregnancies was correlated with the indications of amniocentesis. The rate of spontaneous abortion is 1,7 p. 100, but only 6 of them can be due to amniocentesis (0,6 p. 100). Perinatal mortality was 1,8 p. 100: mortinatality (1,2 p. 100) and neonatal mortality (0.6 p. 100). All this fetal deaths have other causes. The fetal loss was 3,9 p. 100. Fetal morbidity was low: none fetal injuries, none cutaneous scar, few premature deliveries (1,6 p. 100), some malformations more or less serious (2,6 p. 100) with 4 congenital luxations of the hips (0,45 p 100). Maternal morbidity was limited at a greater cesarean section rate: 21 p. 100 (30 p. 100 in women 40 years old and more), none feto-maternal rhesus immunization was observed because immunoprophylaxis was strictly performed. The rate of therapeutic abortion was 4,6 p. 100 without any diagnostic error. Diagnostic accuracy was 100 p. 100. Several conditions are necessary to be the procedure safe accurate and reliable: appropriate genetic counseling, exact determination of gestational age (17 international weeks), sufficient volume of amniotic fluid counseling, exact determination of gestational age (17 international weeks), sufficient volume of amniotic fluid (uterus size: 12 cm), gynecologic examination by operator himself, perfect echography to localize the placenta and detect multiple gestations, adequately trained obstetrician, use of 20 gauge spinal needle, stric asepsis, experimented laboratory and experienced staff.

[Early amniocentesis in twin pregnancies (author's transl)]. / L'amniocentèse précoce en cas de grossesse gémellaire.

Since 1972, we have performed 951 early amniocentesis in 902 pregnant women. There were 19 twin pregnancies, all diamniotic, representing 2.1% of the sample. Diagnosis was always suspected before the amniocentesis. It was confirmed by echography in the 14 cases in which this technique was used. Out of the first 5 cases without echography, we punctured only one sac. In the 14 last cases, the process was successful in 13 cases thanks:--the perfection of echography showing the exact location of the fetuses and the position of the septum--the injection of congo red (12 cases) or methylene blue (2 cases) into the first sac. The indications were as follows: chromosomal aberrations (14 cases) metabolic diseases (1 case), sex-linked disorders (1 cases) neural tube defects (3 cases). No complications due to amniocentesis were observed but three abortions and one fetal death occurred. The reason why is discussed. We have made only one therapeutic abortion.

[Hydramnios and fetal malformations. Use of estimating the level of alpha-fetoprotein and of bilirubin in the amniotic fluid during the last trimester of pregnancy (author's transl)]. / Hydramnios et malformations foetales. Intérêt du dosage de l'alpha-foetoprotéine et de la bilirubine amniotique au cours du dernier trimestre de la grossesse.

Alpha-fetoprotein (AFP) levels in amniotic fluid have been measured by electro-immunodiffusion methods in the last trimester of pregnancy. 122 samples have been taken by abdominal amniocentesis during 58 pregnancies without hydramnios and 51 pregnancies with hydramnios. The level of AFP was always less than 1.2 mcg/ml when the children were normal in the latter group. On the other hand levels were higher than 1.2 mcg/ml in 17 out of 19 abnormal children. These had 5 neural tube abnormalities, 1 hydrocephalus, 3 duodenal atresias, 1 oesophageal atresia, 1 hare lip, 1 omphalocoele and 5 different malformations. The two abnormal children who had levels of AFP within normal limits were hydrocephalic. The diagnostic value of measuring bilirubinaemia which was also measured in 22 cases has been demonstrated.

The lecithin/sphingomyelin ratio in 132 insulin-dependent diabetic pregnancies.

A total of 228 determinations of L/S ratios were performed in 132 insulin-dependent diabetic pregnancies. A declining L/S ratio was observed in 6 per cent of the cases without adverse effects on the fetus. No significant difference in the percentage of mature L/S ratios by weeks of pregnancy was found in the different classes of diabetes. An immature L/S ratio was associated with a significant increase of low Apgar scores. At each stage of pregnancy, there was no significant difference in the percentage of mature L/S ratios according to the sex of the baby nor according to the presence or absence of polyhydramnios. Among the five infants with HMD two had a mature L/S ratio within 2 days of birth. This represents 3 per cent incidence of false-positive results. Despite this finding, we feel that the determination of L/S ratio is a useful advance in the management of diabetic pregnancies.

[Orange colored cells in the amniotic fluid. Statistical evaluation of 504 samples]. / Les cellules orangées du liquide amniotique. Exploitation statistique de 504 prélèvements.

The authors have made a statistical evaluation of 504 estimations of the percentage of orange coloured cells in the liquor amnii. They have been able to draw up a curve of the means which confirms the value of this method. Orange coloured cells of fetal origin first appear after about 28 to 30 weeks. The rise in the percentage which is gradually progressive between the 30th and 37th weeks becomes sharp at the 38th week. The gradients of the curve of the means between the 37th and 38th week is comparable to that of the ratio lecithin/sphingomyelin. It is different from that of creatinaemia which is steeper. False-positive results are rare: at 2 p. 100 they seem to correspond to an advance in fetal maturation which may be spontaneous or may be brought about by treatment. False-negative results are commomer: 13 p. 100. The percentage of orange coloured cells should be viewed in conjunction with other tests for maturity. The technique is simple but the results may be vitiated by the minutae of preservation, of taking or of staining the cells which are described. Orange coloured cells maintain their value in pathological pregnancies and in particular in those where the fetuses are small for dates, for the percentage of orange coloured cells agrees more with the age of the fetus than with its weight.

[The lecithin-sphynogomyelin ratio in the amniotic fluid in insulin dependent diabetic pregnancies]. / Le rapport lécithine-sphingomyéline du liquide amniotique dans les grossesses diabétiques insulino-dépendantes

A delay in the pulmonary maturation of the foetus of diabetic mothers assessed by the lecithin-sphingomyelin (L/S) ratio has been reported (2, 3, 5). A suggestion has been raised that the results of the L/S ratio should be viewed with caution in predicting lung maturity in pregnancies complicated by maternal diabetes (8). We report our findings on 52 insulin-dependent diabetic pregnancies which involved 90 estimations of the L/S ratio on the amniotic fluid. In all cases, the L/S ratio accurately reflected lung maturity, as no hyaline membrane disease (HMD) was observed with a L/S ratio greater than 2. There was no significant difference in the proportion of mature fetal lung between insulin-dependent diabetics and controls for each week of pregnancy between 32 and 38 weeks. There is no statistical difference in the mature L/S ratio between classes B + C and D + F diabetics.