[Assessment of the sonographer's knowledge on the second trimester ultrasound recommendations of the National Technical Committee of Ultrasound]. / Évaluation des connaissances des échographistes sur les clichés d'échographie de dépistage du deuxième trimestre recommandés par le Comité technique national de l'échograpahie.

OBJECTIVE: To evaluate the sonographers' knowledge of the National Technical Committee of Ultrasound's recommendations concerning second trimester ultrasound. MATERIALS AND METHODS: Anonymous questionnaire was sent by e-mails containing 25 questions about demographic elements, the practice of second trimester ultrasound and the recommendations of the National Technical Committee of Ultrasound about second trimester ultrasound. RESULTS: Six hundred and eighty-four responses were obtained. Six hundred and fifty-three upon 684 (95%) of respondents practice second trimester ultrasound and 635 upon 653 (97%) know about the existence of the report of the National Technical Committee of Ultrasound. The rates of correct answers concerning recommended biometrical images vary between 97% for the biparietal diameter and head circumference, 98% for abdominal circumference and 100% for the femur length. While for morphological images, rates vary between 52% and 100%. A subgroup analysis (whether the respondents have already read the recommendations or not) showed that those who had read the recommendations have significantly better results than those who did not. CONCLUSION: Those who have already read the recommendations have better knowledge and global knowledge can be improved. National recommendations serve to promote a policy of quality assurance of ultrasound and may be used in medicolegal issues. The societies that make recommendations should more diffuse their work and practitioners should make effort to pursue the continuing medical education and to implement the recommendations.

[Pregnancy care of visual deficient women: what specificity?]. / Prise en charge des grossesses chez les femmes aveugles ou amblyopes: quelles spécificités?

OBJECTIVES: Maternity has been denied to blind women for a long time, and is still often criticized or not understood in a very demanding social environment for the future mothers. Our objective is to describe the follow-up of the pregnancies and the childbirth of the visual handicapped women within the framework of a dedicated network of care liking with the Maternal and Infant Protection Unit and the paediatric ward. PATIENTS AND METHOD: We studied a retrospective series of 18 women blind or amblyopic followed up at the at the institut de puériculture et périnatologie (Paris, France) from 2001 to 2006. We report the social and morphological characteristics women, the characteristics of the monitoring of their pregnancy and childbirth and the approach of antenatal care. The results were compared with the data of the average French population studied in the perinatal investigation of 2003. RESULTS: The pregnancies proceeded without particular obstetrical complications and lead to the birth of 20 healthy children. The population of the women is older than the French average, of higher initial weight. There is no increase in the number of consultation and ultrasound scans. The characteristics of the follow-up are discussed. DISCUSSION AND CONCLUSION: Each maternity team should be able to follow and deliver women with a visual defect. Some specificity however needs to be helped along for these future mothers. The training of the professionals, the work within a dedicated network and the adjusting of our methodologies not only come to improve the pregnancies but also to enrich our practices.

[Access to preventative care, screening and treatment of women in vulnerable socio-economic groups presenting with cervical cancer]. / Cancer du col et précarité, accès aux soins diagnostic et traitement.

AIM: The object of this study was to evaluate access to preventative care, screening and treatment of women in vulnerable socio-economic groups presenting with cervical cancer and the progression of their disease. METHOD: This is a retrospective study of 123 patients with cervical cancer treated at the hôpital Bichat (Paris) or the hôpital Verdier (Bondy) between 1st January 1996 and 31 December 2005. RESULTS: "CMU" or "AME" is the entitlement for fully state funded medical care and was used in this study to indicate social deprivation. Social deprivation is associated with homelessness (43.9 vs 1.23%; P = 0.0001) and unemployment (90 vs 30%; P = 0.0001). Women from deprived groups seldom enter screening programs (25 vs 56.1%; P = 0.008). Once symptomatic they delay seeking medical attention (1.8 months later than for non-deprived groups; P = 0.027), present more often to accident and emergency departments (51.22 vs 17.07%; P = 0.0003), and do not see any primary care practitioner (41.46 vs 8.64%; P < 0.0001). There was no significant difference with regard to treatment instituted in the two groups. The non-deprived patients residing in Bondy had similar access to care as the deprived patients treated in Paris. The average follow-up period was 30.43 months (+/- 26.64). CONCLUSION: Cervical screening is not taken up adequately throughout the general population. Access to health care is poorly tailored to the needs of the socially deprived. Social deprivation did not demonstrate an association with levels of pelvic recurrence, metastasis or death. The low doctor to patient ratio in certain geographical areas reduces access to medical care.

[Placental metastases from maternal malignancies: review of the literature]. / Métastases placentaires de cancers maternels: revue de la littérature.

The purpose of this paper was to update and analyse all the reported cases of placental metastasis. These tumours are rare and seem to complicate aggressive or disseminated malignant melanomas, leukaemias, breast cancers and lung cancers. Maternal prognosis is poor. The risk factors of cancer in the newborn are unknown. In a pregnant woman with a history of malignancy, a systematic histological examination of the placenta for evidence of metastasis is required. Close observation and follow-up of the infant has to be recommended, especially in case of placental involvement. To estimate the incidence of placental metastases and to improve knowledge of their natural history, the creation of registries of malignancies associated with pregnancy is required.