Congenital heart anomalies in the first trimester: From screening to diagnosis.

Congenital heart defects occur in approximately 1% of liveborn children and represent the most common form of congenital malformation. Due to the small size and complexity of the heart structures, prenatal diagnosis is most often made in the second trimester of pregnancy. Early diagnosis however offers significant advantages regarding the timing of further investigations, prenatal counseling, and access to management options. In the last decade, advances in antenatal imaging have improved the detection of cardiac malformations with increasing emphasis on earlier pregnancy screening and diagnosis. We aim to summarize current "state of the art" imaging of the fetal heart in the first trimester.

Maternal Infection and Adverse Pregnancy Outcomes among Pregnant Travellers: Results of the International Zika Virus in Pregnancy Registry.

In this multicentre cohort study, we evaluated the risks of maternal ZIKV infections and adverse pregnancy outcomes among exposed travellers compared to women living in areas with ZIKV circulation (residents). The risk of maternal infection was lower among travellers compared to residents: 25.0% (n = 36/144) versus 42.9% (n = 309/721); aRR 0.6; 95% CI 0.5-0.8. Risk factors associated with maternal infection among travellers were travelling during the epidemic period (i.e., June 2015 to December 2016) (aOR 29.4; 95% CI 3.7-228.1), travelling to the Caribbean Islands (aOR 3.2; 95% CI 1.2-8.7) and stay duration >2 weeks (aOR 8.7; 95% CI 1.1-71.5). Adverse pregnancy outcomes were observed in 8.3% (n = 3/36) of infected travellers and 12.7% (n = 39/309) of infected residents. Overall, the risk of maternal infections is lower among travellers compared to residents and related to the presence of ongoing outbreaks and stay duration, with stays <2 weeks associated with minimal risk in the absence of ongoing outbreaks.

[Women's health while travelling in tropical countries]. / Santé de la femme en voyage dans les pays tropicaux.

When considering women's health during travels, it is mainly pregnant women who are concerned. Indeed, because of the physiological changes, they are more vulnerable to infectious and non-infectious diseases related to the trip itself or to specific activities. This article lists the essential risks for pregnant women travelling in tropical countries and provides specific recommendations, so that the general practitioner is better able to advise this vulnerable population. If the trip is suitable and in the absence of any pre-existing complication, travelling during pregnancy is not contraindicated.

Les problèmes de santé de la femme en voyage concernent principalement la femme enceinte qui, en raison des changements physiologiques, présente une vulnérabilité aux risques infectieux et non infectieux en lien avec le voyage en tant que tel ou les activités entreprises. Cet article aborde les risques essentiels et détaille les recommandations actuelles spécifiques à cette population vulnérable afin que le praticien soit plus à même de la conseiller avant le départ. Si le voyage est adapté et en l'absence de complication préexistante, il n'est pas contre-indiqué durant la grossesse.

Management of delivery of a fetus with autosomal recessive polycystic kidney disease: a case report of abdominal dystocia and review of the literature.

BACKGROUND: Autosomal recessive renal polycystic kidney disease occurs in 1 in 20,000 live births. It is caused by mutations in both alleles of the PKHD1 gene. Management of delivery in cases of suspected autosomal recessive renal polycystic kidney disease is rarely discussed, and literature concerning abdominal dystocia is extremely scarce. We present a case of a patient with autosomal recessive renal polycystic kidney disease whose delivery was complicated by abdominal dystocia, and we discuss the factors that determined the route and timing of delivery. CASE PRESENTATION: A 23-year-old Caucasian woman, G2 P0, with a prior unremarkable pregnancy was referred to our tertiary center at 31 weeks of gestation because of severe oligoamnios (amniotic fluid index = 2) and hyperechogenic, dedifferentiated, and enlarged fetal kidneys. She had no other genitourinary anomaly. Fetal magnetic resonance imaging showed enlarged, hypersignal kidneys and severe pulmonary hypoplasia. We had a high suspicion of autosomal recessive renal polycystic kidney disease, and after discussion with our multidisciplinary team, the parents opted for conservative care. Ultrasound performed at 35 weeks of gestation showed a fetal estimated weight of 3550 g and an abdominal circumference of 377 mm, both above the 90th percentile. Because of the very rapid kidney growth and suspected risk of abdominal dystocia, we proposed induction of labor at 36 weeks of gestation after corticosteroid administration for fetal lung maturation. Vaginal delivery was complicated by abdominal dystocia, which resolved by continuing expulsive efforts and gentle fetal traction. A 3300-g (P50-90) male infant was born with Apgar scores of 1-7-7 at 1, 5, and 10 minutes, respectively, and arterial and venous umbilical cord pH values of 7.23-7.33. Continuous peritoneal dialysis was started at day 2 of life because of anuria. Currently, the infant is 1 year old and is waiting for kidney transplant that should be performed once he reaches 10 kg. Molecular analysis of PKHD1 performed on deoxyribonucleic acid (DNA) from the umbilical cord confirmed autosomal recessive renal polycystic kidney disease. CONCLUSIONS: Management of delivery in cases of suspected autosomal recessive renal polycystic kidney disease needs to be discussed because of the risk of abdominal dystocia. The route and timing of delivery depend on the size of the fetal abdominal circumference and the gestational age. The rate of kidney growth must also be taken into account.

[Zika virus†: update of the practical guidelines]. / Virus Zika†: mise à jour des recommandations.

Since the outbreak in Latin America and the Caribbean (LAC) region in 2015-2017, the Zika virus (ZIKV) is present in most of tropical and sub-tropical countries. Herd immunity in LAC is now high and the number of cases is reduced. Consequently, the risk for a traveller to be infected is now considered to be low. The epidemiological change and the new published evidences have led to a revision of travel recommendations. Through practical cases, we present here the guidelines updated in April 2019 by the Swiss Expert Committee of Travel Medicine.

Depuis son introduction en Amérique en 2015-2017, le virus Zika est présent dans la plupart des pays tropicaux et subtropicaux. L'immunité de groupe dans les pays en Amérique latine est dorénavant élevée et le nombre de cas déclarés a diminué. Par conséquent, le risque pour un voyageur de s'infecter est généralement considéré maintenant comme faible. Les modifications épidémiologiques et les nouvelles évidences publiées ont permis une révision des recommandations aux voyageurs. Par l'intermédiaire de cas illustratifs, nous présentons les recommandations reconnues en avril 2019 par le Comité suisse des experts de médecine des voyages.

Uterus preservation is superior to hysterectomy when performing laparoscopic lateral suspension with mesh.

INTRODUCTION AND HYPOTHESIS: We aimed to compare differences between laparoscopic lateral suspension with mesh (LLS) performed with supracervical hysterectomy (LLSHE) and without hysterectomy (LLSUP). METHODS: We retrospectively collected data from women operated by a single surgeon between 2003 and 2011. From a total of 339 women with symptomatic anterior and/or apical pelvic organ prolapse (POP) and an intact uterus, 224 had LLSUP (70.4%) and 94 had LLSHE (29.6%). Three hundred and sixteen patients were examined at 1 year. Primary outcomes were objective and subjective success at 1 year during clinical evaluation. Secondary outcomes were complications (Clavien-Dindo scale) and mesh exposure. Patient satisfaction was evaluated by telephone interview using a 10-point scale and the Patient Global Impression of Improvement Scale (PGI-I). RESULTS: LLSUP and LLSHE did not differ for age (mean 57 and 55 years, respectively), preoperative status, complications, and participation at the interview (52 vs 53%). LLSHE is associated with higher mesh exposure (6.5 vs 1.3%, p = 0.014) and more frequent use of Mersilene. Titanium-coated and noncoated polypropylene was more frequently used in LLSUP. At 1 year, both anatomic success rate for the anterior compartment (98.7 vs 94.6%, p = 0.021) and subjective success rate (83.5 vs 72.8%, p = 0.035) were higher for LLSUP. Without hysterectomy, patients more often improved (90.5 vs 76.5%, p = 0.013) and would more frequently recommend the procedure (94.5 vs 80.4%, p = 0.004). CONCLUSIONS: LLS with or without hysterectomy is a safe technique with high patient satisfaction. The uterus-preserving approach appears to result in better anatomic outcome for the anterior compartment, better subjective outcome, and higher patient satisfaction.

[Real-time tele-training for obstetrical ultrasonography in Congo Brazzaville]. / Télémédecine au Congo Brazzaville : formation continue à l'échographie obstétricale par supervision en direct.

The Republic of Congo is facing a shortage of specialists and an unequal distribution of healthcare professionals between urban and rural areas, limiting access to diagnostic ultrasonography. Besides other issues this project aims at establishing the feasibility of remote training by live teleconsultation in obstetrical ultrasonography, as a mechanism to support isolated care by untrained staff. The project includes abdominal ultrasound testing for women during all stages of pregnancy. The first results have shown that the transmission of dynamic images, at a low cost internet connection, offers the possibility of distance training of peripheral health professionals, with the real-time remote support of gynecologists.

La République du Congo fait face à une pénurie de spécialistes et leur répartition est inégale entre la capitale et les zones périphériques. La précarité financière des femmes enceintes et les difficultés logistiques engendrées par un déplacement à la capitale constituent un frein au suivi médical de la grossesse. Ce projet démontre la faisabilité d'une formation à distance à l'échographie obstétricale de professionnels de la santé grâce à une téléconsultation en direct par des gynécologues obstétriciens de Brazzaville. Le projet est encore en cours et les premiers résultats sur le terrain sont très encourageants et en démontrent la pertinence. En effet, la transmission d'images dynamiques permet à ce jour de former des professionnels de santé de périphérie en leur assurant un soutien en temps réel dans la prise en charge des patientes, grâce à des connexions internet à bas coût.

Tracheal agenesis: optimization of computed tomography diagnosis by airway ventilation.

Tracheal agenesis is a rare and often lethal congenital defect that leads to airway emergency at birth. Computed tomography (CT) is the modality of choice to evaluate anomalous tracheal anatomy. The absence of spontaneous aeration of the tracheobronchial tree in children with tracheal agenesis makes CT interpretation difficult. We describe a procedure of airway management applied in two newborns with suspected tracheal agenesis. Correct airway management was performed immediately prior to CT examination by airway ventilation, with bag-valve mask alone in one case, and attached to an endotracheal tube placed into the esophagus in the other case. The images allowed for classification of tracheal agenesis. Computed tomography with appropriate airway ventilation is fundamental for the diagnosis of tracheal agenesis.

Zika virus: practical guidelines. / Virus Zika : recommandations pratiques.

Zika virus suddenly emerged in Latin America in 2015­2016. Congenital malformations have been observed in infected pregnant women, causing a major public health impact in affected countries, particularly in Brazil. In addition, sexual transmission of Zika virus has been well documented. This led to the development of prevention strategies and recommendations for travellers visiting at risk countries. These documents are regularly amended depending on the evolution of scientific knowledge, the epidemiologic trends and the national and international guidelines. Through practical cases, we present here the guidelines developed by the Geneva University Hospitals.

Le virus Zika a émergé brusquement en 2015­2016 en Amérique latine. Lors de cette épidémie, des complications fœtales ont pu être observées avec des conséquences majeures sur la santé publique de ces pays, en particulier au Brésil. De plus, une transmission par voie sexuelle du virus a été bien documentée. Il a ainsi été nécessaire de développer des stratégies de prévention et des recommandations pour les voyageurs visitant des pays à risque. Ces documents sont évolutifs en fonction des connaissances scientifiques, de l'épidémiologie de la maladie et des recommandations nationales et internationales. Par l'intermédiaire de cas illustratifs, nous présentons les recommandations utilisées aux Hôpitaux universitaires de Genève.

Patient satisfaction after laparoscopic lateral suspension with mesh for pelvic organ prolapse: outcome report of a continuous series of 417 patients.

INTRODUCTION AND HYPOTHESIS: Sacropexy is considered the gold standard for the treatment of pelvic organ prolapse (POP) although dissection of the promontory may be challenging, particularly in obese women. Laparoscopic lateral suspension with mesh (LLS) could be an alternative. METHODS: LLS provides lateral attachment by fibrosis of a vesicovaginal mesh. Clinical evaluation was performed at 1 year using the simplified POP quantification system (POP-Q). Primary outcomes were objective and subjective cure at 1 year. After a mean of 7.2 years the rates of reoperation and complications were assessed as secondary outcomes. Patient satisfaction was evaluated by telephone interview using a ten-point-scale and the PGI-I scale. Factors predicting satisfaction were determined by logistic regression analysis. RESULTS: A total of 417 patients were treated between 2003 and 2011. At 1 year 78.4% of patients were asymptomatic and anatomic success rates were 91.6% for the anterior compartment, 93.6% for the apical compartment and 85.3% for the posterior compartment. The complication rate of Clavien-Dindo grade III or higher was 2.2%. The mesh exposure rate was 4.3% and the reoperation rate was 7.3%. Of the 417 patients, 214 participated in the telephone interview. Over 85% rated their situation as improved and satisfaction was associated with the absence of concomitant hysterectomy. CONCLUSIONS: LLS is a safe technique with promising results in terms of a composite outcome, low complication rates and high long-term patient satisfaction. However, a randomized controlled trial is needed to establish the technique as an alternative to sacropexy in the treatment of POP in obese and high morbidity patients.

[Zika virus : a review]. / Virus Zika : mise au point.

Since early 2015, the Zika virus epidemic has spread rapidly through South America and the Caribbean and the first cases of local transmission have just been reported in Florida. Maternal infection during pregnancy can cause serious birth defects. Pregnant women and their partners should avoid travelling to areas of Zika epidemic.

Depuis le début de l'année 2015, l'épidémie de virus Zika s'est répandue rapidement en Amérique du Sud et dans les Caraïbes et récemment les premiers cas de transmission autochtone ont été déclarés en Floride. Une infection maternelle au cours de la grossesse peut être responsable de graves malformations fœtales. Le voyage dans les zones d'épidémie est déconseillé aux femmes enceintes et à leur partenaire.

[Zika virus : from research to vaccine]. / Virus Zika : de la recherche au vaccin.

Zika virus has recently emerged as new teratogenic agent. Research is drastically increasing to allow a better comprehension of the role of this emerging virus in the induction of fetal cerebral anomalies. Several epidemiological and microbiological aspects may explain a higher virulence of the current strain. Various animal models have been developed and confirm the materno-fetal transmission as well as the induction of cerebral development's disorders. In parallel, various companies are working to develop a vaccine and antiviral medicine against Zika virus. Despite promising results, the road remains long until a vaccine or antiviral medicines are available.

Le virus Zika est récemment apparu comme un nouvel agent tératogène. La recherche s'accélère dans le but de mieux comprendre le rôle de ce virus émergent dans la formation de malformations cérébrales chez le fœtus. Plusieurs aspects épidémiologiques et microbiologiques contribuent à la nouvelle virulence observée chez la souche épidémique actuelle. Divers modèles d'infection chez la souris et les primates ont été développés confirmant la transmission transplacentaire du virus et l'induction de troubles du développement cérébral. En parallèle, plusieurs compagnies travaillent au développement d'un vaccin et d'antiviraux contre le virus Zika. Malgré des résultats prometteurs, la route est encore longue avant la mise sur le marché de vaccins ou d'antiviraux pouvant être administrés à la femme enceinte.

Uterus-preserving laparoscopic lateral suspension with mesh for pelvic organ prolapse: a patient-centred outcome report and video of a continuous series of 245 patients.

INTRODUCTION AND HYPOTHESIS: Changes in the psychological value of reproductive organs have led to a growing interest in uterine-preserving surgery for pelvic organ prolapse (POP). Sacral hysteropexy is considered as gold standard, although dissection of the promontory may be challenging. We show a video and present a report on a series of patients operated by laparoscopic lateral suspension with mesh as an alternative. METHODS: Clinical evaluation was performed using the simplified Pelvic Organ Prolapse Quantification System (POP-Q). Primary outcomes were subjective and objective cure; secondary outcomes were rates for reoperation and complications. We assessed patient's satisfaction in a telephone interview using a visual analogue scale and the Patient Global Impression of Improvement Scale (PGI-I) scale. RESULTS: Two hundred and fifty-four patients were treated between 2004 and 2011 with a median follow-up of 7.5 years. At 1 year 82.7 % of patients were asymptomatic, and anatomic success rates were 88.2 % for the anterior, 86.1 % for the apical and 80.8 % for the posterior compartment; 1.2 % had mesh exposure, and the reoperation rate was 7.4 %. More than 80 % of patients were highly satisfied with the outcome. CONCLUSIONS: Uterine-preserving laparoscopic lateral suspension with mesh is a safe technique with promising results and low complication rates. It may be an alternative to sacral hysteropexy for high-morbidity patients.

Randomized comparison of vaginal self-sampling by standard vs. dry swabs for human papillomavirus testing.

BACKGROUND: To evaluate if human papillomavirus (HPV) self-sampling (Self-HPV) using a dry vaginal swab is a valid alternative for HPV testing. METHODS: Women attending colposcopy clinic were recruited to collect two consecutive Self-HPV samples: a Self-HPV using a dry swab (S-DRY) and a Self-HPV using a standard wet transport medium (S-WET). These samples were analyzed for HPV using real time PCR (Roche Cobas). Participants were randomized to determine the order of the tests. Questionnaires assessing preferences and acceptability for both tests were conducted. Subsequently, women were invited for colposcopic examination; a physician collected a cervical sample (physician-sampling) with a broom-type device and placed it into a liquid-based cytology medium. Specimens were then processed for the production of cytology slides and a Hybrid Capture HPV DNA test (Qiagen) was performed from the residual liquid. Biopsies were performed if indicated. Unweighted kappa statistics (к) and McNemar tests were used to measure the agreement among the sampling methods. RESULTS: A total of 120 women were randomized. Overall HPV prevalence was 68.7% (95% Confidence Interval (CI) 59.3-77.2) by S-WET, 54.4% (95% CI 44.8-63.9) by S-DRY and 53.8% (95% CI 43.8-63.7) by HC. Among paired samples (S-WET and S-DRY), the overall agreement was good (85.7%; 95% CI 77.8-91.6) and the κ was substantial (0.70; 95% CI 0.57-0.70). The proportion of positive type-specific HPV agreement was also good (77.3%; 95% CI 68.2-84.9). No differences in sensitivity for cervical intraepithelial neoplasia grade one (CIN1) or worse between the two Self-HPV tests were observed. Women reported the two Self-HPV tests as highly acceptable. CONCLUSION: Self-HPV using dry swab transfer does not appear to compromise specimen integrity. Further study in a large screening population is needed. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01316120.

Laparoscopic repair of vaginal vault prolapse by lateral suspension with mesh.

BACKGROUND: To evaluate the long-term outcomes of laparoscopic lateral suspension using mesh reinforcement for symptomatic posthysterectomy vaginal vault prolapse. MATERIALS AND METHODS: We analyzed in a prospective cohort study all the women treated by laparoscopic lateral suspension with mesh for symptomatic vaginal vault prolapse between January 2004 and September 2010. In this procedure, the mesh is laterally suspended to the abdominal wall, posterior to the anterior superior iliac spine. We performed systematic follow-up examinations at 4 weeks, 6 months and yearly postoperatively. Clinical evaluation of pelvic organ support was assessed by the pelvic organ prolapse quantification (POP-Q) grading system. Main outcome measures were recurrence rate, reoperation rate for symptomatic recurrence or de novo prolapse, mesh erosion rate, reoperation rate for mesh erosion, total reoperation rate. OBSERVATIONS AND RESULTS: Of the 73 patients seen at a mean 17.5 months follow-up, recurrent vaginal vault prolapse was registered in only one woman (success rate of 98.6 %). When considering all vaginal sites, we observed a total of 13 patients with recurrent or de novo prolapse (17.8 %). The non-previously treated posterior compartment was involved in eight cases (new appearance rate of 11 %). Of these 13 women, only 6 were symptomatic, requiring surgical management (reoperation rate for genital prolapse of 8.2 %). Four patients presented with mesh erosion into the vagina (5.5 %). Two required partial vaginal excision of the mesh in the operating room (2.7 %). There were no mesh-related infections. The total reoperation rate was 11 %. CONCLUSION: Laparoscopic lateral suspension with mesh interposition is a safe and effective technique for the treatment of vaginal vault prolapse. This approach represents an alternative procedure to the laparoscopic sacrocolpopexy.

Incidence and risk factors for reoperation of surgically treated pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: The objective of our study was to estimate the incidence and to identify the risk factors for reoperation of surgically treated pelvic organ prolapse (POP). METHODS: We conducted a nested case-control study among 1,811 women who underwent POP surgery from January 1988 to June 2007. Cases (n = 102) were women who required reoperation for POP following the first intervention through December 2008. Controls (n = 226) were women randomly selected from the same cohort who did not require reoperation. RESULTS: The incidence of POP reoperation was 5.1 per 1,000 women-years. The cumulative incidence was 5.6%. Risk factors included preoperative prolapse in more than two vaginal compartments (adjusted OR 5.2; 95% CI 2.8-9.7), history of surgery for POP and/or urinary incontinence (adjusted OR 3.2; 95% CI 1.5-7.1), and sexual activity (adjusted OR 2.0; 95% CI 1.0-3.7). CONCLUSIONS: The risk of POP reoperation is relatively low and is associated with preexisting weakness of pelvic tissues.