Monochorionic monoamnionic twins: vaginal delivery.

Monochorionic monoamnionic pregnancies are rare and have a poor obstetric prognosis. A single amniotic sac promotes cord knotting and entanglement with a high risk of fetal anoxia. The response to this risk has been obstetric management consisting of routine cesarean section at 32 weeks of gestation or when pulmonary maturity is attained. This approach is called into question by the series of seven monochorionic monoamnionic pregnancies we present here. Such pregnancies do indeed require increased surveillance to term, but we think it is possible to apply the usual obstetric management of twin pregnancies.

Antenatal diagnosis of Bart's hydrops fetalis [correction of homozygous alpha thalassemia]. A case report.

OBJECTIVE: Diagnosis of the Bart's hydrops fetalis [corrected]. METHOD: Bart's hydrops fetalis [corrected] was discovered by chance in the fetus of a female Chinese patient. Major intrauterine growth retardation, oligohydramnios, an immobile fetus, and cardiomegaly were the principal echographic signs. Cordocentesis showed fetal anemia, and electrophoresis of fetal hemoglobin revealed the presence of Bart's hemoglobin. RESULT: As there is no known effective treatment, termination of pregnancy was proposed to the patient. CONCLUSIONS: Bart's hydrops fetallis [corrected] is a lethal condition. Early echographic signs (cardiothoracic index >0.50, placental thickening) can be screened during weeks 17-18 or even during weeks 13-14 of gestation. These signs would permit a reduction of invasive examinations in couples at risk.

Effect of dexamethasone and betamethasone on fetal heart rate variability in preterm labour: a randomised study.

OBJECTIVE: To compare the effects of betamethasone and dexamethasone on fetal heart rate in appropriately grown fetuses. METHODS: Eighty-two pregnant women (97 fetuses) with preterm labour were randomly allocated to receive betamethasone (n=42) or dexamethasone (n=40) for fetal lung maturation in a nonblinded fashion. Computerised cardiotocogram (CTG) parameters were compared before, during and after treatment. RESULTS: A decrease in fetal heart rate variability was found with betamethasone but no significant changes were found with dexamethasone. Fetal heart rate variability returned to pre-treatment values within a week after cessation of treatment with betamethasone. Neonatal outcome was similar in the two groups. CONCLUSIONS: These findings might prove useful in the management of compromised fetuses with decreased fetal heart rate variability in which the CTG should be used together with other parameters to assess fetal wellbeing during corticosteroid treatment. Dexamethasone may be preferable as the drug of choice since it was associated with significantly less alteration in fetal heart rate variability compared with betamethasone.

[Breast cancers with central localization: conservative treatment by tumorectomy with ablation of the areolar plaque]. / Cancers du sein à localisation centrale: traitement conservateur par tumorectomie avec ablation de la plaque aréolo-mamelonnaire.

OBJECTIVES: In breast cancer, retroareolar tumors are observed in 5 to 20% of cases; mammectomy is the conventional treatment. Conservative surgery was used in this series of 36 patients with retroareolar cancer situated less than 2 cm from the areola. PATIENTS AND METHODS: Tumorectomy with resection of the areolar plaque was followed by radiotherapy. Six patients had Paget's disease of the nipple, 64% were in classes T0 or T1 and 36% in T2. Chemotherapy or radiotherapy was given for tumor reduction prior to surgery in 8 patients. Wide tumorectomy with resection of the areolar plaque and gland remodeling was performed in all patients. Three plastic surgery techniques were used. Mean tumor size was 17.3 mm (8 to 33 mm). The areola was invaded in 16 patients (44%) and the derma or retroareolar ducts in 26 (72%). RESULTS: The mean distance between the tumor and skin surface was 3.8 mm. The section surface was in healthy tissue in 31 patients and 2 patients underwent subsequent surgery for mammectomy. All patients had either pre-operative (n = 4) or post-operative (n = 32) radio-therapy. Secondary reconstruction of the nipple was performed in 14 patients. CONCLUSION: Histology findings and esthetic results suggested that this conservative approach can be proposed when the tumor is located close to the areola, as confirmed by our series and results from other teams using the same technique.

Effect of antenatal betamethasone and dexamethasone administration on fetal heart rate variability in growth-retarded fetuses.

PURPOSE: To study the effect of betamethasone and dexamethasone on fetal heart rate in 55 growth-retarded fetuses. MATERIAL AND METHODS: Fifty-five fetuses with intrauterine growth retardation were exposed in utero to betamethasone (group 1, n = 32) or dexamethasone (group 2; n = 17). Six fetuses received both steroids alternatively at weekly intervals. Computerized cardiotocograms were recorded and analyzed retrospectively. Traces were obtained before, 1 day, 2 days and 4-7 days after treatment was started. RESULTS: One day after treatment was started, both steroids were associated with an initial increase in fetal heart rate variation that was higher with dexamethasone. Short-term variation was significantly decreased during the betamethasone course. All parameters returned to their pretreatment values within a week. CONCLUSION: Dexamethasone and betamethasone had similar effects compatible with a transient damping effect on fetal heart rate variability that reached significance only with betamethasone.

Transabdominal fetoscopy in fetal anomalies diagnosed by ultrasound in the first trimester of pregnancy.

The ability of ultrasound to diagnose fetal anomalies is limited in the early stages of gestation. We describe a microendoscope that can be used with an 18-gauge needle at the time of amniocentesis to provide more precise diagnostic information when the first-trimester ultrasound examination suggests a problem.

Sickle cell and thiamine deficiency: case report of a fetal death.

The heterozygous state of the sickle cell trait is not known to be a cause of fetal death. This is a report of disseminated placental infarcts associated with thiamine deficiency in a patient with the sickle cell trait. This pathological association suggests an original physiopathological process.