[Epidemiologic data on arterial hypertension in pregnancy]. / Données épidémiologiques sur l'hypertension artérielle gravidique.

A retrospective study of 241 case histories of essential hypertension in pregnancy treated in the Salengro Maternity Hospital of Lille from 1976 to 1981 was carried out. Looking at 450 readings of blood pressure in pregnancy it has been possible to work out a profile for these patients. These patients have as singular factors: They are often fat or very fat. They often have raised cholesterol levels in the blood. They often have a family history of hypertension or of diabetes. Many use oestro-progestogen birth control pills and had trouble in glucose regulation far more than women who had normal blood pressures in pregnancy.

[The unruptured luteinized follicle. Determination of estradiol and progesterone in peritoneal fluid]. / Le follicule lutéinisé non rompu. Dosage de l'estradiol et de la progestérone dans le liquide péritonéal.

The finding of more luteinized unruptured follicles in women who are under investigation for unexplained infertility compared with fertile women suggests that the syndrome does exist and probably plays a causative role in the infertility of these patients. The levels of oestradiol 17-beta and progesterone found in the peritoneum in the early luteal phase showed a much higher figure when there has been rupture of the follicle with a haemorrhagic corpus luteum and a stigma as compared with luteinized unruptured follicles. It does seem to us worth while to obtain some of the peritoneal fluid in order to estimate the levels of hormones and to diagnose more often the unruptured follicle syndrome whenever laparoscopy in undertaken in the early luteal phase.

[Postpartum renal cortical necrosis]. / La nécrose corticale rénale du post-partum.

The authors report two cases of post-partum cortical renal necrosis. The diagnosis was made on clinical and biological criteria (severe, prolonged oliguria, the signs of intra-vascular coagulation defects, a rise in L.D.H. and anaemia with micro-angiopathy. It is confirmed by selective renal arteriography and renal punch-biopsy. There is a threefold method of treatment: --of the kidney condition by repeated haemodialysis and diuretics; --antihypertensive treatment; --treatment aimed at the aetiological pathology (heparin, anti-platelet aggregation and fresh plasma). Functional recovery of the kidney was obtained in both cases (after an interval of 1 year and an interval of 1 1/2 year). The authors review the diagnostic, physiopathological, morphological and therapeutic elements in the condition of cortical renal necrosis.

[The level of glycohaemoglobin (Hb A1c) in connection with diabetes and pregnancy (author's transl)]. / Dosage de l'hémoglobine glycosylée (Hb A1c) dans l'association "diabète et grossesse".

The authors worked out a normal curve using 379 levels obtained over 9 months in 180 normal pregnancies. 6% (with a confidence level between 4.4% and 7.6%) was usual for haemoglobin A1c. Then they compared 42 levels of glycohaemoglobin obtained from 14 pregnant diabetic patients where the mean value was 8.34%. Glycohaemoglobin A1c therefore is a good indicator or the level of stabilisation in diabetic pregnancies in the two months before the estimation is taken. It is therefore possible to think that it does indicate chronic hyperglycaemia and does seem to have a future in screening diabetic pregnancies. On the other hand it does not seem to be of any supplementary value in monitoring the fetus of the diabetic mother in the third trimester of pregnancy because of the small variations in the levels that are obtained as compared with the suddenness of fetal complications.

[The value of estimating the levels of amniotic insulin which come from the fetus in looking after diabetic pregnancies in the last trimester (author's transl)]. / Intérêt du dosage de l'insuline amniotique d'origine foetale dans la surveillance des grossesses de diabétique au dernier trimestre.

The authors carried out 49 estimations of amniotic fluid levels of insulin in 41 patients. 25 of these patients were non-diabetic and they were a control group, and 16 patients were diabetic (24 estimations). The liquor was collected by amniocentesis between the 32nd and the 42nd week of amenorrhoea. The mean of the control levels was 3.17 micro-units per ml. The mean of the values in diabetic pregnancies was 9.97 micro-units per ml. The difference between the two groups is statistically significant. We have studied this insulinaemia in relationship to the duration of the diabetes, the maternal weight increase, the levels of insulin used therapeutically, the blood glucose level, the rise in arterial blood pressure, the weight of the infant, the date of delivery, the presence of fetal distress and the control of blood sugar. There is a statistically significant difference between the insulinaemia of patients in whom the diabetes is well controlled (mean level of 7.08 micro-units per ml) and the patients in whom the diabetes is badly controlled (31.7 micro-units per ml). This new parameter for supervision of the third trimester of pregnancy in diabetics gives rise to the possibilities of a better approach to materno-fetal blood sugar regulation and to an adjustment of the therapeutic doses of insulin that are given which will result in lengthening of the duration of pregnancy, with the aim of achieving a spontaneous vaginal delivery at term.

[The influence of present therapeutic methods and especially of beta-blockers on fetal and maternal prognosis in hypertensive syndromes in pregnancy. 43 case records (author's transl)]. / Influence des thérapeutiques actuelles et notamment des bêta-bloquants sur le pronostic foetal et maternel des syndromes hypertensifs de la grossesse. A propos de 43 observations.

The authors studied 43 cases of arterial hypertension in pregnancy in an attempt to determine the efficiency and safety of different anti-hypertensive drugs. The patients were divided into two major groups: arterial hypertension which revealed itself during pregnancy (true toxaemias of pregnancy and relapsing toxaemias), and arterial hypertensions which were added on to a pre-existing pathology (arterial hypertension, diabetes, chronic nephritis). The cases in these different classes were then divided into two definite groups according to the need for therapy: the first group was treated by rest and hydrallazine as a single therapeutic agent. In the second group multiple agents were needed because of the arterial hypertension, and one was a beta-blocker. Complications were found particularly in the second group of true toxaemias of pregnancy where unfortunately 5 fetal deaths occurred that were attributable to the severity of the hypertension more than to the beta-blockers, which were administered for longer and in higher doses without major complications in recurrent toxaemias and pre-existing arterial hypertension cases.

[The prognostic value of raised uric acid in the blood in arterial hypertension in pregnancy. 58 cases (author's transl)]. / Valeur pronostique de l'hyperuricémie dans les hypertensions artérielles de la grossesse. A propos de 58 observations.

The authors have carried out research in 58 cases to see whether the findings of high uric acid levels in the blood are of prognostic value in all cases of arterial hypertension in pregnancy whatever the aetiology. The material studied consisted of 30 true cases of toxaemia of pregnancy, 13 cases of recurrent toxaemia and 15 cases of the vasculo-renal syndrome on top of the pre-existing pathological condition. In 37 cases where the blood uric acid level was lower than 300 micromoles there were only 4 minor complications. Serious complications were found in 6 cases in which the patients had a blood uric acid level highthan 480 micromoles. This study confirms the prognostic value of blood uric acid levels. The estimation of these levels, however, seems to be of less value in making a differential diagnosis between the various kinds of toxaemia and hypertension found in pregnant women due to different aetiologies.