[The association of an abdominal pregnancy and an intrauterine pregnancy in the 3rd trimester. Apropos of a case and review of the literature]. / Association grossesse abdominale-grossesse intra-utérine au troisième trimestre. A propos d'un cas et revue de la littérature.

We observed a twin pregnancy during the third trimester with one intra-abdominal and one intrauterine infant. The first child was delivered via the normal vaginal route and the second via emergency laparotomy. Both infants were live at birth and the outcome was quite favourable for the mother and the two infants. A review of the literature confirmed the extreme rarity of such cases, and the almost unknown favourable outcome. Different pathophysiological mechanisms may have led to this rare combination of twin pregnancies and several points of the clinical course suggest how the diagnosis could have been made earlier during the pregnancy. Therapeutic problems related to abdominal pregnancy and questions of ethics are raised in case of early diagnosis.

[Evaluation of a public health measure for the amelioration of birth safety in Martinique: 1977-1984]. / Evaluation d'une action de santé publique pour l'amélioration de la sécurité à la naissance en Martinique: 1977-1984.

A public health programme was instituted on the island of Martinique (in the Carribean archipelago) between 1977 and 1984. Its aim was to reduce the perinatal death rate in Martinique which was 25.7 per thousand in 1977 to the level found in France in the same year, namely 14 per thousand. The measures taken to improve the safety of deliveries included closing small maternity homes and improving the hospitals both public and private. The chief measure however, was to improve the availability of specialised antenatal care chiefly administered by midwives (free care consultations near the homes) for the poor and the less well educated women. The results showed that perinatal deaths in the island dropped to 14.9 per thousand in 1984. The major improvement was that women who had been attended by midwives had 10 per thousand perinatal deaths. This involved half the population of the island and the same results were found as to the wealthier and more educated women who were attended by private obstetricians. It was found to be possible to reduce the difference in the perinatal death rate between an African population in Martinique and an European population in European France.

[Detection of haemoglobinopathies at birth, using isoelectric focalization (author's transl)]. / Dépistage des hémolgobinopathies à la naissance par isoélectrofocalisation. Etude de la population de la martinique.

The incidence and nature of haemoglobinopathies were investigated at birth in Martinique, where 4635 samples of umbilical cord blood were examined. Conventional blood values were determined, and a new, extremely simple and highly selective test was performed: isoelectric focalization. Abnormalities were found in 14.3% of blood samples, viz: A/S 7.25%, A/C 3.17%, S/S 0.17%, S/C 0.24%, C/C 0.04%, other mutations 0.63% alpha-thalassaemia minor (alpha 1-thal) 1.72% and isolated microcytosis 1.01%. Unusual abnormalities included 7 different mutations of the 4a-chain, 3 of the beta-chain and 3 of the gamma-chain. The clinical and epidemiological importance of such investigations is emphasized.