Contribution of three-dimensional computed tomography in the assessment of fetal skeletal dysplasia.

OBJECTIVE: To compare the diagnostic accuracy of two-dimensional (2D) ultrasound and three-dimensional (3D) computed tomography (CT) for the diagnosis of fetal skeletal anomalies. METHODS: Eleven pregnant women underwent 2D ultrasound and 3D-CT. Ten fetuses presented skeletal anomalies on 2D ultrasound and one fetus had a normal ultrasound exam but a familial history of osteopetrosis. We compared retrospectively the diagnoses established on 2D ultrasound and 3D-CT with the neonatal and/or postmortem work-up, which were used as the gold standard. RESULTS: 2D ultrasound provided the correct diagnosis in only two of the 11 cases. CT yielded the correct diagnosis in eight; in six of these, 2D ultrasound had been inconclusive. 3D-CT was more accurate than was 2D ultrasound in visualizing vertebral anomalies (abnormal shape of the vertebral bodies, abnormal interpedicular distance), pelvic bone malformations (delayed ossification of the pubic bones, abnormal acetabular shape) and enlarged metaphysis or synostoses in long bones. In three cases, neither 2D ultrasound nor CT provided the correct diagnosis. CONCLUSION: In this series, which included a variety of skeletal dysplasias, 3D-CT had a better diagnostic yield than did 2D ultrasound. Both imaging techniques are useful in the management of fetal dysplasia; 2D ultrasound is a useful screening test and 3D-CT is a valuable complementary diagnostic tool.

[Perinatology: an uncommon type of medicine]. / La périnatologie: une médecine particulière.

Perinatology is a developing medical field where decisions are particularly difficult and may be harmful in that they deal with the life of an infant and the future of the families. It deals with matters that are at cross boards of several medical specialties belonging to medicine and surgery but also relevant to psychology and ethics. Therefore, a collaborative approach is required. Interprofessional exchanges and a team organization are warranted in order to make handling consistent and allow a fruitful follow up. This holds true for the mother and the newborn throughout the pregnancy, delivery and early life. It seems important to us that the parents face with a couple obstetrician-pediatrician. This couple will be able to help them in building their parenthood and considering their newborn as a full human being and not only a sum of several medical problems.

Management of a ruptured basilar artery aneurysm during pregnancy.

A 36 year old woman who ruptured a basilar artery aneurysm at 38 weeks gestation in her second pregnancy was managed successfully by endovascular embolisation 36 hours after an emergency Caesarean section. The timing of treatment along with the obstetric, neurosurgical and anaesthetic aspects of this complex problem are discussed along with a review of the current literature on the subject.

First sickle cell crisis triggered by induction of labor in a primigravida.

Sickle cell anemia is a severe disorder that rarely spares affected adults. We describe here a 32-year-old pregnant woman who presented her first lifetime symptoms of her disease during induction of labor at term. We therefore discuss the possible causes that may have triggered this inaugural crisis.