[Second trimester growth restriction and underlying fetal anomalies]. / Retard de croissance intra-utérin du deuxième trimestre : malformations associées et syndromes sous-jacents.

OBJECTIVES: To determine the incidence of chromosomal abnormalities, syndromic association and fetal defects associated with second trimester fetal growth restriction (FGR) in a tertiary referral center. PATIENTS AND METHODS: Retrospective review of all cases referred between 14 and 27 weeks with an abdominal circumference (AC)<5(th) centile between 2008 and 2012. Multiple pregnancies were excluded. Medical records were retrieved to look for the presence of associated malformations, aneuploidy and outcomes. RESULTS: A total of 8626 fetuses had ultrasonographic examination between 14 and 27 weeks. Of these, there were 239 cases (2.8%) with evidence of FGR as based on AC measurement. Thirty-seven fetuses had an abnormal karyotype or an identified syndromic association (15%). The most common chromosomal defect was Trisomy 18 (10 cases, 4.2%), 67 had at least one associated morphological abnormality without aneuploidy or syndromic association (28%). Most common associated abnormalities were relative short femur (5%), omphalocele (5%) and gastroschisis (4%). Last 135 cases were isolated fetal growth retardation (5%). Maternal age was higher (33 yr ± 5 yr versus 31 yr ± 5.6 yr, P < 0.01) and the z-score for the AC lower (2.5 ± 1 versus 2.15 ± 0.6) in the group with abnormal karyotype or syndromic association than in the group without associated malformation. Amniotic fluid was more often increased in the group with an abnormal karyotype or associated malformation (14% and 17%) than in the group without malformations (0%, P < 0.01). DISCUSSION AND CONCLUSION: This study describes abnormalities and outcomes associated with second trimester fetal growth retardation in a large population of patients. Our results suggest that the absence of associated malformation, degree of growth restriction, maternal age and the amniotic fluid index may help in the prenatal management and counseling of this high risk population.

[Giant retroperitoneal hematoma in the peripartum of a normal delivery, "expectative attitude"]. / Hématome rétropéritonéal géant péripartum d'un accouchement normal, "expectative attitude".

We describe a case involving spontaneous retroperitoneal hematoma complicating a normal delivery in a context of a Disseminated Intravascular Coagulation (DIVC) at the end of the pregnancy. Given the defaced symptomatology, an abdomino-pelvic scanner and an examination with a general anaesthesia made it possible to diagnose and to monitor the hematoma in intensive care. The correction of the hemostasis troubles and of the anemia, without another invasive intervention, allowed a return to home at the eighth day. The pathophysiological mechanisms underlying development and practicable treatments of this post-partum hematoma are discussed.

[A comparison of maternal and fetal complications during operative vaginal delivery using Thierry's spatulas and the vacuum extractor]. / Etude comparative de la morbidité maternofoetale immédiate des extractions par spatules de Thierry et par ventouses.

OBJECTIVE: To compare short-term maternal and fetal morbidities between Thierry's spatules and the vacuum extractor. MATERIAL AND METHODS: A retrospective study of all assisted vaginal deliveries using spatules or the vacuum extractor between January 1, 2005 and December 31, 2007 in a single, university hospital maternity. RESULTS: There were 385 deliveries with the vacuum extractor and 332 with spatulas, among a total number of 6941 deliveries. The obstetrical conditions did not differ between the two groups (indication, level or type of presentation, duration of the second stage before extraction). The rate of episiotomy was higher in the spatules than in the vacuum extractor group (80.3 % vs 54.8 %, p < 0.0001), whereas there was a lower rate of first-to-second degree perineal lacerations (18.8 % vs 35.2 %, p < 0.0001). There was no statistically significant difference in the rate of third-to-fourth degree perineal lacerations (2.1 % vs 0.7 %, respectively, p = 0.31). Neonatal outcomes did not differ significantly between the two groups (5-minute Apgar score < 7 in 0.3 % vs 1.8 %, respectively, p = 0.75). CONCLUSION: There were few differences in maternal and neonatal outcomes according to the type of instrument used, except for a lower episiotomy rate with vacuum extraction.