[Do the quality of prenatal care have an impact on obstetrical outcomes?]. / La qualité du suivi de la grossesse interfère-elle avec les issues de la grossesse, en Guadeloupe ?

OBJECTIVES: To assess the rate of pregnant women not having accurate prenatal care utilization. The others goals were to assess the impact of an inadequate quantitative or qualitative prenatal care on obstetrical outcomes. PATIENTS AND METHODS: Historical cohort study with a prospective data registration. Hospitalised patients at the maternity ward of the University Hospital of Pointe-à-Pitre were eligible if they gave birth after 22 weeks (or≥500g) at home, outside a maternity ward or in another maternity ward. Early postpartum maternal transfers were included but not medical abortions. The principal outcome was preterm birth (before 37 weeks' gestation). RESULTS: Patients without an appointment before 15weeks or without an appointment each month before their delivery represented 27.4% of women (n=2344). We stressed more preterm deliveries outside the maternity ward among the group with an inadequate prenatal care utilization vs. the other group (3,89% vs. 0,88%) (p<0,0001). We did not find any difference concerning the perinatal outcomes among the women with an inadequate quality prenatal care. DISCUSSION AND CONCLUSION: Our study did not stress a difference concerning perinatal outcomes among women with an inadequate quantitative or qualitative prenatal care utilization.

Refining the clinicopathological pattern of cerebral proliferative glomeruloid vasculopathy (Fowler syndrome): report of 16 fetal cases.

Cerebral proliferative glomeruloid vasculopathy (PGV) is a severe disorder of brain angiogenesis, resulting in abnormally thickened and aberrant perforating vessels, forming glomeruloids with inclusion-bearing endothelial cells. This peculiar vascular malformation was delineated by Fowler in 1972 as a stereotyped lethal fetal phenotype associating hydranencephaly-hydrocephaly with limb deformities, called Fowler syndrome (FS) or "proliferative vasculopathy and hydranencephaly-hydrocephaly" or "encephaloclastic proliferative vasculopathy" (OMIM#225790). In PGV, the disruptive impact of vascular malformation on the developing central nervous system (CNS) is now well admitted. However, molecular mechanisms of abnormal angiogenesis involving the CNS vasculature exclusively remain unknown, as no genes have been localized nor identified to date. We observed the pathognomonic FS vascular malformation in 16 fetuses, born to eight families, four consanguineous and four non-consanguineous. A diffuse form of PGV affecting the entire CNS and resulting in classical FS in 14 cases, can be contrasted to two cases with focal forms, confined to restricted territories of the CNS. Interestingly in PGV, immunohistological response to a marker of pericytes (SMA, Smooth in PGV Muscle Actin), was drastically reduced as compared to a match control. Our studies has expanded the description of FS to additional phenotypes, that could be called Fowler-like syndromes and suggest that the pathogenesis of PGV may be related to abnormal pericyte-dependent remodelling of the CNS vasculature, during CNS angiogenesis. Gene identification will determine the molecular basis of PGV and will help to know whether the Fowler-like phenotypes are due to the same underlying molecular mechanisms.

[Changes in the methods of practitioners of fetal medicine after the Perruche judgement and the law passed on the 4th of March 2002]. / Modifications des pratiques des acteurs de la médecine foetale après l'arrêt Perruche et la loi du 4 mars 2002.

OBJECTIVES: The aim of this study was to evaluate the effect of the "Perruche case" and that of law issued on the 4th of March 2002 in order to moderate the effect of the case on the daily practice of prenatal diagnosis and fetal medicine. MATERIALS AND METHODS: We sent questionnaires to the 186 sonologists of two French regions. Changes in their daily practice, as well as communication with the parents to-be, teaching, and stake in a discussion about the future of their specialty were evaluated. RESULTS: We received 54 answers (29%). Diagnosis and prognosis of fetal anomalies have become more difficult to expose than before for 40% of them. Written information as well as medical reports or explanation about ability and limits of ultrasound have been improved, in content for 64% and in use for 42%. For 45% of practitioners, it has become particularly important to carefully chose words used with patients. Some clinicians stopped or limited second (60%) and third (45%) trimester scans. They expressed their need to learn about legal regulations (50%) or improve communication skills (44%). About 60% felt the Perruche case and the subsequent law help to improve reflection about the future of fetal medicine and prenatal scans. CONCLUSION: While the law was poorly perceived by many physicians, it has enabled a careful reorganization and formalization of fetal medicine and particularly prenatal scans. Further debate is needed on the objectives of fetal sonography. Practitioners themselves should initiate this discussion.