[Intestinal obstruction in pregnancy]. / Obstruction intestinale et grossesse.

Intestinal obstruction is a rare but dreadful complication of pregnancy. Both the mother and the foetus may be severely affected and even die. The authors here report their recent experience and review the literature. They emphasize that diagnostic pitfalls are common during pregnancy and there appropriate management most often delayed. A multidisciplinary approach is advocated and the specific aspects of this high-risk situation are discussed.

Prenatal diagnosis of 52 pregnancies at risk for congenital cytomegalovirus infection.

OBJECTIVE: To determine the feasibility of prenatal diagnosis of fetal cytomegalovirus (CMV) infection. METHODS: Fifty-two pregnant women were investigated in our unit between October 1985 and July 1992. The diagnostic procedures included ultrasound examination, amniocentesis, and fetal blood sampling. Specific tests for CMV infection included specific immunoglobulin (Ig) M antibodies, viral culture, and amplification of CMV DNA by polymerase chain reaction. Nonspecific tests included white blood cell count, hemoglobin, hematocrit, platelets, and gamma-glutamyl transferase determination. RESULTS: The combination of tests allowed an antenatal diagnosis of CMV in 13 of the 16 infected fetuses (sensitivity 81%). Amniocentesis allowed the diagnosis in 12 of the 13 antenatally diagnosed cases. The sensitivity of CMV IgM antibody detection in fetal blood was 69%. The culture of fetal blood was never positive. Thrombocytopenia was present in six cases, and ultrasound was abnormal in five. CONCLUSIONS: Amniotic fluid is the best sample to diagnose CMV infection, and fetal blood sampling and sonography are important to assess the fetal condition. Our experience underscores the importance of repetitive sampling.

[Conservative laparoscopic treatment of adnexal torsion during pregnancy]. / Traitement laparoscopique conservateur de la torsion annexielle durant la grossesse.

Adnexal torsion is an unusual but serious complication in pregnancy, occurring most frequently in the first trimester. The difficult and often delayed diagnosis generally imposed laparotomy and adnexectomy, severely affecting foetal and fertility outcome among young women. In case of early diagnosis, a few authors have recommended conservative treatment by untwisting the adnexa. At the moment, only very few cases of laparoscopic conservative management of adnexal torsion during pregnancy have been reported. The authors report three cases of adnexal torsion during the first trimester of pregnancy, all managed by laparoscopy and discuss the validity of conservative management of adnexal torsion.

[Fibronectin: an early marker of pre-eclampsia]. / La fibronectine: marqueur précoce de la pré-éclampsie.

Plasma fibronectin concentration was determined by immuno-nephelometer analysis in 316 pregnant women between 22 and 38 weeks. The plasma fibronectin concentration increases progressively during normal pregnancy. From 22 to 30 weeks, the 90th percentile is 350 mg/l, and from 30 to 38 weeks it is 400 mg/l. 29 patients had a fibronectin level greater than 400 mg/l. Of this group, 95% of the creatinine's clearance were significantly lowered. From 30 weeks of gestation, the correlation between an elevated level of fibronectin and the development of hypertension is 100%. Our results confirm that this glycoprotein may be an early indicator of preeclampsia.

Prenatal diagnosis of an epidermal scalp cyst simulating an encephalocoele.

The majority of extracranial masses detected by prenatal ultrasound screening are encephalocoeles. Several recent publications have drawn attention to extracranial masses which resemble encephalocoeles. The uncertainty in these situations can result in the unnecessary termination of a pregnancy. We report a case of an epidermal cyst of the scalp presenting as an encephalocoele at a routine second-trimester ultrasound scan.