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Resumen El embarazo constituye un periodo de riesgo para las mujeres con patologia cardiovascular. Las complicaciones cardiovasculares son la primera causa de mortalidad indirecta de las mujeres en la etapa del parto en los paises del hemisferio norte. Las cardiopatias preexistentes al embarazo son la primera causa de descompensacion cardiaca: las mas frecuentemente observadas en estas pacientes son las enfermedades valvulares y las cardiopatias congenitas. Las patologias de alto riesgo materno son las valvulopatias estenosantes, la hipertension pulmonar, las protesis mecanicas, la insuficiencia cardiaca, las cardiopatias congenitas cianogenas y los aneurismas de la aorta. El manejo y tratamiento de estas pacientes necesitan adaptarse durante el embarazo, y el parto debe ser programado por un equipo multidisciplinar preparado. No hay que olvidar el riesgo fetal y neonatal, en particular la prematuridad espontanea o inducida, el riesgo de retraso de crecimiento intrauterino, de abortos de repeticion o de teratogenicidad. Es frecuente detectar enfermedades cardiacas subyacentes, desconocidas hasta ese momento, en el periodo del parto, deteccion que se asocia a una importante morbimortalidad materna. En caso de sintomatologia sugerente, soplos, antecedentes familiares de cardiopatia o antecedentes personales de quimioterapia o radioterapia, se puede recomendar realizar una deteccion precoz clinica y ecocardiografica.

Les valves de l’urètre postérieur (VUP) représentent une des principales causes d’insuffisance rénale terminale chez les enfants de sexe masculin. Elles sont la cause principale d’obstruction sous-vésicale chez le fœtus avec une incidence de 2,1/10 000 naissances. L’accès au diagnostic anténatal permet d’envisager pour les cas les plus graves (oligoamnios sévère et/ou syndrome polymalformatif) une interruption de grossesse et d’optimiser, pour les cas moins sévères, la prise en charge néonatale ainsi que le suivi pédiatrique. À chaque étape, à chaque âge, une approche pluridisciplinaire est indispensable afin d’optimiser le suivi et d’informer de manière la plus complète possible les parents et les soignants prenant en charge ces patients. Cet article de revue envisage le parcours de ces patients avec tout d’abord le diagnostic (anténatal) puis leur prise en charge et leur suivi au long terme. Il s’agit de gérer au mieux la survenue de complications et d’éviter ainsi une évolution vers l’insuffisance rénale terminale. Cette approche pluridisciplinaire avec un échange d’information permanent permet une prise en charge optimisée assurant la continuité.

International audience; In the field of clustering techniques, little attention has been paid to the recovery of a set of clusters from the structure of an additive tree. To bridge this gap, this work presents an original partitioning technique which aims to reveal clusters from an additive tree that represents a large set of objects. Specifically, an algorithm that splits a tree into successive subtrees was developed, based on a ratio of the lengths of edges. The stability of the clusters obtained with this technique was then evaluated using measurements of cohesion and isolation that were generated using a bootstrapping strategy. Finally, the degree of association of each object to clusters was analyzed to gain insight into their internal structure. This analysis was performed on the results of a sorting task conducted by 156 subjects, who were asked to sort 96 terms associated with the odor of wine. The methodology developed in this paper represents an innovative way to highlight groups of terms within a large set of wine odor attributes, with the ultimate goal being to improve the structure of the lexicon.

Background The antibody primarily responsible for fetal anemia may influence treatment and prognosis. The primary objective was to compare ante- and postnatal management and the outcomes of maternal red blood cell (RBC) alloimmunizations according to the antibody involved. The secondary objective was to compare anti-D alloimmunizations according to associated number of antibodies. Study design and methods A single-center study from 1999 to 2015 including maternal RBC alloimmunizations requiring intrauterine transfusion (IUT) was conducted. Patients were classified according to the antibody involved: anti-D, other Rh (anti-c and anti-E), and anti-K1. Obstetric data, IUT characteristics, and neonatal outcome were compared. A specific study on the anti-D, when isolated or associated, was then conducted. Results There were 106 pregnancies included, with 77.4% having anti-D, 9.4% having another anti-Rh (Rh group), and 13.2% having anti-K1. No significant difference between the anti-D and Rh groups was found for management and prognosis. The hemoglobin level in the first IUT was higher in the anti-D group than in the Kell group (6.8 vs. 4.7 g/dL, p = 0.008). Newborns in the anti-D group had significantly higher bilirubin levels and phototherapy duration than those in the Kell group. The mean estimated daily decrease in hemoglobin and that between the first two IUTs were lower with an isolated anti-D, compared with anti-D associated with two antibodies (p = 0.04). Conclusion Anti-K1 alloimmunizations seem to cause more severe fetal anemia than anti-D alloimmunizations. Moreover, a decrease in hemoglobin appears to be more rapid when anti-D is associated with other antibodies.

Placenta accreta spectrum disorder (PASD) is a rare obstetrical pathology, however its incidence is increasing. Morbidity associated with PASD is still high. Even if hysterectomy is considered to be the reference standard treatment, the conservative treatment by leaving the placenta in situ is now an approved option. The objective was to describe management and morbidity of patients with PASD, during the decade, in our French high-level maternity.It was a retrospective study of management and morbidity of PASD in our department between 2007 and 2017.Forty-six PASD cases were admitted in our center. Thirty-three (71.7%) had a prenatal suspicion of PASD. Conservative treatment was considered for 22 patients (47.8%). It was successful in 12 cases (54.5%). Thirty-four (73.9%) had a primary hysterectomy, eight (17.3%) had a delayed hysterectomy, four (8.6%) had a uterine conservation. Primary Morbidity included 28 blood transfusions, 12 bladder injuries, 1 ureteral injury and 13 transfers to intensive care unit. Secondary morbidity after conservative treatment included two Hemorrhages (16.6%), five endometritis (41.6%) and three disseminated intravacular coagulations (25%).Morbidity associated with this pathology is severe. Conservative treatment became an option for PASD. Thanks to a better antenatal diagnosis, it can be proposed to more women. Morbidity seems the same as other centers. Our rate of primary and secondary hysterectomy is higher than other centers. Conservative treatment seems an effective option for women who desire to preserve their fertility to avoid peripartum hysterectomy and its related morbidity and consequences on fertility.

Resume Objectif Evaluer le bilan d’imagerie (echographie ± IRM) dans le diagnostic des malformations lymphatiques kystiques de localisations cervicales. Methodes Etude retrospective, descriptive des patientes ayant beneficie d’un depistage echographique de masses cervicales anterieures, confirmees en echographie de reference, au Centre pluridisciplinaire de diagnostic prenatal du Centre hospitalier regional universitaire de Lille de 1997 a 2014. Resultats Dix-sept lymphangiomes ont ete recenses. Douze (71 %) lymphangiomes etaient diagnostiques lors de l’echographie de reference et 88 % lors de l’IRM. On retrouvait une extension de la masse pour 10 (62 %) lymphangiomes en echographie et pour 11 (85 %) en IRM. Dans la plupart des cas, on objectivait respectivement en echographie et en IRM : une extension de la face (4, 23 %/6, 46 %), de la base de la langue (3, 18 %/2, 15 %) et du plancher buccal (3, 18 %/3, 15 %). Une atteinte pharyngee (5,38 %) et mandibulaire (4,31 %) etait depistee en IRM et non retrouvee en echographie. Deux (12 %) fœtus etaient porteurs de malformation urogenitale, 1 (6 %) de malformation cardiaque et 1 (6 %) de malformation faciale associee en echographie. Les lymphangiomes restaient stables dans 12 (71 %) des cas et disparaissaient dans 2 (12 %) des cas avant la naissance. Conclusion L’IRM et l’echographie paraissent indissociables pour permettre une evaluation et une prise en charge optimale des masses cervicales. Le bilan des lesions associees semble pouvoir nous aider dans l’orientation diagnostique. Enfin, les lymphangiomes semblent avoir une stabilite au cours de la grossesse et un bon pronostic en cas de masse cervicale lymphatique non compliquee et sans extension pejorative.

International audience; Aromatic characterization is a key element of enhancing one's knowledge of wine. While several studies have investigated the importance of wine expertise in the ability to perform odor-related sensory tasks, little attention has been paid to the influence of expertise on the semantic categorization of wine odors. To bridge this gap, this study aimed to explore the influence of a subject's expertise on the semantic representation of wine odors by means of a free sorting task. For this purpose, 156 subjects were recruited. Their level of expertise was measured using a questionnaire and the data analysis revealed four clusters of subjects with a gradual level of expertise. Subjects also performed a sorting task on 96 odor terms. From the number and the size of odor groups formed, as well as the additive tree representation and the consensus partition between the terms for each expertise level, we observed that all subjects, regardless of their experience, had largely the same semantic categorization of wine-odor attributes, which was mainly shaped by the sources of the odorants. It appeared that level of wine expertise played a minor role in creating the semantic representation of wine odors, affecting mainly the knowledge of specialized terms.

Background Almost 20% of parvovirus B19 foetal infections require intrauterine transfusions. In addition, myocardial dysfunction has been observed in severe parvovirus B19 infections. One objective of an intrauterine exchange transfusion (IUET) is to avoid an overload during the transfusion. Our aim was to study the obstetrical and neonatal outcomes in cases of IUETs performed for foetal parvovirus infections and to compare our survival rate to those studies in which simple in utero transfusions were chosen. Study design and methods This was a retrospective monocentre study of all patients followed up for parvovirus B19 infections in which IUETs were performed. An IUET was indicated when foetal hydrops was observed and/or when severe foetal anaemia was diagnosed though an elevation in the middle cerebral artery peak systolic velocity. The characteristics of each pregnancy and the neonatal outcomes were studied until hospital discharge. Results Thirty-five IUETs were performed in 26 foetuses. The median gestational age of the first IUET was 22.6 weeks. Only one foetal bradycardia incidence was recorded during the procedure. Three medical pregnancy terminations were observed in our series, secondary to severe cerebral anomalies confirmed in the magnetic resonance imaging. Five in utero deaths occurred, in which 2 of the foetuses underwent multiple IUETs. All the neonates had normal haemoglobin levels at birth, and none were transferred to the neonatal intensive care unit. The overall survival rate was 70%. Conclusion IUETs exhibit a survival rate similar to that of simple intrauterine transfusions in foetal parvovirus infection cases.

Resume But La decouverte d’une hyperechogenicite intestinale fœtale (HEI) entraine souvent la realisation d’un bilan etiologique invasif. Notre objectif est d’etudier les etiologies et le pronostic des HEI selon les constatations echographiques antenatales afin d’evaluer la pertinence de ce bilan. Materiels et methodes Etude retrospective monocentrique, menee de 2008 a 2012, incluant toutes les patientes adressees pour une suspicion d’HEI. Nous avons analyse les resultats des donnees antenatales et neonatales selon 4 groupes definis en echographie : HEI isolee, associee a des signes digestifs, des signes vasculaires ou d’autres signes echographiques. Resultats Cent quarante-neuf patientes ont ete suivies pour une HEI : 69 HEI isolees, 24 associees a des signes digestifs, 16 a des signes vasculaires, 40 a d’autres signes. Les issues etaient differentes entre ces groupes avec respectivement 92,8, 41,7, 0 et 45,0 % d’enfants sains. En cas d’HEI isolee, nous avons note 2,9 % de mucoviscidose, 2,9 % d’infection congenitale et aucune dyschromosomie. Conclusion L’HEI isolee semble avoir un meilleur pronostic que les formes associees. Toutefois, un bilan pour eliminer une mucoviscidose ou une infection congenitale doit etre propose et pourrait etre initialement non invasif, si l’absence de dyschromosomie etait verifiee sur une plus grande serie.

During pregnancy, the occurrence of aortic dissection is a rare event immediately threatening fetal and maternal prognosis. Its occurrence is more common in cases of connective tissue disease. But the absence risk factor shall not exclude or delay diagnosis. We must learn to think about it, because the prognosis is highly dependent on time management. The clinical presentation of this medical and surgical emergency varies, and pregnancy adds its own symptoms. We have to ask without hesitation that echocardiography or chest CT be performed since these diagnostic methods are both reliable and available.

Resume La hernie de coupole diaphragmatique congenitale, dont la physiopathologie est partiellement elucidee, est pourvoyeuse d’une morbi-mortalite importante. Nous rapportons le cas d’un fœtus atteint d’une hernie de coupole diaphragmatique associee a une triplication du gene EDNRA codant pour le recepteur ET-A de l’endotheline 1. Les techniques genetiques de haute resolution ont permis de retrouver la cause probable de la pathologie, et plaidaient en faveur d’une forme isolee de bon pronostic. La sur-expression du recepteur ET-A au niveau des vaisseaux pulmonaires serait responsable d’un remodelage vasculaire et d’une hypertension arterielle pulmonaire. Ces anomalies pulmonaires auraient precede la survenue d’une breche diaphragmatique.

Resume Objectif La tocolyse par inhibiteurs calciques est largement repandue en France. Neanmoins, ces molecules n’ont pas l’autorisation de mise sur le marche dans cette indication. L’objectif de ce travail est de faire une mise au point sur l’ensemble des effets indesirables des inhibiteurs calciques publies ou signales a la Banque nationale de pharmacovigilance. Materiel et methode Nous avons realise une revue de la litterature reprenant les donnees experimentales animales sur les inhibiteurs calciques, les etudes retrospectives et prospectives randomisees ou non comparant les differents tocolytiques, les cas cliniques publies et enfin nous avons fait une requete aupres de la Banque nationale de pharmacovigilance francaise sur les cas declares apres utilisation des inhibiteurs calciques en tant que tocolytique. Resultats Des effets indesirables sont retrouves chez 2 a 6 % des patientes tocolysees par nifedipine (Adalate®), dont 0,9 a 1,9 % d’effets indesirables severes. Il s’agit majoritairement de cephalees, de flushs et d’hypotensions arterielles. Les donnees concernant la nicardipine (Loxen®) sont plus limitees. Pour ce dernier, il existe des effets indesirables specifiquement lies a sa voie d’administration (veinites) mais il semble que les autres effets indesirables rapportes ne soient pas plus frequents. Plusieurs meta-analyses ont mis en evidence une diminution des effets indesirables maternels lorsqu’on utilise les inhibiteurs calciques par rapport aux β-mimetiques. La comparaison des inhibiteurs calciques a l’atosiban est moins documentee. Des effets indesirables plus rares sont rapportes sous forme de cas cliniques. Il s’agit presque exclusivement de complications cardio-vasculaires (dyspnee, œdeme aigu du poumon, infarctus du myocarde, hypotensions arterielles). Elles sont plus frequentes avec la nicardipine qu’avec la nifedipine. On retrouve des observations similaires en interrogeant la Banque nationale de pharmacovigilance. Conclusion La prescription des inhibiteurs calciques dans le cadre de la tocolyse expose a des effets indesirables maternels sans gravite la plupart du temps et moins frequemment qu’avec les β-mimetiques. Des complications severes maternelles ont neanmoins ete rapportees plus frequemment avec la nicardipine qu’avec la nifedipine, ce qui justifie de ne plus utiliser la nicardipine en tocolyse. La nifedipine est la molecule la plus etudiee. Les donnees de la litterature ne permettent pas de definir une posologie maximale. Il apparait raisonnable de ne pas associer differents tocolytiques, et de surveiller de facon rapprochee la tension arterielle maternelle, la survenue d’une reaction cutanee ou d’hypersensibilite, d’une dyspnee, ou d’une douleur thoracique.

Resume Objectifs Analyser les facteurs favorisants l’apparition de pieds bots isoles, identifier les pathologies associees aux pieds bots et discuter la realisation systematique d’un caryotype en cas de pieds bots isoles. Patientes et methodes Etude : ont ete incluses retrospectivement toutes les patientes dont le diagnostic de pied bot varus equin a ete confirme dans notre centre de diagnostic antenatal entre janvier 2007 et decembre 2011. Nous avons defini et analyse les pieds bots varus equin isoles (PBVEI) et les pieds bots associes a d’autres anomalies morphologiques ou syndromiques (PBVES). Resultats Cent vingt-quatre pieds bots ont ete analyses. Quarante-sept cas PBVEI pour lesquels un caryotype a ete realise dans 34 cas et dont le resultat etait normal. Les facteurs de risque retrouves par notre serie etaient le sexe masculin (p = 0,0017), l’existence d’un antecedent familial de pied bot (p = 0,001) et la primiparite (p = 0,04). Soixante-dix-sept cas de PBVES ont ete identifies parmi lesquels 14 anomalies chromosomiques, 18 spina bifida, 10 anomalies neuro-musculo-squelettiques. Parmi les 124 cas, 25 etaient unilateraux et 99 etaient bilateraux. Le caractere bilateral du pied bot ne constituait pas un facteur de risque de PBVES (p = 0,8). Discussion et conclusion Nous n’avons pas retrouve d’anomalies chromosomiques en cas de PBVEI. Les resultats de notre serie permettraient de surseoir a la realisation systematique d’une amniocentese en cas de PBVEI chez les patientes primipares presentant un antecedent familial de pied bot chez un fœtus de sexe masculin. La realisation systematique d’une echographie morphologique realisee par un echographiste referent en diagnostic antenatal devrait etre poursuivie.

Intrauterine transfusion (IUT) has changed fetal anemia prognosis. However, long-term neurodevelopmental outcome is altered in 5% of children. Our objective was to study the contribution of fetal MRI to diagnosis brain lesions in case of fetal anemia.Retrospective monocentric descriptive study from 2005 to 2016, including all patients followed for fetal anemia requiring IUT. The indications for MRI were: hydrops fetalis and / or hemoglobin5 g / dL and / or more than 3 IUTs and / or acute severe anemia and / or ultrasound abnormality. Fetal and neonatal outcome and pediatric neurological monitoring were studied.89 patients were followed for fetal anemia with IUT and 28 (29.1%) had fetal MRI, 12 of which were abnormal. Two out of twelve had abnormal ultrasound. Seven out of twelve had poor neurological prognosis: 2 medical terminations of pregnancy were performed; 2 children had severe developmental delay and 3 children had schooling difficulties. Five out of twelve children had favorable neurological prognosis.MRI of the fetal brain makes it possible to better detect brain lesions than ultrasound does in the management of severe fetal anemia and seems particularly appropriate in cases of acute anemia.

Esophageal atresia (EA) is prenatally diagnosed in less than one third of the cases and is usually only suspected. Recently, magnetic resonance imaging (MRI) with dynamic sequence and biochemistry of the amniotic fluid have been proposed to enhance prenatal diagnosis of EA. We report the case of a triple negative screening (ultrasound, MRI with dynamic sequence and biochemistry of the amniotic fluid) with a postnatal diagnosis of EA type III with a small defect. Even using second line tests, prenatal diagnosis of EA remains a challenge.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 43 - N° 6 - p. 424-430

Resume Objectifs Repertorier les signes echographiques mis en evidence lors de la suspicion d’un placenta accreta. Les objectifs secondaires sont d’analyser la pertinence du diagnostic en echographie et en imagerie par resonance magnetique (IRM), et de connaitre les circonstances diagnostiques afin d’identifier une population a risque. Patientes et methodes Il s’agit d’une etude retrospective monocentrique. Les cas de placentas accreta pris en charge au centre hospitalo-universitaire de Lille entre 2005 et 2010, suspectes en antenatal ou decouverts per-partum, ont ete recenses. Resultats Vingt-sept patientes ont presente un placenta accreta sur cette periode. 22 cas etaient suspectes en antenatal, dont 21 confirmes a la naissance. Six cas etaient decouverts per-partum. Le diagnostic etait suspecte dans 41 % des cas suite a un episode de metrorragies. Cent pourcent des patientes suivies au diagnostic antenatal avaient un uterus au moins unicicatriciel et un placenta anterieur insere bas. Cinquante pourcent des patientes non depistees avaient un placenta posterieur non insere bas. Les signes echographiques les plus frequents etaient « lacune placentaire » (85,7 %), « vascularisation anormale » (71,4 %), « perte du lisere hypoechogene du myometre » (66,7 %), « irregularite de la paroi vesicale » (57,1 %). La sensibilite de l’echographie de depistage est de 78 %. Vingt et une IRM, realisees en deuxieme intention confirmaient le diagnostic dans 66,7 % des cas. Discussion et conclusion L’echographie est un examen pertinent pour le diagnostic de placenta accreta. Les placentas posterieurs, plus difficiles d’acces, ne doivent pas etre negliges. Les placentas anterieurs praevia chez les patientes multipares ayant un uterus cicatriciel doivent requerir toute l’attention de l’examinateur.

Objective Prenatal diagnosis of esophageal atresia (EA) remains a challenge. Our objective was to evaluate the combination of sonography, magnetic resonance imaging (MRI), and amniotic fluid biochemical markers in prenatal diagnosis of EA. Study design A retrospective study of all cases with prenatal suspicion of EA from January 2008 to May 2013 in our regional reference center was carried out. Patients were included if all the three tests were performed. For each test, sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) were evaluated. Each test was compared using Fisher's exact test. Results Fifteen patients were referred at a median gestational age of 28+5 weeks (24–36) for suspicion of EA on the basis of small or non-visualized fetal stomach bubble and/or polyhydramnios. Se, Sp, PPV, and NPV for sonographic pouch sign/MRI/biochemical amniotic fluid were respectively 40/100/100/45.5%, 80/100/100/71.4%, and 90/60/81.8/75%. MRI was the best predictive test (p = 0.007). Conclusion In case of ultrasound prenatal suspicion of EA (with or without visualization of the pouch sign), an MRI at 30–32 weeks using fast imaging employing steady-state acquisition should be proposed. Biochemical amniotic fluid may be helpful and should be evaluated in a larger study. © 2014 John Wiley & Sons, Ltd.

Resume But Etudier l’utilisation du misoprostol pour le declenchement du travail en cas de mort in utero ou d’interruption de la grossesse au deuxieme ou au troisieme trimestre et definir ses modalites d’administration. Materiel et methode Revue de la litterature a l’aide de PubMed, articles en anglais et en francais, mots cles utilises : misoprostol, termination of pregnancy, second and third trimester, scarred uterus, previous cesarean section, uterine rupture. Resultats Le misoprostol est efficace pour le declenchement du travail des patientes presentant une mort in utero ou souhaitant realiser une interruption de la grossesse aux deuxieme et troisieme trimestres. La voie vaginale reduit le delai induction-expulsion et le taux de patientes n’ayant pas accouche dans les 24 premieres heures du declenchement par rapport a la voie orale sans augmentation des effets secondaires. La voie orale est une alternative possible si la patiente le souhaite. La voie sublinguale semble interessante mais les donnees sont peu nombreuses. L’utilisation de doses moderees (800–2400 μg/j) en prises espacees de 3 a 6 heures semble presenter le meilleur compromis efficacite-tolerance mais il n’est pas possible de recommander un schema d’administration precis. Le risque de rupture uterine en cas d’uterus cicatriciel justifie l’utilisation des doses minimales efficaces. Il est alors conseille de ne pas depasser la dose de 100 μg par prise. Le delai induction-expulsion et les doses de misoprostol necessaires pour declencher le travail sont diminues lorsqu’il est associe a la prise de mifepristone 36 a 48 heures avant le debut du declenchement. Conclusion Le misoprostol est efficace et sur pour l’induction du travail en cas de mort in utero ou d’interruption de grossesse aux deuxieme et troisieme trimestres.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 43 - N° 1 - p. 5-11

“Mixed Profiling” (MP) is a descriptive profiling combining a pre-established list of descriptors scored by all tasters and the possibility for each panellist to add free descriptors. All the descriptors, free or not, are rated on an intensity scale. The aim is to improve the reliability of wine characterisation in a professional context. Quantitative Descriptive Analysis® provides a fine characterisation while free-choice profiling is a more holistic method that is easier to implement with professionals. In general, professionals are not trained together and evaluate wines using pre-defined descriptors. MP aims to combine the power of the two methods. It is compared to a classical profiling (CP) largely performed in a wine professional context that uses a pre-defined list of descriptors. Ten red wines were evaluated by two distinct panels of wine professionals without prior common training. Performances of the panel were verified using variance analysis and the results of both sensory methodologies were compared using a multi-block method. The results reveal that MP avoids the omission of a specific sensory characteristic and provides a complete sensory characterisation of products in a short time.

BACKGROUND To best predict the recurrence of fetal anemia after intrauterine transfusion (IUT), the measurement of middle cerebral artery peak systolic velocity (PSV) and the estimation of hemoglobin (Hb) daily decrease are compared. STUDY DESIGN AND METHODS A retrospective study including 38 patients who had at least two IUTs in a context of red blood cell alloimmunization was conducted. PSV values before first, second, and third IUTs were collected and expected Hb level was calculated according to various Hb daily decrease formulas as proposed in the literature. RESULTS Comparison of PSV receiver operating characteristic curves with the various Hb levels did not find any significant difference between first and second IUTs. On the other hand, we found a significant difference between the second and third IUTs, with better prediction of fetal anemia through Hb decrease calculation, whatever the formula. Between the second and third IUTs, no formula was significantly better than the others. CONCLUSION The timing of a second transfusion can be difficult to determine with certainty, but PSV can give an accurate assessment of when to resample the fetus with probably a higher recommended threshold for the diagnosis of fetal anemia. Subsequent to a second transfusion, the intertransfusion interval should be based on estimated Hb decrease rather than PSV thresholds, whatever the chosen formula proposed in the literature. Larger numbers are needed to definitely make this recommendation and it will be interesting to evaluate correlation between different antibodies.

International audience; No abstract available

L’atresie de l’oesophage (AO) est une malformation congenitale rare (1 cas pour 2500 a 3500 naissances). Plusieurs formes anatomiques existent mais l’interruption de l’oesophage est le plus souvent associee a une fistule oesotracheale (90 %). Le diagnostic antenatal (DAN) de cette anomalie est particulierement interessant car il permet de realiser un bilan complementaire a la recherche de formes associees de plus mauvais pronostic (echographie de reference, IRM et amniocentese). Il prepare de plus les parents a la prise en charge postnatale et permet d’optimiser celle ci. L’hydramnios et/ou un estomac absent ou de petite taille sont les deux signes echographiques d’appel les plus frequents mais ils ne sont pas specifiques de l’AO. La visualisation en echographie ou en IRM d’une image liquidienne cervicale ou thoracique lors des mouvements de deglutition (pouch sign des anglosaxons), correspondant a la dilatation du cul-de-sac oesophagien superieur borgne, permet d’augmenter la specificite du diagnostic. Le DAN reste cependant difficile et moins de 50 % des AO sont reperees en antenatal. L’analyse biochimique du liquide amniotique pourrait ameliorer ces resultats.

Haemophagocytic syndrome (HPS) results from an inappropriate stimulation of macrophages in bone marrow and lymphoid organs, leading to haemophagocytosis and hypercytokinemia. HPS may be primitive, essentially in pediatric population, or secondary to malignancy, infection or autoimmune disease. This disease is rare and prognosis is poor. A small number of cases during pregnancy have been described in literature. We report one HPS case in a pregnant patient at 21 week's gestation with systemic lupus erythematosus. We discuss diagnostic difficulties, obstetrical complications and therapeutic options.

The concept of terroir is widely used in the wine industry, and many studies are undertaken to better understand the influence of local terrain features on produced wines. In this context, this study monitored nine Chardonnay plots in the Fruili wine region of Italy to gather information on grapevine growth and berry ripening. The study objective was to define viticulture potentialities allowing to identify future strategies for the production of a “single vineyard” Chardonnay wine at the Vie di Romans estate, Italy. During the growing season of 2017, relations were studied between terrain features and field observations on vine phenology and grape ripening. Stem water potential and gas exchange measurements were also effectuated. Results show that there are significant differences between the studied plots. Earliness of the grapevine cycle between the plots has been less evident to determine than the variation in berry characteristics. The latter were linked with identified pedoclimatic units, but the effect of the cultural practices should not be overlooked. The study should be perceived as a first monitoring campaign, highlighting the important differences between study plots. Further investigation in the following seasons should give a more accurate perception of individual plot characteristics and their impacts.

Resume Objectif L’objectif de notre etude etait d’identifier, dans une population de patientes ayant presente une preeclampsie et/ou un HELLP syndrome, l’incidence et les facteurs de risque de survenue d’une complication vasculaire lors de la grossesse suivante. Patientes et methodes Quatre cent quarante-cinq patientes prises en charge pour une preeclampsie et/ou un HELLP syndrome entre mars 1996 et decembre 2006 ont ete incluses. Les donnees de la grossesse index et de la grossesse suivante ont ete etudiees. Afin de laisser un temps suffisant pour etudier le devenir de la grossesse suivante, seules les patientes ayant accouche depuis plus de deux ans ont ete selectionnees. Resultats Cent cinquante et une patientes ont eu une grossesse dont 142 sont allees au-dela de 20 semaines d’amenorrhee (SA). La mediane de suivi etait de six ans (intervalle : deux a neuf ans). Trente-neuf d’entre elles (27,5 %) ont eu une complication vasculaire. Une preeclampsie recidivait dans 20 cas (51,3 %). Trois patientes (7,7 %) ont developpe un HELLP syndrome. Une hypertension arterielle est survenue pour 14 patientes (35,9 %) et un hematome retroplacentaire pour une d’entre elles (2,6 %). Quatre nouveau-nes (10,3 %) etaient petits pour l’âge gestationnel ( e percentile). Une obesite, un accouchement avant 32 SA et un poids de naissance e percentile lors de la grossesse index etaient les trois principaux facteurs associes a la survenue d’une complication vasculaire lors de la grossesse ulterieure. Discussion et conclusion Les patientes avec un antecedent de preeclampsie et/ou de HELLP syndrome ont un risque accru de developper une complication vasculaire lors de la grossesse ulterieure.

Resume Objectif Definir le lieu de suivi et d’accouchement des grossesses gemellaires en France. Materiel et methodes Recherche bibliographique a partie de la base de donnees Medline et de la Cochrane Database Library. Consultation des recommandations des societes savantes de gynecologie-obstetrique etrangeres. Resultats Il n’existe pas d’etudes de haut niveau de preuve permettant de repondre a la question. Le risque d’accouchement premature et la chorionicite sont les deux facteurs, principaux qui conditionnent la prise en charge des grossesses gemellaires. En cas de situation a risque d’accouchement premature, le transfert in utero est recommande. Le suivi doit etre assure par une equipe connaissant les particularites de prise en charge selon la chorionicite. La prise en charge en structure specialisee n’est pas recommandee. Le travail et l’accouchement necessitent la disponibilite permanente et immediate d’une equipe perinatale incluant un gynecologue obstetricien, un anesthesiste et un pediatre. Conclusion Le lieu de suivi et d’accouchement doit tenir compte des besoins specifiques des grossesses gemellaires et de la chorionicite. Plutot que de definir un lieu precis, il semble plus logique de definir les moyens necessaires a mettre en œuvre pour obtenir une prise en charge optimale de ces grossesses.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 37 - N° 8S1 - p. 398-404

Assess imaging (ultrasound±MRI) in the diagnosis of cervical cystic lymphangioma.Retrospective, descriptive study of the patients who underwent reference ultrasound screening for fetal anterior cervival masses in multidisciplinary prenatal diagnosis center of the Lille Regional University Hospital from 1997 to 2014.Seventeen lymphangiomas were identified. Seventy-three percent of lymphangiomas (n=12) were diagnosed in the baseline ultrasound and 85% (n=11) in MRI. An extra-cervical extension was identified in 10 (62%) with ultrasound and 11 (85%) with MRI. Main sites of mass extension objectived by ultrasound and MRI were respectively the face (4,23%/6,46%), the base of tongue (3, 18%/2, 15%) and buccal floor (3, 18%/3, 15%). Pharyngeal disease (5,38%) and mandible (4,31%) were detected by MRI and not found on ultrasound. Associated malformations detected with ultrasound were 2 (12%) urogenital malformation, 1 (6%) heart defect and 1 (6%) facial anomalies. Lymphangiomas remained stable in volume in 12 (71%) cases and disappeared before birth in 2 (12%) cases.MRI and ultrasound seem inseparable to assess and optimally manage fetal cervical masses. Detection of associated lesions seems to help in the final lymphangioma diagnosis. Most of the time, lymphangiomas seem to be stable lesion during pregnancy and a good prognosis in cases of uncomplicated cervical lymphatic mass and without pejorative extension.

Objective Doppler measurement of peak velocity of systolic blood flow in the middle cerebral artery (PVS-MCA) can safely replace invasive testing in the diagnosis of fetal anemia in Rh-alloimmunized pregnancies and PSV-MCA is now the reference technique. However, no study has evaluated its impact in antenatal care and in survival rate. Our objective was to evaluate the impact of the measurement of PVS-MCA in antenatal management and neonatal outcome in maternal red cell alloimmunization requiring in utero transfusion (IUT). Study design Retrospective study between January 1999 and January 2013. We excluded all cases of hydrops without follow-up before first IUT. From 1999 to 2006, an IUT was indicated on the optical index at 450 nm (Period 1) and was then replaced by the use of PVS-MCA (Period 2). Results 77 patients were included, 39 in Period 1 (104 IUT) and 38 in Period 2 (89 IUT). 5 cases of hydrops fetalis (12.8%) were diagnosed during the follow up in Period 1 and none during Period 2. The average number of IUT, the delays between 2 IUT and between last IUET and birth were comparable. The total rate of complication per IUT during the first period was 9.6% vs 1.1% during the second one ( p = 0.01). The overall survival rate in our population was 34/39 (86.8%) during Period 1 vs 38/38 (100%) during Period 2. Conclusion PSV-ACM allowed an improved monitoring with fewer occurrences of hydrops. Conversely, it did not modify antenatal management and timing of delivery.

In this paper, we present selected results to discuss the 1D Mott localization observed in organic conductors and its influence on the nature of the low temperature magnetic ground state. The approach is essentially experimental and gives an occasion to summarize the work made in Bordeaux during the last twenty years. We first briefly describe the main results concerning the TMTTF salts. Then, we focus the discussion on materials presenting uniform organic stacks to emphasize the relevance of 1/4-Umklapp scattering. Results concerning DMtTTF salts are first described, next the example of the recently studied (EDT-TTF-CONMe 2 ) 2 AsF 6 is developed. In both cases, a low T antiferromagnetic ground state is observed, which suggests that the unified phase diagram proposed for the TMTXF series should be generalized, taking into account a progressive loss of centro-symmetry. We finally show how these arguments may rationalize older results found in the TMTTF series.

Starting from gel suspensions of vanadium pentoxide (V2O5), we have prepared a series of samples by dilution with aqueous solutions of HPF6 or NH4OH to control the vanadium concentration and the pH. We have first accurately determined the limit of stability of V2O5 ribbonlike particles from visual observation and from the wavelength dependence of the absorbency of the solutions. We obtain an unexpected result as we show that flocculation is most likely observed far from the isoelectric point of these colloidal suspensions. To estimate the largest dimensions of the particles in the suspensions, we have made light and small-angle neutron scattering experiments. We show that the particle geometry depends on the preparation process. The analysis of the scattering data indicates that V2O5 ribbons behave like semiflexible objects in solution, allowing us to estimate an elastic constant. We then discuss the observed phase diagram in terms of a simple model where the stabilization of the colloidal particles is a ...

Tocolysis with calcium channel blockers is widespread in France. However, these molecules are off label use for this indication. The objective of this work is to give an update on all the side effects of calcium channel blockers published or reported to the National Bank of Pharmacovigilance.We conducted a literature review incorporating the animal experimental data on calcium channel blockers, retrospective and prospective studies (randomized or not) comparing different tocolytics, and the published clinical case reports. Finally we inquired the National Bank of Pharmacovigilance for reported cases of adverse effects after use of calcium channel blockers as tocolytics.Adverse effects are found in 2% to 6% of patients after use of nifedipine, of which 0.9% to 1.9% are severe. These are mainly headache, flushes and arterial hypotension. Data on Nicardipine are more limited. For the latter, adverse effects specifically related to the route of administration (induced phlebitis) are described but it seems that other adverse effects reported are not more frequent. Several meta-analyses have demonstrated a decrease in maternal side effects when using calcium channel blockers compared to β-agonists. Comparison of calcium channel blockers to Atosiban is less documented. More rare serious side effects are reported as clinical cases, consisting almost exclusively of cardiovascular complications (dyspnea, pulmonary edema, myocardial infarction, arterial hypotension). They are more common with Nicardipine than Nifedipine. Similar observations are found by querying the National Bank of Pharmacovigilance.The prescription of calcium channel blockers as tocolysis exposes patients to maternal side effects, which are not serious most of the time, and less frequent than with the β-agonist. Severe maternal complications were nonetheless reported more frequently with Nicardipine than Nifedipine, which justifies avoiding Nicardipine in tocolysis. Nifedipine is the most studied molecule. It is not possible to define a maximum posology from literature data. It seems unreasonable to associate different tocolytics and necessary to closely monitor maternal blood pressure, the occurrence of a skin reaction or hypersensitivity, dyspnea or chest pain during treatment.

During pregnancy, the occurrence of aortic dissection is a rare event immediately threatening fetal and maternal prognosis. Its occurrence is more common in cases of connective tissue disease. But the absence risk factor shall not exclude or delay diagnosis. We must learn to think about it, because the prognosis is highly dependent on time management. The clinical presentation of this medical and surgical emergency varies, and pregnancy adds its own symptoms. We have to ask without hesitation that echocardiography or chest CT be performed since these diagnostic methods are both reliable and available.

In case of hyperechogenic fetal bowel (HFB), invasive procedures such as amniocentesis are often proposed to detect an underlying cause. Our goal is to study etiologies and prognosis of HFB according to antenatal sonographic findings in order to evaluate the relevance of antenatal assessment.It is a retrospective monocentric study lead from 2008 to 2012, including all patients with a suspicion of HFB on routine sonography. We analysed the antenatal and neonatal results, distinguishing four situations: isolated HFB, HFB+other digestive anomalies, HFB+vascular pathology, HFB+other associated anomalies.For 149 patients, HBF was confirmed. Sixty-nine were isolated HFB, 24 associated with other digestive anomalies, 16 with vascular pathology and 40 with other anomalies. Pregnancy outcomes were different with 92.8, 41.7, 0 and 45.0% of healthy newborns. In the case of isolated HBF, we noted 2.9% cystic fibrosis and 2.9% congenital infection.Isolated HBF seems to have a better prognosis than associated forms. However, prenatal investigations to eliminate cystic fibrosis or congenital infection should be offered and may be initially non-invasive, if a larger series confirmed the absence of dyschromosomy in this population.