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Evaluate management of patients with a borderline ovarian tumor.A multicentric retrospective survey was conducted in 137 patients with borderline ovarian tumor diagnosed between January 1, 19975 and December 31, 1995.Mean follow-up was 6.5 years, mean age was 50 years. Initial surgery was cystectomy, unilateral salpingo-oophorectomy and total hysterectomy with bilateral salpingo-oophorectomy in 22, 40 and 75 cases respectively. Eleven patients had residual disease. Serous, mucinous and Brenner tumors were observed in 67, 69 and 1 cases respectively. Staging was I, II, III in 117, 3, and 17 cases respectively with two pseudomyxomas. Adjuvant therapy was given in 15 patients. There was a recurrence in 15 patients and 14 died. The 5-year survival rate was 89.3%. Prognosis factors with an impact on survival rate were age, recurrence and type of surgery. Factors with a negative impact on recurrence were adjuvant therapy and residual disease after surgery.Careful staging followed by complete and radical surgery is essential. Unilateral salpingo-oophorectomy with omentectomy and multiple peritoneal biopsies may be indicated in younger patients undergoing radical surgery after pregnancy. Aduvant therapy is necessary for invasive implants.

We report the case of a newborn who showed typical signs of rickets at birth craniotabes and severe hypocalcemia. The diagnosis of fetal rickets was confirmed by radiography. Maternal deficiency was revealed by an excessively low vitamin D level. The multiparous Moroccan mother had suffered low back pain and paraesthesia for several years. She wore the veil and rarely left her home. Nutritional and vitamin D deficiency was demonstrated. We report this exceptional case to recall the importance of vitamin D in the development of fetal calcium supply, the prevention of gravid osteomalacia and the prevention of neonatal hypocalcemia. Vitamin D supplementation (ideally 1000 IU per day during the third trimester or at least one 100,000 IU dose at the sixth and eighth months or a single dose of 2 to 3,000,000 IU at the sixth month) should be the rule in pregnancy.

Massive fetomaternal haemorrhage (FMH) occurs in 0.12 to 0.5% of pregnancies. It is most often spontaneous and involves uncomplicated near-term pregnancies. It causes fetal anaemia, with or without fetal distress and hydrops fetalis. To our knowledge only one paper has reported a neurological complication (hemiplegia). We describe one case of FMH (maximal Kleihauer test = 6.5%) at 28 weeks gestation, which was spontaneous, reversible, associated with sinusoidal fetal heart rare (FHR) and hydrops fetalis; and complicated by an intraventricular antenatal haemorrhage at 30 weeks gestation. Echographic abnormalities decreased. The infant was born at 40 weeks gestation. Clinical examination was normal during the first week of life. At the age of 4 1/2 months, examination showed axial hypotonia and moderated dilatation of intracerebral lateral ventricules without any other brain damage. At the age of 24 months, the child had retarded walking and hypotonia. The outcome was spontaneously favourable with disappearance in utero of the intraventricular haemorrhage (HIV), without hydrocephalia or ischaemic lesions. Three cases of similar FMH have been reported but none of them described cerebral complications. Intrauterine intravascular transfusion should be proposed early. No single pathophysiological mechanism of FMH has been universally accepted and there is no aetiological treatment. The risk of recurrence of FMH in later pregnancies requires careful follow-up.

The authors studied the outcome of pregnancies after spontaneous rupture of the membranes before 28 weeks of amenorrhoea in a series of 28 women. The mean time of the rupture was at 25 1/2 weeks. The duration of the time of rupture was a mean of 10 days and deliveries occurred between the 19th and the 32nd weeks. In 5 cases with an average term of 22 1/2 weeks the pregnancy was terminated. Caesarean operation was carried out in 4 cases and spontaneous vaginal delivery occurred between the 26th and 30th weeks of amenorrhoea in 19 cases. Chorio-amnionitis was the most common maternal complication (32.1%). Maternal morbidity was high (82%) without important sequelae. Thirty infants were born out of these 28 pregnancies (two sets of twins). 33% of the infants were stillborn, 46.6% died in the neonatal period, all of these from respiratory complications. 20% of the children are still alive, and all of these weighed at least 1,000 grams and were born after 28 weeks. A child that was born at 27 weeks amenorrhoea has serious neurological deficits. Having studied the bibliography on the subject and their own personal experience the authors suggest a routine to carry out in these cases. Although the prognosis is poor, the totality of these factors could encourage obstetrical teams to be conservative so long as they watch very carefully under well defined conditions.

Two patients with bladder extrophy who had been operated on during infancy (the one by reconstruction of the bladder and the other by Coffey's operation) had delivered by Caesarean section, in the one patient of one child and in the other of two normal children. They formed the basis of this study. Vesical extrophy or ectopia vesicae is a rare malformation (in 1/40 000 to 1/50 000 births). It occurs most often in male children. It can be associated with genital, urological and orthopaedic malformations. The principal complications that can occur in pregnancy are urinary tract infections, prematurity, malpresentations and genital prolapse. As far as the urological side is concerned the complications are of ureteric stones, metabolic troubles, stenosis or obstruction of the uretero-sigmoid anastomosis following Coffey's operation, and ileal prolapse if Bricker's operation had been undertaken. The ways in which the babies should be delivered are discussed, as are the risks of this malformation recurring in children who are born to mothers with vesical extrophy.

Pregnancies with a high risk of fetal growth retardation are at present watched by using clinical observations and biological parameters including ultrasound and estimation of the fetal heart rate. The Doppler waveform in the umbilical arteries provides information about circulatory resistance in the placenta. An index of resistance "R" is evaluated on the Doppler trace. The purpose of this study is to describe the score (with its possibilities and limitations) for this parameter "R" to follow-up pregnancies with fetal growth retardation and to compare it with ultrasound, biological and clinical parameters that are commonly used. Two groups of pregnancies have been explored: pregnancies with hypertension and pregnancies with idiopathic fetal growth retardation. Abnormal values of "R" correlate well with failure of fetal growth. Furthermore pathological values of "R" do not correspond to the same population as abnormal values of the other parameters. In some cases "R" is disturbed before the others are. In conclusion, this study shows that the index increases the accuracy of detection and the follow-up of chronic fetal growth retardation, particularly in cases of pregnancies with vascular placental pathology.

A case of meningitis, caused by Serratia marcescens in a 6-day old newborn triggered a search for Serratia in the Neonatology ward. Fifteen out of 38 newborns were found fecal carriers of S. marcescens. The source of S. marcescens was found in flasks containing almond oil with 1% cetyltrimethylammonium bromide used for skin care. All strain of S. marcescens belonged to pigmented biotype A6a and serotype 014 : H10. The spread of S. marcescens was controlled by heat sterilizing and renewing twice a week the almond oil flasks. Means of control of contamination sources are discussed.

Echotomography has been used for several years in routine for pregnancy follow-up. The morphological parameters provided by this technique (biparietal diameter, transversal abdominal diameter, length of the limbs...) give an objective information on the foetal growth. The exploration of foetal and placental circulation by Doppler measurement has been used in the past for the detection of the foetal cardiac rythm. The association of Doppler and echotomography allows to know precisely the location of vessels of interest, to quantify blood flow volume transcutaneously, and to determine an index of placental resistance. Recent improvements have simplified the use of this complex technique. Transducers for Doppler and imaging have been placed in the same probe very easy to handle. This system allows a precise localization of Doppler sample volume within the vessel to be explored. The great vessels can be studied all long the pregnancy. Normal Doppler spectrum of umbilical arteries shows an important diastolic flow. This fact is related to the low circulatory resistance of the placenta. When the placental circulatory resistances increase (because of placental infarcts for instance) the diastolic flow decreases in the umbilical arteries. To quantify this modification of umbilical circulation we used an index of the resistance (Pourcelot index) [9]: R = (formula; see text) [A systolic amplitude; D diastolic amplitude]. In normal cases, values of R decrease progressively during the course of the pregnancy. In case of abnormal pregnancies (dysgravidy) the index increases. Abnormal values of R had been correlated with hypotrophy or foetus death. With this duplex system it is also possible to determine the different parameters which are necessary to quantify the foetal blood flow in ml/mn. The first results obtained in dysgravidies confirm the major interest of blood flow study in follow-up and prognosis of high risk pregnancies.

Umbilical circulation can be explored by Doppler ultrasound methods very easily. The umbilical arteries spectrum provides information on the placental circulation. The diastolic flow is directly related to the vascular resistances of the placenta (Rp). In cases of pathological pregnancies with hypertension the decrease in the diastolic flow and the increase in the resistance index Rp have been correlated with intra-uterine fetal growth retardation. The specificity of this index Rp is of 95% but the sensitivity much more lower (approximately 70%). For that reason Doppler assessment of the fetal circulation in other areas has been recently carried out. Fetal cerebral arteries have been explored during normal pregnancies. The index of cerebral resistances as defined by Pourcelot Rc = S-D divided by S (with S systolic amplitude and D diastolic amplitude) show similar variations to the placental index but later in the pregnancy. During the pregnancy the cerebral index is higher than the placental one and the cerebro placental ratio (CPR) superior to 1. During pathological pregnancy (hypertension) with fetal growth retardation one of the index Rc or Rp may be out of the normal range but the cerebro placental ratio CPR is always lower than 1. The follow up of both the umbilical and cerebral circulation increases notably the accuracy of the Doppler method for the detection of intra-uterine fetal growth retardation.

Haemostasis in the new-born is a product of various factors which are both qualitative and quantitative. The only factors that compare in levels and quality with those in the adult are factors V, VIII and XIII. They are alterations in the semi-analytical tests for coagulation except in the Stypven time. In contrast with this deficit shown up in haemostasis by global tests coagulation is normal and in truth there is hypercoagulability. Using Laurell's method of immunoelectrophoresis for levels of alpha 2 M high levels of this are shown contrasting with progressively lowered antithrombitic action. These paradoxes no doubt arise from the fact that neonatal haemostasis is analysed using standardised techniques and reactions which were developed for adult haemostasis, from which it is certainly as different as from those of other animals. Neonatal haemostasis is perfectly balanced in normal conditions. Important changes occur however in respiratory distress where there is a drop in factor V and soluble complexes appear, bringing about rough shapes suggestive of the subclinical syndrome of defibrination. This situation will be further developed in a forthcoming article.

The authors report a case of an aneurysm of the posterior cerebral artery that was operated on after 28 weeks of amenorrhoea without any sequelae for the mother or the fetus. The article gives precise details of the neurosurgical procedures carried out in this pregnant woman and how and what neurosurgical anaesthesia was administered while the aneurysm was cured and the pregnancy continued. Finally the obstetrical and neurosurgical care is discussed. The neurosurgeons decided on the operation in view of the neurological findings. Once the neurosurgical decision has been made, the obstetrical procedures depend practically on the length of amenorrhoea. Briefly, we would suggest the following: before 31 weeks of amenorrhoea: curing the aneurysm and going on with the pregnancy; after 32 weeks of amenorrhoea: first to carry out a caesarean section and during the same operation to treat the vascular malformation.

This statistical enquiry carried out in a region of France by the University Hospital Services in Obstetrics and voluntarily devoid of bibliographical references, deals with a group that are particularly pathological and thus probably explains the seriousness of the prognosis for the newborn and the frequency of maternal morbidity following these early operations. 15% of serious maternal complications with severe neonatal pathology which was often heavy and responsible for the death of the fetus in 22.4% of the cases and the late sequelae in the newborn in more than 10% of cases, mad it important to seek for the inevitable link between the pathology and the length of gestation at the time of the operation. Only one in three children were alive without any sequelae after Caesarean carried out between 28 and 31 weeks, but more than 80% were alive when the operation was performed at 34 weeks. In view of these findings the authors suggest that each case should be considered very carefully before early Caesarean section is carried out, both from the advantages and disadvantages of this means of delivery for the baby as well as for the mother. Caesarean section before 30 weeks of amenorrhoea on an infant with an estimated weight of less than 1 000 grams is seldom to be recommended in view of the poor results for the newborn and in the absence of severe maternal pathology which requires immediate evacuation of the uterus. In view of the poor statistical results that have been analysed, early Caesarean section for fetal pathology and particularly for fetal distress when there is no adequate sophisticated means of resuscitating the baby should be lowered to the minimum possible figure. The comparative study of the notes shows that pathological conditions apparently similar to one another lead to occasions for carrying out very early Caesarean section, and also show that the outlook is different from the point of view of the immediate prognosis and a late prognosis for the newborn infant in view of the delay that has occurred before extracting the baby and of the facilities available to resuscitate the baby.

A total of 168 out of 196 pregnancies that were obtained after A.I.D. have been followed up. Six cases were lost for follow-up (3%). The mean age was 30 years and 65% of the women had their ovulation induced. 130 nullipara were delivered. They were compared with a series of nullipara of the same age group and selected from 300 primiparous pregnancies who delivered in the department in the same year. The abortion rate was 12.5%. 79% of the pregnancies were normal in the 2nd and 3rd trimesters as compared with 83% in the control series. 94% delivered at term as compared with 97% in the control series. 21% of the women had Caesarean section as compared with 19.2% in the control series. The sex ratio was 1.08 as compared with 1.06 in the control series. There was no significant difference between the two series. It does seem, however, that the age factor is the most important factor of all in determining how frequent pathological conditions will be and the number of Caesareans that will have to be carried out. 14% were under 30 years of age as compared with 28.5% who were over 30 years of age, which is a significant difference. These results should be followed up in a larger series.