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A Zika virus epidemic is currently ongoing in the Americas. This virus is linked to congenital infections with potential severe neurodevelopmental dysfunction. However, incidence of fetal infection and whether this virus is responsible of other fetal complications are still unknown. National and international public health authorities recommend caution and several prevention measures. Declaration of Zika virus infection is now mandatory in France. Given the available knowledge on Zika virus, we suggest here a review of the current recommendations for management of pregnancy in case of suspicious or infection by Zika virus in a pregnant woman., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objective: To describe the epidemiological, clinical and prognostic factors of placental abruption and fetal death in utero and to investigate possible risk factors for their occurrence., Patients and Methods: Observational retrospective study including the women having presented a placental abruption between January 2001 and January 2012, in a IIB maternity. Women's sociodemographic characteristics, clinical symptoms and the method used to detect placental abruption were collected. Patient data of those whose pregnancy resulted in fetal death were compared to those with more favorable outcomes., Results: There were 171 cases of placental abruption among 21,913 patients having delivered, which represents a 0.78% incidence. Diagnosis was rarely based on clinical data (30%). The rate of fetal death in utero represented 25% of the pregnancy's outcomes. A history of fetal death in utero increased the risk of placental abruption (P<0.001). This complication was more frequent for patients who did not have pregnancy monitoring (P=0.054) and before 37 weeks of amenorrhoea (P=0.005)., Conclusion: Placental abruption is an important cause of perinatal mortality and maternal morbidity. Among the observed risk factors, only regular pregnancy monitoring can be an easy way to prevent these complications., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Objective: To describe issues associated with the diagnosis of acute pregnancy-associated pancreatitis., Materials and Methods: Retrospective study of cases presenting at our establishment from 2002 to 2012. These cases were defined on the basis of the association of abdominal pain, serum lipase levels three times normal values, or signs of pancreatitis on ultrasound scans carried out on women pregnant at the time of diagnosis. A retrospective analysis of the medical files of these patients was carried out, considering epidemiological and etiological criteria, the treatments administered and maternal/fetal fate., Results: We identified 10 cases during the study period, corresponding to an incidence of 1/1942. In 70% of cases, the patient was in the last three months of pregnancy. The pain was atypical in 70% of cases and ultrasound revealed biliary lithiasis in 30% of cases. None of the women died. In terms of neonatal morbidity, there were five preterm births, including one of an infant that died at the age of seven days. We then carried out a literature review, from which we determined the most appropriate course of action in cases of acute pancreatitis during pregnancy., Conclusion: Pancreatitis should be considered in pregnant women with abdominal pains because this diagnosis is easy to confirm and maternal and fetal outcomes are essentially dependent on the early etiological management of this condition. Preterm birth is the predominant factor for neonatal morbidity., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Objective: To provide an overview of the current state of knowledge concerning the determinants and consequences of geophagy during pregnancy., Method: Bibliographic searching of articles published in English or French and included in the Scopus database, and reporting of our experience with the management of geophagic pregnant women at the maternity unit of Saint-Laurent-du-Maroni (French Guiana)., Results: Geophagy is a little known practice initiated by various stimuli, including nausea and iron deficiency. Sustained geophagy during pregnancy has many consequences, due to complex ionic interactions with the digestive tract. Clay consumption may lead to iron deficiency, which may even be life-threatening in cases of post-partum haemorrhage in severely anaemic women. For the foetus, in addition to the known risk of preterm birth associated with maternal anaemia, maternal geophagy may lead to overexposure to heavy metals, including aluminium in particular. This practice should therefore be considered potentially damaging to the neurological development of the child. The ionic imbalances caused by the ingestion of clay over a long period should be systematically evaluated and corrected, given the secondary malabsorption they may cause, often necessitating parenteral feeding., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Pregnancy and delivery are at the heart of all cultures and ethnic groups, as they assure the continuity of any community. Over the millennia, each society has elaborated a combination of prescriptions, proscriptions and protective rites for future mothers and babies, based on their observations of nature in combination with their religious and mythic convictions. Common to the majority are the vulnerability of the mother-to-be to spirits, and the crucial and symbolic importance of the placenta and the umbilical cord. Delivery in hospital, in spite of its reassurance of greater security, may be an unpleasant experience (to both mother and family) because of the impossibility of respecting traditions. Medical personnel in charge of such culturally uprooted patients should, with the help of cultural mediators, become familiar with a minimum of customs and taboos (of the patient's community) and win the patient's confidence through a respectful approach and an empathetic listening in order to adapt their necessary practices of hygiene and security., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Objective: State of knowledge about misoprostol's use out of its marketing authorization during the first trimester of pregnancy, in early miscarriage or to induce abortion or medical termination of pregnancy., Methods: French and English publications were searched using PubMed, Cochrane Library and international learned societies recommendations., Results: Cervical ripening prior to surgical uterine evacuation during the first trimester of pregnancy facilitates cervical dilatation and reduces operative time and uterine retention risk. Misoprostol, mifepristone and osmotic cervical dilators are equally efficient. Concerning first trimester miscarriage, surgical uterine evacuation remains the most effective and the quickest method of treatment (EL 1). Depending on the clinical situation, medical treatment using misoprostol (missed miscarriage) or expectative attitude (incomplete miscarriage) does not increase the risk of complications, neither haemorrhagic nor infectious (EL 1). However, these alternatives generally require longer outpatient follow-up, which leads to more consultations, prolonged bleeding and not planned surgical procedures (EL 1). Concerning missed miscarriage, a vaginal dose of 800 μg of misoprostol, possibly repeated 24 to 48 hours later, seems to offer the best efficiency/tolerance ratio (EL 2). Concerning early abortion, medical method is a safe and efficient alternative to surgery (EL 2). Success rates are inversely proportional to gestational age (EL 2). According to the modalities of its marketing authorization, 400 μg of misoprostol can only be given by oral route, for less than 7 weeks of amenorrhea (WA) pregnancies and after 36 to 48 hours following 600 mg of mifepristone (EL 1). However, 200mg of mifepristone is as efficient as 600 mg (EL 1). Beyond 7WA, misoprostol buccal dissolution (sublingual or prejugal) or vaginal administration are more efficient and better tolerated than oral ingestion (EL 1). Between 7 and 9WA, the best protocol in terms of efficiency and tolerance is the association of 200mg of mifepristone followed 24 to 48 hours later by 800 μg of vaginal, sublingual or buccal misoprostol (EL 1). An additional dose of 400 μg can be given 3 hours later if necessary (EL 3). In case of buccal administration, the dose of 400 μg seems to offer the same efficiency with a better tolerance but further evaluation is needed (EL 2). Between 9 and 12WA, medical treatment is less efficient than surgery and its tolerance is lower (EL 2). However, a protocol of 200mg of mifepristone followed 36 to 48 hours later by 800 μg of vaginal or sublingual misoprostol, plus an additional 400 μg dose every 3-4 hours (until 4-5 doses maximum) seems safe and efficient (EL 5)., Conclusion: Misoprostol use during the first trimester of pregnancy is a safe and efficient alternative to surgery as long as detailed protocols adjusted to each clinical situation are respected., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Objectives: To highlight the value of 3D ultrasound in the prenatal assessment of fetal cardiovascular abnormalities., Patients and Methods: A retrospective offline analysis of volume datasets of fetuses diagnosed with cardiovascular anomalies by 2D ultrasound was performed., Results: Thirty-four fetuses with 38 cardiac malformations were evaluated. Mean gestational age at diagnosis was 26 weeks. Isolated cardiovascular malformations were detected in 23 fetuses. Extracardiac abnormalities were identified in eight fetuses. Ten terminations of pregnancy were performed., Conclusion: Offline analysis of cardiovascular anomalies conferred significant diagnostic advantages over 2D ultrasound. 3D ultrasound is a valuable tool for the prenatal diagnosis and the management of congenital heart diseases., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Objectives: Post-partum hemorrhage (PPH) is the first cause of maternal mortality in France. Uterine tamponade is an alternative in the management of PPH. We investigated the efficiency of the Linton-Nachlas balloon in treating severe PPH in a French Guiana center where interventional radiology is not available., Materials and Methods: In this retrospective study, 25 women with severe PPH were included. Severe PPH is defined by the persistence of PPH despite sulprostone treatment. All women included in the study gave birth by vaginal delivery. The Linton-Nachlas balloon (Coloplast(®), France) used for digestive hemorrhage was inserted transvaginally. The primary endpoint for the efficiency was stopping PPH., Results: The use of this balloon stopped the bleeding for 24 out of 25 patients (96 %). There was one case in which the treatment by the balloon was a failure. In that case, vaginal packing stopped the hemorrhage. No patient needed any complementary surgical treatment., Conclusion: This technique is a non-invasive, inexpensive, easy and efficient treatment. Most of the time, its use can stop hemorrhage and preserve fertility of young women wishing further pregnancies., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Objective: To evaluate the efficacy and tolerance of injectable urapidil (Eupressyl(®)) for the treatment of severe pregnancy-associated arterial hypertension., Materials and Methods: We carried out a prospective study of 100 cases encompassing the various types of severe pregnancy-associated arterial hypertension, with clinical and biological monitoring of the mother and the collection of neonatal data. Treatment was initiated if the blood pressure was higher than 160/110mmHg and efficacy was defined as a lowering of blood pressure to 150/100mmHg or below., Results: Treatment with urapidil alone was effective in 80 cases (80%). In 20% of cases, essentially the most severe forms of preeclampsia, efficacy was achieved only if urapidil was associated with labetalol or if urapidil was replaced with nicardipine. We observed no material complications other than two cases of hypotension due to excessively rapid administration of a bolus of nicardipine to replace urapidil treatment., Conclusion: Injectable urapidil seems to be an antihypertensive agent that is easy to use and effective in 80% of cases and that has very few secondary effects on the mother or the foetus. Further comparative studies are required to determine the potential of this drug for use in the management of pregnancy-associated hypertension., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

The position or location of the organs and vessels is usually classified into three types: situs solitus, situs inversus, and situs ambigus. Situs solitus is the usual arrangement of organs and vessels within the body. Only 0.6 to 0.8% of patients with situs solitus and levocardia have associated congenital heart diseases. Situs inversus refers to an anatomic arrangement that is the mirror image of situs solitus. The incidence of congenital heart disease is increased to 3 to 5% in the patients with situs inversus. The patients with heterotaxy have congenital heart disease in high incidence, ranging from 50 to nearly 100%. We present four cases diagnosed in our department in a period of 18 months. With these four cases and a review in the literature, we explore the definitions and characteristics of heterotaxy syndromes and we study the role of 3D ultrasound., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Objective: To specify clinical and biological characteristics of patients developing eclampsia, and identify atypical eclampsia without prior signs and symptoms of severe preeclampsia., Patients and Methods: This was a retrospective observational study conducted from January 1996 to December 2008 in a maternity type IIB in French Guiana. Data of patients who experienced eclampsia were collected from obstetric records., Results: Sixty-nine patients were selected among 21,525 patients who delivered during this period, corresponding to a prevalence of 3.2 ‰. The average patient age was 21 years (range from 12 to 45 years). Sixty-six percent of patients were nulliparous. The gestational age was greater than 37 weeks of gestation for 62% of patients, between 26 and 37 weeks of gestation for 36% and less than 26 weeks of gestation for 2% of patients. Two thirds of the patients had been examined less than a month before the eclamptic seizure, blood pressure was normal in 62% of cases. Seventy-four percent of patients had at least one Doppler study of the uterine and umbilical arteries velocimetry, the Dopplers studies were normal in 78% of cases. The eclampsia occurred in ante-, peri- and post-partum in 59, 6 and 35% of the cases, respectively 10% of patients were hospitalized for preeclampsia at the time of eclamptic seizure. Less than 10% of patients developed HELLP syndrome. One patient had died of aspiration pneumonia. Newborns had a mean birth weight over 2500 g in 88% of cases. During the follow-up period, 41% of the patients had subsequent pregnancies with 62% without hypertension, 24% complicated by recurrent gestational hypertension, 24% by preeclampsia and 4% by eclampsia., Discussion and Conclusion: In a majority of the patients in our study, eclampsia was the main manifestation, and only 10% were preceded by severe preeclampsia. These results are comparable to recent studies, which found in their series that 40 to 60% of eclampsia manifested without preeclamptic prodromi. Eclampsia can occur after an unremarkable pregnancy, in women without risk factors, and then it is hardly predictable. Prenatal follow-up must be very cautious paying attention to any markers such as intermittent hypertension, functional symptoms or appearance of proteinuria., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Introduction: HELLP syndrome is characterized by generalised thrombotic microangiopathy predominant in the liver. Many investigators consider HELLP syndrome to be a variant of severe preeclampsia. Several other conditions have similar laboratory findings in common with HELLP syndrome and should be eliminated before pregnancy termination., Patients and Methods: The authors report seven observations of patients with biological criteria that mimic HELLP syndrome secondary to severe vitamin B12 deficiency., Conclusion: Vitamin B12 or B9 deficiency developed during pregnancy have laboratory findings similar to those of HELLP syndrome.

Objective: The aim of our study was to assess the impact of maternal syphilis on pregnancy and foetal/neonatal outcomes., Study Design: A retrospective study, conducted from 1 June 1992 to 31 December 2004, involved 85 seropositive pregnant women at the West Guyanese hospital in French Guyana. Inclusion criterias were a positive treponemal pallidum hemagglutination assay (TPHA) with a titre greater or equal to than 1/2560 and a positive Venereal Disease Research Laboratory (VDRL) with a titre greater or equal to than 1/16 for a pregnant woman with different stages of pregnancy. We evaluated maternal characteristics, antenatal care, type of treatment, the presence of coinfections, fetal ultrasound characteristics, outcome of pregnancy, umbilical cord biological diagnosis and neonatal clinical exams. We evaluated the efficiency of early and complete syphilis treatment in the prevention of vertical infection., Results: The proportion of seropositive pregnant women with lack or inadequate antenatal care was high (40%), hence, the diagnosis and treatment were performed late in pregnancy. The incidences of adverse obstetric outcomes were the following: perinatal deaths (20%), stillbirths (12,9%), preterm deliveries (18,8%) and low birth weight (28,2%). Specific ultrasound findings of congenital syphilis (stillbirth excluded) were found in six cases out of 61 (9,8%) and specific neonatal clinical features of early congenital syphilis were found in four cases. There is a high correlation demonstrated between vertical infections and late or inadequate syphilis treatment in a pregnant woman., Conclusion: Antepartum syphilis represents a health problem in developing countries and tends to reappear in developed countries. All pregnant women should receive an adequate prenatal care including obligatory screening test for syphilis, we should keep in mind the possibility of syphilitic infection in case of maternal clinical features or foetal signs especially hepatosplenomegaly, hydrops fetalis or intestinal hyperechogenicity.

Objective: The purpose of this study were to determine the effects and consequences of premature pregnancy and childbirth among adolescents under 15 years of age in French Guyana., Material and Methods: A retrospective field-case study between the 1(st) and the 31(st) December 2001 identified 181 births among adolescents aged 14 years and under. Comparisons were made with 181 births among 18-year-old first-time mothers taking place over the same period., Results: 1.55% of all births in the maternity ward at St Laurent-du-Maroni Hospital involved adolescents under the age of 15. 24.6% of these young mothers were enrolled in secondary school, 21% were beneficiaries of the national social security health insurance and 61% of them were born outside Guyana. Pre-natal monitoring was less frequent among the group of teenage mothers, and preterm labor (0.04 < p < 0.05), anemia (0.02 < p < 0.03) and Chlamydiae trachomatis infections (0.03 < p < 0.04) are more frequent. There is no significant difference regarding high blood pressure, diabetes, or infectious diseases (except from Chlamydiae) or regarding labor and delivery. Mean birth weight was lower (p = 0.01) and the Apgar score was more often less than 7 at the first minute (p < 0.05) among newborn of teenage mothers., Conclusion: While pregnancies among younger teenagers appear to indicate a higher level of associated medical problems, a more thorough pre-natal check-up program would certainly reduce the number of problem related cases. The extremely high proportion of teenage pregnancies in the West of French Guiana has become a major public health issue for the entire region.

Objectives: To demonstrate the effectiveness and safety of mifepristone 600mg with misoprostol 800 mg, for termination of pregnancy at 9-14 weeks gestation., Patients and Methods: This prospective study included 105 women at 9 to 14 weeks gestation given 800 mg of vaginal misoprostol, 2 or 3 days after a single dose of 600 mg of mifepristone for pregnancy termination. Outcomes measures included mean expulsion time, the interval between fotal and placental expulsion, adverse effects, vaginal bleeding, requirement for analgesia, and hospital stay, analyzed by parity and gestational age., Results: Pregnancy termination was successful in 92.4% of the patients without requirement for surgery. The mean time to expulsion was 6 hours. The fetus and placenta were expelled together in 79% of the cases. In 15% the conception products were retained in the cervical canal, and removed with a ring forceps. Additional misoprostol doses were necessary in 33% and analgesia (nalbuphine sublingually, mean dose was 10mg) in 56%. Significant bleeding was observed in 7.5%, leading to curettage in 2 patients. No statistically significant differences were found between the rate of success and term (9-12 versus 12-14) or parity., Conclusion: Combining oral mifepristone and vaginal misoprostol is a successful alternative to surgical termination of pregnancy, even after 9 weeks' gestation. The use of nalbuphine for analgesia improves acceptability; sublingual administration helps avoid invasive procedures. Before 14 weeks gestation, the legal limit for termination of pregnancy in France, the choice between the surgical and medical alternatives should be left to the patient.