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We describe an acute onset of diabetes mellitus during third trimester of pregnancy revealed by ketoacidosis, complicated by fetal death, which could evoke fulminant type 1 diabetes, a novel subtype of type 1 diabetes first described in Japan and rarely described in Caucasian people. Diagnosis of diabetic ketoacidosis could be made on simple signs as abdominal pain, vomiting or ketone bodies on urinary multistix. Capillary glycaemic control is necessary to distinguish fast from ketoacidosis. The treatment of this severe imbalance must be initiated in emergency., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Objectives: To study the efficiency of the official recommendations on the prevention of group B streptococcus and the impact of this strategy., Materials and Methods: A prospective study was realized in 2005. All infants who were live-born at the Jeanne-de-Flandre hospital (Lille, France) and their mothers were included in the study. Data concerned both pregnancy (vaginal screening, intrapartum antibiotic) and newborn (safe, colonization and early-onset neonatal bacterial disease)., Results: Our study included 4353 mother-newborn couples. Vaginal screening was performed on 92% of the women included in the study. Prevalence of vaginal group B streptococcus in screened women was 7%. Perpartum antibioprophylaxia of group B streptococcus was achieved in 12% of the women included in the study. Group B streptococcus was associated to 60% of probable and certain early-onset bacterial neonatal diseases, with an incidence of 9/1000 births. Exposition to antenatal antibiotherapy multiplied by two the risk of ampicillin resistant Gram-negative bacilli (RR=2 [1.1-3.8])., Conclusion: Recommendations were well followed, but in our health center group, B streptococcus was the main bacteria responsible for early-onset bacterial neonatal diseases. Because of the risk of germ selection, a more targeted antibioprophylaxia has to be preferred.

Objectives: Exclusive hepatocele is defined as a hernia containing in majority the liver with possibly some intestinal loops. This study was undertaken to evaluate neonatal morbidity and mortality in this series of exclusive hepatoceles., Materials and Methods: We reviewed 11 cases of exclusive hepatoceles with delivery at the hospital Jeanne-de-Flandre in the CHRU of Lille, in France., Results: The mean gestational age of diagnosis was 14.5+/-3.4 weeks of gestation. Karyotype determination was performed in 100% of cases: it was abnormal in one case of 11. One termination of pregnancy was performed because of trisomy 13. The mean gestational age at delivery was 38+/-1.8 weeks of gestation. Cesarean deliveries were performed in nine cases. Morbidity was important with: one case of fetal growth retardation on total hepatocele, three cases of severe respiratory distress, two cases of severe digestive complications. The mean length of stay was 42.8 days. The mean length of parenteral feeding was 14.4 days. Postnatal mortality concerned one child, which died because of a severe respiratory distress due to pulmonary hypoplasia., Conclusion: In this series, morbidity is thus important, making of exclusive hepatoceles a full entity among the omphaloceles. The multidisciplinary take care is more complex but conceivable.

Objective: To present the different etiologies of fetal cerebral ventriculomegaly (VA) and try to evaluate prognosis., Materials and Methods: A retrospective analysis was made in 141 cases of fetal cerebral ventriculomegaly diagnosed in our obstetrics department between January 1988 and December 1996., Results: Mean gestational age at diagnosis was 24.8 weeks. Myelomeningoceles were the most frequent etiology (50 cases, 36%), usually diagnosed late in pregnancy (25 weeks gestation). Termination of pregnancy was the most frequent outcome. Agenesis of the corpus callosum (ACC) was observed in 16 cases (11%), 8 of them being diagnosed before birth. This etiology has been an important diagnostic problem until recent years. The advent of improved imaging techniques has facilitated diagnostic procedures. Thus in 1996, the 4 ACC were all diagnosed by prenatal ultrasound. The 8 live infants presented developmental retardation. Termination of pregnancy has been performed more and more frequently in accordance with parent wishes. In 6 cases (4%), the etiology was congenital infection. When a chromosome anomaly was found (7%), ventriculomegaly was always associated with other ultrasonographic anomalies. Ventriculomegaly was associated with other malformations in 23% of the cases but only 17% were discovered prenatally; all the live infants but one had severe neurological impairment. Ventriculomegaly was considered to be the unique anomaly in 37% of the prenatal cases and was truly unique in 24%, an etiology being found in 6%. No explanation was found in 18%. The outcome of live infants is known in 139 cases (2 children lost to follow-up) after a 6 month to 6 year follow-up. Overall prognosis was severe as among the 42 infants (30%), 14 (10%) are well including 12 who had ventriculomegaly alone., Conclusion: Prenatal diagnosis of ventriculomegaly implies a severe prognosis. Only children presenting limited ventriculomegaly alone have normal neurological development. In case of ventriculomegaly, clinicians must search carefully for other anomalies, always associated with poor prognosis.

Care given to 1,425 consecutive new-born infants in a University Maternity Ward was screened for high-risk pregnancies. The characteristics of the new-borns retained for study resulted from this choice. Life-threatening distress, defined as the need for respiratory assistance beyond the third minute of life, was observed in 6% of cases. Distress had been predicted 30 minutes before birth in only 42% of cases. In 56.5%, the signs of distress occurred outside "normal" working hours and immediate care was given by the mid-wife in 36% of cases. Despite progress in fetal medicine, these findings would suggest that life-threatening distress at birth is often unpredicted and occurs at a non-negligible rate. This would emphasize the need of training the entire obstetrical team, especially the mid-wives in care the for new-borns.