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International audience; Introduction: - Open fetal myelomeningocele (MMC) surgery is currently the standard of care option for prenatal MMC repair. We described the population referred to our center and reviewed outcome after open fetal MMC repair.Material and methods: - All patients referred to our center for MMC were reviewed from July 2014 to June 2020. For all the patients who underwent fetal MMC repair, surgical details, maternal characteristics and data from the neonatal to the three-years-old evaluations were collected.Results: - Among the 126 patients referred to our center, 49.2% were eligible and 27.4% (n=17) of them underwent fetal MMC repair. Average gestational age at fetal surgery was 24+6 weeks. There was no case of fetal complication and the only maternal complication was one case of transfusion. We recorded 70% of premature rupture of membranes and 47% of premature labor. Average gestational age at delivery was 34+2 weeks and no patient delivered before 30 weeks. There was no case of uterine scar dehiscence or maternal complication during cesarean section. After birth, 59% of the children had a hindbrain herniation reversal. At 1-year-old, 42% were assigned a functional level of one or more better than expected according to the prenatal anatomic level and 25% required a ventriculoperitoneal shunt. At 3-year-old, all the children attended school and 75% were able to walk with orthotics or independently.Conclusion: - Open fetal surgery enables anatomical repair of the MMC lesion, a potential benefit on cerebral anomalies and motor function, with a low rate of perinatal and maternal complications.

Background Intrahepatic cholestasis of pregnancy (ICP) is characterised by otherwise unexplained maternal pruritus, increased serum bile acid concentration over 10 μmol/L and spontaneous relief of symptoms and liver abnormalities after delivery. It occurs most frequently during the third trimester and is usually not induced by medication. Besides, azathioprine is recommended as first-line immunosuppressant in patients with steroid-dependent inflammatory bowel disease and is allowed during pregnancy, in order to stabilize maternal disease. Methods We reviewed all cases of ICP between 2010 and 2018 in two French perinatal centers. Results We encountered eight pregnancies complicated by atypical ICP among patients treated with azathioprine. ICP associated with azathioprine appears to be biologically more severe and to occur earlier than "standard" ICP. Furthermore, clinical and biochemical abnormalities related to ICP disappear when azathioprine is discontinued. Azathioprine safety should be reconsidered and practitioners advised to discuss discontinuing this drug as soon as ICP diagnosis is established.

Resume Objectifs L’objet de ce travail etait de realiser un etat des lieux des transfusions in utero (TIU) en France au sein des centres pluridisciplinaires de diagnostic prenatal (CPDPN) afin de mieux connaitre les pratiques francaises et d’etudier les indications transfusionnelles. Methodes Il s’agissait d’une etude descriptive nationale francaise portant sur la periode 2011–2014. Les donnees etaient obtenues grâce a un questionnaire rempli via courriel par l’ensemble des coordonnateurs des CPDPN francais. Resultats Parmi les 49 CPDPN, 18 centres (38 %) avaient effectue au moins une TIU avec un maillage correct du territoire metropolitain, a l’exception de la region aquitaine Pyrenees. Une moyenne de 204 TIU etaient realisees par an concernant 113 grossesses. Cinq centres representaient 68 % de l’activite nationale de TIU et un centre effectuait 40 % de l’activite francaise. La premiere cause d’anemie fœtale severe motivant une TIU etait l’incompatibilite fœto-maternelle erythrocytaire secondaire a une allo-immunisation maternelle (69 % des causes de TIU) principalement par allo-immunisation anti-RH1. La deuxieme cause correspondait aux infections materno-fœtales a parvovirus B19 (17 % des TIU). Conclusion L’activite nationale de TIU en France etait stable en nombre et repartition territoriale sur la periode d’etude. La mise en place d’un registre national pour cette activite semble necessaire pour permettre un suivi prospectif du nombre de grossesses concernees notamment pour suivre la prevalence des cas d’allo-immunisation RH1.