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Abstract: Human parturition is a painful and sometimes dangerous physiologic process, which has been managed all over the time through mobilisation and various maternal vertical postures. Three hundred years ago, Mauriceau, a French obstetrician, imposed a semi-recumbent position for the second stage of labor, which became largely adopted in western countries. For three decades, spontaneous positions for parturition have been encouraged, based on anatomophysiologic considerations. There is now sufficient data from randomised trials for recommending maternal mobility during labor and various vertical positions for delivery. Yet, the third stage is sometimes more hemorrhagic and should be managed through preventive measures. [Copyright &y& Elsevier]

Abstract: The nuchal translucency is the usual subcutaneous space, between the skin and the soft tissues covering the fetus''neck spine, observed by ultrasound during the first trimester of pregnancy. It increases with gestational age. The association between nuchal translucency thickness and risk of Down syndrome was firstly observed in high risk populations as an old maternal age or a history of a previous child affected by Down syndrome. However, these studies are retrospective and only report the issue among pregnancies associated with an abnormal nuchal translucency thickness. Furthermore, as the performance of a screening test is correlated to the prevalence of the disease in the studied population, such results can not be extrapolated to the general population. To date, eleven prospective studies have been published, assessing the performance of the nuchal translucency measurement in a general population, including about 125 000 patients. The global sensitivity of this screening was 70% for a false positive rate of 5%. For an adjusted risk on the maternal age, the detection rate increased up to 77%. Although nuchal translucency measurement is an early and performing screening tool, uncertainties remain nevertheless about its reproducibility in the general population. In order to correctly measure the nuchal translucency, a previous training course is necessary to guarantee adequate and reproducible measurements. [Copyright &y& Elsevier]

Abstract: Prenatal stress has become a topic of increasing interest in the past few decades. The first studies examined the consequences of prenatal stress on pregnancy, and in particular the effect on prematurity and small birth weight. Based on animal studies, authors are currently interested in the effect of prenatal stress on fetal development but also on psychomotor and affective development. This article provides a literature review on the effect of prenatal stress in animal models and in humans. Then, the limits of these studies and new perspectives will be discussed. [Copyright &y& Elsevier]

In unselected patients, the pregnancy rate after intrauterine insemination (IUI) seldom goes beyond 10–15% per cycle. An insufficient number of spermatozoa at the fertilization site has been hypothesized for a long time to explain the low efficacy of this technique. Thus, the introduction of a larger number of male gametes into the female tubes has been thought of to give better results since the late eighties. First, a direct tubal catheterisation has been proposed for injection of spermatozoa, either by laparoscopy or transvaginally under ultrasound guidance or by tactile sensation. However, these procedures have been abandoned because of some severe traumatic and infectious complications. Alternatively, a spermatozoa suspension of several millilitres can be injected under pressure into the uterine cavity while sealing the cervical os, by various systems. This technique called Fallopian sperm perfusion (FSP) has yielded some interesting results, particularly in unexplained infertility. Nevertheless, the superiority of FSP over IUI still remains controversial. This review describes the current knowledge about intratubal insemination and its potential role in the management of human infertility. [Copyright &y& Elsevier]

Objective. – To study the effects of increased gestational weight gain in women of normal prepregnant weight.Patients and methods. – We compared 174 patients gaining more than 18 kg to 174 patients gaining between 9 and 15 kg. Body mass index was normal for every woman included in the study.Results. – Weight gain ≥18 kg was associated with increased risk of vascular complications (5.2% vs. 1.1%, P < 0.05) but not with increased risk of mellitus diabetes (5.2% vs. 4.0%, NS). Weight gain ≥18 kg prolonged labor length (414.4 ± 147 min vs. 376.5 ± 166.4 min, P < 0.05) and increased the rate of cesarean section (19.5% vs. 10.3%, P < 0.05). Neonatal outcome was similar in both groups, mean birth weight was greater (3413.6 ± 427.0 g vs. 3163.4 ± 495.1 g, P < 0.05) and the frequency of infants weighing more than 4000 g at birth was increased (8.0% vs. 4.0%, P < 0.05) among women gaining more than 18 kg.Conclusion. – Excess weight gain in pregnancy affects gestational and delivery outcomes and results in higher frequency of fetal macrosomia. These results confirm recommendations on weight gain in pregnancy as guidelines for pregnant women. [Copyright &y& Elsevier]

This article describes the current techniques of foetal sampling. All of them are actually ultrasound guided, and therefore generally very safe. Nevertheless, an elaborate learning process remains indispensable, in addition to a particular attention to the quality of the physician–patient dialogue. The choice of a technique depends on the indication and on the term of the pregnancy. The most frequently used technique is amniocentesis which presents a low risk of foetal loss, estimated between 0.2 and 0.5 percent. The interest of chorionic villus sampling is the possibility to obtain results at an earlier stage of pregnancy, with a lower risk taking when compared to early amniocentesis. We prefer the transabdominal chorionic villus sampling to the transvaginal. Foetal blood sampling is still required in some cases, but the risk of complications is higher – around 1 percent. [ABSTRACT FROM AUTHOR]

Objectives. – To determine in which circumstances termination of pregnancy (TOP) could be proposed in case of CMV infection. Patients and methods. – An inquiry was conducted concerning the practice of doctors working in French foetal medicine units in case of CMV infection. The question asked was: "What is your attitude if confronted to a CMV seroconversion at 23 weeks of amenorrhoea with positive PCR at 28 WA, and normal MRI and ultrasound scan at third trimester?" Results. – Thirty-five obstetricians answered. Forty-nine percent do not perform foetal blood sampling (FBS). Among them 1/17 would accept TOP. Fifty-one percent do perform FBS. In this group, 33% would accept TOP in case of negative FBS and 83% if FBS shows foetal infection. Discussion and conclusion. – Techniques available for diagnosis and prognosis of foetal infections are based on PCR on amniotic fluid, ultrasound, MRI and FBS. To date correlation of those tests with foetal outcome has not been fully validated. TOP could therefore be an option in 2 circumstances: • when signs of certain severe foetal disease with positive PCR and ultrasound abnormalities; • on statistical arguments : if positive PCR, and normal ultrasound, the risk of handicap is approximately 10%, the severity of the handicap being impossible to predict. In this last hypothesis, it is tempting to use additional arguments such as FBS even if the interpretation of the results of this test has not been scientifically validated. Such cases with positive PCR and normal ultrasound in which inconsistent decisions are made are likely to be more frequent because of routine serologic screening policy. [ABSTRACT FROM AUTHOR]

Retropubic or transobturator insertions of suburethral tapes are the new gold standard surgical procedure for female stress urinary incontinence. Some women of childbearing age can be treated by a suburethral tape. There are at present no sufficient data to recommend a mode of delivery rather than another in these patients. We report the case of a young woman, cured of her urinary incontinence by a suburethral tape. A recurrence occurred after childbirth by vaginal route. A second suburethral tape made it possible to restore the continence. The patient became again pregnant. A preventive caesarean section was quite as ineffective to preserve the continence. [Copyright &y& Elsevier]

Abstract: We report a case of pregnancy in a rudimentary horn that ruptured at 18 weeks. An emergency laparotomy was taken for acute abdomen and ruptured right rudimentary horn pregnancy was diagnosed. Excision of the rudimentary horn and ipsilateral salpingectomy were carried out. The patient''s postoperative course was uneventful, and she left the hospital 6 days later. [Copyright &y& Elsevier]

Abstract: Purpose. – The use of Hydroxychloroquine (HCQ) during pregnancy has remained controversial for a long time. However, it is generally agreed that pregnancy per se increases disease activity in patients with systemic lupus erythematosus (SLE) and that withdrawal of HCQ at the onset of pregnancy may result in exacerbation of SLE. Therefore, stopping HCQ at the onset of pregnancy may result in exacerbation of SLE which could be detrimental to both mother and fetus. Current knowledge and key points. – The available data suggest that HCQ can be continued safely throughout pregnancy. After the first report by Parke of successful continuation of HCQ throughout gestation, more than 250 pregnancies resulting in live births have been reported and no increase in the rate of birth defects have been demonstrated. When studied, no retinal toxicity and ototoxicity have been found in the children. Data concerning lactation and HCQ treatment are rare. However, the amount of HCQ received by children through lactation seems very low. Future prospects and projects. – For patients with SLE already taking HCQ, the benefits of continuing treatment with this medication throughout pregnancy seem to outweigh the hypothetical risks associated with its use. HCQ should probably be maintained throughout pregnancy in these patients with SLE and it does not seem necessary to advise against breastfeeding. Further studies with prospective follow-up of children exposed in utero to HCQ remain however needed to provide a definitive answer. [Copyright &y& Elsevier]

We report the case of a multigravida presenting in the first trimester of pregnancy with reflex sympathetic dystrophy involving both ankles. Preferential location of reflex sympathetic dystrophy in pregnancy is classically the hip (9 times out of 10). Symptoms develop mostly with primipara in the third trimester of pregnancy or in post-partum. Fracture is the major risk of reflex sympathetic dystrophy. Peculiarities of reflex sympathetic dystrophy's treatment in the course of pregnancy are evoked. The end of the pregnancy can be shortened with the aim of stabilizing disease even to activate its healing. Pathophysiologic mechanisms of reflex sympathetic dystrophy in pregnancy seem multiple and complex. Our observation, by its atypical characteristics, recalls it. [ABSTRACT FROM AUTHOR]