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Résumé: Objectifs: Répertorier les signes échographiques mis en évidence lors de la suspicion d’un placenta accreta. Les objectifs secondaires sont d’analyser la pertinence du diagnostic en échographie et en imagerie par résonance magnétique (IRM), et de connaître les circonstances diagnostiques afin d’identifier une population à risque. Patientes et méthodes: Il s’agit d’une étude rétrospective monocentrique. Les cas de placentas accreta pris en charge au centre hospitalo-universitaire de Lille entre 2005 et 2010, suspectés en anténatal ou découverts per-partum, ont été recensés. Résultats: Vingt-sept patientes ont présenté un placenta accreta sur cette période. 22 cas étaient suspectés en anténatal, dont 21 confirmés à la naissance. Six cas étaient découverts per-partum. Le diagnostic était suspecté dans 41 % des cas suite à un épisode de métrorragies. Cent pourcent des patientes suivies au diagnostic anténatal avaient un utérus au moins unicicatriciel et un placenta antérieur inséré bas. Cinquante pourcent des patientes non dépistées avaient un placenta postérieur non inséré bas. Les signes échographiques les plus fréquents étaient ű lacune placentaire Ƈ (85,7 %), ű vascularisation anormale Ƈ (71,4 %), ű perte du liseré hypoéchogène du myomètre Ƈ (66,7 %), ű irrégularité de la paroi vésicale Ƈ (57,1 %). La sensibilité de l’échographie de dépistage est de 78 %. Vingt et une IRM, réalisées en deuxième intention confirmaient le diagnostic dans 66,7 % des cas. Discussion et conclusion: L’échographie est un examen pertinent pour le diagnostic de placenta accreta. Les placentas postérieurs, plus difficiles d’accès, ne doivent pas être négligés. Les placentas antérieurs praevia chez les patientes multipares ayant un utérus cicatriciel doivent requérir toute l’attention de l’examinateur. [ABSTRACT FROM AUTHOR]

Summary: Objectives: To assess overall and malformation-specific trends in the prevalence and prenatal diagnosis of congenital anomalies in the Parisian population. Methods: The Paris Registry of Congenital Malformations is population-based and since 1981 has registered all cases with structural birth defects or chromosomal anomalies in the Parisian population. The total and livebirth prevalence and the proportion of cases with prenatal diagnosis were calculated for all anomalies and 20 malformations selected based on their higher frequency and their impact on health outcomes. Results: The overall prevalence was 3.30% (95% CI 3.27–3.33), and the livebirth prevalence 2.42% (95% CI 2.39–2.45). The proportion of cases diagnosed prenatally increased from 16.5% (95% CI 14.1–19.1) in 1983 to 70.7% (95% CI 68.3–73.1) in 2007. Terminations of pregnancy for fetal anomaly (TOPFA) increased from 8.8% (95% CI 7.0–10.8) in 1983 to 35.6% (95% CI 33.1–38.1) in 2007. These results varied substantially for the 20 congenital anomalies studied. Conclusion: We found an increase in the overall prevalence of all anomalies, especially for chromosomal abnormalities. The observed increase is at least to a large extent due to trends in delayed childbearing and an increase in both pre- and postnatal diagnosis of congenital anomalies in our population. [Copyright &y& Elsevier]

Abstract: Rapidly involuting congenital haemangioma (RICH) is a rare vascular tumour whose antenatal diagnosis is difficult. During ultrasound examination at 32nd weeks’ gestation, a voluminous heterogeneous cephalic lesion was discovered that could be a haemangioma or a teratoma. A caesarean delivery was performed. The tumour was removed directly after birth. The pathology examination concluded on a RICH. Antenatal, perpartum and postnatal management are not consensual and must consider the lesion size. [Copyright &y& Elsevier]

Summary: Aim of the study: To evaluate the impact of prenatal diagnosis on the epidemiology and outcome of children with posterior urethral valves (PUV), considering that today termination of pregnancy may be proposed in the most severe cases. Patients and methods: Forty-three cases of patients with PUV were diagnosed between 1998 and 2007 in the Languedoc-Roussillon region. In this study, we detailed the prenatal data and postnatal outcome of those patients with a mean follow-up period of 7.6 years. Results: Medical interruption of pregnancy was performed in 15 severe cases. One death in utero was also observed. Twenty-seven patients were managed postnatally and one child died during the neonatal period because of lung hypoplasia. For the 26 remaining patients at the end of the follow-up period, 5 had mild renal insufficiency with a creatinine clearance calculated with the Schwartz formula of less than 80ml/min/1.73m2. One reached end-stage renal failure at the age of 7 years. Proteinuria and hypertension were rare. Discussion and conclusion: Today, because of the increase in medical termination of pregnancy in the most severe cases, most of the children born alive with PUV experienced a better renal prognosis when compared with previous data. Prenatal diagnosis and therapeutic progress significantly modified the epidemiology and outcome of this disease. Nevertheless, the best predictor of renal outcome remains renal function at 1 year of age. [Copyright &y& Elsevier]

The exploration of the foetal digestive tract is not systematized and the ends (thoracic oesophagus and anorectal area) are often excluded from the examination excluded from screening. Only the foetal digestive pathology of liquid expression (digestive obstruction, digestive duplication) is easily detected. The most frequent digestive pathologies (oesophagus atresia, anorectal malformation) are still very often a neonatal discovery. With echography or MRI, the antenatal analysis of the digestive tract is optimized by the acquisition of coronal (thoracic oesophagus, small intestine, and colon) and sagittal median cuts (rectal reference mark, sacral concavity). The interpretation of the echosignal of the contents of the digestive tract (liquid or meconial) takes into account the transition periods responsible for the physiological modifications in charge of the modification of images (24–26 WA and 29–30 WA). [Copyright &y& Elsevier]

Abstract: We report a case of pleuropulmonary blastoma (PPB) prenatally diagnosed at 32 weeks of gestation. The suspected diagnoses was a congenital cystic adenomatoid malformation of the lung (CCAM). The excision of the malformation was performed through a thoracotomy at 4 months of age. On pathological examination, the presence of focal stromal hypercellularity (cambium layer) in the cyst wall was consistent with both the diagnosis of type IV CCAM or grade I PPB. The presence of nodules of immature cartilage and the positivity of particular immunohistochemical staining (indicate which staining came positive) confirmed the diagnosis of grade I PPB. Pleuropulmonary blastoma is a rare malignant tumour in children, sometimes difficult to differentiate from the type IV CCAM as they share similar circumstances of diagnosis, radiological and macroscopic features. The pathological examination does not always allow to differentiate them clearly, implying the necessity of an extended medical supervision for the children carrying those border lesions. Because of the risks of malignancy and of the risks of septic complications, surgical resection during the first year of life is often advocated. Therefore, prenatal detection is essential to allow adequate early management and complete resection of these lesions. [Copyright &y& Elsevier]

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Abstract: We report a case of ruptured ovarian molar pregnancy, diagnosed in the context of haemorragic shock 19 days following evacuation of an intrauterine hydatiform mole. To our knowledge, this is the first reported case of heterotopic molar pregnancy. [Copyright &y& Elsevier]

Abstract: Vasa previa is a rare condition (1/2000 to 1/5000) in which the rupture of membranes may result in fetal haemorrhage (Benckiser''s haemorrhage). We report one unusual case of delayed Benckiser''s haemorrhage 12 hours after rupture of membranes. We point out the risk situations in which prenatal diagnosis should particularly be seeked: low-lying placenta at routine second trimester ultrasound screening, bilobate or succenturiate placenta, velamentous insertion of the umbilical cord, in vitro fertilization. A universal screening, as proposed by certain authors, is also discussed. [Copyright &y& Elsevier]

Abstract: Ultrasonography has become an indispensable tool in prenatal care providing a throughout screening of the morphological abnormalities of the foetus. The examination of the upper limbs is now part of a routine screening checklist available in France since 2005. Recent progress in past years has focused on the early detection of reductional anomalies. As early as the first trimester scan, the three segments of the upper limb are apparent and transversal anomalies can be easily detected. Early diagnosis of malformations may lead to ethical considerations since women may request for medical termination of pregnancy. Apart from transversal anomalies of the limb which remain most of the time accidental, genetic syndromes may also lead to longitudinal reductions of the upper limb. In such cases, ultrasound may be helpful in genetic counselling by detecting other associate malformations. The search for associate malformations in favour of a genetic syndrome is therefore mandatory before referral to a prenatal consultation with the surgeon. Three-dimensional ultrasound and multi detector computed tomography (MDCT) are being increasingly used as additional procedures to improve diagnosis and long-term prognosis. [Copyright &y& Elsevier]