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Résumé: On constate en France un recul de la primo-maternité sous influence de nombreux facteurs socioculturels amenant ainsi à procréer à un âge où la fertilité décroît et où augmentent les risques liés à une grossesse tardive. Le don d’ovocyte en France est soumis à la loi de Bioéthique n’accordant pas de prise en charge au-delà de 43ans. Ainsi, pour satisfaire leur besoin de maternité, certaines françaises ont recours à un don à l’étranger. Nous rapportons le cas d’une grossesse compliquée issue d’un don d’ovocyte chez une femme de 42ans et abordons l’importance de la prise en compte des facteurs de risque avant une prise en charge en AMP, ainsi que les questions éthiques soulevées par ce cas. Après un bref rappel du cadre législatif français encadrant la pratique du don d’ovocyte, nous évoquons les pistes d’amélioration de la couverture des besoins de celui-ci en France. [ABSTRACT FROM AUTHOR]

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Abstract: Seasonal flu is potentially more severe during pregnancy especially when it occurs in the last three months. Pregnant women were shown to be especially exposed to severe forms of the flu and death in the first weeks of the pandemic influenza A/H1N1v. For the first time in history, adequate vaccines were available in the early phase of the pandemic and recommended by WHO as a priority for pregnant women. In France, vaccination with the non-adjuvanted vaccine (Panenza®) was recommended after three months of pregnancy. However, the pandemic vaccines were discredited by the mass media and the population even before they were available. This was due to several factors, and especially to the lack of information on the vaccine and its potential toxicity and, in case of pregnancy, potential risk of adverse fetal events, despite the fact that available data shows the seasonal flu vaccine is effective and well tolerated in pregnant women. This article aimed to provide decisional elements for influenza A/H1N1v vaccination in pregnant women. [Copyright &y& Elsevier]

Abstract: Universal screening for gestational diabetes mellitus (GDM) has been a topic of ongoing controversy for many years. In 2005, the French Health Authority concluded that no recommendation could be issued because of insufficient evidence. Recently, several studies have clarified the issues. It is now clearly established that women with GDM, including mild forms, are at increased risk of perinatal complications. Randomized controlled trials demonstrate that treatment to reduce maternal glucose levels improves perinatal outcomes. Today, the rationale for screening appears unquestionable. There are simple screening tests. However, it remains difficult to define threshold values because there is a strong, continuous association of maternal glucose levels with increased risks of adverse pregnancy outcomes. [Copyright &y& Elsevier]

Objective: Multiple embryo transfer is responsible for a high rate of multiple pregnancies (ICSI), with subsequent risks of premature birth and perinatal death. This prospective non randomized study aimed to assess the ability of an elective single-embryo transfer (eSET) policy to reduce the twin pregnancy rate, compared to a double embryo transfer (DET) approach. Patients and methods: Between March 2005 and May 2006, 180 eligible women were proposed to benefit from an eSET transfer rather than a DET. Inclusion criteria were (i) age less than 37 years old; (ii) at least two good quality embryos available (three to five cells at day 2 or six to nine cells at day 3; less than 20% fragmentation and the absence of multinucleates blastomeres), after IVF or ICSI and (iii) no more than one previous failed treatment cycle. Outcome analysis included cycles with frozen-thawed embryo transfer (FET). Results: According to patients’ decision, 107 and 73 women had an eSET (59.4%) and a DET (40.6%) respectively. No differences were found between eSET and DET groups regarding demographics and biologicals parameters. The clinical pregnancy rate (PR) per transfer was 43.9% in eSET group and 57.5% in DET group (p =0.07). The twin pregnancy rates were 0 and 14.3%, in eSET and DET groups, respectively (p =0.007). The cumulative PR per patient, including the outcome of performed FET cycles, was 63.6% in eSET group and 61.6% in DET group. In this case, the cumulative twin pregnancy rates were 2.9 and 15.6% in eSET and DET groups, respectively (p =0.02). Discussion and conclusion: Our data show that in a selected population of women, transferring one fresh embryo and then, if required, one or two frozen-thawed embryos significantly reduces the twin pregnancy rate without decreasing the overall pregnancy rate. This study supports the policy of eSET in this subgroup of patients. [Copyright &y& Elsevier]

Objective: To define specific features of follow-up in pregnant women with gastric banding in order to evaluate obstetrical outcomes and gastric banding related complications. Materials and methods: A systematic review of observational and case-control studies, as well as case reports to discuss pregnant women follow-up. Results: Seven articles were retained. Doctors manage differently gastric banding. With gastric banding, there is a better maternal weight gain control and less hypertension and diabetic complications. We found four gastric banding related complications. Discussion and conclusion: Gastric banding is well tolerated during pregnancy and can be safely recommended to obese women of childbearing age. [Copyright &y& Elsevier]

Abstract: Intrahepatic cholestasis during pregnancy is a risk factor for prematurity, respiratory distress, fetal death in utero and exposure to meconium stained liquor. Treatment is based on ursodeoxycholic acid, which allows the pregnancy to continue until term. There is no consensus for labor induction criteria or for extraction of the fetus. We report a series of 10 patients who presented cholestasis during pregnancy and for whom we monitored the bile acid levels. These assays provided the means of confirming the diagnosis in patients suffering from pruritis. The threshold of 40μmoles/L could be a way of defining a group at risk of complications. Proper management for monitoring this pathology has not yet been properly established, but assay of the bile acids is an important element. [Copyright &y& Elsevier]