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The level of maternal mortality appears to be higher in France than in other European countries according to the data collected in the 1995 European survey. We performed a retrospective analysis of severe hemorrhage, pregnancy induced hypertension, and maternal sepsis in 1995 in the Lorraine region and reviewed the management scheme used in each case. There was one maternal death and 223 cases of severe maternal morbidity (110 cases of hemorrhage, 105 cases of pregnancy induced hypertension, 8 cases of maternal sepsis). The frequency of these maternal diseases was an estimated 8 per 1000 births. Ninety percent of the children (90.7%) were living 7 days after birth. Pregnancy after the age of 35 years, obesity, and an intermediate level of vocational training were well-documented high risk factors in the Lorraine area. All of the women who developed complications had been followed regularly during their pregnancy. High parity and a scarred uterus were high risk factors for post partum hemorrhage. About 45% (45.5%) of the patients were transferred to an emergency unit for intensive care. Pregnancy-induced hypertension was treated within the normal hospital network, most of the mothers being transferred to a reference center prior to delivery. This retrospective study demonstrates the need for reporting more information on medical records. The data observed improved our knowledge of the prevalence and management of the main causes of direct maternal death in the Lorraine area. It improved our knowledge on the prevalence and management of the main causes of direct maternal death in Lorraine area.

The lower limit for elective delivery depends on technical and ethical issues. Elective delivery is usually accepted after 26 weeks gestation with a 60% survival rate and a 30% handicap rate. Decision making requires close coordination between obstetricians and pediatricians. Sufficient time must be devoted to providing the parents with adequate information. The physician plays a crucial role in decision making, but parent's information and consent are essential.

We report the French experience with high risk pregnancies and fetal heart rate monitoring at home. Data were recorded for 376 patients who underwent obstetrical home monitoring from 1992 to 1997 (12,649 recordings). In comparison with data in the literature, our findings show this method is technically reliable. Telemonitoring of high risk pregnancies is as about as safe as traditional hospitalization. Perinatal mortality was not higher in high risk pregnancies followed with home monitoring. We this method, we achieved a lower number of hospitalization days and stays.

Objective: To study whether there is an iatrogenic transfer of oestradiol through the use of T.O.M. ointment administered to prevent or to cure trophic changes in the breast while breastfeeding and what the dangers of plasma levels of oestradiol in the newborn will be., Type of Study: Controlled, randomised, double blind., Subjects and Methods: 80 mother/infant couples were included in the study: 40 received the ointment containing oestradiol (the treated group), and 40 received an ointment without oestradiol (the non-treated group); the ointment was applied before each breastfeeding from the 2nd to the 6th or 7th day of life. Mothers' milk and blood from the newborn babies were taken for estimating the levels of oestradiol using a radio-immunological technique. The total quantity of ointment was measured for each subject., Results: The mean level of oestradiol in the treated mothers' milk was significantly higher (p. 0.0014) than in the milk of the mothers who had not been treated. The concentration of oestradiol in the plasma of the newborn dropped from the first to the last day of the trial without any difference in the treated or non-treated groups no matter what the sex of the child was, nor the quantity of ointment used.

Sixty-one premature babies delivered by caesarean section (Group C) before the 32nd week of amenorrhoea were compared with 83 control babies (Group T) born by vaginal delivery. The mortality was comparable: 28 and 32.5%, which is statistically more significant in children born before the 28th week of pregnancy (100 and 66% respectively) and weighing less than 1000 g (53 and 57%). Caesarean section improves the prognosis in multiple pregnancies. Morbidity (respiratory troubles, neurological troubles, infections and jaundice) is hardly different in the two groups. Infections in the lungs are less frequent, but broncho-pulmonary dysplasias are more frequent after caesarean section. Sixty-seven per cent of babies in Group C, and 64% in Group T had normal neuro-psychological development. Severe sequellae were found respectively in 9 and 18% of the infants, the difference being due to motor neurone disease of cerebral origin in respectively 0 and 6 cases. Mortality and the sequellae were identical in the two groups in breech presentations. This study does not support extending the indications for caesarean section in pregnancies under 32 weeks.

Full description of the case is given first: an atypical Rokitansky-Kuster-Hauser syndrome (with absence of both fallopian tubes) is associated with Turner-like dysmorphia (including a Klippel-Feil syndrome), karyotype being normal. The Turner-like dysmorphia of the reported case perfectly fits into a syndrome described by Nora in 1974; this Ullrich-Noonan syndrome helps simplifying the classification of Turner syndromes and related syndromes: transmission is autosomal dominant in most cases.