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We report five cases of vomiting associated with a very important increase of maternal plasma uric acid (> 595 mmol/l, 100 mg/l) at the third trimester of pregnancy. In all cases, elevation was transitory and regressive with rehydratation. Pregnancies proceeded normally to term and delivered healthy babies. An important rise of plasmatic uric acid during pregnancy can be found in severe hypertensive disorders (preeclampsia, HELLP syndrome, acute fatty liver). Nevertheless, it can be related to transient renal insufficiency without any severe pathology. In our five observations, digestive disorders seem to be the reason for this phenomenon and spontaneous prognosis was excellent in all cases.

Unlabelled: This study was performed to describe the factors associated with a premature cessation of breastfeeding., Background and Methods: Three hundred and forty nine women with a plan for prolonged breastfeeding over two months were interviewed during their hospital stay to define sociological and medical variables. One month after discharge, mothers were contacted by a physician for making out evolution of the breastfeeding., Results: Eighty-eight (28%) women were no more breastfeeding their infant and were compared to the other 224 (64%) mothers. The main sociological factors influencing the cessation of breastfeeding were low education level (odds ratio 4.2 [95% CI 2.2-8.3]), and primiparity (odds ratio 2.1 [95% CI 1.1-3.9]). Pacifier use was associated with a lower duration of breastfeeding (odds ratio 2.5 [95% CI 1.4-4.5]). Medical predictive factors were infant weight loss (odds ratio 4.3 [95% CI 1.7-10.6]), respect of intervals between feeding times (odds ratio 2.1 [95% CI 1.1-4.4]), delay before the first feeding (odds ratio 1.9 [95% CI 1.0-3.6]). On the other hand formula supplementation was not related with cessation of breastfeeding., Discussion and Conclusion: As the success of breastfeeding depends on maternal motivation, it seems essential to take into account mothers' plan to study breastfeeding duration. The knowledge of predictive factors of the cessation of breastfeeding should allow to identify mothers who need particularly the attention of healthcare professionals.

Objectives: To create a follow-up protocol for pregnant patients with Marfan syndrome., Patients and Methods: We retrospectively reviewed the charts of patients who delivered in the Jeanne de Flandre University Hospital between June 1996 and June 1999. Four pregnant patients with Marfan syndrome were identified., Results: Three of these patients had Bentall procedure. One of them had vaginal delivery and the two others underwent cesarean section. One of these two patients developed aortic valve thrombus at 14 weeks of amenorrhea. The fourth patient did not have surgery and had two vaginal deliveries., Discussion: According to our results and after reviewing literature pregnant patients with Marfan syndrome were divided into two groups. The 1st group was comprised of patients who underwent Bentall procedure. The 2nd one was comprised of patients who did not undergo any surgical procedure. The possibility of vaginal delivery for patients who underwent Bentall procedure (one case) and the interest of Propanolol and anticoagulant treatment are emphasized., Conclusion: The multivariant approach of pregnant patients with Marfan syndrome is stressed out with special reference to the potential complications of this syndrome such as aortic dissection and to the problems related to the anticoagulant treatment.

A prospective study was conducted in 3056 live-born infants delivered at the Jeanneade-Flandre maternity hospital of the Lille Teaching Hospital between January and August 1997. Clinical, laboratory test, and microbiological test findings were compared. A cohort of 1003 infants who remained in the maternity ward but were considered at increased risk of maternofetal infection (MFI) based on history and/or obstetrical criteria and/or neonatal criteria underwent routine collection of specimens including gastric fluid, auricular and anal swabs, amniotic fluid, and placental fragments. Microscopic examination of gastric fluid smears, the first result available to the clinician, was found to have 27.5% sensitivity (983 samples). Positive predictive value (PPV) was only 17.8% because of a high rate of colonization (16.8%), defined as absence of clinical symptoms and three peripheral specimens positive for the same organism. However, negative predictive value (NPV) was as high as 99.8% as a result of high sensitivity (97.8%) in the infected neonates. The gastric fluid smear was positive in 30% and 35% of neonates born to mothers with hyperpyrexia during early and late labor, respectively, and in 42% of neonates born to mothers with a history of group B streptococcus carriage during the pregnancy. Forty-two per cent of neonates with a history of fetal tachycardia had a positive gastric fluid smear. Diagnostic criteria for infection were three peripheral specimens positive for the same organism, C-reactive protein elevation, and/or one or more clinical signs suggestive of infection, and/or a positive central specimen (blood, CSF). The infection rate in infants who remained in the maternity ward was 1.6%. The most common causative organisms were group B streptococci. These findings illustrate the useful contribution of gastric fluid smears to the early diagnosis of MFI and confirm the predominant role of group B streptococci.

Prenatal diagnosis of genetic abnormalities requires nucleated fetal cells which are currently obtained by invasive techniques such as amniocentesis, chorionic villus sampling and percutaneous umbilical blood sampling. Each of these entails a risk to the foetus and sometimes to the mother. Nucleated fetal cells have been reported to be present in maternal blood. Recovery of fetal cells from maternal blood would allow a noninvasive prenatal diagnosis. Their rarity (1 fetal cell for 10(6) to 10(8) maternal cells) presents a technical challenge. Due to the small number of fetal cells, sensitive analysis techniques such as PCR and FISH are necessary. Some degree of fetal cells enrichment in the maternal blood sample often precedes the analysis. Different techniques are used for the enrichment: discontinuous density gradient, magnetic activated cell sorting, fluorescence activated cell sorting, micromanipulator.... Several prenatal diagnosis have already been performed from maternal venous blood samples: diagnosis of gender, RhD blood genotype, Duchenne muscular dystrophy and hemoglobinopathy by PCR, diagnosis of gender and chromosome aneuploidy by FISH. Many teams are working on this subject. It is difficult to compare the studies because the techniques of enrichment and analysis vary. We review the different strategies chosen for prenatal diagnosis from maternal blood and discuss the results.

Since Liggins and Howie first published their work, numerous studies have shown that corticosteroids significantly decrease perinatal mortality and morbidity, without complication for the mothers and child. Corticosteroids should be prescribed in case of threatening premature birth. Imminent delivery premature rupture of the membranes and gestationnal age over 34 weeks are not contraindications to prescription, as corticosteroids can be safely given all in these circumstances. Theoretically, more than half of premature neonates should have been treated with corticosteroids. Actually, only 20% or less are currently treated. The cost-effectiveness ratio of an antenatal corticosteroid policy would be extremely positive: more than 1,500 prenatal deaths could theoretically be avoided in France annually and the overall cost of neonatal care would decrease by 10%.

Objectives: The aim of this study was to establish the panorama of uropathies discovered during the antenatal period and to analyze the explorations performed. Pregnancy outcome and infant prognosis was also recorded., Method: Ultrasonographic imaging revealed dilatation in 62.5% of the cases, parenchymal anomalies in 26.3% and unilateral or bilateral agenesia in 11.2%. The percentage of abnormal karyotypes was 4.76% for all urorenal symptomatologies. These abnormal karyotypes corresponded to 10% of those performed in 17 fetuses, urine puncture was used in order to assess in utero renal function. There were 113 live births, 31 medically termined pregnancies and 3 spontaneous abortions. Among the 113 live infants, 12 died during the post-natal period. Thirty-two infants were considered to be normal and 69 had an urorenal malformation, including 2 infants with pre-end-stage renal failure at 4 and 3 years., Conclusion: It is uncommon to discover an urorenal malformation at prenatal ultrasonography. The main problem is antenatal management and evaluation of prognosis. Urine puncture and in utero derivation are discussed. When no other reliable factors affecting fetal prognosis are available, puncture of fetal urine provides useful information for management although the technique remains under debate.

Aim: To define therapeutic ways to manage obstetrics at an optimal level for a patient carrying a mechanical prosthetic heart valve., Method: From a review of literature and documented cases, we propose an obstetrical and cardiological management scheme for pregnant patients carrying a mechanical prosthetic heart valve. We deal successively with the preventive (anticoagulation) and curative treatment (surgery and thrombolytic therapy) of valvular thrombosis, in fact, a severe -but unfortunately frequent- complication of these pregnancies., Results: Pregnancy concerning patients with mechanical prosthetic heart valves is a high-risk pregnancy. In fact, the risk of thrombo-embolic accidents even with a closely followed anticoagulant treatment seems to come from the existence of the prothese, the state of physiological hypercoagulation and peri-partum hemorrhages. Naturally, multidisciplinary follow-up is indispensable. The prescription of anticoagulant treatments must respect the main principals and the normal counter-indications in order to minimise maternal and fetal complications., Conclusion: Pregnancy amongst patients carrying mechanical prosthetic heart valves should be considered rare and highly exceptional cases, from a cardio-vascular surgeon's point of view. For obstetricians, it is sometimes difficult to forbid pregnancy to a nullipara. The discussion whether to authorize a pregnancy will be treated case-by-case, holding into account the socio-cultural environment of the patient, as the principles of an anticoagulant treatment and the underlying risks must be well understood.

Willebrand's disease, the most frequent inborn coagulopathy, is defined as a deficiency in Willebrand's factor required for normal hemostasis as a mediator in platelet adhesion to the subendothelium and which also contributes to plasma coagulation pathway (by preserving the coagulating activity of factor VIII). Classically, Willebrand's disease improves somewhat during pregnancy. We followed 15 pregnancies in 12 patients with Willebrand's disease in an attempt to determine the best management strategy to reduce the risk of bleeding during delivery. This risk can be assessed on the basis of prior history of bleeding and the laboratory tests and reduced by administration of concentrated Willebrand's factor at 8 months gestation. In patients with type I disease, desmopressin is proposed as curative treatment during the post partum period. Antenatal diagnosis is possible in the most severe forms. Programmed delivery is recommended. Spinal analgesia is contraindicated.

Objectives: Identify the role of cord prolapse in modern obstetrics by estimating the frequency of this obstetrical accident, its conditions, prognosis and treatment and by analyzing factors favoring development of cord prolapse., Method: From a retrospective study of 50 observations of cord prolapse occurring in the department of obstetrics from January 1985 to June 1994. Results were compared with those reported in the literature., Results: The frequency of cord prolapse was 0.21% over the 10-year period. Cesarean section was required in 72% of the cases, and obstetrical manoeuvers were used in some of the vaginal deliveries (28%). Neonatal mortality was 20/1000. Predisposing factors were breech presentation, prematurity, twin pregnancy and multiparity., Conclusion: Despite much progress in obstetrics, the frequency of cord prolapse has not changed over time. The consequences are not as lethal as in the past, because of progress in diagnosis and neonatal resuscitation. Fetal prognosis remains however severe.

During pregnancy 50% of all cases with a ventriculo-peritoneal shunt malfunction. This is because of anatomo-physiological changes associated with the pregnant state, and shows itself as a rise in intracranial tension. There were no acute neurological complications at term; with the malfunction of the shunt distally, vaginal delivery is preferable. It is not necessary routinely to carry out instrumental delivery.

This is a preliminary report on an original method of local regional electronic analgesia. From it the first results can be deduced. The threshold for pain which was appreciated at 25 mmHg without electronic stimulation was raised to 48 mm Hg under electronic stimulation. Fetal ill-effects are nil.

The authors, having studied a case of Meadows syndrome, confirm that this cardiomyopathy is a specific entity in pregnancy and the puerperium. They point out the difficulties in diagnosis, as Meadows syndrome seems to be diagnosis of elimination. They point out that a paraclinical balance has to be drawn up very fully on the biological and haemodynamic planes to confirm this condition. Finally, after a short discussion about the therapy, they tackle the problem of the prognosis for life and for future childbearing in these patients, which is determined by the persistence or absence of cardiac enlargement.

Pulmonary maturity of the fetus can be evaluated by the lecithin/sphingomyelin (L/S) ratio in amniotic fluid. To existing methods of lipid extraction, precipitation with acetone and chromatography, we add a simple and accurate estimation of sphingomyelins (S) and precipitated lecithins (Lp) without acid digestion. The method is reproducible (C.V. less than 9%) for the measurement of Lp/S ratio and gives with accuracy the concentrations of Lp, avoiding possible errors in interpretation of Lp/S. Our results show that at 35 weeks of normal gestation, Lp/S ratio is about 2 and Lp concentration, 10 mg/1.

The fetal crown rump length was measureed by means of pulsed ultrasound. The normal values between 49 and 94 days from the onset of the last menstrual period were determined in 72 patients. Statistical analysis showed a good correlation between gestationnal age and fetal crown rump length. The usefulness of this measure is so demonstrated: assessment of gestational age, within few days.

Affinity experiments with the lentil (Lens culinaris) lectin have revealed the existence of two distinct molecular populations of alpha-fetoprotein: lectin reactive and lectin non-reactive. Using a combination of crossed lectin immunoelectrophoresis and radio-immunoelectrophoresis, it has been possible to obtain directly the lentil lectin affinity patterns of alpha-fetoprotein present in maternal sera. The lentil lectin reactivity of maternal alpha-fetoprotein decreases almost linearly with the gestational age from week 15 to 35.