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Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

L'examen du placenta est indispensable dans le diagnostic du retard de croissance intra-utérin (RCIU). Son intérêt réside dans la recherche étiologique de cette pathologie, et les conséquences materno-fœtal qui peuvent en découler, ainsi dans la mise en place des stratégies préventive lors des grossesses ultérieures dans le cas des pathologies récidivantes. Nous rapportons les lésions anatomopathologiques possibles retrouvées au niveau du placenta de cette pathologie à travers une observation de RCIU sévère suivi au sein du Service de Néonatologie du CHU Ibn Sina de Rabat.

The examination of the placenta is part of the assessment of intrauterine growth retardation (IUGR). Its interest lies in retardation etiology research and in maternal-fetal consequences which can arise from it as well as in the implementation of preventive strategies for subsequent pregnancies in patients with recurrent diseases. We conducted a study of patients with severe IUGR monitored in the Department of Neonatology of the Ibn Sina University Hospital in Rabat in order to identify possible anatomopathological lesions in the placenta. [ABSTRACT FROM AUTHOR]

• La présence d'anticorps antiphospholipides, l'activité de la maladie, la consommation de tabac et le statut socio-économique sont des facteurs qui ont une forte influence sur le devenir fœtal durant la grossesse lupique. • L'HCQ peut réduire le risque de RCIU et de prématurité au cours de la grossesse lupique. • L'efficacité de l'HCQ dans la prévention de la prématurité et du RCIU durant la grossesse lupique n'a pas été confirmée dans cette méta-analyse. • Nos résultats doivent être interprétés avec prudence en raison de l'hétérogénéité des études et ne doivent pas dissuader de recourir à l'HCQ dans un tel contexte. Le lupus érythémateux systémique (LES) est une maladie auto-immune chronique qui touche préférentiellement les femmes en âge de procréer. Si l'effet de l'hydroxychloroquine (HCQ) sur l'activité du LES et la survenue d'un lupus néonatal a fait l'objet de nombreuses études, son intérêt dans la prévention de la prématurité et du retard de croissance intra-utérin (RCIU) reste à définir. L'objectif était d'analyser l'efficacité du traitement par HCQ sur la prématurité et le RCIU durant la grossesse de femmes atteintes de LES. Nous avons mené une revue systématique et une méta-analyse comparant le taux de prématurité et de RCIU au cours de grossesses lupiques, traitées ou non par HCQ. Les odds ratio du RCIU et de la prématurité ont été calculés, puis comparés entre les grossesses de chaque groupe, en fonction de l'exposition à l'HCQ. Six études ont été incluses (3 études de cohorte descriptives et 3 séries de cas) totalisant 870 grossesses. Parmi les grossesses lupiques, 308 ont été exposées à l'HCQ et comparées aux 562 grossesses lupiques non traitées par HCQ. Aucune différence statistique n'a été relevée concernant la prématurité ou le RCIU entre les deux groupes. Cette méta-analyse n'a pas apporté la preuve de l'efficacité de l'HCQ dans la prévention de la prématurité et du RCIU au cours des grossesses lupiques. Compte tenu de l'hétérogénéité des études, ces résultats méritent d'être interprétés avec prudence. [ABSTRACT FROM AUTHOR]

Le syndrome de Silver-Russell (SSR) associe un retard de croissance intra-utérin, sans rattrapage, à une dysmorphie faciale et une asymétrie des membres. L'incidence est évaluée à 1-30/100 000 cas et environ 500 cas sont rapportés dans la littérature. Le déficit pondéral est souvent plus marqué que celui de la taille, avec un retard de maturation osseuse. Le volume normal du crâne contraste avec la petite taille et peut donner un aspect de pseudohydrocéphalie, dans de rares cas, une légère déficience mentale est décrite. La plupart des cas sont sporadiques. Une disomie uniparentale maternelle du chromosome 7 est retrouvée chez 10% des patients. Environ 35 à 50% des cas ont une hypométhylation du gène H19 dans la région 11p15 soumise à empreinte parentale. Celle-ci résulte le plus souvent d'un mécanisme épigénétique ou d'un microréarrangement génomique, notamment une microduplication maternelle de la région. Le diagnostic est avant tout clinique, mais il peut être confirmé par la mise en évidence de l'anomalie moléculaire sous-jacente. Le conseil génétique dépend du mécanisme moléculaire sous-jacent. Le risque de récurrence est extrêmement faible en cas de disomie uniparentale du chromosome 7 ou d'anomalies épigénétiques de la région 11p15. Le diagnostic prénatal n'est habituellement pas possible, puisque la majorité des cas sont sporadiques. Le traitement est symptomatique. L'administration d'hormone de croissance accélère la croissance et augmente la taille définitive, mais ne permet pas d'atteindre la taille cible. En dehors de la persistance d'une petite taille et d'une faible corpulence, le pronostic à long terme est bon. L'hémihypotrophie ne semble pas être associée à un risque tumoral accru.

Silver-Russell syndrome (SRS) is a disorder characterized by intrauterine growth retardation, without catching up, associated with facial dysmorphism and limbs asymmetry. Its incidence is estimated at 1-30/100.000 cases and approximately 500 cases have been reported in the literature. Ponderal deficit is often more marked than statural deficit, with delayed bone maturation. Normal skull volume contrasts with the small stature and can suggest pseudohydrocephaly. In rare cases patients suffer from a slight mental deficiecy. Most cases are sporadic. Maternal uniparental disomy of chromosome 7 is found in 10% of patients. Approximately 35 to 50% of cases have H19 hypomethylation in the 11p15 region subject to parental imprinting. It is most often caused by an epigenetic mechanism or by genomic microrearrangement, including maternal microduplication of the region. Diagnosis is mainly based on clinical parameters but can be confirmed by the identification of the underlying molecular anomaly. Genetic counselling depends on the underlying molecular mechanism. Recurrence risk is extremely low in patients with uniparental disomy of chromosome 7 or with epigenetic anomalies of 11p15 region. Prenatal diagnosis is not usually possible, since the majority of cases are sporadic. Treatment is symptomatic. The administration of growth hormone accelerates growth and increases the final height, but it does not allow to reach the target height. Despite the persistence of small stature and slight build, long-term prognosis is good. Hemihypotrophy does not appear to be associated with increased tumor risk. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Dans notre milieu, il n'existe aucune politique de prévention du Retard de Croissance Intra-Utérin (RCIU) clairement défini. L'objectif de ce travail était d'identifier les facteurs de risque de RCIU afin de proposer une stratégie de lutte contre cette pathologie en agissant surtout sur des facteurs pouvant faire l'objet d'une action préventive. MÉTHODES: Une étude cas-témoins a été menée dans 11 centres hospitaliers de Lubumbashi en République Démocratique du Congo, de Janvier 2010 à Juin 2011, dans le but d'identifier les facteurs de risque du retard de croissance intra-utérin (RCIU). Au total 420 gestantes (cas et témoins) avec grossesse monofoetale d'au moins 24 semaines daménorrhée ont été inclues dans l'étude. Les cas correspondaient aux gestantes dont le poids du foetus était resté inférieur au 10 eme percentile des courbes de référence d'Alexander, après 2 échographies successives réalisées à intervalle de 4 semaines. Les témoins correspondaient aux gestantes dont le poids du f'tus était supérieur ou égal au 10 eme percentile de mêmes courbes. A chaque cas a été apparié un témoin de même parité porteur d'une grossesse de même âge. RÉSULTATS: L'analyse univariée a identifié comme facteurs de risque : la taille maternelle greater than 155 cm (OR=2,45 (1,17-5,10)) et l' âge maternel 18 ans (OR=2,88 (1,12-7,74)), le bas niveau socio-économique (OR=2,53(1,76-4,23)), le mauvais état nutritionnel (OR=1,96 (1,20-3,19)), l'espace inter génésique inferieur à 12 mois (OR=1,92 (1,02 -3,63)), l'hypertension artérielle (OR=2,44 (1,32-4,55)), le paludisme (OR=1,95 (1,26-3,00))et l'anémie sévère (OR=2,28 (1,21-4,34)). L'analyse multi variée a permis de retenir les facteurs de risque suivants : la taille maternelle greater than 155cm (OR=3,93 (1,61-9,61)), le niveau socio-économique bas (OR=5,33 (2,57-11,04)), l'hypertension artérielle (OR=4,64 (2,25-9,59)) et le paludisme (OR=2,26 (2,25-4,20)). CONCLUSION: L'amélioration du niveau socio-économique des populations, la lutte contre le paludisme et les consultations prénatales mieux organisées couplées à une meilleure éducation sanitaire et nutritionnelle peuvent contribuer sensiblement à la réduction de la fréquence du RCIU à Lubumbashi.

Résumé Objectif Déterminer l’incidence des anomalies chromosomiques, des associations syndromiques et des malformations fœtales en cas de retard de croissance intra-utérin (RCIU) dans un centre de référence en diagnostic prénatal. Patientes et méthodes Il s’agit d’une revue rétrospective de tous les cas vus entre 14 et 27 SA avec un périmètre abdominal (PA) < 5 e percentile entre 2008 et 2012. Les aneuploïdies et malformations associées étaient recherchées. Les grossesses multiples étaient exclues. Résultats Un total de 8626 fœtus a bénéficié d’un examen échographique entre 14 et 27 SA. Deux cent trente-neuf fœtus (2,8 %) présentaient un RCIU défini par un PA < 5 e percentile. Parmi eux, 37 fœtus avaient un caryotype anormal ou un syndrome identifié (15 %). L’anomalie chromosomique la plus fréquente était la trisomie 18 (10 cas, 4,2 %). Soixante-sept fœtus avaient au moins une anomalie morphologique sans aneuploïdie ou association syndromique (28 %), 135 cas étaient isolés (57 %). Les anomalies associées les plus courantes étaient le fémur court (5 %), l’omphalocèle (5 %) et le laparoschisis (4 %). L’âge maternel était plus élevé (33 ans ± 5 ans versus 31 ans ± 5,6 ans, p < 0,01) et le z-score pour le PA plus bas (2,5 ± 1 versus 2,15 ± 0,6) dans le groupe à caryotype anormal ou association syndromique que dans le groupe sans malformation. Le liquide amniotique était plus souvent augmenté dans le groupe à anomalie du caryotype ou avec malformations associées (14 % et 17 %) que dans le groupe sans malformation (0 %, p < 0,01). Discussion et conclusion Cette étude décrit les anomalies et issues associées au diagnostic de RCIU au 2 e trimestre dans une large population de patientes. Nos résultats suggèrent que l’absence de malformation associée, le degré de retard de croissance, l’âge maternel et la quantité de liquide amniotique peuvent orienter le diagnostic et le conseil anténatal de cette population à haut risque. Objectives To determine the incidence of chromosomal abnormalities, syndromic association and fetal defects associated with second trimester fetal growth restriction (FGR) in a tertiary referral center. Patients and methods Retrospective review of all cases referred between 14 and 27 weeks with an abdominal circumference (AC) < 5 th centile between 2008 and 2012. Multiple pregnancies were excluded. Medical records were retrieved to look for the presence of associated malformations, aneuploidy and outcomes. Results A total of 8626 fetuses had ultrasonographic examination between 14 and 27 weeks. Of these, there were 239 cases (2.8%) with evidence of FGR as based on AC measurement. Thirty-seven fetuses had an abnormal karyotype or an identified syndromic association (15%). The most common chromosomal defect was Trisomy 18 (10 cases, 4.2%), 67 had at least one associated morphological abnormality without aneuploidy or syndromic association (28%). Most common associated abnormalities were relative short femur (5%), omphalocele (5%) and gastroschisis (4%). Last 135 cases were isolated fetal growth retardation (5%). Maternal age was higher (33 yr ± 5 yr versus 31 yr ± 5.6 yr, P < 0.01) and the z-score for the AC lower (2.5 ± 1 versus 2.15 ± 0.6) in the group with abnormal karyotype or syndromic association than in the group without associated malformation. Amniotic fluid was more often increased in the group with an abnormal karyotype or associated malformation (14% and 17%) than in the group without malformations (0%, P < 0.01). Discussion and conclusion This study describes abnormalities and outcomes associated with second trimester fetal growth retardation in a large population of patients. Our results suggest that the absence of associated malformation, degree of growth restriction, maternal age and the amniotic fluid index may help in the prenatal management and counseling of this high risk population. [ABSTRACT FROM AUTHOR]

Introduction: Dans notre milieu, il n'existe aucune politique de prévention du Retard de Croissance Intra-Utérin (RCIU) clairement défini. L'objectif de ce travail était d'identifier les facteurs de risque de RCIU afin de proposer une stratégie de lutte contre cette pathologie en agissant surtout sur des facteurs pouvant faire l'objet d'une action préventive. Méthodes: Une étude cas-témoins a été menée dans 11 centres hospitaliers de Lubumbashi en République Démocratique du Congo, de Janvier 2010 à Juin 2011, dans le but d'identifier les facteurs de risque du retard de croissance intra-utérin (RCIU). Au total 420 gestantes (cas et témoins) avec grossesse monofoetale d'au moins 24 semaines d'aménorrhée ont été inclues dans l'étude. Les cas correspondaient aux gestantes dont le poids du fœtus était resté inférieur au 10 eme percentile des courbes de référence d'Alexander, après 2 échographies successives réalisées à intervalle de 4 semaines. Les témoins correspondaient aux gestantes dont le poids du fœtus était supérieur ou égal au 10 eme percentile de mêmes courbes. A chaque cas a été apparié un témoin de même parité porteur d'une grossesse de même âge. Résultats: L'analyse univariée a identifié comme facteurs de risque: la taille maternelle Conclusion: L'amélioration du niveau socio-économique des populations, la lutte contre le paludisme et les consultations prénatales mieux organisées couplées à une meilleure éducation sanitaire et nutritionnelle peuvent contribuer sensiblement à la réduction de la fréquence du RCIU à Lubumbashi. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Ultrasonography is an essential tool in the management of twin pregnancies. Fetal weight estimation is useful to anticipate neonatal care in case of prematurity, growth restriction or growth discordance. The aim of this study was to evaluate the accuracy of ultrasound fetal weight prediction in twin pregnancies. Patients and methods: Two hundred and twenty-four patients with an ultrasonography within 7 days before birth were retrospectively studied. Estimated fetal weight (EFW) was calculated with the Hadlock''s formula and was compared with birth weight (BW). Growth restriction and growth discordance superior or equal to 25% between the first (T1) and the second twin (T2) were recorded. Results: Absolute differences between EFW and BW were similar for both twins (127g [56.25–210] for T1 and 110g [50–206.25] for T2). Mean absolute percentage error was 5.41% (2.32–9.65) for T1 and 5.64% (2.46–10.37) for T2 and was superior to 10% for 24% of T1 and 27% of T2. Gestational age inferior to 32 weeks, obesity and oligoamnios were associated with a better accuracy of ultrasonography. Chorionicity as well as fetal presentation did not influence fetal weight estimation. Ultrasonography in the diagnosis of growth restriction had a sensitivity of 82%, a specificity of 76%, a positive predictive value (PPV) of 22% and a negative predictive value (NPV) of 98%. For diagnosis of growth discordance, sensitivity was 72%, specificity 95%, PPV 72% and NPV 95%. Conclusion: Fetal weight can be accurately predicted in twin pregnancies. The contribution of ultrasonography in the diagnosis of growth restriction and growth discordance is mainly due to a high NPV. [Copyright &y& Elsevier]

Abstract: Objectives: The purpose of this study was to describe outcome of subsequent pregnancy after preeclampsia or HELLP syndrome during the first pregnancy and to evaluate potential risk factors for gestational vascular complications. Patients and methods: Follow-up data were obtained from 445 women who were delivered between March 1996 and December 2006. Medical records of the index pregnancy and subsequent outcomes were available for review. To have adequate time to study subsequent pregnancy outcome, only patients who were delivered>2years before the analysis were included. Results: There were 151 subsequent pregnancies of which 142 pregnancies progressed beyond 20 weeks of gestation. The median duration of follow-up was 6years (range: 2–9years). Thirty-nine (27.5%) had a gestational vascular complication. Preeclampsia reoccurred in the second pregnancy in 20 women (51.3%), HELLP syndrome developed in three of these pregnancies. Gestational hypertension occurred in 14 patients (35.9%) and abruptio placentae in one (2.6%). Four of the newborn infants (10.3%) were small for gestational age (<3rd percentile). Obesity, delivery<32weeks of gestation and small for gestational age newborns at index pregnancy were related to a higher incidence of gestational vascular complication during the subsequent pregnancy. Discussion and conclusion: Patients with a history of preeclampsia or HELLP syndrome during the index pregnancy are at increased risk for obstetric complications in subsequent pregnancies. [Copyright &y& Elsevier]

Copyright of Diabetes & Metabolism is the property of Masson Editeur and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: During the last years, obesity and subsequent metabolic disorders and cardiovascular diseases have tremendously increased. Recent studies have shown that risk factors of cardiovascular diseases appear as soon as in infancy. In many situations, these disorders are programmed in early life during fetal development. These observations have lead to the concept of programming. The first studies on this subject underlined the link between poor fetal growth and the risk of nutritional and metabolic disorders during adulthood. But, it is now evident that excess of fetal growth as it is observed during pregnancy with maternal diabetes leads to the same consequences. The metabolic syndrome or syndrome X is the name for a clustering of risk factors for cardiovascular diseases and type II diabetes that are of metabolic origin. This syndrome, first described in the adults, is more and more studied during childhood and adolescence. Metabolic syndrome is now described in youth, particularly in subjects with risk factors as obesity. Alterations of intra-uterine environment lead to modified early development and represent short-term adaptations transmitted from one generation to another. This intergeneration effect contributes to the burden of adult metabolic disorders and cardiovascular diseases, as seen in the last decades. There is considerable evidence for the contribution of epigenetic mechanisms for the lifelong and the intergenerational alteration of gene transcription by variation in the early life environment. One of the major challenges in the following years is to promote public health programs which are aimed at prevention of long-term consequences of fetal programming. [Copyright &y& Elsevier]

Abstract: Purpose: Intra-uterine growth restriction and preterm birth can lead to cardiovascular diseases in adulthood. Current knowledge and key points: Preterm birth and intra-uterine growth restriction induce long-term changes in organ development such as arterial system and kidney function. Among these changes, the impairment of arterial wall structure or properties occurring in low birth weight babies, as a result of preterm birth and intra-uterine growth restriction, may lead on a long-term to an elevation of arterial pressure and arterial stiffness. These notions are still not completely understood and seem of high importance in regard to the high frequency in preterm birth and intra-uterine growth restriction. Future prospects and projects: Identifying clinical, paraclinical markers and better understanding a link between adverse perinatal conditions and cardiovascular diseases might improve actions for preventing cardiovascular diseases in adulthood in this population. [Copyright &y& Elsevier]

Copyright of Obésité is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Aim of the study: Intra-uterine growth retardation (IUGR) is a frequent pathology in obstetrics characterized by high heterogeneity. Fetal smallness is sometimes constitutional, but can also be accompanied by fetal distress and vital risks for the infant. In 35 pregnancies complicated by IUGR of different etiologies, we measured on fetal blood obtained by cordocentesis, biochemical variables characteristic of the fetuses'' respiratory and metabolic status. The aim of the study was to identify the discriminative biological alterations, related to growth retardation and fetal distress. Patients and methods: The studied population includes 27 cases of severe IUGR, of gestational age 30,2±4,6 weeks of gestation (WG) (divided into 20 cases of isolated IUGR and 7 cases of IUGR associated with malformative syndrome), as well as 8 cases of moderate IUGR, of gestational age 26±4,5 WG; all fetuses had normal karyotypes. A group of 73 normal fetuses, of gestational age 26,3±5,7 WG, constituted a reference population. PH, pCO2, bicarbonate concentration, pO2 and SaO2, as well as glucose, pyruvate, lactate, free fatty acids, aceto-acetate, beta-hydroxybutyrate and cholesterol concentrations were measured on umbilical venous blood (UVB). Results: In case of severe but isolated growth retardation, UVB analysis showed the frequency of acid-base and gasometric disturbances: acidemia and hypoxemia (65% of cases), hypercapnia (60% of cases). Metabolic abnormalities were shown: decrease in glycemia (35% of cases), increase in pyruvatemia and lactatemia (40% of cases), increased free fatty acids serum concentration; a diminution of umbilical venous cholesterol level, the most frequent abnormality, can be seen in 70% of fetuses. In case of severe IUGR associated with malformative syndrome, UVB acid-base and metabolic changes were rarely seen; however, UVB cholesterol level is low in some cases. In case of growth retardation classified as moderate, modifications are relatively not frequent and essentially gasometric. Conclusion: In about 60% of cases of severe and isolated IUGR, there is a risk of fetal distress, related to an alteration of the transplacental transfer of respiratory gases and nutritional substrates; chronic fetal malnutrition can be involved, with an impact on the growth of the fetus. In case of IUGR associated with malformative syndrome, fetal smallness is probably a result of intrinsic fetal damage, without nutritional origin. [Copyright &y& Elsevier]

Abstract: Marijuana is the most commonly used illegal drug, especially among young women in Western societies. The effects of cannabis use during pregnancy have been studied for many years. The vast majority of studies have shown a link between maternal consumption of cannabis and foetal development. Foetal growth restriction seems to be the major complication of cannabis exposure. Nevertheless, all these studies have suffered from several methodological biases. The maternal marijuana use should be first and foremost detected in pregnant women for a specific addiction management and pregnancy follow-up. [Copyright &y& Elsevier]

Abstract: Objective. – To investigate the frequency of main symptoms of Obstructive Sleep Apnea Syndrom (OSAS) and their relationship with Pregnancy Induced-Hypertension (PIH) as well as Intrauterine Growth Retardation (IGR) as suggested by recent studies. Methodology. – Four hundred (and) thirty-eight enquiry forms completed during post-partum period were analysed, after exclusion of multiple pregnancies. Collected data were demographic characteristics, obstetrical events, sleep disorders during last trimester, screening of snoring and vigilance troubles with an Epworth score. Results. – Forty-five percentages of the patients reported to have habitual snoring during pregnancy. Among these, 85% were non-snorers before pregnancy. Daytime somnolence concerned 84,5% of the population with an Epworth score significatively increased (P <0,0001). The prevalence of PIH was found to be 4,5%, with two apparently independent risk factors: the body mass index (OR=1,1) and an association between snoring and increased vigilance trouble (OR=2,6). No statistical difference was found concerning IGR. Conclusions. – SAS symptoms are frequent during pregnancy and snoring appears to be linked with PIH. However, polysomnographic data are not yet sufficient to explain pathophysiological mechanisms and find relevant diagnostic markers during pregnancy. [Copyright &y& Elsevier]

Abstract: The prenatal management of fetuses with intrauterine growth restriction (IUGR) has been a matter of perpetual evolving in obstetrics and has been the topic of numerous studies. The management of IUGR fetuses is currently available in tertiary centres using fetal heart monitoring, short term variability, or doppler investigation of the umbilical artery, ductus venosus and middle cerebral artery. The aim of the prenatal management is to detect anomalies that may predict severe fetal hypoxemia. On the other hand, any efforts should focus on the possibility to delay the time for delivery as gestational age at delivery together with birth weight appear to be essential parameters of the postnatal outcome. [Copyright &y& Elsevier]

Abstract: Malnutrition is quite rare in neonates. However perinatal malnutrition occurs in two situations. Fetal malnutrition leading to intra-uterine growth retardation with a birth weight below the lower limit for gestational age. On the other hand a postnatal relative malnutrition ("extra-uterine" growth retardation) which occurs mainly in preterm neonates. Both these situations need specific nutritional care after birth but also during the first years of life as there is probably a relationship between post-natal nutrition and health in adults (Barker hypothesis). [Copyright &y& Elsevier]

Abstract: Objective. – To establish fullterm newborn anthropometric parameters to determine the frequency of intrauterine growth retardation and to study mother''s and socio-economic risk factors associated with the intrauterine growth retardation in the population in North-Togo. Methods. – Twelve month prospective study in the savana area in North-Togo. One thousand and six alive newborns born after normal single pregnancy, and without severe neonatal diseases were included. Results. – The mean birth-weight±SD was 2938±421 g. The incidence of low birth-weight was 11,7%. Among mother''s and socio-economic risk factors, teenage mothers, mothers with a weight lower than 50 kg or with body mass index lower than 20 kg/m2 had a significantly high risk of having a child with intrauterine growth retardation (Odds ratio=2,71; 2,57; 1,57 respectively). Father''s job also affected the mother''s and newborn''s weight. Conclusion. – The recognition of these easy to identify risk factors should allow specific recommendations for this population. [Copyright &y& Elsevier]

Copyright of EMC-Gynecologie--Obstetrique is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Inflammatory response is a major component in physiopathology of preeclampsia and intra-uterine growth retardation. Endothelium is a main connection between placental ischemia and clinical manifestations during vascular pregnancy complications. In this review recent findings concerning inflammatory response and its links with endothelium are reported. Studies concerning isolated intra-uterine growth retardation confirm the hypothesis of a similar pathophysiology with an activation confined to utero-placental bed or at a lower level. Current information on oxidative stress, atherosclerosis, and apoptosis in vascular pregnancy complications are available in this review. These concepts offer innovative possibilities of treatment. [Copyright &y& Elsevier]

Abstract: Clotting disorders are associated with the severe, early and complicated forms of PE. Compensated hypercoagulability states associated with a thrombocytopenia (PLT<150k/mm3) affect 25 to 50% of severe PE patients. Laboratory markers of platelet and endothelial activation are the early increase of fibronectin levels, the worsening of the thrombocytopenia and the raised platelet turnover. The excessive thrombin formation is physiologically compensated by a rise in thrombin-antithrombin (TAT) complex levels, which is the most specific marker of a PE pregnancy, and a decrease in anti-thrombin (AT) activity. The placenta induced depression of the fibrinolysis appears to contribute towards the hypercoagulable state. The etiological importance of the erythrocyte and leucocyte activation with regards to the abnormal clotting activation is highlighted in the setting of maternal systematic inflammatory disease. The state of compensated coagulopathy found in the PE patient can suffer a pro-coagulatory imbalance because of a quantitative, or a qualitative failure (i.e. thrombophilia) of the physiological coagulation inhibitors, or a combination of both. This disseminated intravascular coagulation, qualified as chronic, is associated with clinically evident signs of fœto-placental unit impairment (i.e. IUGR, foetal death) with or without systemic repercussions in the mother (i.e. renal failure, HELLP syndrome, eclampsia). This set of haemostatic disturbances found in the PE patient is a dynamic phenomenon, which can evolve by the hour therefore requires frequent laboratory investigations. Delivery remains the only curative treatment for these haemostatic disturbances. A better understanding of the aetiology of DIC in PE, an early detection method and a specific identification of the at-risk patients could allow prophylactic and curative treatment. [Copyright &y& Elsevier]

Summary: Most of the published studies evaluating renal prognosis of children born very preterm found asymptomatic abnormalities (blood pressure, glomerular filtration rate GFR, hypercalciuria, decreased renal size, microalbuminuria…) during childhood or early adulthood. The objective of this study was to assess renal function (inulin clearance) in a prospective single-center cohort of children born preterm between 1998 and 2001 (< 30 GW,<1000g) and to identify neonatal risk factors for renal abnormalities during childhood. Fifty children were included in the final part of the study. At a mean age of 7.6 years, no patient had arterial hypertension or chronic kidney disease, but mean centile for diastolic blood pressure was higher than expected and ultrasounds revealed small-sized kidneys compared to controls. The average GFR was 112ml/min per 1.73m2 (91-158). Two children had microalbuminuria, two had hypercalciuria and one had nephrocalcinosis. Children with intra- or extra-uterine growth retardation had an impaired GFR compared to children with appropriate pre- and post-natal growth (107 vs. 110 vs. 125ml/min per 1.73m2, p<0.05). Children with bronchopulmonary dysplasia had a significant higher microalbuminuria. In conclusion, findings of borderline blood pressure and reduced kidney size in children born preterm can be regarded as markers of reduced nephron number. Long term renal follow-up (blood pressure, serum creatinine, urine albumin / creatinine ratio) should be performed in all children born very preterm, with an early referring when abnormalities are highlighted. [Copyright &y& Elsevier]