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Little is known about the long-term neurological development of children diagnosed with congenital Zika infection at birth. Here, we report the imaging and clinical outcomes up to three years of life of a cohort of 129 children exposed to Zika virus in utero. Eighteen of them (14%) had a laboratory confirmed congenital Zika infection at birth. Infected neonates have a higher risk of adverse neonatal and early infantile outcomes (death, structural brain anomalies or neurologic symptoms) than those who tested negative: 8/18 (44%) vs 4/111 (4%), aRR 10.1 [3.5–29.0]. Neurological impairment, neurosensory alterations or delays in motor acquisition are more common in infants with a congenital Zika infection at birth: 6/15 (40%) vs 5/96 (5%), aRR 6.7 [2.2–20.0]. Finally, infected children also have an increased risk of subspecialty referral for suspected neurodevelopmental delay by three years of life: 7/11 (64%) vs 7/51 (14%), aRR 4.4 [1.9–10.1]. Infected infants without structural brain anomalies also appear to have an increased risk, although to a lesser extent, of neurological abnormalities. It seems paramount to offer systematic testing for congenital ZIKV infection in cases of in utero exposure and adapt counseling based on these results., Here, using diagnostic tools in a longitudinal cohort of ZIKV-infected pregnant women of the French Guiana Western Hospital Center (CHOG) and their infants, the authors investigate the long term neuropathological effects of congenital infection, finding that a laboratory confirmed congenital ZIKV infection at birth is associated with higher risks of adverse neurological outcomes up to three years of life.

The objective of this article was to study the reproducibility and reliability of the fetal corpus callosum measurements between two-dimensional (2D) and three-dimensional (3D) acquisitions. This prospective study enrolled 475 fetuses, monitored between 18 and 38 weeks of gestation by two operators. Starting from a transcerebellar axial plane, 3D and 2D mid-sagittal views of the corpus callosum were obtained. Measurements of length and thickness were performed and underwent quality control by independent reviewers. The acquisition time of the two methods was measured. Means, differences, and linear correlations were analyzed using t-test, regression and Pearson's correlation coefficients, and Bland–Altman's plots. This analysis was performed for each operator to test the interobserver reproducibility. Among the 432 cases measured using both methods, 380 (88%) were validated by quality control. The mean corpus callosum length and thickness were essentially the same using 2D and 3D measurements (2D: 33.8 ± 8.7 vs. 3D: 33.7 ± 8.7 mm, 2D: 2.2 ± 0.4 vs. 3D: 2.2 ± 0.4 mm, respectively; mean ± standard deviation [SD]). Linear regression coefficients and Pearson's coefficients were similar for length (2D: 0.8283 and 0.9191 vs. 3D: 0.8271 and 0.9095), but slightly different regarding thickness (2D: 0.6775 and 0.8231 vs. 3D: 0.5831 and 0.7636). Differences between 2D and 3D measurements, considering Bland–Altman's plots and correlated with gestational age, were acceptable (2D: 0.097 ± 0.559 mm, 3D: 0.004 ± 0.111 mm). The acquisition time required was significantly lower for 3D acquisitions (3D: 25.2 ± 14.5 seconds vs. 2D: 35.1 ± 19.4 seconds, p

International audience; Whether prolonged maternal viremia after Zika virus infection represents a risk factor for maternal-fetal transmission and subsequent adverse outcomes remains unclear. In this prospective cohort study in French Guiana, we enrolled Zika virus-infected pregnant women with a positive PCR result at inclusion and noninfected pregnant women; both groups underwent serologic testing in each trimester and at delivery during January-July 2016. Prolonged viremia was defined as ongoing virus detection >30 days postinfection. Adverse outcomes (fetal loss or neurologic anomalies) were more common in fetuses and neonates from mothers with prolonged viremia (40.0%) compared with those from infected mothers without prolonged viremia (5.3%, adjusted relative risk [aRR] 7.2 [95% CI 0.9-57.6]) or those from noninfected mothers (6.6%, aRR 6.7 [95% CI 3.0-15.1]). Congenital infections were confirmed more often in fetuses and neonates from mothers with prolonged viremia compared with the other 2 groups (60.0% vs. 26.3% vs. 0.0%, aRR 2.3 [95% CI 0.9-5.5]).

INTRODUCTION The western French Guiana hospital (Chog) is atypical. The creation of a public health department (PSP) is the result of a willingness of the institution to respond to public health issues on its territory. The main objective of this article is to identify the levers and impediments for the development of public health activities within this hospital, after five years of implementation. METHOD This article was based on the analysis of documents produced within the PSP, the institution and at the regional level (2013-2018), and on interviews conducted in 2017 with PSP professionals, and chiefs of other departments of the Chog (N = 16). RESULTS The added value of the PSP is based on the pooling of human resources and technical skills, the coexistence of clinical activities, prevention, research, teaching and international cooperation with Suriname, and the development of multidisciplinary and evaluative approaches. The lack of a set of public health objectives in the establishment project, the lack of place for these activities in its new hospital, and the difficult mobilization of financial resources, however, limit the prospects. CONCLUSION This analysis has shown difficulties in developing public health activities within this hospital, in an overseas territory with nonetheless multiple and complex needs. The authors invite politics and health authorities to value, and develop these activities, conditions necessary for the positioning of the hospital as an actor of the “turn in prevention”.

The aim of our study was to evaluate the efficacy and safety of oral mifepristone use for cervical ripening and the initiation of labor in women with normal pregnancies at or beyond term.We conducted a monocentric, prospective, comparative study on the induction of labor in women with an unfavorable cervix after 37 or more weeks of gestation in the Franck Joly Hospital, French Guiana. The immediate induction of labor by mifepristone was compared to expectant management and the induction of labor with routine cervical ripening agents during two consecutive periods. During the first period, patients received mifepristone (600 mg orally at the moment of enrollment) and were evaluated after 48 h. In the second period, patients did not receive any drugs and were evaluated after 48 h of expectant management.Spontaneous labor or a Bishop Score ≥6 within 48 h of mifepristone administration.enrollment-induction to delivery interval, rate of failed induction, doses of prostaglandin used, mode of delivery, requirement of oxytocin augmentation, and neonatal outcomes.This study enrolled 231 women, 108 in the first and 123 in the second period undergoing induced labor at term caused by various obstetric conditions. There were no significant differences between groups for age, body mass index, gravida, parity, the initial Bishop Score, scarred uterus, or post-term pregnancy. There were statistically significant differences between the two groups concerning spontaneous labor and/ or a Bishop Score ≥6 within 48 h (p10-3) and received doses of misoprostol (p = 0.01). Patients receiving mifepristone were 10 times more likely to be in labor after 48 h of inclusion (RR = 9.98, CI 95 % = [4.47-22.29]). The enrollment-induction to delivery interval was significantly shorter for the mifepristone group (p 0.001). There were no other differences in mode of delivery, placenta abnormalities or neonatal outcomes.Mifepristone efficiently induced cervical ripening and labor initiation in women with normal pregnancies at or beyond term. It may offer an alternative method to the classic induction especially for patients seeking spontaneous labor.

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease. ispartof: SCIENTIFIC REPORTS vol:11 issue:1 ispartof: location:England status: published

Background Early preterm births are still represented as a major public health problem in French Guiana. The objective of the present study was to study factors associated with early preterm birth in French Guiana. Methods A monocentric age-matched case control study was conducted at the sole level 3 maternity in French Guiana. In utero fetal deaths and multiple pregnancies were not included. Cases were defined as giving birth prematurely between 22 and 32 weeks of pregnancy. Controls were defined as women delivering on term. For each case three controls were matched on age. In utero deaths, medical pregnancy interruptions and multiple pregnancies (a known major cause of preterm delivery) were excluded from the study. Sociodemographic variables, medical and obstetrical history, the complications of the current pregnancy, and the results of the last vaginal swab before delivery were recorded in the second or the third trimester. Thematic conditional logistic regression models were computed. Results Overall 94 cases and 282 matched controls were included. Preterm delivery was spontaneous in 47.9% (45/94) of the cases and induced in 52.1% (49/94).A history of preterm birth was associated with both spontaneous and induced preterm delivery. The absence of health insurance was associated with spontaneous early preterm delivery AOR (adjusted odd ratio) = 9.1 (2.2–38.3), p = 0.002 but not induced preterm delivery adjusted odd ratio (AOR) = 2.1 (0.6–6.7), p = 0.2. Gravidic hypertension, placenta praevia, intrauterine growth retardation and mostly preeclampsia (66%, 32/49) were linked to induced preterm delivery but not spontaneous delivery. Gardnerellavaginalis and group B Streptococcus infections were significantly associated with induced early preterm delivery but not spontaneous early preterm delivery. Conclusions Social factors were associated with spontaneous early preterm delivery, suggesting that efforts to reduce psychosocial stressors could lead to potential improvements. Vaginal infections were also associated with induced preterm labor suggesting that early diagnosis and treatment could reduce induced early preterm delivery. Preeclampsia was a major contributor to induced early preterm delivery. Reliable routine predictors of preeclampsia are still not available which makes its prevention impossible in first pregnancies.

Introduction Postpartum hemorrhage remains the leading cause of maternal death in France. Parturients in western French Guiana have specific sociodemographic features and a high rate of pathological pregnancies. The objective of this study was to determine the incidence of immediate postpartum hemorrhage (IPPH) in western French Guiana, and to describe the etiologies and risk factors. Methods A case control study with incident cases was conducted in the Maternity Department of the Western French Guiana Hospital over a period of one year. The cases included women giving birth to a child of 22 weeks’ GA and/or a child weighing 500 g, and who presented with IPPH. Two control subjects were included per case (after pairing for mode of delivery). The data were collected by questionnaire and from medical records. Multivariate analyses by logistic regression were conducted. Results 154 cases and 308 controls were included. The incidence rate of IPPH was 6.7%. The primary etiologies were: atony, placenta retention, and cervico-vaginal lesions. The factors associated with IPPH were: past history of IPPH (ORadj = 3.36 [1.65–6.87]), pre-eclampsia (ORadj = 2.56 [1.07–6.14]), labor induction by oxytocin (ORadj = 2.03 [1.03–3.99]), the absence of managed placental delivery (ORadj = 2.46 [1.24–4.91]), a gap of more than 30 min between birth and placental delivery (ORadj = 10.92 [2.17–54.99]), and macrosomia (ORadj = 6.38 [1.97–20.67]). Conclusion The incidence rate of IPPH is similar to that found in metropolitan France and in the literature. The risk factors identified here will enable the development of appropriate preventive protocols.

OBJECTIVE: To describe the proportions of asymptomatic, mild and severe diseases in infected pregnant women admitted for delivery. To compare maternal, fetal and neonatal outcomes of SARS-CoV-2 infected pregnant women with those of non-infected patients. STUDY DESIGN: Through an universal PCR testing for SARS-COV-2 at admission (not symptoms-based), this prospective cohort study enrolled all pregnant women admitted for delivery between 16th of June and the 16th of August 2020 in the West French Guiana Hospital Center. RESULTS: 507 pregnant women were included during the study period, of which 137 (27 %) were infected with SARS-COV-2. On admission, only 34/137 (24.8 %) of these patients presented with clinical symptoms. Among asymptomatic women, 16 /103 (15 %) became symptomatic after diagnosis. Throughout the delivery hospitalization and follow-up, 87/137 (63.5 %) remained always asymptomatic, 45/137 (32.8 %) developed a mild COVID-19 and 5/137 (3.6 %) developed a severe infection. SARS-CoV-2 infected patients were more likely to have post-partum hemorrhage >500 mL (14.2 % vs 7.2 %, RR 2.0 [95 %CI 1.1-3.4]), to be transfused (5.5 % vs 1.1 %, RR 4.9 [1.5-16.6]), and to be hospitalized in ICU (3.6 % vs 0.8 %, RR 4.5 [95 %CI 1.1-18.6] than uninfected ones. Intra-uterine fetal demises were more common in infected mothers compared to controls (5.1 % vs 1.1 %, RR 4.7 [95 % CI 1.4-45.9). Among 108 neonates from infected mothers tested at birth, none tested positive (0/108). When tested between 25 and 42 h after delivery, 4/29 (13.7 %) were positive for SARS-CoV-2 RT-PCR on nasopharyngeal swabs and remained asymptomatic. CONCLUSION: Pregnant women admitted for delivery and diagnosed with a SARS-COV-2 infection through an universal screening were symptomatic in only a quarter of cases. Their risks of post-partum hemorrhage, transfusion and admission to ICU were higher than those of uninfected patients. They also presented a higher risk of intra-uterine fetal demise. There were no other differences in maternal, obstetrical or neonatal outcomes.

International audience

The ability of ultrasound to predict postpartum hemorrhage remains poorly described. The aim of this study was to evaluate whether ultrasound measurement of intrauterine content can predict blood loss and postpartum hemorrhage after vaginal delivery. We used a preliminary prospective monocentric study of 201 women who delivered vaginally after 34 wk of gestation. Measurements were performed 30–45 min after normal vaginal delivery according to strict ultrasonographic criteria. Analysis of the relationship between ultrasound measurements and hemoglobin loss showed a strong linear correlation (R² = 0.59 and R² = 0.4 for isthmic and fundal measurements). The maximal value between the fundal and isthmic measurements seems to provide the best accuracy to predict loss of hemoglobin higher than 3 g/dL (area under the curve [AUC] of the receiver operating characteristic curve, 0.9; 95% confidence interval [CI], [0.76–0.97]) and post-partum hemorrhage (AUC, 0.99; 95%CI, [0.984–0.99]). In case of intrauterine content >2 cm (135/201), the risks of loss of hemoglobin higher than 3 g/dL (5/135 vs. 0/66) and post-partum hemorrhage (11/135 vs. 0/66) were increased, all the more if the intrauterine content was >4 cm (4/16 and 11/16, respectively). Considering the maximal measurement, the most optimal cut-off value for clinical practice could be 2.4 cm (sensibility 100%, specificity 57%) and 4.1 cm (sensibility 100%, specificity 97%) for loss of hemoglobin higher than 3 g/dL and post-partum hemorrhage, respectively.

Background: Pregnant women represent a vulnerable population at higher risk of complications of infectious diseases. Data regarding the consequences of the emerging pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy are scarce. Recent evidence suggests that pregnant women might be at higher risk of severe disease, while exposed fetuses and newborns could suffer from preterm birth, growth restriction and neonatal infections. Methods: We developed an international web registry to allow structured data collection. Pregnant women at any stage during gestation tested for SARS-CoV-2 infection were enrolled. Maternal, obstetrical and neonatal outcomes were recorded. Findings: 1033 pregnant women tested for SARS-CoV-2 were included, among which 926 tested positive and 107 tested negative. Positive pregnant women were at higher risk of severe maternal outcomes compared to negative women [aRR 5.6, 95% CI 1.4-22.7]. Risk factors for severe maternal outcomes among positive women were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. No difference in term of obstetrical and neonatal outcomes were observed between positive and negative women. Positive pregnant women with severe maternal outcomes were at higher risk of cesarean sections [70.7% (n=53/75)], preterm deliveries [62.7% (n= 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n=31/75)]. A positive neonatal SARS-CoV-2 test was observed in 2.9% (n=11/384) of newborns with an available test at birth. Interpretation: Pregnant women, particularly those with associated comorbidities, seem to be at higher risk of severe complications of SARS-CoV-2 infection. Preliminary data regarding obstetrical and neonatal outcomes among women with a mild disease are reassuring. Funding Statement: None. Declaration of Interests: The authors declare that we have no conflicts of interest. Ethics Approval Statement: The study was approved by both the Swiss Ethical Board (CER-VD-2020-00548) and the local ethics boards at each participating center.

Background: Recent evidence suggests that pregnant women might be at higher risk of severe disease associated with the emerging pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), while exposed fetuses/newborns could suffer from preterm birth, growth restriction and neonatal infections. The magnitude of this increased risk and specific risk factors for severity remains unclear. Methods: We performed a case control study comparing pregnant women with severe coronavirus disease 19 (case) to pregnant women with a milder form (controls) enrolled in COVI-Preg international registry cohort between from March 24 to July 26, 2020. Risk factors for severity, obstetrical, fetal and neonatal outcomes were assessed. Findings: A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented a severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. Pregnant women with severe maternal outcomes were at higher risk of cesarean sections [70.7% (n=53/75)], preterm deliveries [62.7% (n= 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n=31/75)]. Interpretation: Pregnant women, particularly those with associated comorbidities, seem to be at higher risk of severe complications of SARS-CoV-2 infection. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease; complications include cesarean sections, prematurity and neonatal admission to the intensive care unit. Funding Statement: None. Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: The study was approved by both the Swiss Ethical Board (CER-VD- 2020-00548) and the local ethics boards at each participating center.

Objective: Given the high rate of premature birth in French Guiana (13.5%), and its stability in time, the aim of the present study was to define a predictive score for preterm birth in women with a unique pregnancy in order to help prioritize health resources in the local context. Methods: A retrospective study was conducted on all deliveries of unique pregnancies in French Guiana collected between 1 January 2013 and 31 December 2014 in the Registre d’Issue de Grossesse Informatisé (RIGI), a registry that collects data on live births over 22 weeks of amenorrhea on the territory. Statistically significant predictors (p Results: Seven explanatory variables, all measurable during the first trimester of pregnancy, were significantly associated with preterm birth. The predictive score divided in deciles allowed to establish sensitivity and specificity thresholds. Overall, depending on the chosen threshold the score sensitivity was low and the specificity was high. Lowering the threshold identified half of women as “at risk” for preterm birth. Conclusion: This first trimester score was insufficiently sensitive to identify individual women at risk for preterm delivery.

International audience; Objectives: French Guiana has the highest birth rate in South America. This French territory alsohas the highest premature birth rate and perinatal mortality rate of all French territories. Theobjective was to determine the premature birth rate and to identify the prevalence of risk factorsof premature birth in French Guiana.Methods: A retrospective study of all births in French Guiana was conducted between January2013 and December 2014 using the computerized registry compiling all live births over 22weeks of gestation on the territory.Results: During this period 12 983 live births were reported on the territory. 13.5% of newbornswere born before 37 (1755/12 983). The study of the registry revealed that common sociodemographicrisk factors of prematurity were present. In addition, past obstetrical history was alsoimportant: a scarred uterus increased the risk of prematurity adjusted odds ratio ¼1.4, 95%CI(1.2–1.6). Similarly, obstetrical surveillance, the absence of preparation for birth or of prenatalinterview increased the risk of prematurity by 2.4 and 2.3, the excess fraction in the populationwas 69% and 72.2%, respectively.Conclusions: Known classical risk factors are important. In the present study excess fractionswere calculated in order to prioritize interventions to reduce the prematurity rate.

International audience; BACKGROUND:In French Guiana, cervical cancer is the second most frequent cancer in females. The objective of the present study was to describe the prevalence of HPV infections in women with normal cervical cytology living in the remote villages of French Guiana.METHODS:Before the study, the study team communicated in the remote villages on the importance of screening. All women from the target population were offered to participate. They signed informed consent during inclusion and then had a concomitant HPV-test and cervical smear. Only women with normal cytology and a good quality smear were analyzed. The detection of HPV-DNA was performed using the GREINER-BIO-ONE kit.RESULTS:Overall, 27.2% of women with normal cervical cytology had a positive HPV-test. There was a U-shaped evolution of prevalence with women over 50 years having the highest HPV prevalence, followed by the 20 to 29 years group. The most prevalent HPV genotypes were HPV 53(3.52%), 68(3.33%), 52(2.59%), 31(2.22%) and 16 (1.85%). The proportion of HPV 16 among HPV-infected women was 6.8%.CONCLUSIONS:HPV prevalence in cytologically normal women was very high. The most prevalent genotypes were very different from what is usually described in the world, and notably in South America.

To describe placental findings on prenatal ultrasound and anatomopathological examination in women with Zika virus (ZIKV) infection, and to assess their association with congenital ZIKV infection and severe adverse outcome, defined as fetal loss or congenital Zika syndrome (CZS).This was a prospective study of pregnancies undergoing testing for maternal ZIKV infection at a center in French Guiana during the ZIKV epidemic. In ZIKV-positive women, congenital infection was defined as either a positive reverse transcription polymerase chain reaction result or identification of ZIKV-specific immunoglobulin-M in at least one placental, fetal or neonatal sample. Placental ZIKV-infection status was classified as non-exposed (placentae from non-infected women), exposed (placentae from ZIKV-infected women without congenital infection) or infected (placentae from ZIKV-infected women with proven congenital infection). Placentae were assessed by monthly prenatal ultrasound examinations, measuring placental thickness and umbilical artery Doppler parameters, and by anatomopathological examination after live birth or intrauterine death in women with ZIKV infection. The association of placental thickness during pregnancy and anatomopathological findings with the ZIKV status of the placenta was assessed. The association between placental findings and severe adverse outcome (CZS or fetal loss) in the infected group was also assessed.Among 291 fetuses/neonates/placentae from women with proven ZIKV infection, congenital infection was confirmed in 76 cases, of which 16 resulted in CZS and 11 resulted in fetal loss. The 215 remaining placentae from ZIKV-positive women without evidence of congenital ZIKV infection represented the exposed group. A total of 334 placentae from ZIKV-negative pregnant women represented the non-exposed control group. Placentomegaly (placental thickness 40 mm) was observed more frequently in infected placentae (39.5%) than in exposed placentae (17.2%) or controls (7.2%), even when adjusting for gestational age at diagnosis and comorbidities (adjusted hazard ratio (aHR), 2.02 (95% CI, 1.22-3.36) and aHR, 3.23 (95% CI, 1.86-5.61), respectively), and appeared earlier in infected placentae. In the infected group, placentomegaly was observed more frequently in cases of CZS (62.5%) or fetal loss (45.5%) than in those with asymptomatic congenital infection (30.6%) (aHR, 5.43 (95% CI, 2.17-13.56) and aHR, 4.95 (95% CI, 1.65-14.83), respectively). Abnormal umbilical artery Doppler was observed more frequently in cases of congenital infection resulting in fetal loss than in those with asymptomatic congenital infection (30.0% vs 6.1%; adjusted relative risk (aRR), 4.83 (95% CI, 1.09-20.64)). Infected placentae also exhibited a higher risk for any pathological anomaly than did exposed placentae (62.8% vs 21.6%; aRR, 2.60 (95% CI, 1.40-4.83)).Early placentomegaly may represent the first sign of congenital infection in ZIKV-infected women, and should prompt enhanced follow-up of these pregnancies. Copyright © 2019 ISUOG. Published by John WileySons Ltd.

An association between HIV infection and cervical cancer, a major public health issue worldwide, has been reported. The aim of this study was to estimate the prevalence of human papillomavirus (HPV) infection and the distribution of HPV genotypes in HIV-infected women living in French Antilles and Guiana and to determine HIV-related characteristics associated with HPV infection. This cross-sectional study included 439 HIV-infected women who were followed between January 2011 and May 2014. Variables related to HIV infections were collected, and cervical samples were analysed to determine HPV genotypes. The median age of the population was 46 years. Estimated prevalence of HPV and high-risk (HR)-HPV infection were 50.1% IC95 [45.4-54.7] and 42% IC95 [37.3-46.6], respectively. HR-HPV 16, 52, 53 or intermediate risk-HPV-68 were found in 25% to 30% of the HPV-infected patients. Gynaecological screening revealed abnormal cervical smear in 24% and 42% of HR-HPV-negative and HPV-positive women, respectively (p = 0.003). Approximately 90% of women were on antiretroviral therapy (ART). Demographic characteristics associated with a higher prevalence of HPV infection included alcohol consumption. Regarding HIV-related characteristics, current therapy on ART, its duration, and undetectable plasma concentrations of RNA-HIV1 were associated with a lower risk of HPV infection. Infection rate with HR-HPV was higher than what is commonly reported in HIV-negative women worldwide and was more likely in women with incomplete HIV suppression. These results highlight the need for supporting adherence to ART, cervical cytology, HPV testing and HPV vaccination.

A Zika virus epidemic is currently ongoing in the Americas. This virus is linked to congenital infections with potential severe neurodevelopmental dysfunction. However, incidence of fetal infection and whether this virus is responsible of other fetal complications are still unknown. National and international public health authorities recommend caution and several prevention measures. Declaration of Zika virus infection is now mandatory in France. Given the available knowledge on Zika virus, we suggest here a review of the current recommendations for management of pregnancy in case of suspicious or infection by Zika virus in a pregnant woman.

Started in 2015 in Brazil, an outbreak linked to a little known arbovirus, Zika virus spread throughout Latin America. This virus, considered until recently as responsible of only mild symptoms, made mention of previously unsuspected complications, with severe neurological manifestations in adults and malformations of the central nervous system, including microcephaly, in newborns of mother infected during the pregnancy. While the continent is more accustomed to the succession of arbovirus epidemics, suspected complications and the many unknowns keys of the latter arriving raise many public health issues. French Guiana, a French territory located in the north-east of the continent, combines both European level of resources and climate and issues specific to the Amazon region and Latin America. We discuss here the issues for 2016 Zika virus epidemic in our region, many of them are generalizable to neighboring countries.

International audience; BACKGROUND: In French Guiana, pregnant women may be exposed to infectious, environmental, and social risks leading to congenital malformation. The objective of the study was to study mortality rates from congenital malformations among infants

ObjectivesTo estimate the rates of maternal-fetal transmission of Zika virus, adverse fetal/neonatal outcomes, and subsequent rates of asymptomatic/symptomatic congenital Zika virus infections up to the first week of life.DesignCohort study with prospective data collection and subsequent review of fetal/neonatal outcomes.SettingsReferral centre for prenatal diagnosis of the French Guiana Western Hospital.ParticipantsPregnant women at any stage of pregnancy with a laboratory confirmed symptomatic or asymptomatic Zika virus infection during the epidemic period in western French Guiana. The cohort enrolled 300 participants and prospectively followed their 305 fetuses/newborns.Main outcome measuresRate of maternal-fetal transmission of Zika virus (amniotic fluid, fetal and neonatal blood, urine, cerebrospinal fluid, and placentas); clinical, biological, and radiological outcomes (blindly reviewed); and adverse outcomes defined as moderate signs potentially related to congenital Zika syndrome (CZS), severe complications compatible with CZS, or fetal loss. Associations between a laboratory confirmed congenital Zika virus infection and adverse fetal/neonatal outcomes were evaluated.ResultsMaternal-fetal transmission was documented in 26% (76/291) of fetuses/newborns with complete data. Among the Zika virus positive fetuses/newborns, 45% (34/76) presented with no signs/complications at birth, 20% (15/76) with moderate signs potentially related to CZS, 21% (16/76) with severe complications compatible with CZS, and 14% (11/76) with fetal loss. Compared with the Zika virus positive fetuses/neonates, those that were identified as negative for Zika virus (215/291) were less likely to present with severe complications (5%; 10/215) or fetal loss (0.5%; 1/215; relative risk 6.9, 95% confidence interval 3.6 to 13.3). Association between a positive Zika virus test and any adverse fetal/neonatal outcome was also significant (relative risk 4.4, 2.9 to 6.6). The population attributable fraction estimates that a confirmed congenital Zika virus infection contributes to 47% of adverse outcomes and 61% of severe adverse outcomes observed.ConclusionIn cases of a known maternal Zika virus infection, approximately a quarter of fetuses will become congenitally infected, of which a third will have severe complications at birth or fetal loss. The burden of CZS might be lower than initially described in South America and may not differ from other congenital infections.

International audience; BACKGROUND:The risk of congenital neurologic defects related to Zika virus (ZIKV) infection has ranged from 6 to 42% in various reports. The aim of this study was to estimate this risk among pregnant women with symptomatic ZIKV infection in French territories in the Americas.METHODS:From March 2016 through November 2016, we enrolled in this prospective cohort study pregnant women with symptomatic ZIKV infection that was confirmed by polymerase-chain-reaction (PCR) assay. The analysis included all data collected up to April 27, 2017, the date of the last delivery in the cohort.RESULTS:Among the 555 fetuses and infants in the 546 pregnancies included in the analysis, 28 (5.0%) were not carried to term or were stillborn, and 527 were born alive. Neurologic and ocular defects possibly associated with ZIKV infection were seen in 39 fetuses and infants (7.0%; 95% confidence interval, 5.0 to 9.5); of these, 10 were not carried to term because of termination of pregnancy for medical reasons, 1 was stillborn, and 28 were live-born. Microcephaly (defined as head circumference more than 2 SD below the mean for sex and gestational age) was detected in 32 fetuses and infants (5.8%), of whom 9 (1.6%) had severe microcephaly (more than 3 SD below the mean). Neurologic and ocular defects were more common when ZIKV infection occurred during the first trimester (24 of 189 fetuses and infants [12.7%]) than when it occurred during the second trimester (9 of 252 [3.6%]) or third trimester (6 of 114 [5.3%]) (P=0.001).CONCLUSIONS:Among pregnant women with symptomatic, PCR-confirmed ZIKV infection, birth defects possibly associated with ZIKV infection were present in 7% of fetuses and infants. Defects occurred more frequently in fetuses and infants whose mothers had been infected early in pregnancy. Longer-term follow-up of infants is required to assess any manifestations not detected at birth. (Funded by the French Ministry of Health and others; ClinicalTrials.gov number, NCT02916732 .).

International audience; BACKGROUND: Cervical cancer prevention using cervical cytology is insufficiently sensitive, a significant proportion of HPV-infected women having normal cytology. The objective of the present study was to try to identify factors associated with abnormal cytology in HPV-infected women living in remote areas of French Guiana.METHODS: A study was conducted in women aged 20-65 years having HPV infections confirmed by HPV DNA detection using the GREINER-BIO-ONE kit. In addition to HPV testing, cytology was performed and classified as normal or abnormal. Demographic and life history variables, and infecting genotypes were compared between the normal and abnormal cytology groups.RESULTS: None of the demographic and life history variables were associated with cytology results. HPV genotype 53 was significantly associated with absence of cytological abnormalities whereas HPV 52, 58, 16 and perhaps 33 and 66 were independently associated with a greater risk of cytological abnormalities. When grouping HPV genotypes in different species, only species 9 (HPV 16, 31, 33, 35, 52, 58, 67) was significantly associated with abnormal cytology AOR = 5.1 (95% CI = 2.3-11.2), P

International audience; Dengue fever is an increasing problem worldwide, but consequences during pregnancy remain unclear. Much of the available literature suffers from methodological biases that compromise the validity of clinical recommendations. We conducted a matched cohort study during an epidemic in French Guiana to compare events and pregnancy outcomes between two paired groups of pregnant women: women having presented with symptomatic dengue during pregnancy (n = 73) and women having had neither fever nor dengue during pregnancy (n = 219). Women in each arm were matched by place of follow up, gestation weeks at inclusion, and place of residence. Dengue infection was considered to be confirmed if viral RNA, N S1 antigen, the seroconversion of IgM antibodies or the presence of IgM was detected in collected samples. According to the 2009 WHO classification, 27% of the women with symptomatic dengue had at least one clinical or biological warning sign. These complications occurred after the 28th week of gestation in 55% of cases. The medical history, socioeconomic status and demographic characteristics were included in multivariate analysis. Exposure to dengue during pregnancy was not significantly associated with pre-maturity, small for gestational age infants, hypertension or emergency caesarian section. Maternal dengue with warning signs was a risk factor for peripartum hemorrhage with adjusted relative risk = 8.6(95% CI = 1.2-62). There was a near significant association between dengue and in utero death (p = 0.09). This prospective comparative study underlined the importance of taking into account potential confounders between exposure to den-gue and the occurrence of obstetrical events. It also confirms the need for increased vigilance for pregnant women with dengue, particularly for women who present with severe dengue. PLOS ONE | https://doi.org/10.1371/journal.pone.

International audience; The incidence of dengue worldwide is increasing rapidly. A better understanding of dengue transmission may help improve interventions against this major public health problem. The virus is mostly transmitted by vectors. There are, however, other modes of transmission, notably mother-to-child transmission or vertical transmission. We studied a prospective cohort of 54 women who had dengue while pregnant during the 2012–2013 epidemic in French Guiana to estimate the mother-to-child transmission rate and assess the clinical and biological presentation of neonatal dengue. The rate of vertical transmission was between 18.5% (95% confidence interval [CI]: 9.25–31.4) and 22.7% (95% CI: 11.5–37.8), depending on the calculation method used. Mother-to-child transmission occurred both in early and late pregnancy. There were 52 births, including three newborns who presented neonatal dengue with warning signs requiring platelet transfusion. This quantification of the mother-to-child transmission of dengue highlights three points: first, vertical transmission of dengue is not negligible; second, it is more frequent when maternal dengue occurs late during pregnancy near delivery; and third, reliable diagnostic tests must be used to allow the diagnosis of vertical transmission. Our findings indicate that if there is a known history of maternal dengue during pregnancy, or if there is fever during the 15 days before term, cord blood and placenta should be sampled after delivery and tested for the virus, and the newborn should be closely monitored during the postpartum period.

International audience; Objectives:The aim of this study was to describe the epidemiology of infantile Pompe disease (IPD) in French Guiana, a French overseas territory, by combining a retrospective case records study and a prospective anonymous genotyping in a sample of mothers followed in the two major maternity units of French Guiana.Methods:We identified 19 newborns with IPD born within a 13-year-period in French Guiana, corresponding to 1/4528 births. All children were born within the African-American Maroon (Bushinengue) community originating from slaves who settled along the Maroni river in the 19th century. We also performed an anonymised screening for all women in postpartum, in the two main maternity units of French Guiana.Results:Genetic investigations revealed that all patients with IPD were homozygotes or compound heterozygotes for two known pathogenic variations: c.2560C>T p.(Arg854*) that has already been reported in African-Americans and c.1942G>A p.(Gly648Ser), a rare previously considered to be variant. We identified no heterozygotes among 453 mothers of various ethnicities in Cayenne, but 15 heterozygotes among 425 mothers (1/27) in Saint-Laurent-du-Maroni (95% CI 1/45 to 1/17), all from the Maroon community, which corresponds to an expected IPD incidence in Maroons of 1/1727 (95% CI 1/1156 to 1/8100).Conclusion:The incidence of IPD in the Maroon community is roughly 50 times higher than elsewhere in the world. The presence of only two different variants in all affected patients is compatible with a double founder effect in a relatively small population that has seldom mixed with other regional populations in the past and therefore has a reduced pool of genotypes.

The objective of this review was to assess benefits and harms of different management options for induction of labor and obtaining of uterine vacuity in case of fetal death beyond of 14 weeks of gestation. In second-trimester, the data are numerous but low methodological quality. In terms of efficiency (induction-expulsion time and uterine evacuation within 24 hours rate) and tolerance in the absence of antecedent of caesarean section, the best protocol for induction of labor in the second-trimester of pregnancy appears to be mifepristone 200mg orally followed 24-48 hours later by vaginal administration of misoprostol 200 to 400 μg every 4 to 6 hours. In third-trimester, there is very little data. The circumstances are similar to induction of labor with living fetus. A term or near term, oxytocin and dinoprostone have a marketing authorization in this indication but misoprostol may be an alternative as the Bishop score and dose of induction of labor with living fetus. In case of previous caesarean section, the risk of uterine rupture is increased in case of a medical induction of labor with prostaglandins. The lowest effective doses should be used (100 to 200 μg every 4 to 6 hours). Prior cervical preparation by the administration of mifepristone and possibly the use of laminar seems essential in this situation.

Postpartum hemorrhage is a major cause of maternal death worldwide. Many therapeutic strategies have been developed to reduce maternal morbidity and mortality like oxytocin, prostaglandin, and uterine balloons. A new member of the therapeutic arsenal has recently emerged, the chitosan (Celox®), used since several years by military doctors to stop bleeding of combat wounds. In 2012, a first study was reported with the successful use of chitosan-coated gauze to treat severe postpartum hemorrhage. We report here three cases of the use of chitosan to treat life-threatening obstetric bleeding. In the first case, a pelvic packing with chitosan gauze after hemostatic hysterectomy with persistent bleeding. In the second case, the use of chitosan powder in a case of severe bleeding from multiple vaginal tears. In the third case, the use of chitosan gauze in uterine packing for postpartum hemorrhage by atonia. Postpartum hemorrhage of uterine origin resistant to treatment with prostaglandins can be treated with chitosancoated gauze. This treatment requires no training and its costs are one fifth those of a Bakri® intrauterine balloon. Using these two forms of chitosan, powder and gauze, we have developed a new therapeutic method at our disposal for dealing with the most serious cases of bleeding.

International audience; Zika virus (ZIKV) infection has been associated with complications during pregnancy. Although the presence of symptoms might be a risk factor for complication, the proportion of ZIKV-infected pregnant women with symptoms remains unknown. Following the emergence of ZIKV in French Guiana, all pregnancies in the territory were monitored by RT-PCR and/or detection of ZIKV antibodies. Follow-up data collected during pregnancy monitoring interviews were analysed from 1 February to 1 June 2016. We enrolled 3,050 pregnant women aged 14-48 years and 573 (19%) had laboratory-confirmed ZIKV infection. Rash, arthralgia, myalgia and conjunctival hyperaemia were more frequently observed in ZIKV-positive women; 23% of them (95% confidence interval (CI): 20-27) had at least one symptom compatible with ZIKV infection. Women 30 years and older were significantly more likely to have symptoms than younger women (28% vs 20%). The proportion of symptomatic infections varied from 17% in the remote interior to 35% in the urbanised population near the coast (adjusted risk ratio: 1.6; 95% CI: 1.4-1.9.). These estimates put findings on cohorts of symptomatic ZIKV-positive pregnant women into the wider context of an epidemic with mainly asymptomatic infections. The proportion of symptomatic ZIKV infections appears to vary substantially between populations.

International audience; Leptospirosis is a cosmopolitan zoonosis caused by bacteria of the genus Leptospira. Whether the distribution is worldwide, the hot and humid climate of the tropics is particularly conducive to its expansion. In most French overseas departments and territories, leptospirosis is considered as a public health problem. In French Guiana, a French department located in the northeastern part of the Amazon rainforest, it is supposed to be rare. The objective of this review was to make an inventory of the knowledge on human and animal leptospirosis in French Guiana and neighboring countries. A comprehensive search was conducted through the indexed and informal medical literature in English, French, Spanish and Portuguese. Thus, respectively ten and four publications were identified on human and animal leptospirosis in French Guiana, published between 1940 and 1995 in the form of case reports or case series. The publications concerning this disease in the other countries of the Guiana Shield, eastern Venezuela, Guyana, Suriname, and Brazilian state of Amapá, also scarce or nonexistent. However recent data from the French National Centre of leptospirosis showed a recent and sudden increase in the number of cases in the department, probably partly due to the development of diagnostic tools such as Elisa IgM serology. It is likely that leptospirosis is a neglected disease in the region, due to the lack of diagnostic tools readily available, the lack of knowledge of the local clinicians on this disease and the existence of many other pathogens with similar clinical presentation such as malaria, arboviruses and Q fever and Amazonian toxoplasmosis. The establishment of more large-scale studies on animal and human leptospirosis is necessary and urgent to know the true burden of this disease in our region.

International audience; Concerns regarding lead (Pb) poisoning in French Guiana first arose in 2011 following the discovery of excessively high levels of the metal amongst children in a small neighborhood without any apparent source of Pb. Since 2012, blood lead level (BLL) measurement has been proposed for all pregnant women in western French Guiana. The aim of this study was to determine BLL in pregnant women in this region and identify factors associated with elevated BLL. An observational study of a consecutive sample of women who delivered in the maternity ward of the hospital was conducted. Risk factors were investigated using a questionnaire administered postdelivery by midwives (N = 531). Approximately 25 and 5% of women displayed BLL of ≥50 μg/L and ≥100 µg/L, respectively. The geometric mean was 32.6 μg/L. Factors that were significantly associated with an elevated BLL after modeling (multivariate linear regression) included place of residence along the Maroni river, low level of education, daily consumption of manioc derivatives, weekly and daily consumption or personal preparation of manioc flour during pregnancy, and weekly consumption of wild game. This study provides insight into the regional and social disparities in BLL in French Guiana and potential sources of exposure. Evidence indicates that foods that are primarily produced and consumed in the Guiana Shield significantly affect BLL levels. Taken together with existing data, our results demonstrate that specific actions in terms of prevention, screening, and care are required to be adapted and put into place in order to reduce exposure.

SUMMARYCervical cancer is the second most frequent cancer in women in French Guiana. Studies have shown that populations living in the remote areas of the interior have early sexual debut and that multiple sexual partnerships are common. The objective of the present study was thus to determine the prevalence of human papillomavirus (HPV) infection in these areas. A study was conducted in women aged 20–65 years with previous sexual activity. Women were included on a voluntary basis after using local media and leaders to inform them of the visit of the team. HPV infection was defined by the detection of HPV DNA using the Greiner Bio-One kit. In addition to HPV testing cytology was performed. The overall age-standardized prevalence rate was 35%. There was a U-shaped evolution of HPV prevalence by age with women aged >50 years at highest risk for HPV, followed by the 20–29 years group. Twenty-seven percent of women with a positive HPV test had normal cytology. Given the high incidence of cervical cancer in French Guiana and the high prevalence of HPV infections the present results re-emphasize the need for screening for cervical cancer in these remote areas. Vaccination against HPV, preferably with a nonavalent vaccine, also seems an important prevention measure. However, in this region where a large portion of the population has no health insurance, this still represents a challenge.

The objective of this review was to assess early and late benefits and harms of different management options for first-trimester miscarriage. Surgical uterine evacuation remains the most effective and the quickest method of treatment. Depending on the clinical situation, medical treatment using misoprostol (missed miscarriage) or expectative attitude (incomplete miscarriage) does not increase the risk of complications, neither haemorrhagic nor infectious. However, these alternatives generally require longer outpatient follow-up, which leads to more prolonged bleeding and not planned surgical procedures.

Purpose To design and test a new telesonography technique using remote volume acquisition by untrained operators in locations without access to trained sonographers, postprocessing, and interpretation done at expert centers. Materials and Methods The technique was tested with 84 sonograms of organs acquired in pregnant women (n = 8) and patients with various abdominal pathologic conditions (n = 11) located in French Guyana (France), Ceuta (Spain), and Murighiol (Romania). An operator inexperienced in sonography (US) placed the transducer over the predetermined acoustic window for each organ, then swept it from a −45° to a +45° position to scan the targeted organ. The acquired volume dataset was sent to an expert center via the Internet and reconstructed using a proprietary software, which allowed a trained sonographer to navigate through the appropriately reconstructed sonograms. Results After three-dimensional processing at the expert center, the organs scanned in the obstetrical cases were adequately visualized by the expert in seven of eight (88%) examinations of the fetal head, femur, and umbilical cord and eight of eight (100%) examinations of the fetal abdomen and placenta, whereas in the general abdominal cases, the liver, gallbladder, portal vein, and right kidney were correctly visualized in 10 of 11 (91%) examinations. Conclusions Telesonography allowed untrained operators to scan and transfer the US volume datasets over the Internet to an expert center where an expert sonographer could navigate through the reconstructed US volume and visualize sonograms of diagnostic quality. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42:67–73, 2014

Objective To establish the incidence of fetal central nervous system (CNS) anomalies (including microcephaly), signs of congenital infection and fetal loss in pregnant women infected with Zika virus (ZIKV) and non-infected pregnant women in western French Guiana. Methods This prospective cohort study was conducted between 1 January and 15 July 2016. We evaluated and compared clinical and fetal ultrasound examinations of 301 pregnant women with biological confirmation of ZIKV infection and 399 pregnant women who were negative for ZIKV infection. Results Overall, the total number of fetuses with CNS involvement was higher in the infected than in the control group (9.0% vs 4.3%; relative risk, 2.11 (95% CI, 1.18–4.13)). Anomalies of the corpus callosum and presence of cerebral hyperechogenicities were significantly more common in the infected group. There was an increased risk of microcephaly in the infected compared with the control group (1.7% vs 0.3%; relative risk, 6.63 (95% CI, 0.78–57.83)), although this was not statistically significant. When the mother was infected during the first or second trimester, there was a greater risk of severe CNS involvement, more signs of infection and intrauterine fetal death than with infection in the third trimester. The rate of vertical transmission in the exposed group was 10.9%. Conclusion ZIKV infection during pregnancy is associated with a significant risk of fetal CNS involvement and intrauterine fetal death, particularly when infection occurs during the first or second trimesters. Microcephaly was not present in every case of congenital ZIKV syndrome that we observed. Until more is known about this disease, it is paramount to evaluate suspected cases by detailed neurosonography on a monthly basis, paying particular attention to the corpus callosum and the presence of hyperechogenic foci. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Postpartum hemorrhage is a major cause of maternal death worldwide. Many therapeutic strategies have been developed to reduce maternal morbidity and mortality like oxytocin, prostaglandin, and uterine balloons. A new member of the therapeutic arsenal has recently emerged, the chitosan (Celox®), used since several years by military doctors to stop bleeding of combat wounds. In 2012, a first study was reported with the successful use of chitosan-coated gauze to treat severe postpartum hemorrhage. We report here four cases of the use of chitosan to treat life-threatening obstetric bleeding. In the first case, a pelvic packing with chitosan gauze after hemostatic hysterectomy with persistent bleeding. In the second case, the use of chitosan powder in a case of severe bleeding from multiple vaginal tears. In the third case, the use of chitosan gauze in uterine packing for postpartum hemorrhage by atonia. In the fourth case, the use of chitosan powder for stop bleeding during a hemorrhagic cesarean section. Postpartum hemorrhage of uterine origin resistant to treatment with prostaglandins can be treated with chitosan-coated gauze. This treatment requires no training and its costs are one fifth those of a Bakri® intrauterine balloon. Using these two forms of chitosan, powder and gauze, we have a new therapeutic method at our disposal for dealing with the most serious cases of bleeding.

Sickle cell disease is a serious genetic disorder affecting 1/235 births in French Guiana. This study aimed to describe the follow-up of pregnancies among sickle cell disease patients in Cayenne Hospital, in order to highlight the most reported complications. 62 records of pregnancies were analyzed among 44 females with sickle cell disease, between 2007 and 2013. Our results were compared to those of studies conducted in Brazil and Guadeloupe. There were 61 monofetal pregnancies and 2 twin pregnancies, 27 pregnancies among women with SS phenotype, 30 SC pregnancies, and five S-beta pregnancies. The study showed that the follow-up of patients was variable, but no maternal death was found. We also noted that the main maternofetal complications of pregnancies were anemia (36.5%), infection (31.7%), vasoocclusive crisis (20.6%), preeclampsia (17.5%), premature birth (11.1%), intrauterine growth retardation (15.9%), abnormal fetal heart rate (14.3%), and intrauterine fetal death (4.8%). Pregnancies were more at risk among women with SS phenotype. Pregnancy in sickle cell disease patients requires a supported multidisciplinary team including the primary care physician, the obstetrician, and the Integrated Center for Sickle Cell Disease.