Search

Hyperhomocysteinemia has been associated with several pregnancy complications. We have investigated the variation of plasma total homocysteine (tHcys) during the 2 last trimesters of normal pregnancy and related it to blood vitamin B12 and folate and to the excretion of the degraded intrinsic factor receptor (IFCR) in urine, in a follow-up study of 15 cases. A significant rise in tHcys was observed between the beginning of the second trimester and the third trimester with respective values (median) 6.1, 5.8 and 6.7 micromol/l (p = 0.038). The tHcys/albumin ratio also increased significantly, while no correlation was found between albumin and folate blood concentration. In contrast, a significant decrease in vitamin B12 was observed (279, 225 and 199 pmol/l, between the 4th and 6th, and the 6th and 9th month, respectively (p = 0.017-0.002)). A significant negative correlation was found between tHcys between the 4th and 9th month of pregnancy and the ratio of vitamin B12 between the 4th and 9th month of pregnancy (r = 0.55, p = 0.037). The urine excretion of IFCR was increased and was not related to vitamin B12 and tHcys. In conclusion, we have observed a rise in tHcys between the beginning of the second trimester and the third trimester of pregnancy which was related to the decreased blood level of vitamin B12. Subclinical deficiency of vitamin B12 should be further investigated in pregnant women who remain on inadequate diet.

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

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

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

The objective of this study was to analyse the relation between severity of maternal condition at the time of intensive care unit (ICU) admission and various individual and institutional factors. This study analysed data from a retrospective population-based study in three French regions during 1991. The population study included 355 patients who were admitted to an ICU during pregnancy, delivery or within 42 days after delivery, for an obstetrical cause. The main outcome measure was the severity of maternal condition at ICU admission estimated from the level of consciousness and from the Simplified Acute Physiology Score (SAPS). The most severe maternal condition was associated with a change in hospital category (from the initially chosen hospital to the hospital referring for ICU) (OR 3.8, 95% CI 1.5-9.6) and with treatment in a private hospital at ICU referral (OR 3.3, 95% CI 1.3-8.3). Foreign nationality was the only individual factor related to very severe maternal condition. These results suggest that health care organisation during pregnancy affects the prognosis of severe maternal condition. The factors involved appear to include the management of unpredictable disorders, the conditions of maternal transfers before ICU admission, and antenatal care of foreigners.

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

Betaxolol levels in blood were monitored in the perinatal period in 28 pregnant hypertensive women and in their babies. In the mothers betaxolol concentrations at delivery ranged from less than 1 to 115 ng.ml-1 after doses of 10 to 40 mg.day-1. The apparent blood half-life was 15.6 to 22.1 h mean (19 h). Umbilical cord levels indicated a rapid equilibrium between fetal and maternal units (ratio 0.93) within few hours after dosing. Milk betaxolol concentrations, measured in few cases, exceeded those in blood by a factor of 3. Amniotic fluid concentrations were similar to those observed in maternal venous blood and umbilical cord blood. In neonates, the blood betaxolol half-life ranged from 14.8 to 38.5 h, with a definite trend towards a negative correlation with gestational age. A 11-61% rise in the betaxolol concentration was observed in 64% of the neonates during the first 12 h of extrauterine life. The data indicate that betaxolol kinetics is not altered in pregnant women and they stress the need for careful and prolonged (72-96 h) intensive monitoring of neonates born to hypertensive mothers treated with beta-blocking agents.

Twenty two pregnant women with mild to moderate hypertension were treated with betaxolol (10-40 mg/day), a cardioselective beta adrenoceptor blocking agent. The analysis of the changes from the baseline confirmed the antihypertensive effect of the drug with a mean decrease in SBP of 11.8 mm Hg and in DBP of 8.3 mm Hg. A diastolic BP less than 90 mm Hg was obtained in 20 patients after the first day of therapy. Fetal safety, assessed by ultrasonography and cardiotocographic recording was excellent. The 22 mothers gave birth to 23 live born babies (one twin pregnancy). Mean Apgar scores were 8.3 and 9.1 at 1 and 5 min. Only 1 newborn had an Apgar score less than 7. Three newborns suffered from fetal distress and 1 from threat for causes not related to therapy. At 9 months follow-up, all 23 babies were in good health. These data suggest that betaxolol is effective in reducing maternal blood pressure without any deleterious effect on the foetus and the newborn.

Erythrocytapheresis was performed 6 times in 4 patients with sickle cell anemia and thalassemia. Good results were obtained, particularly in pregnant patients, no crisis being observed during pregnancy. In the other patients the painful crisis was suppressed over 4 months. The technic is very easy. The Haemonetics H 30 was used, 70% of red cell volume being removed and replaced with leukocyte-poor blood.

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

The efficacy and the safety of betaxolol (BTX), a cardio-selective adrenoceptor blocking agent with a long half life, was tested in 22 hypertensive pregnant women. BTX doses varied from 10 to 40 mg/day. BTX given as monotherapy (n = 19) or associated to dihydralazine (n = 3) led to a satisfactory control of arterial blood pressure (ABP). In the mother, the drug was very well tolerated. (table; see text) The fetal safety, evaluated by mean of cardiotocography and echography was also satisfactory. Fetal heart rythm was significantly slowed following first intake of BTX and remained stable until delivery; there was only one case of intra-uterine growth retardation pre-existing to the pharmacological treatment. Nine deliveries were ceasarian [fetal distress (n = 1); poor control ABPI (n = 1); obstetrical reasons (n = 7)]. Seventeen neonates were full-term and six were premature (twins included). The state of neonates at birth was very satisfactory (Apgar at 5 minutes greater than 9 in 21/23). Glycemia less than 1.66 mmoles/1 in two neonates, was normal within 24 to 48 hours. In conclusion, BTX was very efficacious in controlling increased blood pressure in pregnant women and its safety in the mother, the fetus and the newborn was very good.

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