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Resumen El diagnostico prenatal de la patologia abdominal fetal se basa en la exploracion ecografica. El principal signo clinico de alarma es el exceso de liquido amniotico o hidramnios. En los casos de patologia abdominal fetal, la evolucion prenatal y los riesgos fetales son todavia poco conocidos, y el traslado materno a un hospital adecuado para el tratamiento posnatal es una practica generalizada. Algunas patologias se asocian con frecuencia a anomalias cromosomicas, lo que hace que su pronostico sea reservado. Ademas, hay que tener cuidado con las formas sindromicas y geneticas, que pueden cambiar el pronostico y la estrategia terapeutica de forma radical. En estas condiciones, la evaluacion prenatal es esencial en este tipo de patologia; incluye la ecografia, muy a menudo obtencion de muestras para pruebas de laboratorio (liquido amniotico, etc.) y mas raramente una resonancia magnetica. Cada caso debe ser objeto de una sintesis multidisciplinaria en un centro de diagnostico prenatal que reuna a todos los especialistas implicados (obstetras, ecografistas, cirujanos pediatricos, genetistas, etc.). El diagnostico prenatal de algunas patologias, en particular la laparosquisis, ha transformado su pronostico de forma radical al permitir un tratamiento adecuado. En el futuro, sera necesario mejorar la precision y la fiabilidad del diagnostico prenatal de las patologias abdominales para esperar ofrecer la posibilidad de un tratamiento in utero.

OBJECTIVE To identify risk factors for early- and late-onset postpartum depression (PPD) among a wide range of variables, including sociodemographic characteristics, childhood trauma, stressful life events during pregnancy and history of personal and family psychiatric disorders, and to assess the contribution of each risk factor. DESIGN Nested case-control study in a prospective longitudinal cohort study. SETTING Eight maternity departments in the Paris metropolitan area, France. SAMPLE A cohort of 3310 women with deliveries between November 2011 and June 2016. METHODS Cases were women with early- or late-onset PPD. Controls were women without depression during pregnancy or the postpartum period. Logistic regression adjusted on sociodemographic variables was performed for each outcome and a multivariable model was proposed based on a stepwise selection procedure. MAIN OUTCOME MEASURES Early- and late-onset PPD assessed at 2 months and 1 year postpartum, respectively. RESULTS Stressful life events during pregnancy have a dose-response relationship with both early- and late-onset PPD. CONCLUSIONS Early- and late-onset PPD presented distinct patterns of determinants. These results have important consequences in terms of prevention and specific care. TWEETABLE ABSTRACT Early- and late-onset postpartum depression are associated with stressful life events and psychiatric history.

SARS-CoV-2 is more likely to cause severe cases in pregnant women. They were part of the priority groups since April 2021 to benefit from SARS-CoV-2 vaccination before its extent to general population. This contribution aims to evaluate, in the postpartum period, the achievement of COVID-19 vaccination and factors associated in women during their pregnancy.Multicenter cross-sectional survey study conducted from September to December 2021 with online self-questionnaire. All postpartum patients hospitalized in one of the 6 participating maternity hospitals were invited to answer. The questionnaire asked patients about their demographic characteristics, vaccination modalities, vaccine tolerance, and their general perception of vaccination.Of the 371 women who responded, the vaccination rate was 65.7% (IC95% [60.8-70.4]), whom 98.8% entirely during pregnancy. Associated factors with vaccination during pregnancy were older age, higher socio-professional category, and prior information provided by health professionals. Factors that appear to motivate vaccination were personal protection and protection of the newborn. Finally, main factors negatively influencing the vaccination process were the fear of vaccine side effects and the negative perception of vaccines in general.Acceptability and information about the vaccine by health professionals is in constant improvement. Information campaigns should be continued to improve the acceptability of vaccination, in light of the accumulating data.

Las menometrorragias constituyen un motivo frecuente de consulta. El tratamiento de la paciente depende fundamentalmente de su edad y del concepto de gestacion. En la nina pequena, las hemorragias genitales son bastante infrecuentes, pero posibles. Si existen signos de impregnacion hormonal, la paciente debe derivarse a un centro especializado con el fin de determinar el origen central (idiopatico o tumoral) o periferico de la pubertad precoz (tumores, quistes ovaricos). Si no existe impregnacion hormonal, se debe siempre descartar un traumatismo o un origen tumoral local (infrecuente). En la adolescente, el origen suele ser funcional, pero no se debe olvidar descartar un trastorno de la hemostasia. En relacion con la mujer en edad fertil, se debe pensar siempre en descartar un embarazo en curso (embarazo extrauterino, aborto espontaneo, mola), con base en la ecografia pelvica y la prueba de embarazo, pruebas complementarias claves. Por ultimo, en la mujer menopausica, se debe pensar siempre en descartar un origen tumoral (cancer de endometrio o de cuello uterino).

Objectives To conduct an audit of vaccination practices against pertussis in maternity wards to assess immunization practices targeting women, knowledge and awareness among health professionals and their involvement in the vaccination process, and to estimate their vaccine coverage. Materials and methods 2017 cross-sectional descriptive survey using a data collection sheet of immunization practices targeting women and an anonymous questionnaire for health professionals whose vaccine coverage had been documented by the occupational health service. Results Five public maternity wards participated: one had a vaccination policy for women; 426 of 822 health professionals completed the questionnaire, 76% (from 50% of all residents to 83% of nurses) declared their vaccination status as up to date. Staff files in occupational health services showed that 69% of 822 health professionals received at least one vaccine booster during adulthood (57% less than 10 years before the survey); documented vaccination coverage rates ranged from 75% for residents to 91% for senior physicians. Occupational physicians and family physicians respectively performed 41% and 34% of vaccinations. While knowledge regarding vaccines was good, only 47% of health professionals declared prescribing them and 18% declared administering the anti-pertussis vaccine “often” or “very often”. Conclusions Updated data is needed to confirm the reported increase as participating centers are not representative of all birth centers. The active role of health professionals in vaccination-based pertussis prevention needs to be reinforced.

Los abortos espontaneos iterativos (AEI) se caracterizan por tres episodios, al menos, de abortos espontaneos (AE) consecutivos, inferiores a 14 semanas de amenorrea, con la misma pareja, en una paciente menor de 40 anos. El 80% de estas pacientes presenta una causa identificable que justifica la existencia de un enfoque etiologico. Los principales tipos etiologicos son los siguientes: anatomicos, cromosomicos, endocrinologicos, trombofilicos, inmunologicos e idiopaticos. Son necesarias una anamnesis y una exploracion fisica orientadas. Se debe realizar un estudio etiologico: un estudio hormonal en el tercer dia del ciclo (estradiol [E2], hormona foliculoestimulante [FSH], hormona luteinizante [LH], prolactina [PRL], tirotropina [TSH] con anticuerpos antiperoxidasa tiroidea (anti-TPO) y tiroglobulina (TG) en caso de hipotiroidismo, glucemia en ayunas ± HbA1c), junto a una ecografia pelvica. Asi mismo, se realiza un estudio de SAFL, una determinacion de las vitaminas B9 y B12, una determinacion de la homocisteina, una histeroscopia (HSC) o ecografia en 3D o RM pelvica si se sospecha una malformacion uterina y un cariotipo de los dos miembros de la pareja. La histerosalpingografia y el estudio de trombofilia ya no estan indicados. Puede resultar interesante el analisis citogenetico de los tejidos resultantes de los abortos. Las demas pruebas son de segunda eleccion y estan orientadas por el medico especialista en funcion del estudio de base. En caso de existir una causa identificada, deben plantearse algunas medidas terapeuticas o preventivas con el objetivo de limitar el riesgo de recidivas. Las actuales investigaciones han permitido sugerir la existencia de fenomenos inmunologicos que podrian estar implicados. Estos nuevos datos podrian explicar una gran parte de los AEI y serian susceptibles de ofrecer nuevas vias de prevencion.

Gli aborti spontanei a ripetizione (ASR) sono definiti da almeno tre episodi di aborti spontanei (AS) consecutivi, di meno di 14 settimane di amenorrea (SA), con lo stesso partner, in una paziente di meno di 40 anni. Queste pazienti presentano per l’80% una causa individuabile che giustifica un approccio eziologico. Le principali classi eziologiche sono le seguenti: anatomiche, cromosomiche, endocrinologiche, trombofiliche, immunologiche e idiopatiche. Sono necessari un interrogatorio e un esame clinico orientati. Si deve realizzare un bilancio eziologico: un bilancio ormonale il terzo giorno del ciclo (estradiolo [E2], follicle stimulating hormone [FSH], luteinizing hormone [LH], prolattina [PRL], thyroid stimulating hormone [TSH] con anticorpi anti-TPO e TG se ipotiroidismo e glicemia a digiuno ± HbA1c), accoppiato a un’ecografia pelvica. Si eseguono anche un bilancio di SAFL, un dosaggio delle vitamine B9 e B12, un dosaggio dell’omocisteina, un’isteroscopia (ISC) o un’ecografia 3D o RM pelvica se ci si orienta verso una malformazione uterina, nonche un cariotipo dei due membri della coppia. L’isterosalpingografia e il bilancio di trombofilia non hanno alcun ruolo nel bilancio. L’analisi citogenetica del prodotto di uno degli aborti puo essere interessante. Gli altri esami sono di seconda intenzione e orientati in funzione del bilancio di base dal medico specialista. In caso di causa identificata, devono essere discusse alcune misure terapeutiche o profilattiche per ridurre il rischio di recidiva. Le ricerche in corso hanno permesso di sospettare dei fenomeni immuni che potrebbero essere in causa. Queste nuove strade potrebbero spiegare una parte importante degli ASR e sarebbero suscettibili di aprire delle nuove vie di prevenzione.

Objective Because the effectiveness of antenatal care in reducing pregnancy complications is still discussed despite widespread recommendations of its use, we sought to assess the association between utilisation of recommended antenatal care and severe maternal (SMM) and perinatal morbidity (SPM). Design Prospective cohort study. Setting Four maternity units around Paris in 2010–2012. Sample 9117 women with singleton pregnancies. Methods Logistic regression models adjusted for maternal social, demographic and medical characteristics. Main outcome measures Antenatal care utilisation was assessed by: (1) initiation of care after 14 weeks, (2) < 50% of recommended visits made, according to gestational age, (3) absence of the first, second or third trimester ultrasounds, (4) two modified Adequacy of Prenatal Care Utilisation indexes, combining these components. The two main outcomes were composite variables of SMM and SPM. Results According to the modified Adequacy of Prenatal Care Utilisation index, 34.6% of women had inadequate antenatal care utilisation; the incidence of severe maternal morbidity (SMM) was 2.9% and severe perinatal morbidity (SPM) 5.5%. A percentage of recommended visits below 50% (2.6% of women) was associated with SMM [adjusted odds ratio (OR) 2.40 (1.38–4.17)] and SPM [aOR 2.27 (1.43–3.59)]. Late initiation of care (17.0% of women) was not associated with SMM or SPM. Failure to undergo the recommended ultrasounds (16, 17 and 22% of women) was associated with SPM. Inadequate antenatal care utilisation according to the index was associated with SPM [aOR 1.37 (1.05–1.80)]. Conclusion Inadequate antenatal care utilisation is associated with SMM and SPM, to degrees that vary with the component of care and the outcome considered. Tweetable abstract Inadequate antenatal care utilisation is associated with severe maternal and perinatal morbidity.

Resume Objectifs L’infection congenitale a cytomegalovirus (CMV) constitue la premiere cause d’infection virale materno-fœtale dans les pays industrialises. Elle concerne 1 % des nouveau-nes, avec risque de sequelles. Pour de nombreuses raisons, les recommandations de l’Agence nationale d’accreditation et d’evaluation en sante de 2004 ne sont pas favorables a un depistage systematique du CMV pendant la grossesse. Certaines maternites pratiquent ce depistage et le but de ce travail est de dresser un etat des lieux de cette pratique en Ile-de-France. Patientes et methodes Il s’agit d’une une enquete descriptive transversale aupres des 99 maternites d’Ile-de-France entre le 30 juillet 2011 et 15 janvier 2012. Les donnees ont ete recueillies a l’aide d’un questionnaire lors d’un entretien telephonique. Quatre-vingt onze questionnaires ont ete recueillis et analyses. Le critere principal de jugement etait la realisation ou pas du depistage. Resultats Sur ces 91 maternites, 13 (14,3 %) effectuent ce depistage. Cette pratique minoritaire est sans rapport avec le statut (public/prive), le type obstetrico-pediatrique ou l’activite. Discussion et conclusion Aux vues des donnees de la litterature, la recherche du CMV en cours de grossesse n’est realisee que sur signes d’appel cliniques ou echographiques. Un depistage systematique du CMV en cours de grossesse n’est, a ce jour, pas recommande en France. Et dans l’attente d’un vaccin efficace en cours de developpement, l’information des femmes enceintes sur les mesures de prevention est la mesure la plus efficace comme le precisent les recommandations de l’Agence nationale d’accreditation et d’evaluation en sante (Anaes) de 2004. Celle-ci passera par une plus large diffusion de ces recommandations vers nos collegues medecins generalistes, en premiere ligne dans la prise en charge des femmes en debut de grossesse.

Decisions regarding whether to initiate or forgo intensive care for extremely premature infants are often based on gestational age alone. However, other factors also affect the prognosis for these patients and must be taken into account. After a short review of these factors, we present the thoughts and proposals of the Risks and Pregnancy department. The proposals are to limit emergency decisions, to better take into account other factors than gestational age and prenatal predicted fetal weight in assessing the prognosis, to introduce multidisciplinary consultation in the evaluation and proposals that will be discussed with the parents, and to separate prenatal steroid therapy from decision-making regarding whether or not to administer intensive care.

The fertility sparing management of endometrial cancer and atypical hyperplasia concern women in childbearing age with stage 1, grade 1, endometrioid adenocarcinoma confined to endometrium or atypical hyperplasia (simple or complex). These pathologies affecting more frequently postmenopausal women, the number of people involved is relatively low. The main risk factor is hyperestrogenism and these patients often present a history of infertility with a desire for pregnancy. The recommendations for this conservative management are scarce and unclear. The national observatory in the gynecology and obstetrics department of Bichat hospital gives expert advice to help doctors and patients concerned. We present a type of conservative management based on the expertise of the national observatory. Rigorous pre-therapeutic assessment must first be made to avoid missing a more advanced lesion. Hormone therapy is then started to obtain complete remission. In case of remission, fast achieving pregnancy is advised, and the use of assisted reproductive therapy is possible if necessary. Monitoring by hysteroscopy and histological examination is essential during the treatment. Hysterectomy is the last time the conservative management. It is motivated by the risk of recurrence and progression. The probability of remission after conservative treatment is estimated at 78.0 % at 12 months, the probability of recurrence at 29.2 % at 24 months, and the risk of progression at 15 % (stage 1A with myometrial invasion or more on the hysterectomy specimen). In terms of fertility, 32 % of women get at least one pregnancy.

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.

Adenomyosis is an enigmatic disease whose impact on implantation and fertility outcome is still controversial. A negative effect on IVF outcome was already observed, but it is mainly explained by an increase in early spontaneous miscarriages. We reviewed scientific data in order to bring relevant information about adenomyosis and endometrial receptivity for patient counselling and to precise if screening of adenomyosis is indicated before IVF treatment.

Hawaii's extreme isolation has resulted in a native stream fauna characterized by high endemism and unusual life history characteristics. With the rapid increase in the human population, the viability of Hawaiian stream ecosystems is threatened by development and the associated habitat alteration. Thirty-eight sites on three islands (Oahu, Kauai, and Hawaii) were sampled to determine how habitat alteration resulting from urbanization and development was associated with the establishment of introduced species. Undeveloped sites had higher streamflow velocities, more riffles, lower embeddedness, deeper water, larger substrate, and lower water temperature than developed sites. Developed sites additionally had more pools and greater sparseness of riparian canopy cover. Overall, 23 fish species from 11 families and 5 crustacean species from 3 families were collected. Of these, 16 fish species and 3 crustacean species were introduced. Developed sites had on average almost twice as many species as undev...

We report three cases of the antenatal appearance of a pial arteriovenous fistula (AVF). In Case 1, the diagnosis of pial AVF was made by ultrasound examination at 32 + 3 weeks of gestation and confirmed by magnetic resonance imaging (MRI) at 34 + 3 weeks of gestation. After birth, the neonate had cardiac insufficiency and an embolization was performed 8 days postpartum which was followed by extended cerebral ischemia and death. In Cases 2 and 3 pial fistulae were diagnosed at birth. In Case 2, the patient was referred following the diagnosis of an aneurysmal malformation of the vein of Galen at 38 weeks of gestation. Owing to immediate delivery following her transfer, no ultrasound examination was performed and the diagnosis of pial AVF was established on the first postnatal day. An embolization was performed and the child is doing well. Case 3 presented with cardiomegaly at 30 weeks of gestation and cerebral ischemic lesions after birth. These cases highlight the difficulties encountered in the prenatal diagnosis of pial AVFs. The diagnosis should be considered in cases of unexplained cardiomegaly and it is also important to make sure that AVFs draining into the vein of Galen are not misdiagnosed as aneurysmal malformations of this vein. The complications of pial AVFs are cardiac failure and cerebral ischemia. Embolization is the treatment of choice; however it is a risky procedure in neonates. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.

Introduction et but de l’etude La nutrition parenterale a domicile (NPAD) a permis d’augmenter la survie et d’ameliorer la qualite de vie des patients atteints d’insuffisance intestinale chronique (IIC). Peu de grossesses chez des femmes en NPAD ont ete rapportees. L’objectif de ce travail etait de decrire les grossesses chez des patientes en NPAD de longue duree pour une IIC benigne. Materiel et methodes Cette etude retrospective multicentrique (trois centres agrees de NPAD francais) incluait toutes les grossesses recensees chez des femmes en NPAD. Les caracteristiques demographiques, la pathologie sous-jacente, la nutrition parenterale, les complications maternelles et le devenir du nouveau-ne ont ete analyses. Resultats Entre 1984 et 2014, 1181 patients (femmes, n = 500) en NPAD pour IIC ont ete suivis. Parmi eux, 18 grossesses ont ete recensees chez 13 patientes (syndrome de grele court [ n = 10], troubles moteurs intestinaux [ n = 3]). La duree mediane de suivi etait de 14 ± 10,3 ans et la duree de NP avant grossesse etait de 10 ans. L’adaptation de la NP etait mensuelle avec surveillance et correction rapprochees des carences en micronutriments. Les apports energetiques etaient regulierement augmentes pour atteindre 133 % de la depense energetique de repos avec une prise de poids maternelle de 10 kg. Dans un centre, un suivi preconceptionnel a ete mis en place depuis 2009 pour les femmes ayant exprime un desir de grossesse. 11 grossesses sur 18 ont eu lieu apres 2010. Le terme etait de 37 ± 2 SA avec 35 % de prematurite. Lors des grossesses, les complications maternelles ont ete une aggravation de la maladie sous-jacente a type de sub-occlusion ( n = 7), ou une complication liee a la NP ( n = 6) dans la majorite des cas, avec, au total, des complications au cours de 67 % des grossesses. L’accouchement s’est complique dans deux cas d’une hemorragie de la delivrance dont une rupture uterine chez une patiente atteinte de pseudo-obstruction intestinale chronique. Les nouveau-nes etaient hypotrophes 4 fois sur 18, un enfant etait mort-ne (vasculopathie non etiquetee). Avec un suivi de 3,5 ans, 15 enfants sur 17 sont consideres en bonne sante. Conclusion Cette serie, la plus importante rapportee a ce jour, montre que la grossesse est possible chez des femmes en NPAD de longue duree. Le taux de complications, relativement eleve en cas de troubles moteurs intestinaux, suggere que cette population devrait etre particulierement surveillee. L’augmentation croissante des grossesses au cours des 15 dernieres annees, probablement liee a l’amelioration de la survie, de la qualite de vie en NPAD et a un changement d’attitude des praticiens, incite a alerter l’ensemble des centres de NPAD, et a favoriser la mise en place d’un suivi specifique rapproche multidisciplinaire (gastroenterologue, nutritionniste, obstetricien) des femmes enceintes mais, egalement, a envisager des consultations pre-conceptionnelles pour l’ensemble des femmes sous assistance nutritive, en âge de procreer.

Introduction Le lait maternel est, par ses benefices, le mode d’alimentation optimal du nourrisson. Sa non pratique semble engendrer des inegalites sociales de sante s’ajoutant a celle connu : prematurite, petit poids pour l’âge gestationnel, anomalie congenitale, morbi-mortalite maternelle. Pour la promouvoir, il est capital de connaitre les determinants lies au choix d’allaiter. L’objectif de ce travail est, en se basant sur la cohorte PreCARE, d’evaluer l’effet de la precarite maternelle sur le choix d’alimentation du nouveau-ne, a terme, en sortie de maternite. Materiels et methode L’analyse porte sur 8257 femmes ayant accouche apres 37 semaines d’amenorrhee d’une grossesse mono fœtale et incluses entre 2010 et 2012 dans la cohorte prospective multicentrique PreCARE. Le choix d’alimentation du nouveau-ne (allaitement maternel exclusif, partiel ou artificiel) en sortie de maternite, a ete etudie par regression logistique multinomiale. Un indice de precarite a ete calcule a partir des informations disponibles de deux auto-questionnaires. L’indice composite de precarite integrait la somme de quatre variables binaires (isolement social, revenu du foyer lie au travail, couverture sante, logement instable). L’effet global et direct de la precarite sur le choix du mode d’alimentation a ete evalue. Resultats Le taux d’allaitement maternel (exclusif et partiel) est plus eleve dans la population de la cohorte PreCARE qu’a l’echelon national (84,1 % versus 70,0 %). On ne retrouve pas d’effet direct significatif entre score de precarite et mode d’alimentation mais un effet global. Cet effet ne porte que sur le choix entre allaitement maternel exclusif ou allaitement artificiel ORa = 0,8 [0,6–0,9] pour un score de precarite egal a 1 et de 0,6 [0,5–0,8] pour un score superieur a 1. Le mode d’alimentation choisi differe egalement significativement selon l’origine maternelle. Comparativement a une femme nee en France, une femme immigree depuis moins de cinq ans, preferera initier un allaitement exclusif (ORa = 5,0 [3,8–6,7]) ou partiel (ORa = 5,8 [4,0–8,3]) par rapport a un allaitement artificiel. Conclusion Cette etude montre l’impact global de la precarite sur le choix du mode d’alimentation du nouveau-ne. Cependant ce choix n’est que faiblement influence par la situation socioeconomique qui semble plus agir comme un modulateur de l’effet majeur de la culture sur ce choix lors de la sortie en maternite.

Resume But de l’etude Le virus de la choriomeningite lymphocytaire (CMLV) est un arenavirus transmis par les rongeurs, virus souvent meconnu d’infection congenitale severe. L’incidence de l’infection durant la grossesse reste imprecise. Le but de notre etude est d’estimer la frequence de l’infection a CMLV chez des femmes enceintes dans un contexte de malformation neurologique fœtale d’origine indeterminee. Materiel et methodes Les prelevements de 160 femmes enceintes obtenus durant trois ans ont ete retrospectivement analyses : 155 serums maternels, 150 liquides amniotiques (LA) et 12 sangs fœtaux (SF). Des anomalies neurologiques congenitales avaient ete diagnostiquees, mais les serologies Torch ainsi que la culture des LA ou SF etaient negatives. Un dosage de l’interferon alpha ete effectue pour tous les LA et SF. Pour realiser les tests serologiques, des cellules L929 ont ete infectees par la souche Armstrong du CMLV. Les anticorps de type IgG et IgM anti-CMLV ont ete recherches par technique d’immunofluorescence en utilisant ces cellules infectees. Resultats Aucune serologie positive n’a ete retrouvee parmi les 317 prelevements etudies y compris ceux ayant un interferon alpha eleve. Conclusion L’atteinte congenitale par le CMLV parait encore rare en France. Neanmoins, a la lumiere de la litterature recente, il faut penser a cet agent teratogene devant toute atteinte congenitale d’origine indeterminee, notamment lors d’une exposition a des rongeurs.

To evaluate the diagnostic accuracy of rectal endoscopic sonography (RES) in the prediction of the infiltration depth of rectal endometriosis and to ascertain whether RES could be used to choose between segmental bowel resection and a more conservative approach, such as shaving or discoid resection.In this retrospective study, 38 consecutive patients with symptomatic deep infiltrating endometriosis of the rectum who underwent laparoscopic colorectal resection were included. RES results for infiltration depth of rectal endometriosis were compared with results of pathological examination. The sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), positive and negative likelihood ratios (LRs) and test accuracy were calculated for the presence of infiltration of the muscularis layers and submucosal/mucosal layers, as demonstrated by RES and confirmed by histopathological analysis.For the detection of muscularis layer infiltration by endometriosis, the PPV of RES was 100%, whereas for the detection of submucosal/mucosal layer involvement, the sensitivity was 89%, specificity was 26%, PPV was 55%, NPV was 71%, test accuracy was 58% and positive and negative LRs were 1.21 and 0.40, respectively.RES is a valuable tool for detecting rectal endometriosis as endometriotic infiltration of the muscularis layer can be predicted accurately. However, RES is less accurate in detecting submucosal/mucosal layer involvement and cannot, therefore, be used to choose between bowel resection and a more conservative approach.

A replication-incompetent retroviral vector derived from spleen necrosis virus (SNV), in which the viral structural genes gag, pol, and env were replaced with the bacterial β-galactosidase gene lacZ, was used to infect embryos from outbred and inbred chicken lines, japanese quail and duck between embryonic day 0 and 13. LacZ expression was restricted to a few organs or cell types, and this distribution was not influenced by the different routes of inoculation tested but was specified by the age of the embryo at the time of inoculation. Inoculations at E0-E1 beneath or onto the blastodisc resulted in lacZ expression in ectodermal derivatives, i.e. skin and neural structures. From E2 onwards, heart muscle and skin were the preferential targets in all the species or inbred lines tested. Heart muscle was positive in 100% of the embryos displaying lacZ+ clones. Skin exhibited on and off periods depending on the age at inoculation. No lacZ-positive clones were detected in chick embryos infected after Ell. Outbred chick embryos displayed the largest array of organs labelled (heart, skin, liver, gizzard) while quail and duck embryos exhibited a more restrictive pattern. These results are of import if the vector is to be used as a tool to map lineages or to transfer genes into the developing embryo.

Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease, asymptomatic during a protracted time, characterized by changes in the small-sized bile ducts near portal spaces. The etiology of PBC is undefined, but immunologic and environmental disturbances may contribute to the disease. Infertility is often associated with PBC and cirrhosis, but pregnancy may well occur in women with PBC and without cirrhosis or in some others with compensated cirrhosis. A pluridisciplinary approach including gastroenterologists and obstetricians is recommended. The patient must be closely monitored throughout her pregnancy with maternal and routine antenatal care. Medical treatment requires ursodeoxycholic acid (UDCA). In non-cirrhotic UDCA-treated women with PBC, pregnancy often follows a normal course with vaginal delivery. In cirrhotic patients, UDCA must be continued during pregnancy, esophageal and gastric varices must be evaluated before pregnancy, and endoscopic ligature is recommended for treating large varices. Additionally, beta-blocker therapy may be associated, especially when variceal rupture occurred previously. Elective cesarean section is recommended in patients with large esophageal or gastric varices because of the potentially increased risk of variceal bleeding during maternal expulsive efforts in case of vaginal delivery.

The mean age of first sexual intercourse is still around 17 in France, but a lot of teenagers are concerned by contraception before, with approximately 25% of sexually active 15-year-old girls. The contraceptive method must take into consideration some typical features of this population, as sporadic and non-planned sexual activity, with several sexual partners in a short period of time. In 2004, the "Haute Autorité de santé" has recommended, as first-line method, combined oral contraceptive (COC) pills, in association with male condoms. Copper-containing intrauterine contraceptive devices (IUCD) and etonogestrel-containing subcutaneous implant have been suggested but not recommended. However, oral contraceptive pill, as a user-based method, carries an important typical-use failure rate, because remembering taking a daily pill, and dealing with stop periods, may be challenging. Some easier-to-use method should be kept in mind, as 28-day COC packs, transdermal contraceptive patches, and vaginal contraceptive rings. Moreover, American studies have shown that long-acting reversible contraceptives (LARC), i.e. IUCD and implant, have many advantages for teenagers: very effective, safe, invisible. They seem well-fitted for this population, with high satisfaction and continuation rates, as long as side effects are well explained. Thus, LARC methods should be proposed more widely to teenagers. Anyway, before prescribing a contraceptive method, it is important to determine the specific situation of every teenager, to let them choose the method that they consider as appropriate in their own case, and to think about the availability of the chosen method. It is necessary to explain how to handle mistakes or misses with user-based contraceptive methods, and emergency contraception can be anticipated and prescribed in advanced provision. The use of male condoms should be encouraged for adolescents, with another effective contraceptive method, in order to reduce the high risk of sexually transmitted infections (STI) in this population.

Congenital infection with cytomegalovirus (CMV) is the leading cause of materno-fetal viral infection in industrialized countries. It covers up to 1% of neonates with risk of sequelae. The recommendations of the National agency for accreditation and evaluation in health from 2004 does not support routine screening for CMV during pregnancy. Some maternity hospitals still practice this screening and the purpose of this work is to present an overview of this practice in Île-de-France.We present a descriptive cross-sectional survey among 99 maternity hospitals of Île-de-France between July 30, 2011 to January 15, 2012. Data were collected using a questionnaire in most cases during a telephone interview. Ninety-one questionnaires were collected. The primary endpoint was the achievement or otherwise of this screening.Of the 91 maternity hospitals surveyed, 13 (14.3%) still were conducting this screening in 2012. This practice was a minority and unrelated to the status (public/private), obstetric-pediatric type or activity.According to recent literature data, this diagnosis should be proposed only in case clinical or ultrasound signs. Screening could be included as part of research protocol for a better understanding of this pathology. It is not recommended in France and pending the development of an effective vaccine, informing pregnant women about preventive measures appear to be the most effective measure. This will involve a wide dissemination of recommendations to general practitioners in first line in support of women in early pregnancy.

To evaluate the estimation of fetal weight by external abdominal measurements, alone or associated with fundal height measurement and/or ultrasonographic exams near 32 weeks, to detect intra-uterine growth retardation (IUGR) near term.A retrospective cohort study included all women who delivered a small-for-gestational-age infant less than 37 weeks gestation during 2008-2009. We analyzed the sensitivity of estimation of fetal weight by external abdominal measurements and the others different routine exams during third trimester, and compared them to detect IUGR near term.The estimation of fetal weight by external abdominal measurements was used in 263 pregnant patients. External abdominal measurements and fundal height measurement were not statistically different and were better tests than ultrasonographic exams at 32 weeks to detect IUGR near term (sensitivity: 41.4%, 42.2% and 22.8%, respectively; P0.05). External abdominal measurements associated with regular ultrasonographic examination at 32 weeks of gestation significantly increased the sensitivity to detect IUGR near term (42.9% vs. 22.8%; P0.05). But, the association of external abdominal measurements and fundal height measurement did not increase the rate of detection (47.9% vs. 42.2%; P=0.22).The present findings confirm that the use of the estimation of fetal weight by external abdominal measurements to detect intra-uterine growth retardation is effective. Measures to improve the learning of this technique and its reproducibility are recommended.

We report a case of uterine necrosis in a 38 year-old patient, who underwent a caesarean section for placenta praevia and an embolisation of the uterine arteries for postpartum haemorrhage. The pelvic embolisation was performed with absorbable gelatine sponge pledgets. This woman presented with abdominal pain and fever three weeks after delivery and a computed tomography scan revealed the presence of gas in the myometrium and endometrium and allowed the diagnosis of uterine necrosis. A total abdominal hysterectomy was performed with adnexal conservation and the diagnosis of uterine necrosis was confirmed histologically. The complications of pelvic embolization and the risks of surgical procedures for the management of intractable obstetric hemorrhage are described.

Splenosis is the heterotopic autotransplantation of splenic tissue that usually follows traumatic splenectomy. Rare pelvic localizations are reported. We report here a case of a 36-year-old woman, followed for secondary infertility. On transvaginal ultrasound pelvic scanning hypervascular paracervical nodules were demonstrated. Pelvic splenosis was suspected regarding the patient's medical past (post-traumatic splenectomy). Surgical exploration and resection were decided considering the nodule localization, the risk during ovarian punction for IVF, and the hypothetical risk of bleeding at delivery. Generally, it is recommended to leave in place the splenic tissue, which may be immunologically functional.