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OBJECTIVE—To evaluate perinatal outcome in pregnancies in women with type 1 and type 2 diabetes and the influence of preconception care 10 years after the St. Vincent’s declaration.RESEARCH DESIGN AND METHODS—A cross-sectional study was conducted in 12 perinatal centers in France in 2000-2001. The main investigated outcomes were perinatal mortality, major congenital malformations, and preterm delivery.RESULTS—Among 435 single pregnancies, 289 (66.4%) were from women with type 1 and 146 (33.6%) from women with type 2 diabetes. Perinatal mortality rate was 4.4% (0.7% national rate), severe congenital malformations rate was 4.1% (2.2% national rate), and preterm delivery rate was 38.2% (4.7% national rate). Preconception care was provided in 48.5% women with type 1 diabetes and in 24.0% women with type 2 diabetes. Women whose first trimester HbA1c was >8% had higher rates of perinatal mortality (9.2 vs. 2.5%; odds ratio 3.9; 95% CI 1.5–9.7; P < 0.005), major congenital malformations (8.3 vs. 2.5%; 3.5; 1.3–8.9; P < 0.01), and preterm delivery (57.6 vs. 24.8%; 1.4; 1.1–1.7; P < 0.005) than those with first trimester HbA1c CONCLUSIONS—Pregnancies in women with diabetes are still poorly planned and complicated by higher rates of perinatal mortality and major congenital malformations. Despite knowledge of the importance of intensified glycemic control before pregnancy, reaching the St. Vincent’s target needs further implementation in France.

Objective: The aim of this study was to conduct a statistical analysis to determine the outcome of conservative treatment after delivery of a first fetus in multiple pregnancy and thus define new prognostic factors. Study design: Multicentre retrospective study involving 12 centers over a 10-year period. Results: Twenty-eight twin pregnancies and seven triplet pregnancies which were managed conservatively. In twin pregnancies, 79% of the delayed-delivery fetuses survived; only 7% of the first delivered fetuses survived. The mean interval between deliveries was 47 days. No statistical difference was found concerning cerclage, antibiotic therapy, tocolysis and hospitalization. Earlier delivery of the first twin and premature rupture of membranes for the second twin were significantly related to a longer interval between deliveries. Conclusion: Delayed delivery in multifetal pregnancies can be successful if there are no contraindications and these pregnancies are managed in a tertiary perinatal center. Publications limited to successful cases have undoubtedly introduced some bias in assessment.

In some countries, the incidence of obesity doubles every 10 years. For the obstetrician-gynecologist, there are many different situations where the patient's excess body weight calls for an adapted diagnostic and therapeutic approach. Obesity does not in itself appear to be a factor lowering fertility. However obesity-induced hormone disorders could contribute, in certain cases, to biological imbalance and thus favor the development of ovulation dysfunction. Pregnancy in obese women should be managed as a high risk pregnancy. The incidence of gestational diabetes and hypertension is increased. Macrosomatia is frequent. There is a 2- to 3-fold increase in the rate of cesarean sections with more complications. Fetal morbidity does not appear to be changed when maternal weight gain is limited. With obesity, there is an increased risk for breast and endometrial cancer due, for most authors, to elevated levels of circulating estrogens resulting from aromatization of male sex steroids in adipose tissue and decreased levels of sex hormone-binding globulin. Anesthesia and surgery in obese patients can be problematic and special care must be taken to prevent further morbidity. Laparoscopic surgery is possible under certain conditions, although its role remains to be determined. Prescription of hormone replacement must take into consideration several parameters which determine its usefulness and surveillance. Obesity is not a contraindication for hormone replacement therapy but is frequently a non-indication.

Two cases of thrombophlebitis of the right ovarian vein, one occurring after cesarean section and the other after natural childbirth, are reported. The clinical diagnosis was based on the symptoms of postpartum fever in association with right flank pain and confirmed by abdominal CT scans. In both cases the thrombosis extended into the inferior vena cava and was associated with a free-floating thrombus extending up to the renal veins. Thrombectomy of the inferior vena cava and ligation of the right ovarian vein were performed with good results in both cases, as shown by late follow-up CT scans. This and alternative therapeutic strategies are discussed.

(2004). Very large Skene's duct cyst. Acta Obstetricia et Gynecologica Scandinavica: Vol. 83, No. 6, pp. 598-598.

Human fetal adipocyte produces leptin. At birth, cord-blood leptin concentration closely correlates with the amount of newborn fat mass. It is suggested that the sexual dimorphism observed in adults already exists in utero. The higher leptin levels in newborns of diabetic mothers (1) compared with the offspring of nondiabetic mothers could reflect increased adipose tissue. It has also been postulated that hypoxic conditions during pre-eclamspsia affect cord-blood leptin (2) and that fetal insulin stimulates fetal adipocyte leptin production (3). We assessed cord-blood levels of leptin and insulin in …

Objective: To investigate the relationship between human immunodeficiency virus (HIV) and cervical intra-epithelial neoplasia (CIN). Design: A prospective study to determine the prevalence of cervical intra-epithelial neoplasia in 111 HIV-positive women. Methods: In total, 111 HIV + women were enrolled and underwent cervical biopsy and CD4 T-lymphocyte determination. Of the 111 women, 26 (23.4%) had CIN and another 26 (23.4%) had histologic evidence of cervicitis. Results: No significant difference was found between transmission group, CDC stage of disease, CD4 T-lymphocyte count and pregnancy. There was a significant association with concomitant human papillomavirus (HPV) infection ( P Conclusion: Public health measures are needed to provide Papanicolaou smear screening and appropriate clinical follow-up and treatment of women infected with the human immunodeficiency virus.

Objectives: Our purpose was to evaluate the prevalence of thrombocytopenia related to human immunodeficiency virus among seropositive pregnant women and its impact on maternal and neonatal outcome. Study Design: A retrospective survey of all deliveries of women infected with human immunodeficiency virus in 14 maternity units in France over a 6-year period collected data on mothers who had thrombocytopenia 9 /L and their infants. Results: Among 890 women, 29 were thrombocytopenic (3.2%, 95% confidence interval 2.1% to 4.3%). Thrombocytopenia appeared directly related to human immunodeficiency virus infection in 25 of these women. During pregnancy 16 patients were treated for thrombocytopenia with zidovudine, corticosteroids, or high-dose intravenous gamma globulin. Zidovudine was effective in five of seven cases, and intravenous gamma globulin was effective in five of 11 cases. Cesarean sections were performed in 13 of 29 women. Abnormal intrapartum or postpartum bleeding was recorded in five cases. Among 28 infants for whom neonatal platelet counts were available, only one had thrombocytopenia 9 /L at birth; he went on to have early-onset acquired immunodeficiency syndrome. Conclusions: The incidence of fetal or neonatal thrombocytopenia appears low and may not justify invasive sampling or routine cesarean delivery. Therapy with zidovudine or intravenous gamma globulin should be considered for women with severe thrombocytopenia, because of the risk of maternal hemorrhage.

Ovarian responses to stimulation for in vitro fertilization by clomiphene citrate menotropins have been correlated to the hormonal profiles determined during spontaneous cycles. The authors found 80% of high plasmatic luteinizing hormone (LH) and/or androgens levels associated with an inappropriated response: premature LH surge, multifollicular ovarian response, or dissociated cystic response, versus only 11% with appropriated responses. High plasmatic follicle-stimulating hormone existed in 71% of the no response group. Detryptoreline, a luteinizing hormone-releasing hormone agonist associated with menotropins, in a "short procedure" maintained the adequate responses and suppressed premature LH surges. The no response group was moderately improved, as were multifollicular and dissociated cystic response groups. Hormonal profiles could be useful predictive factors of the ovarian response for adaptation on the first procedure of stimulation.