108 results on '"Pierre Boulot"'
Search Results
2. Δ6- and Δ5-desaturase activities in the human fetal liver: kinetic aspects
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Annie Rodriguez, Pierre Sarda, Catherine Nessmann, Pierre Boulot, Claude Louis Leger, and Bernard Descomps
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kinetic ,desaturase activity ,human fetus ,liver ,microsomes ,endogenous substrate ,Biochemistry ,QD415-436 - Abstract
Δ6- and Δ5-desaturase activities were studied in human fetal liver microsomes obtained after legally approved therapeutic abortion. Enzyme activities were measured by a radiochemical method using reverse-phase high performance liquid chromatography (HPLC). Free and phospholipid fatty acids were assessed in each liver sample by a combination of thin-layer chromatography (TLC) and gas–liquid chromatography (GLC) procedures. The kinetic measurements showed higher Δ6-desaturase activity for the n–3 series than for the n–6 series. Apparent Km of 6.5, 3.9, and 24.5 μm and Vm of 7.5, 9.1, and 24.4 pmol·min-1·mg-1 were obtained, respectively, for 18:2n–6 Δ6-, 20:3n–6 Δ5-, and 18:3n–3 Δ6-desaturases. Beyond 30, 20, and 60 μm of 18:2n–6, 20:3n–6, and 18:3n–3 concentration, respectively, the enzyme activity deviated from Michaelis-Menten kinetics, suggesting an inhibition by excess substrate which is unlikely to occur in vivo as endogenous substrate concentration is much lower. We observed a breakdown in linearity between desaturase activity and microsomal protein concentration beyond 4–5 mg microsomal protein, whatever the enzyme or substrate. Both this phenomenon and the inhibition due to excess substrate should be taken into account in the determination of Δ6- and Δ5-desaturase activities. Comparison of concentrations of the respective endogenous substrates and the kinetic constants of each enzyme suggested that the higher Δ6-desaturase activity observed for the n–3 series than for the n–6 series is not physiologically relevant in human fetal liver.—Rodriguez, A., P. Sarda, C. Nessmann, P. Boulot, C. L. Leger, and B. Descomps. Δ6- and Δ5-desaturase activities in the human fetal liver: kinetic aspects.
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- 1998
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3. Prenatal ultrasound diagnosis of cleft palate without cleft lip, the new ultrasound semiology
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Jean-Michel Faure, Constance Wells, Pierre Boulot, Florent Fuchs, Guillaume Captier, Michèle Bigorre, and E Mousty
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0301 basic medicine ,medicine.medical_specialty ,030105 genetics & heredity ,Ultrasonography, Prenatal ,03 medical and health sciences ,Prenatal ultrasound ,Imaging, Three-Dimensional ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,Longitudinal Studies ,Prospective Studies ,Prospective cohort study ,Genetics (clinical) ,Orthodontics ,Palatine bone ,030219 obstetrics & reproductive medicine ,business.industry ,Ultrasound ,Obstetrics and Gynecology ,Semiology ,Cleft Palate ,Plastic surgery ,medicine.anatomical_structure ,Female ,Secondary palate ,Posterior nasal spine ,business - Abstract
Objectives The aim of this study was to define the prenatal ultrasound semiology of cleft palate without cleft lip using 3D visualization of the fetal palate. Methods A prospective longitudinal study was performed in our University Hospital Center from 2011 to 2018. The fetal secondary palate was studied in 3D, starting with 2D axial transverse ultrasound view. We defined a cleft palate as a disruption of the horizontal plate of the palatine bone of the secondary palate. Prenatal findings were correlated to anatomic postnatal examinations performed by a paediatric plastic surgeon. Results Forty-three cases of cleft palate without cleft lip were prenatally diagnosed, of whom 34 were associated with malformations. We defined four types of disruptive appearances: isolated nonvisualization of the posterior nasal spine; partial-disruption or cleft velum; complete disappearance or V-shaped cleft palate; and complete disappearance or U-shaped cleft palate. The adjusted kappa coefficient, between prenatal and postnatal evaluation, was 0.88 (95% CI: 0.79-0.97), corresponding to an excellent agreement. Conclusions Using a strictly axial transverse ultrasound view, visualization of the secondary fetal palate enables to diagnose a cleft palate without cleft lip. This method offers a prenatal anatomic classification of cleft palate with a high level of concordance to postnatal findings.
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- 2020
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4. Which risk score best predicts cardiovascular outcome in pregnant women with congenital heart disease?
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Charlene Bredy, Fanny Deville, Helena Huguet, Marie-Christine Picot, Gregoire De La Villeon, Hamouda Abassi, Martina Avesani, Laetitia Begue, Gilles Burlet, Pierre Boulot, Florent Fuchs, and Pascal Amedro
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Health Policy ,Cardiology and Cardiovascular Medicine - Abstract
Background Management of pregnancy and risk stratification in women with congenital heart diseases (CHD) are challenging, especially due to physiological haemodynamic modifications that inevitably occur during pregnancy. Aims To compare the accuracy of the existing pregnancy cardiovascular risk scores in prediction of maternal complications during pregnancy in CHD patients. Method and results From 2007 to 2018, all pregnant women with a CHD who delivered birth after 20 weeks of gestation were identified. The discriminating power and the accuracy of the five existing pregnancy cardiovascular risk scores [CARPREG, CARPREG II, HARRIS, ZAHARA risk scores, and modified WHO (mWHO)] were evaluated. Out of 104 pregnancies in 65 CHD patients, 29% experienced cardiovascular complications during pregnancy or post-partum. For the five scores, the observed rate of cardiovascular events was higher than the expected risk. The values of area under the ROC curve were 0.75 (0.62–0.88) for mWHO, 0.65 (0.53–0.77) for CARPREG II, 0.60 (0.40–0.80) for HARRIS, 0.59 (0.47–0.72) for ZAHARA, and 0.58 (0.43–0.73) for CARPREG. Conclusion The modified WHO classification appeared to better predict cardiovascular outcome in pregnant women with CHD than the four other existing risk scores. Clinical Trial Registration: Clinicaltrials.gov: NCT04221048.
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- 2022
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5. Use of Remifentanil Associated with Lidocaine for Feticides in Late Terminations of Pregnancy: A Randomized Clinical Trial
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Constance Wells, Tarik Hlioua, Pierre Boulot, Romy Rayssiguier, Estelle Morau, Yuri Musizzano, Florent Fuchs, Christelle Graf, Nicolas Nagot, Coralie Dumont, Eve Mousty, Charles Legoux, CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Institut Desbrest de santé publique (IDESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Pathogenesis and Control of Chronic and Emerging Infections (PCCEI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université des Antilles (UA)-Etablissement français du don du sang [Montpellier]-Université de Montpellier (UM), Université de Montpellier (UM), CHU Sud Saint Pierre [Ile de la Réunion], and Fuchs, Florent
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Embryology ,Time to fetal asystole ,Lidocaine ,Sufentanil ,Feticide ,Remifentanil ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,law.invention ,Randomized controlled trial ,law ,Pregnancy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Asystole ,Maternal side effects ,business.industry ,Obstetrics and Gynecology ,Gestational age ,Abortion, Induced ,General Medicine ,medicine.disease ,[SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,Anesthesia ,Pediatrics, Perinatology and Child Health ,Termination of pregnancy ,Female ,business ,medicine.drug - Abstract
Introduction: In France, performance of a termination of pregnancy is legally possible without any gestational age limit. After 22 weeks of gestation, a feticide is ethically performed using usually sufentanil and lidocaine. The aim of this study was to compare the use of remifentanil, a fast-acting morphine-derivating product, instead of sufentanil. Methods: This 2-center randomized, controlled, single-blinded phase-III treatment trial had 2 parallel arms: an experimental group using remifentanil with lidocaine versus a control group receiving sufentanil associated with lidocaine. This trial took place over a 40-month period. The primary outcome was time to fetal asystole after lidocaine injection. The secondary outcome measures were the procedure’s success rate, the rate of serious maternal side effects, and the presence of cellular or tissue modifications. Results: The study included 66 women, randomized into 2 groups of similar size and characteristics. Time to fetal asystole did not differ significantly between the groups, with a delay of 4 min (Q1−Q3, 2–11) in the sufentanil group and 4 min (Q1−Q3, 1–10) in the remifentanil group (p = 0.84). Similarly, the success rate of the procedure did not differ significantly. Fetal asystole was procured in 1 min for 16 (25.8%) women in our total population: 7 (22.5%) in the sufentanil group and 9 (29.0%) in the remifentanil group, p = 0.77. No severe maternal side effects were observed. Among the 49 fetopathological examinations performed, the few tissue and cell modifications observed did not cause any interpretation difficulties in either group. Discussion/Conclusion: Use of remifentanil instead of sufentanil for feticide procedure did not improve time to fetal asystole. No harmful effect was observed for either maternal tolerance or interpretation of the histologic slides.
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- 2022
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6. Suivi obstétrical après décès périnatal : anticipation, écoute, cohérence
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Émilie Wallaert and Pierre Boulot
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- 2021
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7. « Posturage du nouveau-né » et pratiques innovantes autour de la naissance : un défi collectif pour le développement précoce
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Pierre Boulot, Rose-Marie Toubin, and Aurélien Jacquot
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03 medical and health sciences ,030219 obstetrics & reproductive medicine ,0302 clinical medicine ,030225 pediatrics - Abstract
Les acteurs de santé en période périnatale sont désormais confrontés à la nécessité d’intégrer les multiples registres en jeu dans le développement de l’enfant à venir en fonction des connaissances récentes sur la plasticité cérébrale. Le cerveau présente une réceptivité maximale à des compétences spécifiques au cours des « périodes sensibles » des deux premières années de vie : passée cette période, il devient difficile, voire impossible, pour la structure cérébrale considérée, de reprendre un développement normal. Un manque ou un dysfonctionnement dans l’ajustement environnemental sur cette période est fort préjudiciable. Les objectifs de l’étude sont d’optimiser les conditions d’accueil du nouveau-né et de croiser les regards sur le développement précoce dans l’espoir de réduire les troubles ultérieurs de l’enfant. La collaboration croissante et rigoureuse avec l’ensemble des équipes concernées, et particulièrement des pédiatres depuis une dizaine d’années, a permis de développer des stratégies innovantes visant à améliorer la continuité sensorielle et émotionnelle des parents et de l’enfant, de la vie foetale aux toutes premières étapes de son développement. La méthode expérimentale de « posturage » du nouveau-né a été conçue dans ce climat de collaboration étroite : simple et reproductible, s’appuyant sur le bon sens, elle permet au bébé de ressentir un sentiment de continuité dans le temps de la naissance et d’exprimer de nombreuses compétences interrelationnelles. Dans les situations de vulnérabilité psychique maternelle majeure, les pères se sont mobilisés en grand nombre pour venir dès la consultation pédopsychiatrique anténatale échanger sur cette thématique. Ils ont fait l’effort d’être présents en post-partum et dans le suivi pluridisciplinaire des trois premiers mois, ce qui laisse présager de l’efficacité de cette démarche. Une telle perspective ouvre de sérieux espoirs sur une recherche permettant de valider ces pistes de réflexion au regard de l’avancée fulgurante des neurosciences. Poursuivre l’effort de repérage par la diffusion de l’entretien prénatal précoce et prendre soin des nouveau-nés à terme avec la même rigueur que dans les soins de développement pour les grands prématurés sont autant de défis à relever ensemble avec des parents devenus coacteurs du développement de leur enfant.
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- 2019
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8. A prospective cohort study of postpartum glucose metabolic disorders in early versus standard diagnosed gestational diabetes mellitus
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Sarah Kabani, Christophe Demattei, Valeria Cosma, Pierre Boulot, Jeanne Imbernon, Pierre Marès, Eric Renard, Cécile Brunet, Léonore Zagdoun, Anne-Marie Guedj, and Michel Rodier
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Adult ,Blood Glucose ,medicine.medical_specialty ,Time Factors ,Science ,medicine.medical_treatment ,030209 endocrinology & metabolism ,Type 2 diabetes ,Article ,Impaired glucose tolerance ,03 medical and health sciences ,Endocrinology ,Medical research ,Obstetric Labor, Premature ,0302 clinical medicine ,Pregnancy ,Risk Factors ,Glucose Metabolism Disorder ,Glucose Intolerance ,medicine ,Humans ,Insulin ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Multidisciplinary ,business.industry ,Obstetrics ,Postpartum Period ,Glucose Tolerance Test ,medicine.disease ,Gestational diabetes ,Diabetes, Gestational ,Diabetes Mellitus, Type 2 ,Pregnancy Trimester, Second ,Medicine ,Gestation ,Female ,business ,Follow-Up Studies - Abstract
Early gestational diabetes mellitus (eGDM) is diagnosed when fasting plasma glucose before 24 weeks of gestation (WG) is ≥ 5.1 mmol/L, whilst standard GDM is diagnosed between 24 and 28 WG by oral glucose tolerance test (OGTT). eGDM seems to have worse obstetric outcomes than standard GDM. We compared the rates of postpartum glucose metabolism disorders between women with early versus standard GDM in this prospective study on women with GDM from three university hospitals between 2014 and 2016. Patients were included if they were Trial registration: NCT01839448, ClinicalTrials.gov on 22/04/2013.
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- 2021
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9. Pregnancy in women with congenital heart diseases: Does the Carpreg II score significantly predict maternal outcomes in congenital heart diseases (PREG-GUCH study)?
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Pierre Boulot, Gregoire De La Villeon, Gilles Burlet, Laetitia Bègue, Fanny Deville, Pascal Amedro, Hamouda Abassi, and Charlene Bredy
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Pregnancy ,medicine.medical_specialty ,Obstetrics ,business.industry ,Hemodynamics ,medicine.disease ,Confidence interval ,GUCH ,Risk stratification ,medicine ,Gestation ,Cardiology and Cardiovascular Medicine ,business ,Risk classification - Abstract
Background Management of pregnancy and risk stratification in women with congenital heart diseases (CHD) are challenging especially due to physiological haemodynamic modifications that inevitably occur during pregnancy. Objective To compare the accuracy of the main published scores including CARPREG II score in prediction of maternal complications during pregnancy in CHD patients. Method We included all pregnant women with CHD who delivered their babies after the 20th gestational week in our institution between 2007 and 2018 until 6 months postpartum. Pregnancy scores (CARPREG, CARPREG II, Harris, ZAHARA risk scores and modified WHO (mWHO) risk classification) were applied retrospectively. Results Of 121 pregnancies in 65 CHD patients, 30% had cardiovascular complications. The c-statistic was 0.577 (95% confidence interval (CI): 0.428, 0.727; P = 0.19) for CAPREG score, 0.593 (95% CI: 0.469, 0.717; P = 0.11) for the ZAHARA score, 0.601 (95% CI: 0.402, 0.799; P = 0.15) for Harris score, 0.646 (95% CI: 0.525, 0.767; P Fig. 1 ). Conclusion Even if the new CARPREG II score seems to be better than most of the previously used scores as predictor of adverse maternal cardiovascular events mWHO appears to be more accurate in CHD patients.
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- 2021
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10. Conservative versus active management in HELLP syndrome: results from a cohort study
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Elodie Chantalat, Paul Guerby, Marie Cavaignac-Vitalis, Caroline Simon-Toulza, Pierre Boulot, Fabien Vidal, Olivier Parant, Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Toulouse [Toulouse], Hôpital Paule de Viguier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université de Montpellier (UM), and Institut National de la Santé et de la Recherche Médicale (INSERM)
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Adult ,medicine.medical_specialty ,HELLP syndrome ,morbidity ,Infant, Premature, Diseases ,030204 cardiovascular system & hematology ,Betamethasone ,Preeclampsia ,preeclampsia ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,active management ,medicine ,Humans ,Watchful Waiting ,Glucocorticoids ,Expectant management ,Retrospective Studies ,expectant management ,Fetus ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics ,Infant, Newborn ,Pregnancy Outcome ,Obstetrics and Gynecology ,medicine.disease ,3. Good health ,Pediatrics, Perinatology and Child Health ,Pregnancy, Twin ,Gestation ,Female ,France ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,Cohort study - Abstract
International audience; OBJECTIVE:HELLP syndrome exposes to severe maternal and fetal complications. Prompt delivery is thus recommended after 34 weeks of gestation, or earlier in case of nonreassuring maternofetal conditions. However, no consensus has been raised in the treatment of HELLP syndrome occurring before 34 weeks of gestation, when both maternal and fetal conditions are stable: it remains still unclear whether an active attitude should be prioritized over expectant management. Herein, we aimed to compare mother and child outcomes according to the type of obstetrical management, either active or conservative.STUDY DESIGN:Retrospective and multicenter study involving two tertiary care units. In Center A, obstetrical attitude consisted in expectant management: all women received full antenatal betamethasone therapy and pregnancy was prolonged until maternal or fetal follow up indicated delivery. In Center B, management was active: all deliveries were initiated within 48 hours following diagnosis.RESULTS:From 2003 to 2011, 118 patients were included (87 in Center A, 31 in Center B). Both groups of patients were similar regarding maternal and fetal features at baseline. Active management led to increased risks of post-partum hemorrhage (relative risks (RR) = 5.38, 95%CI: 1.2-24.06) and neonatal morbidity including respiratory distress syndrome (RR = 3.1, 95%CI: 1.4-7.1), sepsis (RR = 2.5, 95%CI: 1.1-6.0), necrotizing enterocolitis (RR = 4.8, 95%CI: 1.1-21.2), intracerebral hemorrhage (RR = 5.4, 95%CI: 2.1-13.6), and blood transfusion (RR = 6.1, 95%CI: 1.7-21.7).CONCLUSIONS:Conservative management may be beneficial for both mother and newborn in patients with stable HELLP syndrome. Identification of maternal and fetal specific prognostic factors would allow a better stratification of women with HELLP syndrome according to illness progressive potential, resulting in a more personalized management.
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- 2019
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11. Fetal growth retardation and hemorheological predictors of oxygen delivery in hypertensive vs normotensive pregnant women
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Céline Roques, Bénédicte Marion, Emmanuelle Varlet-Marie, Eric Raynaud de Mauverger, Jacques Mercier, Pierre Boulot, Jean-Frédéric Brun, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut des Biomolécules Max Mousseron [Pôle Chimie Balard] (IBMM), Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Université de Montpellier (UM), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM)-Institut de Chimie du CNRS (INC)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)
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Adult ,medicine.medical_specialty ,obesity ,Physiology ,[SDV]Life Sciences [q-bio] ,Blood viscosity ,Blood Pressure ,030204 cardiovascular system & hematology ,Hematocrit ,030218 nuclear medicine & medical imaging ,Preeclampsia ,preeclampsia ,03 medical and health sciences ,small for gestational age ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Blood fluidity ,ComputingMilieux_MISCELLANEOUS ,Fetal Growth Retardation ,medicine.diagnostic_test ,business.industry ,Infant, Newborn ,hypertensive disorders of pregnancy ,Gestational age ,Hematology ,Blood Viscosity ,medicine.disease ,Oxygen ,Low birth weight ,medicine.anatomical_structure ,Blood pressure ,Endocrinology ,Hemorheology ,Hypertension ,Vascular resistance ,hemostasis ,Small for gestational age ,Female ,pregnancy ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Physiological modifications of blood rheology during pregnancy and their alterations in pregnant hypertensive women have been extensively studied in the 1980's. Since vascular resistance is higher in hypertensive pregnant women whose newborns are small-for gestational-age (SGA), we investigated in a personal database if growth retardation of newborns is related to the oxygen delivery index (ratio hematocrit/blood viscosity) and to the difference between hematocrit (Hct) and the prediction of its optimal valued based on Quemada's equation. A sample of 38 hypertensive pregnant women (age 29 yr±1) was compared with 64 controls matched for age and gestational age, studied at 35±1 weeks gestation, extracted from a larger series of 162 pregnant women. On the whole the hypertensive group gave birth to smaller children (p = 0.014). Plasma viscosity correlated with blood pressure (BP) only in hypertensive women (r = 0.403 p < 0.05). The bell-shaped curve of predicted optimal Hct of non hypertensive pregnant women was similar to that of non-pregnant women, but in hypertensive women it was shifted toward higher values (p = 0.07), and the predicted optimal Hct (but not the actual one) was correlated with systolic blood pressure (SBP) (r = 0.349 p < 0.001) and diastolic blood pressure (DBP) (r = 0.218 p < 0.05). The predicted optimal Hct/viscosity (h/η) ratio was higher in hypertensive women whose newborns exhibited a low birth weight (p = 0.03), resulting in a higher discrepancy between actual and model-predicted «ideal» values of h/η ratio (p = 0.03) and Hct (p = 0.02) compared with the subgroup with no growth retardation. Therefore, in hypertensive women whose newborns exhibited a low birth weight, hemorheological parameters predicting oxygen supply are shifted to lower values than predicted by the model.
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- 2019
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12. Prognosis of severe congenital heart diseases: Do we overestimate the impact of prenatal diagnosis?
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Pascal Amedro, Gilles Cambonie, Pierre Boulot, Beatrice Clarivet, Thibault Mura, Marie Vincenti, Valérie Macioce, Sophie Guillaumont, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service de cardiologie Pédiatrique [Montpellier], Neuropsychiatrie : recherche épidémiologique et clinique (PSNREC), Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), MORNET, Dominique, Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Université Montpellier 1 (UM1)-Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)
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Pediatrics ,medicine.medical_specialty ,Pregnancy ,Heart disease ,business.industry ,Mortality rate ,[SDV]Life Sciences [q-bio] ,Prenatal diagnosis ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,3. Good health ,Cardiac surgery ,[SDV] Life Sciences [q-bio] ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,medicine ,030212 general & internal medicine ,Ultrasonography ,Risk factor ,Cardiology and Cardiovascular Medicine ,business ,ComputingMilieux_MISCELLANEOUS - Abstract
Summary Background Prenatal diagnosis of congenital heart disease (CHD) is controversial because of unclear benefits in terms of morbidity and mortality, and issues with healthcare costs and organization. Aim To compare, in children with severe CHD, 1-year morbidity and mortality between prenatal and postnatal diagnosis groups. Methods All pregnancies and children aged Results Overall, 322 cases of severe CHD were identified; 200 had a prenatal diagnosis and there were 97 terminations of pregnancy. Of the 225 live births, 34 died before the age of 1 year. The 1-year mortality rate was not significantly different between prenatal and postnatal groups (16.7% vs. 13.9%; p = 0.13). In the prenatal group, prostaglandin use was more important and precocious, duration of hospitalization stay was longer, extracardiac complications were less common and cardiac surgery was performed more frequently and later. An association with chromosomal or syndromic anomalies was a risk factor for 1-year mortality. Conclusions Prenatal diagnosis of severe CHD had an impact on the decision regarding termination of pregnancy, but not on the 1-year prognosis among live births. We should now use large multicentre CHD registries to determine the impact of prenatal diagnosis on postnatal management, neurological prognosis and quality of life.
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- 2019
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13. Présence du père lors des césariennes : un pas de plus pour une naissance partagée ?
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Pierre Boulot, Estelle Morau, Nicolas Nagot, Clémentine Combes, and Florent Fuchs
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- 2018
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14. Continuité périnatale : quels enjeux ?
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Pierre Boulot, Françoise Molénat, and Rose-Marie Toubin
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- 2019
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15. Comparison between potassium chloride and lidocaine as lethal agents for feticide in termination of pregnancy
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Pierre Boulot, E. Mousty, A. Ménard, Florent Fuchs, Y. Musizzano, Marie-José Perez, C. Dumont, R. Rayssiguier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Gui de Chauliac [Montpellier], Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Saint Jean de Perpignan, Centre de recherche en épidémiologie et santé des populations (CESP), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)
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medicine.medical_specialty ,Lidocaine ,Potassium ,MEDLINE ,chemistry.chemical_element ,Abortion ,03 medical and health sciences ,0302 clinical medicine ,Feticide ,medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Abortifacient agent ,ComputingMilieux_MISCELLANEOUS ,Pregnancy ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,3. Good health ,Reproductive Medicine ,chemistry ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,medicine.drug - Abstract
International audience
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- 2019
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16. Conductrices d’hémophilie : expérience d’un CHRU en France
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J.-F. Schved, C. Biron-Andréani, P. Aguilar-Martinez, Pierre Boulot, P. Sauguet, and J.-B. Escudié
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Gynecology ,medicine.medical_specialty ,business.industry ,Obstetrics and Gynecology ,General Medicine ,030204 cardiovascular system & hematology ,3. Good health ,03 medical and health sciences ,0302 clinical medicine ,Reproductive Medicine ,Post-partum hemorrhage ,Medicine ,business ,030215 immunology - Abstract
Resume But Realiser un etat des lieux de la prise en charge des femmes conductrices d’hemophilie dans un CHRU francais et evaluer les differents problemes rencontres chez ces patientes. Patientes et methodes Etude retrospective concernant les conductrices d’hemophilie ayant consulte au CHRU de Montpellier entre 1995 et 2011. Le recueil des donnees a ete effectue a partir des dossiers medicaux et d’un questionnaire envoye aux conductrices. Les informations recueillies concernaient les caracteristiques biologiques, l’histoire hemorragique et la prise en charge des grossesses. Resultats Soixante-quatre conductrices d’hemophilie A ou B ont ete incluses. Leur taux de FVIII ou FIX median est de 52 % (15–137 %). Trente et un pour cent des conductrices ont des regles d’une duree superieure a 7 jours. Cent quarante-deux grossesses ont ete debutees par 54 conductrices qui ont donne naissance a 101 enfants, dont 26 garcons hemophiles. Soixante-deux diagnostics prenatals ont ete realises, 15 ont conduit a une interruption medicale de grossesse en raison d’un fœtus de sexe masculin hemophile. Soixante-seize pour cent des accouchements se sont deroules par voie basse et 49 % ont eu lieu dans une maternite de niveau III. L’accouchement a ete complique par une hemorragie du post-partum primaire dans 10,8 % des cas et secondaire dans 8,5 % des cas. Conclusion Le risque hemorragique chez les conductrices est associe a leur taux de facteur antihemophilique. Pour ameliorer la prise en charge de ces patientes, un dossier pluridisciplinaire et standardise, avec un questionnaire specifique pour evaluer les saignements pourrait etre envisage. Un registre regional repertoriant toutes les conductrices, quel que soit leur taux de facteur, serait egalement utile.
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- 2015
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17. Does prenatal MRI enhance fetal diagnosis of intra-abdominal cysts?
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Coralie Dumont, Alain Couture, Florence Hugele, Pierre Boulot, and Olivier Prodhomme
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medicine.medical_specialty ,Pregnancy ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Obstetrics and Gynecology ,Prenatal diagnosis ,Magnetic resonance imaging ,Retrospective cohort study ,medicine.disease ,3. Good health ,medicine.anatomical_structure ,medicine ,Abdomen ,Cyst ,Radiology ,Medical diagnosis ,business ,Genetics (clinical) - Abstract
Objective The aim of this study was to evaluate the contribution of prenatal magnetic resonance imaging (MRI) to ultrasound (US) in the prenatal diagnosis of intra-abdominal cystic masses, correlated with the postnatal diagnosis. Methods In this retrospective, observational study, prenatal MRI and US diagnoses were compared with postnatal diagnoses. MRI was performed in 56 fetuses with intra-abdominal cyst diagnosed by US between 2004 and 2013. Final diagnosis, revealed by postnatal evaluation, was obtained for 49 of them and was taken as the reference. MRI was evaluated as superior, equal, or inferior to US. Results An accurate diagnosis was provided by US in 25 cases (51%) and by MRI in 36 out of the 49 cases (73.4%). MRI corrected the US diagnosis in 13 cases (26.5%) by providing a more precise localization or additional etiologic information. In two cases (4%), MRI wrongly changed the diagnosis correctly made by US. Conclusion Prenatal MRI better characterized the nature of abdominal cystic lesions previously diagnosed by US in 13 cases. This enhanced postnatal therapeutic planning and so improved parental counseling and pregnancy management. © 2015 John Wiley & Sons, Ltd.
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- 2015
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18. Actual vs optimal fetal hematocrit measured with punctures of cord blood in utero: Relationship with umbilical artery resistance
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Pierre Boulot, Jean-Frédéric Brun, Emmanuelle Varlet-Marie, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
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erythrocyte deformability ,medicine.medical_specialty ,Physiology ,hematocrit ,[SDV]Life Sciences [q-bio] ,Blood viscosity ,030204 cardiovascular system & hematology ,Hematocrit ,Umbilical Arteries ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Physiology (medical) ,Internal medicine ,medicine.artery ,hemic and lymphatic diseases ,medicine ,Humans ,Erythrocyte deformability ,Fetus ,medicine.diagnostic_test ,exercise ,Obstetrics ,business.industry ,Umbilical artery ,Hematology ,Fetal Blood ,fetus ,medicine.anatomical_structure ,Cord blood ,Hemorheology ,Vascular resistance ,Cardiology ,Female ,Vascular Resistance ,Cardiology and Cardiovascular Medicine ,business - Abstract
International audience; Physiological studies on fetal blood in narrow glass tubes have suggested that fetal optimal hematocrit (hct) might be as high as 60%. A theoretical 'ideal' hct can also be predicted with a theoretical curve of hematocrit/viscosity (h/η) ratio vs hct constructed with Quemada's model. We used the database of one of our previous papers on fetal hemorheology to reinterpret its results with this concept. A series of 28 intrauterine cord punctures (between 19 and 33 weeks gestation) with doppler measurements of resistance in umbilical arteries was studied. The theoretical 'optimal hematocrit' was well correlated to actual (r = 0.857, p
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- 2017
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19. Thrombosis of torcular herophili: diagnosis, prenatal management, and outcome
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Pierre Boulot, Sabrina Flunker, Romy Rayssiguier, Coralie Dumont, Alain Couture, and Olivier Prodhomme
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medicine.medical_specialty ,Pregnancy ,medicine.diagnostic_test ,business.industry ,Obstetrics and Gynecology ,Magnetic resonance imaging ,Retrospective cohort study ,Prenatal diagnosis ,medicine.disease ,Thrombosis ,Torcular Herophili ,medicine.anatomical_structure ,medicine.vein ,medicine ,Radiology ,business ,Genetics (clinical) ,Sinus (anatomy) ,Full Term - Abstract
Objectives The objective of this article is to describe and assess prenatal imaging findings, fetal and postnatal outcomes of thrombosis of torcular herophili, and to determine diagnostic features, pathophysiology, prognosis, and optimal management. Methods Over a decade, we compiled the largest single-center retrospective study of outcomes. Fetal magnetic resonance imaging (MRI) was used to confirm the sonographic suspicion and monitor thrombosis of torcular herophili. We noted prenatal and postnatal imaging specifications, pregnancy outcomes, and clinical and radiological pediatric monitoring. Analysis of findings and review of the literature allowed us to define prognostic factors. Results In eight cases of prenatal diagnosis of thrombosis of torcular herophili, MRI outcomes were specific. There were five deliveries at full term, two terminations of pregnancy, and one fetal demise in utero. Neonates had a good clinical and radiological outcome. Factors of poor prognosis were deep venous sinus thrombosis, enduring mass effect, brain parenchymal injury, and heart failure related to dural arteriovenous shunt. Conclusion Among dural sinus malformations, thrombosis of torcular herophili with or without extension at the posterior segment of the longitudinal sinus frequently has a good prognosis. It is urgent to wait because the prognosis can only be ascertained over time by means of ultrasound scan and MRI monitoring. © 2014 John Wiley & Sons, Ltd.
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- 2014
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20. Fetal serum α -1 microglobulin for renal function assessment: comparison with β 2-microglobulin and cystatin C
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Claire Nguyen, Fabien Guimiot, Isabelle Czerkiewicz, Laurence Heidet, Sophie Dreux, Françoise Muller, Thomas Schmitz, Thierry Rousseau, Laurent Salomon, Pierre Boulot, and Vassilis Tsatsaris
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Fetus ,medicine.medical_specialty ,Kidney ,Creatinine ,biology ,Beta-2 microglobulin ,business.industry ,Urinary system ,Urology ,Obstetrics and Gynecology ,Renal function ,urologic and male genital diseases ,chemistry.chemical_compound ,medicine.anatomical_structure ,Endocrinology ,Cystatin C ,chemistry ,Internal medicine ,medicine ,biology.protein ,Cystatin ,business ,Genetics (clinical) - Abstract
Objective To compare the prognostic value of fetal serum α1-microglobulin with that of β2-microglobulin and cystatin C for postnatal renal function. Method Retrospective study of α1-microglobulin, β2-microglobulin, and cystatin C in fetal serum from 126 fetuses with congenital abnormalities of the kidney and urinary tract (73 and 53, respectively). Two groups were defined: group with normal renal function and group with renal failure. For live born infants, renal function was assessed on the basis of serum creatinine (cutoff 50 µmol/L) or glomerular filtration rate (cutoff 75 mL/min/1.73 m2) or both. In case of infant or fetal death, histological kidney lesions were considered. Results Significant differences (p
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- 2013
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21. Infection maternelle à Parvovirus B19 et anémie fœtale
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Coralie Dumont, Michel Segondy, Pierre Boulot, Vincent Foulongne, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Pathogénèse et contrôle des infections chroniques (PCCI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire de Montpellier (CHU Montpellier )-Université de Montpellier (UM), and Service de Biopathologie [CHRU Montpellier]
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03 medical and health sciences ,Medical Laboratory Technology ,030219 obstetrics & reproductive medicine ,0302 clinical medicine ,business.industry ,Biochemistry (medical) ,Medicine ,030212 general & internal medicine ,business ,ComputingMilieux_MISCELLANEOUS ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,Analytical Chemistry - Abstract
International audience
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- 2016
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22. Non-intégrité des membranes en cas de manœuvres : facteur de risque de césarienne sur deuxième jumeau
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G Burlet, Lionel Reyftmann, E Rebufa-Dhenin, A Flandrin, Hervé Dechaud, and Pierre Boulot
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Reproductive Medicine ,Obstetrics and Gynecology ,General Medicine - Abstract
Resume Objectif Etablir si la realisation des manœuvres a membranes rompues sur deuxieme jumeau (J2) est un facteur de risque de cesarienne. Patientes et methodes Deux cent cinquante-neuf accouchements gemellaires par voie basse apres 33 semaines d’amenorrhee de 1997 a 2009 au sein d’une maternite de niveau III. Etude cas–temoins retrospective, comparant un groupe constitue de cesariennes sur J2 et un groupe temoin constitue des cinq accouchements par voie basse des grossesses gemellaires suivant le cas. Une prise en charge active de J2 etait effectuee avec un intervalle libre court entre les deux naissances. Resultats Onze cesariennes sur J2 (4,2 %) ont ete pratiquees. L’indication la plus frequente etait l’echec de la version par manœuvre interne. Le risque de cesarienne sur J2 etait plus eleve quand les membranes etaient rompues immediatement avant ou pendant la version par manœuvre interne (VMI) (OR : 25,4 IC 95 % [2,35–275,7] p Discussion et conclusion Dans notre experience, la rupture des membranes avant ou pendant la VMI est significativement associee a un risque d’echec de la manœuvre et de cesarienne sur J2. Par consequent, nous preconisons d’effectuer la VMI a membranes intactes conformement a l’accord professionnel des recommandations francaises de 2009.
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- 2012
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23. Accuracy of prenatal three-dimensional ultrasound in the diagnosis of cleft hard palate when cleft lip is present
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Jean-Michel Faure, M. Bäumler, Michèle Bigorre, Pierre Boulot, C. Bäumler-Patris, Christophe Demattei, and Guillaume Captier
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Male ,Palate, Hard ,medicine.medical_specialty ,Cleft Lip ,Population ,Dentistry ,Gestational Age ,Prenatal diagnosis ,Sensitivity and Specificity ,Ultrasonography, Prenatal ,Imaging, Three-Dimensional ,Pregnancy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,3D ultrasound ,Prospective Studies ,education ,Fetus ,education.field_of_study ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Obstetrics ,Ultrasound ,Infant, Newborn ,Reproducibility of Results ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,medicine.disease ,Cleft Palate ,Reproductive Medicine ,Bilateral cleft lip ,Female ,business - Abstract
Objective To investigate the accuracy of prenatal axial three-dimensional (3D) ultrasound in predicting the absence or presence of cleft palate in the presence of cleft lip. Methods Between March 2005 and January 2009, there were 81 cases with a prenatal two-dimensional (2D) ultrasound screening diagnosis of unilateral or bilateral cleft lip at 22–25 weeks of gestation referred to our tertiary care center. Of these, 79 fetuses were included in this prospective study and two were excluded. Axial 3D ultrasound imaging of the fetal palate was performed and the diagnoses were compared with clinical findings at delivery. The frequencies of intact and cleft palate, the degree of association between the prenatal predictions and postnatal findings and the probability of detection of cleft lip and palate were determined. Results Of 79 prenatal predictions, 77 (97%) were correct and the association between the prenatal predictions and postnatal findings was strong. The sensitivity for detection of cleft lip and palate within this high-risk population was 100% and the specificity was 90%. In one of the excluded cases, the palate could not be visualized due to a fetal prone position. There were chromosomal anomalies in 4% of cases and associated structural or growth anomalies in 23%, termination of pregnancy was carried out in 4% and intrauterine fetal demise occurred in 3%. Conclusion Axial 3D ultrasound of the fetal palate has high accuracy in identifying prenatal cleft palate when cleft lip is diagnosed at mid-trimester 2D ultrasound screening. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.
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- 2011
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24. Second- and third-trimester management of medical termination of pregnancy and fetal death in utero after prior caesarean section
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Jean-Luc Faillie, Anaïg Flandrin, Pierre Boulot, and Mélanie Cayrac
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Adult ,medicine.medical_specialty ,Time Factors ,Blood transfusion ,Pregnancy Trimester, Third ,medicine.medical_treatment ,Administration, Oral ,Abortion ,Uterine Rupture ,Pregnancy ,Risk Factors ,Humans ,Medicine ,Caesarean section ,Fetal Death ,Misoprostol ,Retrospective Studies ,Gynecology ,Abortifacient Agents, Nonsteroidal ,Dose-Response Relationship, Drug ,Cesarean Section ,business.industry ,Obstetrics ,Vaginal delivery ,Abortifacient Agents, Steroidal ,Obstetrics and Gynecology ,Abortion, Induced ,Mifepristone ,medicine.disease ,Uterine rupture ,Reproductive Medicine ,Pregnancy Trimester, Second ,Female ,business ,medicine.drug - Abstract
Objectives To evaluate the results and risks of a protocol for second- and third-trimester termination of pregnancy after prior caesarean section. Study design This is a retrospective study, conducted in a level 3 (university hospital) maternity unit between January 2001 and September 2008. 67 women with a history of caesarean section underwent second- and third-trimester termination of pregnancy. The protocol was administration of 600 mg mifepristone the first day and application of laminaria tents the second day. One the third day, 48 h after mifepristone, two 200 μg tablets of misoprostol were given orally every 3 h until delivery. Epidural analgesia was performed routinely. Complications analysed were uterine rupture, labour lasting over 12 h, and bleeding requiring blood transfusion. Results Delivery was vaginal in 64 cases (95.5%), a median 4 h 20 min (P25: 3 h 5 min, P75: 7 h 7 min) after administration of misoprostol (median number of tablets 2; P25: 2, P75: 4). The median number of tablets of misoprostol was significantly higher for termination of pregnancy than for fetal death in utero (4 vs. 2; p = 0.002). The rate of uterine rupture was 4.8% [95% CI: 1.2–14.2]. Bleeding during delivery requiring a transfusion occurred in 2 cases (3.0%; 95% CI: 0.5–11.3). Conclusion A high rate of vaginal delivery was achieved at low doses of misoprostol, with a short median induction-to-delivery interval, and a rate of uterine rupture higher than that observed during attempted vaginal delivery at term in a caesarean scar pregnancy. The rate of severe bleeding during delivery was low.
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- 2011
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25. Torsion d’annexe récidivante, sur ovaire sain, aux deuxième et troisième trimestre de grossesse
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P.-L. Giacalone, G. Rathat, C. Vincens, and Pierre Boulot
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Gynecology ,medicine.medical_specialty ,Reproductive Medicine ,Second trimester ,business.industry ,Adnexal torsion ,Oophoropexy ,medicine ,Obstetrics and Gynecology ,General Medicine ,business ,Third trimester - Abstract
We report the only case of recurrent bilateral adnexal torsion during pregnancy with normal ovaries. This rare situation raises diagnostic as well as therapeutic management difficulties.
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- 2010
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26. Early postpartum discharge and breastfeeding: An observational study from France
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Sébastien Fournier-Favre, Thierry-Pascal Baum, Jean-Charles Picaud, Pierre Boulot, Sophie Sabarros, Valérie Rey, Gilles Cambonie, and Evelyne Mazurier
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Adult ,medicine.medical_specialty ,Time Factors ,Multivariate analysis ,Obstetrics ,business.industry ,Postpartum Period ,Breastfeeding ,Length of Stay ,Planned Duration ,Patient Discharge ,Breast Feeding ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,Female ,Observational study ,France ,business ,Breast feeding ,Early discharge ,Postpartum period ,Early postpartum - Abstract
Background: Early postpartum discharge is a recent practice in France, but the influence of a shortened hospital stay on subsequent breastfeeding is unknown. The objective of the present study was to compare the breastfeeding mode after early discharge (ED) and conventional discharge (CD) from a hospital maternity unit. Methods: An observational study was conducted in a French university hospital among 135 breastfeeding mothers, who delivered between 1 January and 31 July 2006. Forty-five ED mothers were matched with 90 CD mothers on 13 criteria. A structured questionnaire was used to collect data regarding feeding practices at 10 weeks postpartum, the period corresponding to paid maternity leave. Results: Exclusive breast-, mixed, and bottle feedings were reported by, respectively, 35 (77.8%), three (6.7%) and seven (15.5%) ED mothers and 64 (71.1%), 12 (13.3%) and 14 (15.6%) CD mothers (no significant differences). Satisfaction with support for breastfeeding and reasons for switching to mixed or bottle feeding were comparable in the two groups. Multivariate analysis indicated that only the planned duration of breastfeeding and the mother's dissatisfaction with help significantly influenced breastfeeding prevalence. Conclusions: Early postpartum hospital discharge organized by skilled professionals is compatible with a satisfactory rate of exclusive breastfeeding up to the return to work. Formalized programs of instruction for perinatal professionals would help to reduce early abandonment.
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- 2010
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27. Hypodysfibrinogenaemia due to production of mutant fibrinogen alpha-chains lacking fibrinopeptide A and polymerisation knob ‘A’
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Christine Biron-Andréani, Lionel Reyftmann, Richard J. Fish, Philippe de Moerloose, Chandrasekaran Nagaswami, Pierre Boulot, John W. Weisel, Silja Vorjohann, and Marguerite Neerman-Arbez
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Male ,Fibrinogen/*genetics/metabolism ,DNA Mutational Analysis ,medicine.disease_cause ,Fibrinogen ,Compound heterozygosity ,Exon ,Fibrinogens, Abnormal/*genetics/metabolism ,Fibrinopeptide A/*genetics/metabolism ,Chlorocebus aethiops ,ddc:576.5 ,Blood coagulation test ,ddc:616 ,Genetics ,Mutation ,biology ,Fibrinogens, Abnormal ,Blood Coagulation/*genetics ,Hematology ,Afibrinogenemia ,Pedigree ,Phenotype ,COS Cells ,Female ,Blood Coagulation Tests ,medicine.drug ,Adult ,Heterozygote ,Adolescent ,RNA Splicing ,Blotting, Western ,Transfection ,Article ,Fibrin ,Cercopithecus aethiops ,Young Adult ,Thrombin ,medicine ,Animals ,Humans ,Genetic Predisposition to Disease ,Blood Coagulation ,Fibrinopeptide A ,Afibrinogenemia/blood/*genetics ,Molecular biology ,Introns ,Microscopy, Electron, Scanning ,biology.protein ,Protein Multimerization ,Minigene - Abstract
SummaryInherited disorders of fibrinogen are rare and affect either the quantity (hypofibrinogenaemia and afibrinogenaemia) or the quality of the circulating fibrinogen (dysfibrinogenaemia) or both (hypodysfibrinogenaemia). Extensive allelic heterogeneity has been found for all these disorders: in congenital afibrinogenaemia for example more than 40 mutations, the majority in FGA, have been identified in homozygosity or in compound heterozygosity. Numerous mutations have also been identified in patients with hypofibrinogenaemia, many of these patients are in fact heterozygous carriers of afibrinogenaemia mutations. Despite the number of genetic analyses performed, the study of additional patients still allows the identification of novel mutations. Here we describe the characterization of a novel FGA intron 2 donor splice-site mutation (Fibrinogen Montpellier II) identified in three siblings with hypodysfibrinogenaemia. Functional analysis of RNA produced by the mutant minigene in COS-7 cells revealed that the mutation led to the in-frame skipping of exon 2. Western blot analysis of COS-7 cells expressing an exon 2 deleted FGA cDNA revealed that an alpha-chain lacking exon 2, which codes in particular for fibrinopeptide A and polymerisation knob ‘A’, has the potential to be assembled into a hexamer and secreted. Analysis of precipitated fibrinogen from patient plasma showed that the defect leads to the presence in the circulation of alpha-chains lacking knob ‘A’ which is essential for the early stages of fibrin polymerisation. Fibrin made from purified patient fibrinogen clotted with thrombin displayed thinner fibers with frequent ends and large pores.
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- 2010
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28. Rapidly involuting congenital diaphragmatic hemangioma
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Alain Couture, Olivier Prodhomme, Jean-Charles Picaud, Florence Masson, Gilles Cambonie, Pierre Boulot, and Magali Saguintaah
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medicine.medical_specialty ,Pathology ,medicine.diagnostic_test ,business.industry ,Diaphragmatic breathing ,Magnetic resonance imaging ,medicine.disease ,Abdominal wall ,Hemangioma ,medicine.anatomical_structure ,medicine ,Hydrothorax ,Pericardium ,Radiology, Nuclear Medicine and imaging ,Involution (medicine) ,Radiology ,Congenital Hemangioma ,business - Abstract
Rapidly involuting congenital hemangiomas are rare tumors, usually localized in the dermal-hypodermic tissue. They are fully developed at birth and present as solitary masses that do not proliferate postnatally. We report on a fetus that presented with hydramnios and left hydrothorax. Postnatal ultrasounds and computed tomography imaging showed a congenital hemangioma invading the left diaphragmatic dome and extending to the abdominal wall, pericardium, and liver. The mass was well tolerated, showing regular involution on serial ultrasounds and complete involution by the end of the second year of life. Rapidly involuting congenital hemangiomas can exceptionally affect the diaphragmatic region in the perinatal period. This observation demonstrates the relevance of current radiologic techniques, which are minimally invasive, for the diagnosis and follow-up of this particularly rare and potentially life-threatening lesion.
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- 2009
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29. Epiphyseal punctate calcifications (stippling) in complete trisomy 9
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Jean-Michel Faure, David Geneviève, Haissam Rahil, Pierre Boulot, Anouck Schneider, Nami Wadih, Marie-José Perez, Nicole Bigi, Patricia Blanchet, Alain Couture, Pierre Sarda, Anne-Marie Chaze, Geneviève Lefort, and Caroline Rouleau
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Adult ,Pathology ,medicine.medical_specialty ,Aneuploidy ,Trisomy ,Biology ,Trisomy 9 ,Ultrasonography, Prenatal ,Pregnancy ,medicine ,Humans ,Genetics (clinical) ,Stippling (dentistry) ,Bone Diseases, Developmental ,Calcinosis ,Obstetrics and Gynecology ,Epiphyseal punctate calcifications ,Anatomy ,medicine.disease ,Epiphyseal calcification ,Female ,Chromosomes, Human, Pair 9 ,Epiphyses ,Abortion, Eugenic ,Epiphyseal stippling ,Calcification - Published
- 2009
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30. Évaluation du cerclage isthmique par voie cœlioscopique
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G. Nicolet, Hervé Dechaud, M. Cohen, Pierre Boulot, Lionel Reyftmann, and L. Begue
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Coelioscopy ,Gynecology ,medicine.medical_specialty ,Reproductive Medicine ,Fetal death ,business.industry ,medicine ,Obstetrics and Gynecology ,General Medicine ,Incompetent cervix ,business ,medicine.disease - Abstract
Resume Objectif Le cerclage isthmique par voie abdominale est indique dans les echecs de cerclage par voie vaginale, les pertes fœtales recurrentes du second trimestre et les conisations etendues ou delabrements cervicaux. L’approche cœlioscopique plus recemment decrite doit demontrer, outre sa faisabilite technique, son interet en termes de prevention des accidents obstetricaux. Patientes et methodes Il s’agit d’une evaluation retrospective monocentrique sur 14 cas de cerclage isthmique cœlioscopique selon la technique de Benson, realises hors grossesse entre mai 2005 et novembre 2007. Nous avons analyse les antecedents obstetricaux, les etiologies de beances cervico-isthmiques, les therapeutiques deja mises en œuvre pour leur prise en charge et le devenir de ces patientes apres cerclage. Resultats L’âge moyen des patientes est 33,5 ans. Quatre-vingt-treize pour cent d’entres elles avaient au moins un antecedent d’avortement tardif ou d’accouchement premature et 42,9 % avaient deja eu un echec de cerclage par la technique de Mac Donald. Les indications de cerclage par voie haute ont ete portees dans six cas pour antecedent d’echec de cerclage par voie vaginale et dans huit cas pour impossibilite anatomique du cerclage par voie vaginale. La duree operatoire des cerclages a ete de 45 minutes (35–60 minutes) et la duree d’hospitalisation d’un jour. Aucune complication n’est, a ce jour, survenue en per- ou postoperatoire. Sur les 14 cerclages realises, six ont abouti a une grossesse. Cinq grossesses ont ete menees a terme avec naissance d’enfants vivants. Une grossesse s’est terminee par un avortement spontane du premier trimestre. Discussion et conclusion Le cerclage isthmique par voie cœlioscopique est techniquement realisable et apporte aux patientes les avantages de la cœlioscopie. L’indication doit etre correctement posee et doit repondre aux memes criteres que le cerclage par laparotomie. L’evolution des grossesses cerclees par cette technique semble etre favorable.
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- 2009
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31. La grossesse chez la femme obèse : des conséquences sous-estimées ?
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Isabelle Raingeard, Pierre Boulot, Eric Renard, F. Galtier, and Jacques Bringer
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medicine.medical_specialty ,Pregnancy ,Obstetrics ,business.industry ,General Medicine ,Type 2 diabetes ,Overweight ,medicine.disease ,Obesity ,Childhood obesity ,Gestational diabetes ,medicine ,Gestation ,medicine.symptom ,business ,Weight gain - Abstract
As the prevalence of obesity grows in western countries, maternal obesity is becoming an increasingly frequent high-risk obstetrical situation. Obese women have a higher incidence of pregnancy complications (gestational diabetes, hypertension, toxaemia, etc.) and of adverse fetal outcomes (macrosomia, neural tube defects, perinatal mortality). Cesarean section is more frequent in obese women, resulting in a higher risk of anaesthetic and post-operative complications. Maternofetal complications are proportional to the degree of obesity, and even moderate overweight amplifies the risk. Long-term complications include worsening of maternal obesity, maternal type 2 diabetes, and childhood obesity and metabolic disorders. Before conception, these patients should receive tailored weight-loss advice and be screened for obesity complications. Food intake during pregnancy should be tailored to achieve the minimum maternal weight gain required for normal fetal growth. Long-term follow-up is required to prevent worsening of maternal obesity after delivery, and the child's growth curve should be closely watched
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- 2008
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32. Optimizing the outcome of pregnancy in obese women: From pregestational to long-term management
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Jacques Bringer, Eric Renard, F. Galtier, Isabelle Raingeard, and Pierre Boulot
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medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Type 2 diabetes ,Overweight ,Fetal Macrosomia ,Endocrinology ,Pregnancy ,Risk Factors ,Internal Medicine ,medicine ,Fetal macrosomia ,Humans ,Obesity ,Chromosome Aberrations ,Obstetrics ,business.industry ,Infant, Newborn ,Pregnancy Outcome ,General Medicine ,medicine.disease ,Pregnancy Complications ,Gestational diabetes ,Diabetes Mellitus, Type 2 ,Gestation ,Female ,medicine.symptom ,business ,Weight gain - Abstract
The obesity epidemic is of some concern in women of reproductive age. Maternal obesity is associated with many pregnancy complications, especially gestational diabetes and hypertensive disorders of pregnancy. Delivery in obese women is characterized by a high caesarean-section rate and an increased risk of anaesthetic and postoperative complications. Weight retention after birth may increase the risk of type 2 diabetes in the long term. Foetal risks include macrosomia, malformations and increased perinatal mortality, with the long-term infant health marked by a higher risk of obesity and metabolic disorders. Optimal management includes preconception counselling, pregravid weight-loss programmes, monitoring of gestational weight gain, repeated screening for pregnancy complications and long-term follow-up to minimize the social and economic consequences of pregnancy in overweight women.
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- 2008
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33. Prenatal assessment of the normal fetal soft palate by three-dimensional ultrasound examination: is there an objective technique?
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Pierre Boulot, Michèle Bigorre, M. Bäumler, Jean-Michel Faure, and Guillaume Captier
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medicine.medical_specialty ,Population ,Prenatal diagnosis ,Sensitivity and Specificity ,Ultrasonography, Prenatal ,Imaging, Three-Dimensional ,Pregnancy ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,3D ultrasound ,Prospective Studies ,education ,Prospective cohort study ,Observer Variation ,education.field_of_study ,Fetus ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Obstetrics and Gynecology ,Gestational age ,Soft tissue ,General Medicine ,Anatomy ,Cleft Palate ,Reproductive Medicine ,Pregnancy Trimester, Second ,Female ,Radiology ,Palate, Soft ,business - Abstract
Objectives To describe a three-dimensional (3D) ultrasound technique for assessing the fetal soft palate. Methods A prospective study conducted from April to December 2006 included 87 fetuses in a low-risk population. Fetal ultrasound scans were performed between 21 and 25 weeks of gestation to determine the normal 3D ultrasound view of the fetal soft tissues of the palate. The sonographers used a 30°-inclined axial 3D view of the fetal palate. Ultrasound images obtained in this view were compared with fetopathological specimens of the same gestational age by two observers, both pediatric surgeons. Each observer indicated whether they thought that the uvula or the velum could be detected, and the differences in responses between the observers were assessed. Results The frequencies of detection of the uvula and velum of each observer varied between 80% and 90%. The observers showed a significant difference in judging the visualization of the uvula, but not in judging the velum. Conclusions A 30°-inclined axial 3D ultrasound view seems to be effective in assessing the integrity of the fetal soft palate. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.
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- 2008
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34. Prenatal diagnosis of an isolated incomplete V-shaped cleft palate using a new three-dimensional ultrasound technique investigation
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Guillaume Captier, M. Bäumler, Pierre Boulot, Jean-Michel Faure, and Michèle Bigorre
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Adult ,medicine.medical_specialty ,Prenatal diagnosis ,Ultrasonography, Prenatal ,Pathology and Forensic Medicine ,Imaging, Three-Dimensional ,Pregnancy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Three dimensional ultrasound ,Fetus ,Oral cleft ,business.industry ,Ultrasound ,Pregnancy Outcome ,medicine.disease ,Surgery ,Cleft Palate ,Plastic surgery ,medicine.anatomical_structure ,Female ,Hard palate ,Radiology ,Anatomy ,business - Abstract
The objective of this case report is to evaluate the faculty of a recently described original three-dimensional ultrasound technique to detect pathological processes of the fetal palate. The palate of the fetus of a patient with a personal history of isolated incomplete cleft palate is evaluated by three-dimensional ultrasound at 34 weeks of gestation. The postnatal findings are compared to the prenatal investigation. The used three-dimensional ultrasound technique provides selective visualization of the total hard palate which permits the prenatal diagnosis and multidisciplinary approach of an incomplete cleft palate. These prenatal findings might encourage further studies to confirm the value of this recently described innovative technique in the diagnosis and surgical prenatal counselling of fetal cleft palate.
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- 2007
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35. Un suivi multidisciplinaire et un soutien psychosocial diminuent les complications de la dépendance aux opiacés chez les femmes enceintes
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Charlotte Brulet, Evelyne Mazurier, Corinne Chanal, Patrice Ravel, Vincent Faucherre, and Pierre Boulot
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medicine.medical_specialty ,Fetus ,Pediatrics ,Pregnancy ,business.industry ,Obstetrics ,Public health ,Addiction ,media_common.quotation_subject ,General Medicine ,Prenatal care ,medicine.disease ,Substance abuse ,Medicine ,business ,Prospective cohort study ,media_common ,Buprenorphine ,medicine.drug - Abstract
Summary Purpose Drug abuse during pregnancy is an important public health problem. Montpellier University Hospital established a center for addiction and pregnancy in 1997 to provide multidisciplinary prenatal care aimed at reducing maternal and fetal risks during pregnancy and afterwards. This study assesses the trends in drug-taking behavior and pregnancy outcome among women receiving this prenatal care. Methods This exploratory prospective study examined participants in this program during its first 5 years (1997-2002). Women were included if they had been: pregnant, addicted to opiates, enrolled in the program for at least 15 days, and if their delivery took place at Montpellier Hospital. We recorded how often they came to prenatal care, drug-taking behavior, social and economic level, and obstetrical and neonatal outcomes. Results The study included 114 women. Those receiving drug substitution at the onset of pregnancy mainly saw general practitioners (64/89 at the beginning of pregnancy), who most often prescribed buprenorphine (70/105 at the end of pregnancy). More than two thirds of patients (n=78) abused several substances. Heroine abuse decreased (p Conclusion Multidisciplinary prenatal care with medical, social, and psychological support can decrease opiate abusers' risks during pregnancy even when the drug treatment program is essentially unsupervised.
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- 2007
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36. Fetal Toxic Effects of Angiotensin II Receptor Antagonists: Case Report and Follow-Up after Birth
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Marie-Andrée Bos-Thompson, Evelyne Mazurier, Françoise Muller, Dominique Hillaire-Buys, Hervé Dechaud, Pierre Boulot, and Denis Morin
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Male ,medicine.medical_specialty ,Angiotensin receptor ,Pregnancy Complications, Cardiovascular ,Levothyroxine ,Tetrazoles ,Gestational Age ,Hydrochlorothiazide ,Pregnancy ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Renal Insufficiency ,Antihypertensive Agents ,Angiotensin II receptor type 1 ,business.industry ,Infant, Newborn ,Infant ,Gestational age ,Valine ,Amniotic Fluid ,medicine.disease ,Angiotensin II ,Endocrinology ,Valsartan ,Child, Preschool ,Prenatal Exposure Delayed Effects ,Hypertension ,Female ,beta 2-Microglobulin ,business ,Angiotensin II Type 1 Receptor Blockers ,Follow-Up Studies ,medicine.drug ,Kidney disease - Abstract
OBJECTIVE: To report a child born with renal impairment following severe anhydramnios due to maternal exposure to an angiotensin II receptor type 1 (AT1) antagonist, valsartan, and hydrochlorothiazide during the first 28 weeks of pregnancy. CASE SUMMARY: A hypertensive woman treated with valsartan 80 mg/day, hydrochlorothiazide 12.5 mg/day, prazosin 10 mg/day, lysine acetylsalicylate 100 mg/day, and levothyroxine 250 μg/day became pregnant. At 28 weeks' gestational age, severe anhydramnios associated with high β2-microglobulin levels in the fetal blood cord was observed. Upon discontinuation of valsartan, fetal renal prognosis improved. In this case, using the Naranjo probability scale, the renal insufficiency of the child was probably related to valsartan. At the age of 2.5 years, the child presented with only mild chronic renal insufficiency. Growth parameters were within the normal range, and there was no evidence of developmental delay. DISCUSSION: Exposure to AT1 antagonists during the second part of pregnancy can lead to abnormalities similar to those observed after exposure to angiotensin-converting enzyme inhibitors, that is, reduced fetal kidney perfusion that may result in oligoamnios and neonatal renal insufficiency. Fourteen previous reports of maternal exposure to AT1 antagonists during this period have been published. In 6 cases, fetal or neonatal death occurred; in 2 cases, pregnancy was terminated because of complete anhydramnios or fetal abnormalities; in 1 case, renal insufficiency persisted at 8 months of age; in 2 cases, kidney function was fairly normal at birth; and in 4 cases, including the one described here, neonatal renal failure improved in the first year of life. CONCLUSIONS: AT1 antagonists should be avoided throughout pregnancy. If these agents are prescribed accidentally to a pregnant woman, monitoring of amniotic fluid volume and β2-microglobulin fetal blood levels after discontinuation of the AT1 antagonist can provide critical data for advising parents on pregnancy and fetal outcome.
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- 2005
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37. Prenatal diagnosis of megacystis-microcolon-intestinal hypoperistalsis syndrome: contribution of amniotic fluid digestive enzyme assay and fetal urinalysis
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Françoise, Muller, Sophie, Dreux, Pascal, Vaast, Yves, Dumez, Israel, Nisand, Yves, Ville, Pierre, Boulot, Jean, Guibourdenche, Marc, Althusser, Gérard, Blin, Evelyne, Gautier, Catherine, Lespinard, Franck, Perrotin, Patrice, Poulain, and Marie-France, Sarramon
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Male ,medicine.medical_specialty ,Pathology ,Amniotic fluid ,Adolescent ,Urinalysis ,Prenatal diagnosis ,Urine ,Gastroenterology ,Predictive Value of Tests ,Pregnancy ,Prenatal Diagnosis ,Internal medicine ,medicine ,Humans ,Child ,Genetics (clinical) ,Retrospective Studies ,Fetus ,medicine.diagnostic_test ,business.industry ,Intestinal Pseudo-Obstruction ,Infant, Newborn ,Pregnancy Outcome ,Infant ,Obstetrics and Gynecology ,Megacystis ,Microcolon ,Amniotic Fluid ,medicine.disease ,Enzymes ,Fetal Diseases ,Child, Preschool ,Female ,business ,Hypoperistalsis - Abstract
Objectives Megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) is a usually lethal disease during the first year of life. There is no specific ultrasound prenatal diagnosis and no identified genetic locus. The value of amniotic fluid digestive enzyme assay and fetal urine biochemistry in the prediction of MMIHS was analysed. Methods Retrospective study of 14 MMIHS cases. Amniotic fluid digestive enzymes and fetal urine biochemistry were compared in MMIHS and megabladder (63 and 264 cases respectively). Results Abnormal amniotic fluid digestive enzyme profile (vomiting of bile or digestive secretion leakage) was observed in 8/10 MMIHS cases. These profiles were observed in 7/63 controls; 80% sensitivity (95%CI = 55%–100%); 89% specificity (95%CI = 81%–96%). Fetal urinalysis was normal in 12/12 MMIHS cases except high calcium (>0.6 mmol/l). This profile was observed in 33/264 megabladder control cases; 100% sensitivity; 98.7% specificity (95%CI = 83.5%–91.5%). Conclusion For the first time, we propose a prenatal diagnosis of MMIHS based on amniotic fluid digestive enzyme assay and on fetal urinalysis. Copyright © 2005 John Wiley & Sons, Ltd.
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- 2005
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38. French Multicentric Survey of Outcome of Pregnancy in Women With Pregestational Diabetes
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Alain Fournier, Claude d'Ercole, Brigitte Pfister, Anne Vambergue, Jean Yves Gillet, Pierre Fontaine, Odile Verier-Mine, Médéric Hoffet, Michele Floriot, Ann Marie Geudj, Eric Renard, Alain Miton, Pierre Boulot, Anne Sylvie Valat, Marie Françoise Lamotte, Sylvie Hauguel-de-Mouzon, Nathalie Chabbert-Buffet, Henri Gin, Françoise Lorenzi, Michel Rodier, Brigette Guionnet, Jacques Lepercq, Philippe Roth, Alfred Penfornis, Veronique Lejeune, Sylvie Grandperret-Vauthier, Dominique Jullien, José Timsit, Guy-Alain Sery, Sylvie Hiéronimus, and Pierre Marès
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medicine.medical_specialty ,Cross-sectional study ,Endocrinology, Diabetes and Metabolism ,Pregnancy in Diabetics ,Type 2 diabetes ,Preconception Care ,Pregnancy ,Diabetes mellitus ,Prevalence ,Internal Medicine ,medicine ,Humans ,Glycemic ,Advanced and Specialized Nursing ,Type 1 diabetes ,business.industry ,Obstetrics ,Pregnancy Outcome ,Odds ratio ,medicine.disease ,Cross-Sectional Studies ,Diabetes Mellitus, Type 1 ,Logistic Models ,Diabetes Mellitus, Type 2 ,Female ,France ,business - Abstract
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.
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- 2003
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39. Thrombosis of torcular herophili: diagnosis, prenatal management, and outcome
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Romy, Rayssiguier, Coralie, Dumont, Sabrina, Flunker, Alain, Couture, Pierre, Boulot, and Olivier, Prodhomme
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Central Nervous System Vascular Malformations ,Male ,Infant, Newborn ,Pregnancy Outcome ,Infant ,Prognosis ,Magnetic Resonance Imaging ,Ultrasonography, Prenatal ,Fetal Diseases ,Pregnancy ,Child, Preschool ,Humans ,Female ,Retrospective Studies - Abstract
The objective of this article is to describe and assess prenatal imaging findings, fetal and postnatal outcomes of thrombosis of torcular herophili, and to determine diagnostic features, pathophysiology, prognosis, and optimal management.Over a decade, we compiled the largest single-center retrospective study of outcomes. Fetal magnetic resonance imaging (MRI) was used to confirm the sonographic suspicion and monitor thrombosis of torcular herophili. We noted prenatal and postnatal imaging specifications, pregnancy outcomes, and clinical and radiological pediatric monitoring. Analysis of findings and review of the literature allowed us to define prognostic factors.In eight cases of prenatal diagnosis of thrombosis of torcular herophili, MRI outcomes were specific. There were five deliveries at full term, two terminations of pregnancy, and one fetal demise in utero. Neonates had a good clinical and radiological outcome. Factors of poor prognosis were deep venous sinus thrombosis, enduring mass effect, brain parenchymal injury, and heart failure related to dural arteriovenous shunt.Among dural sinus malformations, thrombosis of torcular herophili with or without extension at the posterior segment of the longitudinal sinus frequently has a good prognosis. It is urgent to wait because the prognosis can only be ascertained over time by means of ultrasound scan and MRI monitoring.
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- 2014
40. The effects of mifepristone on uterine sensitivity to oxytocin and on fetal heart rate patterns
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Jean-Michel Faure, Bernard Hedon, Pierre Boulot, Jean-Pierre Daurès, P L Giacalone, and François Laffargue
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Adult ,Bradycardia ,medicine.medical_specialty ,Gestational Age ,Oxytocin ,Hormone Antagonists ,Pregnancy ,Heart rate ,Odds Ratio ,medicine ,Humans ,Labor, Induced ,Cervix ,Progesterone ,Retrospective Studies ,Fetus ,business.industry ,Obstetrics ,Uterus ,Obstetrics and Gynecology ,Gestational age ,Mifepristone ,Heart Rate, Fetal ,medicine.disease ,body regions ,Logistic Models ,medicine.anatomical_structure ,Reproductive Medicine ,Anesthesia ,Prostaglandins ,Hypertonia ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
Objective : To compare the incidences of tachysystole, hypertonia and fetal heart rate (FHR) abnormalities in women treated by mifepristone plus prostaglandins (PGs), mifepristone alone or PGs alone for an unfavourable cervix. Study Design : In this retrospective study, all women between 37 and 42 weeks were eligible for the study if they had undergone cervical ripening prior to labour induction. In group 1, the women were treated with mifepristone plus PGs ( n =103). Group 2 women were treated with mifepristone alone ( n =96) and group 3 women with PGs alone ( n =100). Incidences of tachysystole, hypertonia and FHR abnormalities were compared. Results : During induction of labour, tachysystole and hypertonia occurred more frequently in women treated with mifepristone. Severe bradycardia and recurrent late decelerations were more frequent after the initiation of oxytocin in groups 1 and 2 than in group 3. Conclusions : In this study, mifepristone increased the incidences of tachysystole, hypertonia and FHR abnormality.
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- 2001
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41. A randomised evaluation of two techniques of management of the third stage of labour in women at low risk of postpartum haemorrhage
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François Laffargue, P.-L. Giacalone, Jacques Vignal, Jean Pierre Daures, Pierre Boulot, and Bernard Hedon
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Adult ,medicine.medical_specialty ,Cord ,Umbilical cord ,Umbilical Cord ,Hemoglobins ,Pregnancy ,Risk Factors ,Placenta ,medicine ,Humans ,business.industry ,Postpartum Hemorrhage ,Confounding ,Obstetrics and Gynecology ,Prenatal Care ,Stepwise regression ,medicine.disease ,Postpartum haemorrhage ,Surgery ,medicine.anatomical_structure ,Drainage ,Female ,business ,Labor Stage, Third ,Placenta, Retained ,Student's t-test - Abstract
Objective To determine whether early placental drainage plus cord traction reduces the incidences of manual removal and blood loss, and to determine the risk factors associated with blood loss after delivery. Design Prospective randomised study. Setting University teaching hospital, Montpellier, France. Methods A randomised study compared 239 women who had placental cord drainage plus cord traction with 238 women with expectant delivery. The need for manual removal of the placenta and the drop in haemoglobin after delivery were assessed. The duration of the third stage of labour and the time between birth and the beginning of perineal suturing were measured. Statistical analysis used the paired t test for continuous variables, the Kruskal-Wallis test for nonparametric data and χ2 test for categoric variables. Stepwise logistic regression analyses were performed with a drop in haemoglobin as the outcome variable. Results No significant difference was found in the two groups with regard to the incidence of manual removal of retained complete or incomplete placenta or postpartum haemorrhage. The median values of the duration of the third stage of labour, birth-to-perineal suture time and drop in haemoglobin were significantly lower in the cord drainage group than in the control group. After controlling for confounding variables, parity proved to be the only significant predictor of drop in haemoglobin. Conclusion Cord drainage decreases the duration of the third stage of labour and reduces blood loss but not the incidence of manual removal of the placenta.
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- 2000
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42. Fetal cells in maternal blood: the use of primedin situ (PRINS) labelling technique for fetal cell detection and sex assessment
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Béatrice Orsetti, Brigitte Andréo, Franck Pellestor, Pierre Boulot, and Geneviève Lefort
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Adult ,Male ,Pathology ,medicine.medical_specialty ,X Chromosome ,Cell ,Aneuploidy ,Prenatal diagnosis ,Cell Separation ,Biology ,Polymerase Chain Reaction ,Peripheral blood mononuclear cell ,Andrology ,Pregnancy ,Y Chromosome ,Labelling ,Centrifugation, Density Gradient ,medicine ,Humans ,Taq Polymerase ,Genetics (clinical) ,DNA Primers ,Cell Nucleus ,Differential centrifugation ,Fetus ,Obstetrics and Gynecology ,Chromosome ,Sex Determination Processes ,Fetal Blood ,medicine.disease ,medicine.anatomical_structure ,Microscopy, Fluorescence ,Karyotyping ,Female - Abstract
Prenatal diagnosis is presently performed following invasive procedures with variable risks of fetal loss; non-invasive procedures using fetal cells in maternal blood would be welcome for the early detection of fetal sex or aneuploidy. We describe a simple and rapid protocol to detect fetal cells and thus to assess fetal sex. In a first step, nucleated blood cells were separated into mononuclear and polynuclear cells using a double density gradient centrifugation. In a second step primed in situ (PRINS) labelling technique was performed to label Y-chromosomes. 15 samples were studied and correct gender assignment was made in 13/15. The number of labelled nuclei was higher in polynuclear cell phases than in mononuclear cell phases. Moreover, the polylobular aspect of labelled nuclei from polynuclear cell phases strongly suggested that they could belong to fetal polynuclear cells. The PRINS technique combines some advantages of FISH, such as visual assessment of in situ chromosome labelling and the powerful specificity and sensitivity of PCR. In association with a simple enrichment procedure it constitutes a rapid protocol for fetal cell detection, non-invasive early prenatal sex assessment, and could further be applied to detect the main viable aneuploidies.
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- 1998
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43. Fatty acid desaturase activities and polyunsaturated fatty acid composition in human liver between the seventeenth and thirty-sixth gestational weeks
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Pierre Sarda, Claude Louis Legera, Pierre Boulot, Jean-Pierre Poisson, Annie Rodrigueza, Catherine Nessmann, and Bernard Descomps
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Fatty Acid Desaturases ,medicine.medical_specialty ,Docosahexaenoic Acids ,Gestational Age ,Fatty Acids, Monounsaturated ,Pregnancy ,Fatty Acids, Omega-6 ,Internal medicine ,Fatty Acids, Omega-3 ,medicine ,Humans ,chemistry.chemical_classification ,Fetus ,Arachidonic Acid ,biology ,business.industry ,Obstetrics and Gynecology ,Fatty acid ,Gestational age ,medicine.disease ,Endocrinology ,Fatty acid desaturase ,Liver ,chemistry ,Docosahexaenoic acid ,Fatty Acids, Unsaturated ,Microsomes, Liver ,biology.protein ,Gestation ,Female ,business ,Polyunsaturated fatty acid - Abstract
Objective: The aim of the study was to characterize n-3 and n-6 fatty acid Δ5- and Δ6-desaturase activities and their time course variations in human fetal liver between the 17th and 36th gestational week. Study Design: Twenty-one biologic samples were obtained after legally approved medical abortion, according to French law. The desaturase activities were measured in the 21 liver samples by a radiochemical method by means of reverse-phase high-performance liquid chromatography. The fatty acid composition (percentage by weight) of liver phospholipids was assessed in 16 samples by gas-liquid chromatographic analysis. Results: Both Δ5- and Δ6-desaturase activities were significantly expressed between the 17th and 36th gestational weeks. During the second trimester n-6 fatty acid Δ5- and Δ6-desaturase activities showed opposite patterns of variation; both then remained stable between the 25th and 36th weeks. Δ6-Desaturation was higher in n-3 than n-6 fatty acids and peaked at the 18th gestational week. The percentages of linoleic and docosahexaenoic acids in liver microsomes were positively correlated with the gestation age ( P Conclusion: Significant n-3 and n-6 Δ5- and Δ6-desaturase activities are expressed in human fetal liver as early as the 17th gestational week and are stable throughout the third trimester. Their theoretic capacity evaluated from in vitro measurements appears lower than polyunsaturated fatty acid requirements and is not directly related to liver microsomal membrane fatty acid composition. (Am J Obstet Gynecol 1998;179:1063-70.)
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- 1998
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44. Δ6- and Δ5-desaturase activities in the human fetal liver: kinetic aspects
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Claude L. Léger, Bernard Descomps, Catherine Nessmann, Annie Rodriguez, Pierre Boulot, and Pierre Sarda
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chemistry.chemical_classification ,Chromatography ,biology ,Chemistry ,desaturase activity ,Phospholipid ,kinetic ,Substrate (chemistry) ,Cell Biology ,QD415-436 ,liver ,High-performance liquid chromatography ,human fetus ,Biochemistry ,Enzyme assay ,chemistry.chemical_compound ,Endocrinology ,Enzyme ,In vivo ,biology.protein ,Microsome ,Linoleoyl-CoA desaturase ,microsomes ,endogenous substrate - Abstract
Δ6- and Δ5-desaturase activities were studied in human fetal liver microsomes obtained after legally approved therapeutic abortion. Enzyme activities were measured by a radiochemical method using reverse-phase high performance liquid chromatography (HPLC). Free and phospholipid fatty acids were assessed in each liver sample by a combination of thin-layer chromatography (TLC) and gas–liquid chromatography (GLC) procedures. The kinetic measurements showed higher Δ6-desaturase activity for the n–3 series than for the n–6 series. Apparent Km of 6.5, 3.9, and 24.5 μm and Vm of 7.5, 9.1, and 24.4 pmol·min-1·mg-1 were obtained, respectively, for 18:2n–6 Δ6-, 20:3n–6 Δ5-, and 18:3n–3 Δ6-desaturases. Beyond 30, 20, and 60 μm of 18:2n–6, 20:3n–6, and 18:3n–3 concentration, respectively, the enzyme activity deviated from Michaelis-Menten kinetics, suggesting an inhibition by excess substrate which is unlikely to occur in vivo as endogenous substrate concentration is much lower. We observed a breakdown in linearity between desaturase activity and microsomal protein concentration beyond 4–5 mg microsomal protein, whatever the enzyme or substrate. Both this phenomenon and the inhibition due to excess substrate should be taken into account in the determination of Δ6- and Δ5-desaturase activities. Comparison of concentrations of the respective endogenous substrates and the kinetic constants of each enzyme suggested that the higher Δ6-desaturase activity observed for the n–3 series than for the n–6 series is not physiologically relevant in human fetal liver.—Rodriguez, A., P. Sarda, C. Nessmann, P. Boulot, C. L. Leger, and B. Descomps. Δ6- and Δ5-desaturase activities in the human fetal liver: kinetic aspects.
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- 1998
45. First-Trimester Multifetal Pregnancy Reduction: Evaluation of Technical Aspects and Risks from 2,756 Cases in the Literature
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Pierre Boulot, Bernard Hedon, Marie Christine Picot, and Hervé Dechaud
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Risk analysis ,Embryology ,medicine.medical_specialty ,Surgical approach ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,Gestational Age ,General Medicine ,Pregnancy Reduction, Multifetal ,Abortion, Spontaneous ,Pregnancy Trimester, First ,First trimester ,Pregnancy ,Risk Factors ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,Multifetal pregnancy ,Female ,Radiology, Nuclear Medicine and imaging ,Pregnancy, Multiple ,business - Abstract
Objective: To evaluate the technical aspects, efficacy and safety of first-trimester multifetal pregnancy reduction in the management of multifetal pregnancies, an analysis of the international literature on first-trimester multifetal pregnancy reduction was made. Materials: Thirty-three studies were selected from an international review of the literature. Total fetal loss rate, risk of fetal loss after the procedure with the different techniques and gestational age at delivery were the main parameters studied. The Kruskal-Wallis test and Mann-Whitney test were used for statistical analysis. Results: 2,756 multifetal pregnancy reductions were performed (2,145 transabdominal, 363 transcervical, and 248 transvaginal procedures). Total fetal loss rates were different: 16.7% for the transabdominal, 24.8% for the transcervical and 10.9% for the transvaginal procedure (p = 0.03). The risk of fetal loss was 12% for the transabdominal, 20% for the transcervical, and 10% for the transvaginal approach at less 24 weeks of gestation (p = 0.04). There was no difference for the gestational age at the time of the procedure, the initial and final number of embryos, and the gestational age at delivery. Conclusion: Because the transvaginal approach seems to be the safer procedure, surgeons may opt for it. The transcervical approach has a high fetal loss rate and should be excluded.
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- 1998
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46. Discordant sex in monozygotic XXY/XX twins: a case report
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Anouck Schneider, Pierre Boulot, O. Prodhomme, S. Taviaux, Jacques Puechberty, Isabelle Touitou, Pierre Meyer, Claire Jeandel, Gaelle Tachon, Franck Pellestor, David Geneviève, Vincent Gatinois, Geneviève Lefort, Philips, Alexandre, Département de génétique médicale, maladies rares et médecine personnalisée [CHRU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Montpellier, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), and Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
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Male ,DNA Copy Number Variations ,[SDV]Life Sciences [q-bio] ,Karyotype ,Twins ,Biology ,Y chromosome ,03 medical and health sciences ,0302 clinical medicine ,Klinefelter Syndrome ,medicine ,Humans ,Testosterone ,Copy-number variation ,ComputingMilieux_MISCELLANEOUS ,Genetics ,0303 health sciences ,Comparative Genomic Hybridization ,030219 obstetrics & reproductive medicine ,Male Phenotype ,Mosaicism ,Twinning, Monozygotic ,030305 genetics & heredity ,Rehabilitation ,Obstetrics and Gynecology ,Chromosome ,medicine.disease ,Zygosity ,[SDV] Life Sciences [q-bio] ,Phenotype ,Reproductive Medicine ,Child, Preschool ,Female ,Klinefelter syndrome ,Gonadotropins ,Comparative genomic hybridization - Abstract
We report a case of discordant phenotypic sex in monozygotic twins mosaic 47,XXY/46,XX: monozygotic heterokaryotypic twins. The twins presented with cognitive and comprehension delay, behavioural and language disorders, all symptoms frequently reported in Klinefelter syndrome. Molecular zygosity analysis with several markers confirmed that the twins are in effect monozygotic (MZ). Array comparative genomic hybridization found no evidence for the implication of copy number variation in the phenotypes. Ultrasound scans of the reproductive organs revealed no abnormalities. Endocrine tests showed a low testosterone level in Twin 1 (male phenotype) and a low gonadotrophin level in Twin 2 (female phenotype) which, combined with the results from ultrasound examination, provided useful information for potentially predicting the future fertility potential of the twins. Blood karyotypes revealed the presence of a normal 46,XX cell line and an aneuploid 47,XXY cell line in both patients. Examination of the chromosome constitutions of various tissues such as blood, buccal smear and urinary sediment not surprisingly showed different proportions for the 46,XX and 47,XXY cell lines, which most likely explains the discordant phenotypic sex and mild Klinefelter features. The most plausible underlying biological mechanism is a post-zygotic loss of the Y chromosome in an initially 47,XXY zygote. This would result in an embryo with both 46,XX and 47,XXY cells lines which could subsequently divide into two monozygotic embryos through a twinning process. The two cell lines would then be distributed differently between tissues which could result in phenotypic discordances in the twins. These observations emphasize the importance of regular paediatric evaluations to determine the optimal timing for fertility preservation measures and to detect new Klinefelter features which could appear throughout childhood in the two subjects.
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- 2014
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47. 13th International Congress The Fetus as a Patient
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Reuben Amster, Georgios Daskalakis, Elizabeth J.T. Winsor, Liria L.T. Miyague, P L Giacalone, Esmie Rose, John F. Bealer, R. D. Wilson, Ariel J. Jaffa, Annaleena Heikkilä, Susan M. Irtenkauf, Scott Adzick, Jean-Michel Faure, Rubén A. Quintero, Jerome Dansereau, D. Aravantinos, D. Kalousek, Pertti Kirkinen, Michelle Bonnett, Yuval Yaron, Joy L Graf, Alessandro Ghidini, John W. Hotra, Jo-Ann Johnson, Sherman Elias, Françoise Deschamps, R. Windrim, Pierre Boulot, Cyril Legum, S. Michalas, Nelson I. Miyague, Markku Ryynänen, William J. Crossland, Kim Waller, Carlos A. Carreno, J. Singer, Joseph Har-Toov, Aristides Antsaklis, Janice L. B. Byrne, Michael R. Harrison, Seppo Saarikoski, William J. Kupsky, David L Gibbs, Mordechai Hallak, and Joseph B. Lessing
- Subjects
Embryology ,Fetus ,medicine.medical_specialty ,business.industry ,International congress ,Pediatrics, Perinatology and Child Health ,Physical therapy ,Obstetrics and Gynecology ,Medicine ,Radiology, Nuclear Medicine and imaging ,General Medicine ,business ,Intensive care medicine - Published
- 1997
- Full Text
- View/download PDF
48. Fetal serum α-1 microglobulin for renal function assessment: comparison with β2-microglobulin and cystatin C
- Author
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Claire, Nguyen, Sophie, Dreux, Laurence, Heidet, Isabelle, Czerkiewicz, Laurent J, Salomon, Fabien, Guimiot, Thomas, Schmitz, Vassilis, Tsatsaris, Pierre, Boulot, Thierry, Rousseau, and Françoise, Muller
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Infant, Newborn ,Fetal Blood ,Kidney ,Kidney Function Tests ,Sensitivity and Specificity ,Predictive Value of Tests ,Pregnancy ,Prenatal Diagnosis ,Urogenital Abnormalities ,Alpha-Globulins ,Humans ,Female ,Cystatin C ,beta 2-Microglobulin ,Retrospective Studies - Abstract
To compare the prognostic value of fetal serum α1-microglobulin with that of β2-microglobulin and cystatin C for postnatal renal function.Retrospective study of α1-microglobulin, β2-microglobulin, and cystatin C in fetal serum from 126 fetuses with congenital abnormalities of the kidney and urinary tract (73 and 53, respectively). Two groups were defined: group with normal renal function and group with renal failure. For live born infants, renal function was assessed on the basis of serum creatinine (cutoff 50 µmol/L) or glomerular filtration rate (cutoff 75 mL/min/1.73 m2) or both. In case of infant or fetal death, histological kidney lesions were considered.Significant differences (p 0.001) were observed for the three markers between fetuses with good renal prognosis and those with renal failure (34.4 mg/L vs 67.6 mg/L for α1-microglobulin, respectively; 3.9 mg/L vs 7.35 mg/L, for β2-microglobulin, respectively; and 1.67 mg/L vs 2.12 mg/L for cystatin C, respectively). Areas under receiver operator curves were used to compare the three markers, 0.96, 0.90, and 0.74 for β2-microglobulin, α1-microglobulin, and cystatin C, respectively.Although α1-microglobulin is significantly different in fetuses with good renal prognosis and those with renal failure, overall, it is a less reliable prognostic marker than fetal serum β2-microglobulin.
- Published
- 2013
49. Red blood cell vitamin E concentrations in fetuses are related to but lower than those in mothers during gestation
- Author
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Marie-Hélène Vernet, Françoise Michel, Claude L. Léger, Bernard Descomps, AndréCrastes de Paulet, Odile Cachia, and Pierre Boulot
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education.field_of_study ,medicine.medical_specialty ,biology ,Cholesterol ,business.industry ,Vitamin E ,medicine.medical_treatment ,Population ,Obstetrics and Gynecology ,Lipoprotein(a) ,chemistry.chemical_compound ,Red blood cell ,Endocrinology ,medicine.anatomical_structure ,chemistry ,Cord blood ,Internal medicine ,medicine ,biology.protein ,Gestation ,education ,business ,Lipoprotein - Abstract
OBJECTIVE: The purpose was to establish which blood characteristics of vitamin E status were highly correlated between mothers and fetuses during gestation. STUDY DESIGN: Twenty-four pregnant women were selected because of suspicion of toxoplasmosis or other disease and malformation or intrauterine growth delay justifying cord blood puncture. After maternal and fetal blood was collected, analyses of plasma and red blood cell vitamin E contents were performed together with analyses of standard lipid parameters and lipoprotein (a) in maternal plasma and fatty acid compositions of maternal and fetal red blood cells. RESULTS: The maternal population was characterized by a plasma lipid-normalized vitamin E mean content higher (3.5 mmol/mol lipids) than usually found in nonpregnant adults. There was no relationship between plasma and red blood cell vitamin E contents. This was also true for fetuses. When the vitamin E status of mothers was compared with that of fetuses, we found no correlation in plasma vitamin E in the whole population and in the high lipoprotein (a) (>300 mg/L) and low lipoprotein (a) ( r = 0.94 for the red blood cell content). Improved correlations were also found in the high lipoprotein (a) group for the interrelationship between vitamin E and plasma lipid contents (cholesterol and triglycerides), whereas improvement was noted in the low lipoprotein (a) group by positive correlation between age and vitamin E red blood cell content or red blood cell relative charge. CONCLUSION: Determination of red blood cell vitamin E and plasma lipoprotein (a) in mothers could be useful in antenatal blood analysis in cases of ris of prematurity at birth, to prevent peroxidative membrane damage in neonates, and > 85% of the mothers in the current population would benefit from vitamin E supplementation from the viewpoint of the fetal red blood cell vitamin E requirement in spite of the rather high maternal lipid-normalized vitamin E plasma content.
- Published
- 1995
- Full Text
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50. Amniocentesis before 15 weeks' gestation: technical aspects and obstetric risks
- Author
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C. Bonifacj, François Laffargue, B. Bachelard, Bernard Hedon, Pierre Boulot, J. L. Viala, P. Nagy, O. Rousseau, and G. Lefort
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Gynecology ,medicine.medical_specialty ,Pregnancy ,Amniotic fluid ,medicine.diagnostic_test ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,Gestational age ,Chorionic villus sampling ,Prenatal diagnosis ,medicine.disease ,Therapeutic abortion ,Miscarriage ,Reproductive Medicine ,medicine ,Amniocentesis ,business - Abstract
In a prospective case-control study, early amniocenteses (EAC, n = 242) at between 12 and 14 weeks gestation, were compared with standard amniocenteses (SAC, n = 242) performed at between 15 and 24 weeks gestation. The medical records of these 484 cases were reviewed for indications, success rate, color and volume of amniotic fluid, gestational age, number of needle insertions, location of the placenta, culture failure rate, obstetric complications and therapeutic abortion rate. There were no significant differences between the two groups in success rate, in culture success rate or in the outcome of the pregnancies. The volume of the sample taken was smaller in the EAC patients (P < 0.001), and therapeutic abortions were performed significantly earlier (P < 0.02.) Results show that EAC is feasible from 11 weeks' gestation, and can be performed for the usual indications as an alternative to chorionic villus sampling. In the near future, cytogenetic techniques will enable results to be obtained in less than a week.
- Published
- 1995
- Full Text
- View/download PDF
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