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Biomedical subjects

C Tchobroutsky

Publications and source records attributed to C Tchobroutsky.

At least 37 records · Page 2Linked to original sources
PubMed1987

[Does hypertension have fewer complications in pregnancy in obese patients?].

In order to study the relationships between hypertension, obesity and perinatal morbidity and mortality, we have studied a group of 264 women included in a cooperative prospective study with respect to obesity arbitrarily defined as a body mass index greater than or equal to 27 kg/m2. The obese and normal-weight groups comprised respectively 55 and 209 women of similar age (29.1 +/- 5.5 vs 30.2 +/- 5.3 years, NS). Obese women were less often primiparous than women with a normal weight (29.1 vs 50.2 p. 100, p less than 0.01). Hypertension before pregnancy was similarly frequent in both groups (41.8 vs 31.6 p. 100). Hypertension begun sooner during the pregnancy in the obese than in the normal group (17.1 +/- 11 vs 22 +/- 11 weeks of amenorrhea, p less than 0.01), the first abnormal blood pressure being comparable in both groups (156 +/- 15/96 +/- 14 vs 152 +/- 15/95 +/- 10 mmHg, NS). Indicators of perinatal risk were less often observed in the obese group: hypertension begins less often during the second trimester of the pregnancy (7.4 vs 21.7 p. 100, p less than 0.05), proteinuria greater than or equal to 2+ is more rare (13.0 vs 25.1 p. 100, p = 0.07), plasma urates are lower (maximum recorded value: 272 +/- 63 vs 322 +/- 96 mumol/l, p less than 0.001). No perinatal death occured in the obese group, as compared with 15 in the normal group (p less than 0.05). The weight of surviving babies was higher in the obese than in the normal group (3,294 +/- 596 vs 2,947 +/- 702 g, p less than 0.001), despite a comparable gestational age (38.3 +/- 2.3 vs 38.9 +/- 1.8 weeks, NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Factors predictive of perinatal outcome in pregnancies complicated by hypertension.

Perinatal outcome and various indicators of perinatal risk were analyzed in a prospective study of 268 pregnant women with hypertension. Poor perinatal outcome was defined by stillbirth (n = 13), neonatal death (n = 2), and in surviving babies, by birth before 32 weeks or a birthweight below 1500 g (n = 13). In multivariate analysis, proteinuria and onset of hypertension between the 27th and 36th weeks of amenorrhea were the only two independent indicators of poor outcome (relative risks of 4.0 and 3.7, p less than 0.001 and p less than 0.01 respectively). Both these indicators were more frequent in mothers with no history of pre-pregnancy hypertension.

Adult↗
PubMed1986

Spontaneous recurrent fetal wastage and autoimmune abnormalities: a study of fourteen cases.

Case records of 14 women with spontaneous recurrent fetal wastage were analyzed. Venous and/or arterial thrombosis developed in nine patients and vasospastic symptoms in eight. Every patient had some kind of autoantibodies: prothrombin activation inhibitor was present in seven cases, anticardiolipin in five, and, antimitochondrial antibodies in two. Antinuclear antibodies were present in seven cases, and significant titer of antibodies to single-stranded DNA in nine cases. With a mean follow up of 6.5 years no patient developed systemic lupus erythematosus. It is suggested that such women have a peculiar form of vasculitis.

Abortion, Habitual↗
PubMed1985

[Inhibition of angiotensin converting enzyme in human pregnancy. 15 cases].

Angiotensin converting-enzyme inhibitors cross the placenta and modify the maternal, foetal and utero-placental renin-angiotensin system. Eight cases of pregnancy in women taking captopril have been published, 7 other cases being reported in this review paper. There were one spontaneous and 2 therapeutic abortions, one of which disclosed a malformation of uncertain diagnosis and imputation. One intrauterine death at 28 weeks was probably due to the severity of the maternal disease. Two children born to mothers also treated with frusemide died of neonatal anuria. Delivery or caesarean section occurred before term in 8 cases, and there were 3 cases of neonatal respiratory distress with a favourable outcome. Finally, one mother gave birth at term to twins of normal weight. The cases with respiratory distress can be attributed to the mother's hypertension, to prematurity and/or to concomitant treatment with beta-blockers, while the cases with anuria seem to be due to inhibition of the effects of angiotensin on renal haemodynamics, with salt depression as a possible aggravating factor. Treatment with angiotensin converting enzyme inhibitors does not seem to warrant therapeutic abortion. However, these drugs are contra-indicated in pregnancy and should only be given to women wishing to become pregnant if they present with resistant and dangerous arterial hypertension. A programme of pharmacovigilance is being set up to follow up such pregnancies.

Abortion, Spontaneous↗
PubMed1983

[Diabetes and pregnancy].

During the last few years perinatal mortality and neonatal morbidity in children of insulin-dependent diabetic mothers have considerably decreased, mainly because of strict 24-hour control of glycaemia throughout pregnancy and centralized care. Congenital malformations are now emerging as the leading cause of the remaining perinatal mortality and late disabilities; control of the diabetes prior to conception may lessen their frequency. Concerning gestational diabetes, there is lack of agreement on diagnostic criteria: who must be screened? What are the adverse effects on the child? The risk of foetal death is greater when arterial hypertension, prolonged pregnancy or previous stillbirth are associated with carbohydrate intolerance.

Congenital Abnormalities↗
PubMed1983

[Administration of diethylstilbestrol during pregnancy, a public health problem].

The analysis of the health risks associated with the administration of diethylstilbestrol (DES) during pregnancy (for the prevention or treatment of threatened abortions) has been largely published. Concerning mothers, a relationship between DES exposure during pregnancy and risk of cancer is unproved. However, existing studies are sufficient cause for serious concern over drug's carcinogenic potential, and further follow-up studies are required. Concerning daughters, a clear association between in utero exposure to DES and clear cell adenocarcinoma of the vagina or cervix is established (incidence between 0.14 and 1.4 per 1000 through age 24). The risk for squamous cell cancer of the vagina and cervix does not seem to be increased. Cervico-vaginal adenosis is frequent (20% to 60% of exposed subjects). This is not a pre-cancerous lesion, its spontaneous evolution is towards regression. No treatment is prescribed. Morphological changes of the genital tract have been described, their consequences on fertility and pregnancy are not clear. Concerning sons, an excess of genital abnormalities (especially of the epididymis and undescended testis) has been reported, but information on the fertility implications of these findings is not available. There is no evidence of an increased risk of testicular cancer. The analysis of all these informations should allow to bring up a policy to take into account these risks in the population.

Adult↗
PubMed1982

[Arterial hypertension during pregnancy. 531 cases treated in one centre (author's transl)].

Between 1977 and 1979, 531 consecutive cases of hypertension complicating pregnancy were observed at the Maternité de Port-Royal, Paris. All patients were treated preferentially with methyldopa, and most women with moderate hypertension were treated as out-patients. Perinatal mortality in these hypertensive women was the same as for normotensive women who delivered at the Maternité and for the French population as a whole during the same period.

Female↗
PubMed1981

Neonatal effects of maternal administration of acebutolol.

Systolic blood pressure, heart rate, and blood glucose concentration were measured in the first three days of life in 10 infants born to mothers who had received acebutolol, a cardioselective beta-adrenergic-blocking agent, for hypertension in pregnancy and compared with values in 10 infants whose mothers had received methyldopa. The blood pressure was expressed as a percentage of the expected value. Blood pressure was significantly lower in the infants of the mothers given acebutolol (p less than 0.02, less than 0.01, and less than 0.01 respectively during the three days of observation). Heart rate was also lower, but the significance was only at the 0.05 level. Blood glucose was not significantly different between the two groups. These results suggest that care should be taken in prescribing beta-adrenergic-blocking drugs during pregnancy.

Acebutolol↗
PubMed1981

Incidence of idiopathic respiratory distress syndrome during the last ten years.

In the Port Royal Maternity Hospital, with about 2000 deliveries per year, the incidence of idiopathic respiratory distress syndrome (IRDS) has been studied during the last ten years. Because of the potential hazards of drugs, the attitude of restricting the use of steroids to a few particular cases was adopted. In period I (1968-1969), the incidence of IRDS was 1 per 100 live births. In period II (1972-73), the incidence dropped to 0.54% of the live births. In period III (1975-77), the incidence remained at 0.47% of the live births. The difference in frequency between period I and period II and III is statistically significant (P less than 0.01). This diminution appears to be the result of an overall improvement in the pre- and postnatal care of premature infants. The newborns who could have benefited from prenatal glucocorticoid treatment are studied in period III. From 28 to 34 wk of gestational age, 148 infants were born. Seventy-eight (not equal to 50%) did not have any respiratory problems, 54 had mild and transitory distress and 16 (not equal to 10%) had IRDS. In only 7 cases was the time interval between the first signs of premature labor and delivery longer than 24 h. In conclusion, at least 148 neonates would have had prenatal glucocorticoid treatment, in order possibly to avoid 7 cases of IRDS, which would mean hazard for 20 and benefit for 1. A hazardous effect on brain development seems to be the main concern and has to be more fully documented.

Female↗
PubMed1981

[Neonatal mortality and morbidity. Priorities in perinatal care (author's transl)].

Perinatal mortality rates have been decreasing from 25 to 15 0/00 at the Port-Royal maternity hospital from 1969 to 1978. The incidence of materno-foetal infection has been stable within the last 10 years, around 1.2% live-births; mortality linked with these infections represents 28% of early neonatal deaths and remains nearly as high as mortality from malformations. The incidence of Idiopathic Respiratory Distress Syndrome has been decreasing as low as 0.3% live births (14% between 28 and 34 weeks of gestation). The risk appears not high enough to justify the systematic use of prenatal glucocorticoids. Birth injury in the full term newborn occurs at a rate of 1 0/00 births in the most severe cases. In cases of moderate severity, the incidence has been decreasing from 1% to 1 0/00 births within the last 5 years, probably due to improved obstetrical care.

Female↗
PubMed1980

Amniotic fluid C-peptide in normal and insulin-dependent diabetic pregnancies.

Glucose, insulin and C-peptide were determined in amniotic fluid from 28 normal and 46 insulin-treated diabetic pregnant women. Glucose, insulin and C-peptide concentrations in amniotic fluid were higher in the diabetics than in the normal subjects. In diabetic women insulin levels did not correlate with birth weight or birth weight adjusted for gestational age, but C-peptide did. C-peptide correlated poorly with insulin (p < 0.05) in diabetics but closely (p < 0.002) in normal subjects. These results suggest that amniotic fluid investigations in insulin-treated diabetic women should use C-peptide assays as these seem to reflect more closely the insulin production of the fetus than do insulin assays. There were no differences in amniotic fluid glucose, insulin and C-peptide concentrations where the amniotic fluid lecithin-sphingomyelin ratio indicated fetal pulmonary maturity or immaturity.

Adolescent↗