Biomedical subjects
Publications and source records attributed to E Vuillard.
A case of prenatal gastrointestinal bleeding is presented. Abnormal echogenic amniotic fluid was detected by routine ultrasound during the third trimester of a normal pregnancy. The diagnosis and postnatal implications of antenatal hemorrhage are discussed, with a review of the literature. To our knowledge, this is the first case to be diagnosed in utero and resulting in preterm delivery.
In order to evaluate the efficiency of antenatal diagnosis and postnatal management of urinary malformations, we reviewed 142 cases from October 1988 to December 1992 with abnormalities detected by routine ultrasound. A routine karyotype analysis showed 7 fetuses with chromosomal defects. Nine cases with isolated bilateral urinary tract dilatation underwent pelvic fetal urine sampling in order to assess antenatal renal function. The 142 cases comprised 107 children born alive (group I) and 35 intrauterine fetal deaths (group II). In group I, 79 kidneys had a transient pyelectasis, and 11 kidneys had a hydronephrosis which disappeared at postnatal examination. Among 103 pyelectasis cases detected during the second trimester of pregnancy, 22 kidneys were pathological after birth (positive predictive value (PPV) = 21.4%) with 17 ureteropelvic junction obstructions. The PPV was 66% when ultrasound showed hydronephrosis at the end of pregnancy. In that group, 15 cases had vesicoureteric reflux, with 5 cases where the homolateral upper urinary tract was morphologically normal in utero. Group II comprised 27 fetuses with multiple defects in other systems, and 8 cases with urological defects only 7 of which had urethral anomalies. This study confirmed the benefit of antenatal diagnosis for uropathies, and the advantage of prenatal consultation between pediatric surgeon and parents in order to explain what anomalies are involved and to program postnatal follow-up.
OBJECTIVE: To evaluate the prognosis of prenatally diagnosed gastroschisis. STUDY DESIGN: In a retrospective study, we analyzed the clinical and echographic data of gastroschisis. These data were correlated with fetal outcome including delivery, surgical procedure, follow-up in the neonatal intensive-case unit and in the gastropediatric unit. RESULT: Twenty cases were analyzed. The overall survival rate was 85%. Classical criteria were analyzed (maximal bowel dilatation, thickening of bowel wall). Fetuses with both severe perivisceritis and meconium-stained amniotic fluid were born earlier than fetuses with mild perivisceritis and normal amniotic fluid (p < 0.01). CONCLUSION: Our data suggest that an inflammatory response could follow bowel exposure to amniotic fluid. This response could lead to perivisceritis and premature birth. This hypothesis is currently under investigation.
BACKGROUND: The association of hyperthyroidism and pregnancy is a rare but serious condition which can jeopardize fetal outcome. Classical follow-up relies on: serial clinical and echographic assessment; serial funipuncture to determine fetal thyroid status, and maternal propylthiouracil (PTU) treatment to treat fetal and/or maternal hyperthyroidism. CASE: We report the case of a euthyroid patient with Graves' disease who had already been delivered of two hyperthyroid fetuses; the present pregnancy revealed a hyperthyroid fetus diagnosed by funipuncture. Echography showed a fetal goiter at 28 weeks of gestation (WG) with important signal on colored Doppler echography. We observed an extinction of this signal as maternal PTU treatment was intensified. The patient was delivered of a mildly hyperthyroid newborn at 37 WG. Both newborn and patient are doing well. CONCLUSION: Fetal thyroid assessment by colored Doppler echography could help in the management of fetal thyroid dysfunction.