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Biomedical subjects

F Audibert

Publications and source records attributed to F Audibert.

At least 55 records · Page 3Linked to original sources
PubMed1999

Neonatal outcome in severe preeclampsia at 24 to 36 weeks' gestation: does the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome matter?

OBJECTIVE: Our purpose was to compare neonatal outcome after preterm delivery of infants whose gestation was complicated by the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, partial HELLP syndrome, or severe preeclampsia. STUDY DESIGN: We reviewed the maternal and neonatal charts from 269 consecutive pregnancies complicated by the HELLP syndrome or severe preeclampsia managed at our perinatal center. The HELLP syndrome was defined by previously published laboratory criteria. Viable pregnancies were divided into 3 groups: HELLP syndrome, partial HELLP syndrome (at least 1, but not all 3, features of the HELLP syndrome), and severe preeclampsia (no features of the HELLP syndrome). Results were compared by means of chi2 analysis and Student t test where appropriate. Logistic regression was used to evaluate outcome variables at different gestational ages. RESULTS: There were no significant differences in complications among the 3 groups at each gestational age. There was, as expected, a significant decrease in morbidity and mortality rates with advanced gestational age. CONCLUSIONS: In severe preeclampsia, neonatal morbidity and death are related to gestational age rather than to the presence or absence of the HELLP syndrome. Whether expectant management is safe for women with the HELLP syndrome requires further study.

Adult↗
PubMed1999

Herpes simplex virus encephalitis in pregnancy.

BACKGROUND: Although polymerase chain reaction (PCR) can detect herpes simplex virus (HSV) in the cerebrospinal fluid (CSF), HSV encephalitis remains a significant cause of neurologic impairment in pregnant women. Assessment of fetal contamination also remains a problem. CASES: We report two cases in which HSV encephalitis initially was not suspected and led to significant maternal neurologic impairment. In both cases, HSV PCR of CSF confirmed the diagnosis. In one case, fetal serum HSV PCR excluded fetal contamination. CONCLUSION: As soon as encephalitis in pregnancy is suspected, a combination of acyclovir and penicillin is recommended because the potential benefits far outweigh the risks. Using the HSV PCR, HSV infection in the fetus can be diagnosed.

Adult↗
PubMed1999

Implication of apolipoprotein E and the L-arginine-nitric oxide system in preeclampsia.

OBJECTIVE: During pregnancy, Apolipoprotein (Apo) E is synthesized in the placenta to facilitate the uptake of maternal lipoproteins. Preeclampsia is associated with an abnormal lipid profile. Apo E levels may affect the production of nitric oxide. We investigated whether Apo E variations could be related to the high lipid levels and nitric oxide secretion in preeclamptic women. METHODS: Blood samples from 15 normotensive women and 12 mild and 23 severe cases of preeclampsia were assayed for standard lipid profile, Apo E, and nitrate. Urine samples were analyzed for nitrate and cyclic GMP. RESULTS: In women with mild preeclampsia, the triglyceride concentration was significantly higher (p < 0.05) than in normotensive women (3.30 +/- 1.38 versus 2.31 +/- 0.92 g/L) and associated with a higher (p < 0.01) triglyceride/Apo E ratio (0.71; range = 0.40-1.70). In women with severe preeclampsia, the triglyceride/Apo E ratio was similar to normotensive women [0.39 (range = 0.18-1.19) versus 0.41 (range = 0.18-0.79)] associated with a normal triglyceride level and a twofold higher serum nitrate level [36 (range = 1-63 mumol/L) versus 14 (range = 1-37 mumol/L)]. CONCLUSION: The triglyceride/Apo E ratio is significantly higher in mild preeclampsia. In the severe form, this ratio is similar to that of normotensive pregnant women, probably due to a better uptake of triglyceride. Moreover, in the severe form, it is associated with a twofold normal serum nitrate level. Thus, Apo E and the nitric oxide status may be implicated in preeclampsia.

Apolipoproteins E↗
PubMed1999

[Clinical importance of fetal pulse oximetry. I. Methodological evaluation. Multicenter study. French Study Group on Oximetry of Fetal Pulse].

OBJECTIVE: To evaluate the feasibility of intrapartum fetal pulse oximetry, the distribution of fetal oxygen saturation values, and the relation with the neonatal outcome in a population with an abnormal fetal heart rate (FHR). STUDY DESIGN: A prospective multicenter observational study, from June 1994 to November 1995. Fetal oxygen saturation was continuously recorded using a Nellcor N-400 fetal pulse oximeter in case of abnormal FHR during labor. Simultaneous readings of fetal oxygen saturation and of fetal blood analysis (FBA) were obtained at inclusion and before birth. Feasibility, adverse effects, distribution of fetal oxygen saturation values and relation with neonatal outcome were assessed. RESULTS: 74 patients were included. From 172 attempted sensor placements, the procedure was impossible in three cases and fetal oxygen saturation values were obtained in 164 cases (95.3%). Physicians considered sensor placement an easier task than FBA attempt (easy in 87.5% vs 78.9% for FBA, p = 0.03). The mean reliable signal time (+/- SD) was 64.7 +/- 32% during the first stage. There were no serious adverse effects in the study population. The mean fetal oxygen saturation during the first stage of labor was 42.2 +/- 8.0% (10th-90th centile range: 30-53%). Fetal oxygen saturation was significantly correlated with scalp pH (r = 0.29; p = 0.01) but not with neonatal umbilical artery pH or gas values. There was a significant association between a low fetal oxygen saturation (< 30%) and a poor neonatal condition. CONCLUSION: The feasibility of fetal pulse oximetry is satisfactory in clinical practice. It is easy to use and provides a fair rate of recorded values, even in a population with suspicion of fetal distress. A low fetal oxygen saturation is significantly associated with an abnormal neonatal outcome.

Adult↗
PubMed1999

[Clinical importance of fetal pulse oximetry. II. Comparative predictive values of oximetry and scalp pH. Multicenter study].

OBJECTIVE: To compare the predictive value of intrapartum fetal pulse oximetry to that of fetal blood analysis for an abnormal neonatal outcome in case of abnormal fetal heart rate (FHR). STUDY DESIGN: A prospective multicenter observational study, from June 1994 to November 1995. Fetal oxygen saturation was continuously recorded using a Nellcor N-400 fetal pulse oximeter in case of abnormal FHR during labor. Simultaneous readings of fetal oxygen saturation and fetal blood analysis obtained before birth, i.e. either at full dilatation, or before cesarean section when indicated, were compared with the neonatal status. The criteria for an abnormal neonatal outcome were 1) an umbilical arterial blood pH < or = 7.15 and 2) a combined variable including: 5 min. Apgar score < or = 7, umbilical arterial pH < or = 7.15, secondary respiratory distress, transfer in a neonatal care unit, or neonatal death. RESULTS: At a 7.20 threshold for fetal scalp pH, and 30% for fetal oxygen saturation (i.e. the tenth centile in the study population), the predictive value of fetal pulse oximetry was similar to that of fetal blood analysis for an arterial umbilical pH < or = 7.15, and for an abnormal neonatal outcome (positive predictive value 56% vs 55%, negative predictive value 81% vs 82%, sensitivity 29% vs 35%, and specificity 93% vs 91% respectively). The receiver operating curve showed similar performance of either technique for cut-off values < or = 7.20 for fetal blood pH and < or = 30% for fetal oxygen saturation, whereas fetal pulse oximetry became superior at higher thresholds. CONCLUSION: The predictive value of intrapartum fetal pulse oximetry can be favorably compared with that of fetal blood analysis. Randomized controlled management trials can now be performed to assess potential clinical benefits of this new tool.

Female↗
PubMed1998

Randomized trial of conservative laparoscopic treatment and methotrexate administration in ectopic pregnancy and subsequent fertility.

Methotrexate treatment was compared to laparoscopic salpingotomy for conservative management of ectopic pregnancy in a prospective randomized study. One hundred patients were randomized into two groups using random numbers. Inclusion criteria were an ectopic pregnancy visualized by ultrasound with a pre-therapeutic score <13 as assessed by the following six criteria, graded from 1 to 3: gestational age, human chorionic gonadotrophin (HCG) concentration, progesterone concentration, abdominal pain, haemoperitoneal volume and diameter of the haematosalpinx. The treatments were either 1 mg/kg of methotrexate injected transvaginally into the ectopic pregnancy without anaesthesia or administered i.m. when the pregnancy could not safely or easily be punctured (group 1), or laparoscopic salpingotomy (group 2). Success was defined as the return to normal (<10 mIU/ml) of HCG concentrations. Treatment was successful for 45 of 51 patients in group 1 (88.2%) and 47 of 49 in group 2 (95.9%). Medical treatment was significantly (P < 0.05) associated with shorter postoperative stay (24 compared with 46 h), but HCG returned to normal more quickly after laparoscopic treatment (13 compared with 29 days). Spontaneous reproductive performance was similar in both groups, but overall intrauterine pregnancy was higher, and repeat ectopic pregnancy lower, after methotrexate treatment. In selected cases of ectopic pregnancy, with a pre-therapeutic score <13, methotrexate treatment appeared as safe and efficient as conservative treatment by laparoscopy and was associated with improved subsequent fertility.

Adolescent↗
PubMed1998

Should we routinely screen for cytomegalovirus antibody during pregnancy?

In order to evaluate the usefulness of cytomegalovirus (CMV) antibody screening during pregnancy, women attending for antenatal care at the Antoine Béclère Hospital (Clamart, France) were prospectively studied during 22 months (1995-1996). Forty-five percent of these women were CMV-seropositive. Twenty suspected or confirmed CMV primary infections were detected. Nine infected infants were born to these women. All infected infants are now between 10 months and 2.5 years old. They all are asymptomatic even those who initially presented abnormal biological parameters or slightly abnormal ultrasound scans during fetal life. Presently, screening for CMV antibody cannot be recommended because it induces economic, psychological and ethical problems. Furthermore, there is no efficient and safe treatment available so far. However, we do think that large studies must be performed to increase our knowledge about the natural history of intrauterine CMV infection. This is also important for an improved assessment of the value of ultrasound examination results as well as the biological parameters measured in fetal blood samples.

Amniotic Fluid↗
PubMed1998

The incidence of caseous lymphadenitis in Alberta sheep and assessment of impact by vaccination with commercial and experimental vaccines.

In Alberta, caseous lymphadenitis (CLA) is one of the leading causes of lamb and mutton carcass condemnation. In this study, serologic results confirmed a high (50-94%) incidence of exposure to Corynebacterium pseudotuberculosis, the causative agent of CLA, in mature, unvaccinated sheep in southern Alberta. To assess the efficacy and impact of vaccination with 2 commercial (Glanvac-6 and Case-Vac) and 1 experimental (WC+ MDP-GDP) CLA vaccines, a series of 3 field trials in 3249 ewes and lambs was conducted in affected flocks from 1992-1996. Efficacy was assessed from the serological response to vaccination, prevalence and size of injection site reactions by treatment, and the incidence of CLA abscesses. Overall, agglutinating antibody titres to C. pseudotuberculosis in lambs vaccinated with WC+MDP-GDP and Case-Vac remained significantly elevated above nonvaccinated control lambs for the 12 mo period after the initial vaccination. Lambs vaccinated with the WC/MDP-GDP maintained higher titres (P < 0.06) than those vaccinated with Case-Vac for the period from 6 to 12 mo after vaccination. Agglutinating antibody titres for lambs vaccinated with Glanvac did not differ from those of controls at any point during the 12 mo period after vaccination. The number of injection site reactions was elevated in lambs vaccinated with Glanvac as compared to those vaccinated with WC+MDP-GDP but the size of injection site reactions did not significantly differ. Sheep vaccinated with WC+ MDP-GDP also had a reduced incidence of putative CLA abscesses, although confirmation of the presence of C. pseudotuberculosis was only successful in a small number of instances.

Abscess↗
PubMed1998

Prenatal diagnosis of glycogen storage disease type Ia by restriction enzyme digestion.

Glycogen storage disease type Ia (GSD Ia) is an autosomal recessive condition, caused by a deficiency of hepatic glucose-6-phosphatase (G6Pase) activity. In a consanguineous family originating from northern Africa whose first daughter was affected with GSD Ia, we were able to identify the disease-causing mutation, a cytosine to thymine substitution at nucleotide 326 in exon 2 of the G6Pase gene (R83C). This mutation causes the disappearance of an HgaI site, and is thus easily detectable by restriction enzyme digestion. Both parents were heterozygous for this mutation. During the third pregnancy, fetal genomic DNA was extracted from a chorionic villus biopsy sampled at the 24th week of gestation. Exons 2 of the G6Pase gene were amplified by the polymerase chain reaction followed by HgaI digestion. Fetal DNA analysis indicated that the fetus had received both normal G6Pase alleles. This result was confirmed after birth. DNA analysis is the only reliable method for prenatal diagnosis of GSD Ia.

Consanguinity↗
PubMed1997

Multicenter study on the clinical value of fetal pulse oximetry. II. Compared predictive values of pulse oximetry and fetal blood analysis. The French Study Group on Fetal Pulse Oximetry.

OBJECTIVE: Our purpose was to compare the predictive value of intrapartum fetal pulse oximetry with that of fetal blood analysis for an abnormal neonatal outcome in case of an abnormal fetal heart rate. STUDY DESIGN: A prospective multicenter observational study was conducted from June 1994 to November 1995. Fetal oxygen saturation was continuously recorded with a Nellcor N-400 fetal pulse oximeter in case of an abnormal fetal heart rate during labor. Simultaneous readings of fetal oxygen saturation and fetal blood analysis obtained before birth (i.e., either at full dilatation or before cesarean section when indicated) were compared with the neonatal status. The criteria for an abnormal neonatal outcome were (1) an umbilical arterial blood pH < or = 7.15 and (2) a combined variable including 5-minute Apgar score < or = 7, umbilical arterial pH < or = 7.15, secondary respiratory distress, transfer in a neonatal care unit, or neonatal death. RESULTS: At a 7.20 threshold for fetal scalp pH and 30% for fetal oxygen saturation (i.e., the 10th percentile in the study population), the predictive value of fetal pulse oximetry was similar to that of fetal blood analysis for an arterial umbilical pH < or = 7.15 and for an abnormal neonatal outcome (positive predictive value 56% vs 55%, negative predictive value 81% vs 82%, sensitivity 29% vs 35%, and specificity 93% vs 91%, respectively). The receiver-operator characteristic curve showed similar performance of either technique for cutoff values < or = 7.20 for fetal blood pH and < or = 30% for fetal oxygen saturation, whereas fetal pulse oximetry became superior at higher thresholds. CONCLUSION: The predictive value of intrapartum fetal pulse oximetry can be favorably compared with that of fetal blood analysis. Randomized controlled management trials can now be performed to assess potential clinical benefits of this new tool.

Apgar Score↗
PubMed1997

Uterine thermal balloon therapy under local anaesthesia for the treatment of menorrhagia: a pilot study.

This study evaluates the use of local anaesthesia in a subset of patients undergoing uterine thermal balloon endometrial ablation for the treatment of menorrhagia. Out of 51 patients with dysfunctional uterine bleeding, 18 were included for uterine balloon therapy under local anaesthesia. Inclusion criteria were dysfunctional bleeding with absence of organic lesions in the uterine cavity, adequate relaxation and pain control during physical examination and diagnostic hysteroscopy, and patient desire to avoid a general anaesthetic. Paracervical block was performed with 20 ml of dilute 1% lignocaine HCl with epinephrine 1:200,000. Success of the procedure was defined as amenorrhoea, hypomenorrhoea, or eumenorrhoea. The median follow-up period was 13.9 +/- 5 months and 11 patients (61%) had follow-up of >1 year. Treatment led to a significant decrease in menstrual flow, duration, and pad count in all patients (P < 0.0001). No intra-operative complications occurred. A pain scale (level 1-10) was used to evaluate the patients' tolerance of the procedure (mean 3.8 +/- 1.3). In light of these successful and well tolerated procedures, thermal balloon endometrial ablation, utilizing local anaesthesia, appears practical as an office-based therapy.

Adult↗
PubMed1996

[Management of HELLP syndrome before 32 weeks of amenorrhea. 22 cases].

OBJECTIVES: Assess expression and management of HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) occurring before 32 weeks gestation. METHODS: Among 50 patients presenting HELLP syndrome from 1990 to 1994, 22 (44%) who developed the syndrome before 32 weeks gestation were evaluated retrospectively. RESULTS: Most of the patients were primiparous and HELLP syndrome recurred in 2 during a second gestation before 32 weeks gestation. Only three cases began during the post partum period. All patients had severe pre-eclampsia before discovery of the HELLP syndrome. Episodes of eclampsia also occurred in 6. The most frequent clinical manifestation was epigastric pain. Ten patients had acute severe renal failure. The 3 post partum patients had severe complications (eclampsia, renal failure, subcapsular hepatic hematoma). Obstetrical intervention was required in all cases. Cesarean section was performed within 48 hours of diagnosis. Pregnancy had to be terminated in 3 cases between 24 and 29 weeks gestation. There was one fetal death in utero and one during the neonatal period. Seventeen live infants were delivered. In the group of 11 infants born after 30 weeks gestation, only 1 had hyalin membrane disease which developed in all those born before 30 weeks, including 2 with broncho-pulmonary dysplasia. CONCLUSION: Based on the physiological mechanisms involved in HELLP syndrome, criteria for obstetrical extraction and the possibilities for conservative management in very premature pregnancies, we propose a management protocol for HELLP syndrome developing before 32 weeks gestation. Corticosteroid therapy may be given for 48 hours in cases without maternal or fetal complications in order to accelerate fetal maturation before extraction.

Abortion, Therapeutic↗
PubMed1996

Clinical utility of strict diagnostic criteria for the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.

OBJECTIVE: Our purpose was to compare the maternal outcome of pregnancies complicated by HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, partial HELLP syndrome, or severe preeclampsia. STUDY DESIGN: In a retrospective cohort study we reviewed the maternal charts of 316 women with HELLP syndrome or severe preeclampsia managed at our perinatal center between July 1, 1992, and June 30, 1995. HELLP syndrome was strictly defined by previously published laboratory criteria. Women were divided into three groups: HELLP syndrome (n = 67), partial HELLP syndrome (one or two but not all three features of HELLP syndrome, n = 71), and severe preeclampsia (no features of HELLP syndrome, n = 178). Results were compared by chi 2 analysis and one-way analysis of variance. RESULTS: Mean gestational ages at delivery in the HELLP, partial HELLP, and severe preeclampsia groups were, respectively, 31.7, 32.7, and 34.5 weeks (p < 0.001 between HELLP and severe preeclampsia). There was one maternal death from intracerebral hemorrhage in the HELLP group. In women with HELLP syndrome there was a higher incidence of cesarean section (p < 0.05), disseminated intravascular coagulation (p < 0.001), and need for transfusion (p < 0.001) than in the other two groups. CONCLUSIONS: Higher incidences of maternal complications in women with HELLP syndrome stress the importance of strict criteria for the definition of HELLP syndrome. Women with partial HELLP syndrome should be studied and managed separately from women with complete HELLP syndrome.

Adult↗
PubMed1996

Serial amniotic fluid index in severe preeclampsia: a poor predictor of adverse outcome.

OBJECTIVE: The purpose of the study was to determine the relationship between low amniotic fluid index and intrauterine growth restriction and nonreassuring fetal testing in patients with severe preeclampsia. STUDY DESIGN: We reviewed the medical records of 136 women with severe preeclampsia managed conservatively for at least 48 hours. Patients were followed up with a daily nonstress test and amniotic fluid index. We evaluated amniotic fluid index < or = 5 cm and < or = 7 cm, measured on admission or just before delivery (i.e., final), and attempted to correlate these findings with the incidence of nonreassuring fetal testing necessitating cesarean section or the incidence of intrauterine growth restriction (birth weight < or = 10th percentile). RESULTS: One hundred seven patients had a cesarean section, but only 42 (39%) of these were for a nonreassuring fetal heart rate tracing or a persistent biophysical profile of < or = 4, and 38 (36%) of the pregnancies resulted in infants with intrauterine growth restriction. During expectant management, the amniotic fluid index worsened for 61 (45%) patients and improved or remained the same for 75 (55%). For those with an amniotic fluid index of < or = 5 cm both on admission and at delivery, there was a significantly higher incidence of intrauterine growth restriction compared with those with an amniotic fluid index > 5 cm (p = 0.007 and p = 0.029, respectively). However, there was no association between intrauterine growth restriction and an amniotic fluid index < or = 7 cm. Moreover, there was no difference in the frequency of nonreassuring fetal heart rate testing on the basis of amniotic fluid volume (p = 0.59) or intrauterine growth restriction (p = 0.4). CONCLUSIONS: For women with severe preeclampsia remote from term, an amniotic fluid index < or = 5 cm is predictive of intrauterine growth restriction but lacks sensitivity. There is no association between the amniotic fluid index status and frequency of cesarean section for fetal distress or nonreassuring fetal testing.

Adult↗