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Biomedical subjects

F Pierre

Publications and source records attributed to F Pierre.

At least 91 records · Page 5Linked to original sources
PubMed1992

For a systematic policy of i.v. oxytocin inducted placenta deliveries in a unit where a fairly active management of third stage of labour is yet applied: results of a controlled trial.

The authors analysed the effect of the i.v. oxytocin induced third stage of labour in a controlled trial concerning 1000 patients. The appliance of such an policy in a unit that already had a fairly active management of delivery was very encouraging. The incidence of post-partum haemorrhage (greater than 500 ml) is significantly (P less than 0.001) less than in the control group; and the same for severe haemorrhage. The third stage is significantly (P less than 0.001) shorter in the oxytocin-injected group than in the control group. Moreover, there is no significant difference between the two groups for retained placenta. The economy of blood transfusion, which is a major concern nowadays, could be the real interest of this active management of the third stage of labour.

Female↗
PubMed1992

[Quality assurance or quality control. Lessons from an intercomparison circuit].

This article deals with the evaluation of the three year results of the French interlaboratory control for serum copper and zinc analysis. We pointed out some results interpreted on the basis of the existence of differences between the notions of quality control and total quality assurance. The main finding was a surprising change in the annual range in the final results of the laboratories. All 'good' laboratories in the first year showed a significant fall in their individual performance the second year. We can interpret that as a falling off of vigilance in relation with the self satisfaction after the publication of the first results. We concluded that good laboratory practices must be accompanied by a quality program not limited to an analytical control.

Copper↗
PubMed1992

[Bacterial infection of the newborn by maternal fetal contamination: one can depend on the anamnesis].

All babies born in a University maternity unit over a period of four months had bacteriological swabs taken in the labour ward. This was to see whether a list of criteria in the history for bacterial infection of the newborn could be relied on. The criteria were: premature rupture of the membranes (before labour had started at all), rupture of the membranes for more than 12 hours, stained liquor, prematurity, fetal tachycardia of more than 160 per minute or abnormal rhythm of the heartbeat, an Apgar score of less than 7 after 1 minute, maternal genital or urinary tract infection (not cured) in month before delivery, maternal temperature above 38 degrees C in labour. During the study there were: 570 live births of which 222 (39%) were at risk of infection according to the above list of criteria, 35 had bacterial colonies present and 4 were definitely infected. More cultures from the placenta, the gastric fluid and the skin came back positive when there was a recognised risk of infection. Both the clinical and bacteriological results show that the risk was 5.24 of colonisation when the risk of infection had been recognised. These prospective results when checked against the retrospective results already obtained in the same department, suggest that this kind of screening for infection is worthwhile without being too expensive, and one can rely on the history to screen for neonatal bacterial infection.

Apgar Score↗
PubMed1992

[Endometriosis and sterility: whom to treat and how?].

The difficulty in evaluating the efficacy of treatments for endometriosis in terms of sterility results from the frequent confusion between the inhibition of the natural progression of endometriosis and a beneficial effect on fertility. The authors review the supposed benefits and the drawbacks of the various medical and surgical treatments available and medically assisted fertilization (IVF) in the context of the various types of endometriosis damage. They highlight the inadequacy of the AFS score, which gives very similar scores for effects with widely differing impacts on fertility. The authors attempt to identify the therapeutic associations which seem currently to be useful in treating endometriosis and also beneficial in obtaining a pregnancy.

Adult↗
PubMed1991

[The social protection of pregnant women and young mothers in Europe].

Through the study of perinatal legislation in 24 European countries, the authors have analyzed Social Protection for pregnant women and young mothers. For maternity leave, the durations of pre- and post-natal leaves were compared, including its possible variations according to the obstetrical pathology and the number of births in different countries. Maternity benefits vary from 50 to 100% of the previous salary and a payment curve shows considerable differences in salaries or the global benefits attributed. Parental leave, which has only recently been created in some countries, is subject to great variations from one country to another and sometimes even within the same country, according to the public or private sectors of activity. Protection of the single parent and the benefits or allowances at birth are studied as well as benefits for infants. The latter were pioneered by France and have not been emulated in many other countries. In the discussion the authors try to establish the motivations leading to the various perinatal measures in Europe, be they social, medical or demographic. They consider the possibility of harmonization, but homogeneity, which has to respect existing sociological, cultural and ideological particularities. This work continues according to the guidelines laid down by the European Parliament, which could, in due course, comprise the whole continent, bearing in mind the probable transfer of populations expected in the last years of this century.

Employment↗
PubMed1991

[Leg amputation as a result of attempted voluntary abortion].

The authors looked at the clinical situation and the possible pathogenicity which in this case was almost certainly traumatic. It would explain the total absence of one leg at the delivery of a baby who had no other psychomotor changes. They used this very exceptional case history of the loss of the lower limb after an attempt at terminating a pregnancy to study the matter from the French and foreign bibliography on the subject, which anyhow is very short. There was an attempt to terminate a pregnancy at an undisclosed duration of amenorrhoea (between 9 and 13 weeks) by suction evacuation followed by curettage. On the medico-legal side the authors analysed the reasons why there was no penal indictment brought at the same time as the civil action was brought prosecution, and also points out that the Conseil d'Etat decided, contrary to the Administrative Tribunal who were petitioned as to the responsibility for the serious handicap this child suffered to be established publically. They analysed the evolution of judicial and administrative jurisprudence on the matter of failure to terminate a pregnancy. The authors list other possibilities for traumatising a fetus in utero when the inside of the uterus is explored either when the pregnancy is a spontaneous pregnancy or an assisted reproductive pregnancy. The cases of pregnancy requiring a reduction in the number of embryos who will be born or the destruction of handicapped children whose legal status seems not only to be recognised at birth, but even in utero by the judges of the supreme administrative court.

Abortion, Induced↗
PubMed1991

[Newborn bacterial infection caused by materno-fetal contamination. Retrospective epidemiologic study at a maternity unit].

A retrospective epidemiological study of neonatal bacterial infection due to contamination from the mother was carried out in maternity unit. We analysed the results of taking bacterial swabs from the skin and GI tract in newborn children when there was a possibility, or even probability, from the criteria given that there would be infection. These results compare with different criteria. In 19 months there were 2,622 live born children; 40.6% of those had swabs taken; the infection rate was 0.61% of newborns, but 16% of the newborns, had asymptomatic colonisation by bacteria. The high risks of finding positive swabs as shown by increased infection rates by colonisation occurred where the mothers had high temperatures. Our results led us to change the criteria for antibiotic treatment immediately after birth, in newborn babies.

Bacterial Infections↗
PubMed1991

[Applications in gynecology-obstetrics of the first legal cases concerning HIV transmission by blood transfusion and errors in screening].

The intention of the authors in this paper is to provide a preliminary report on what is going on in order to inform gynaecologists and obstetricians of the initial legal steps concerning the transmission of HIV by blood transfusion and the defects in screening for the infection which could have been caught by a pregnant woman; where there was a possibility of a false-positive diagnosis from the serum which could have brought about a termination of pregnancy unnecessarily. Two decisions have been analysed, the one according to the old administrative law and the other according to the more recent judgement, involving pregnancy and other decisions which were not directly concerned with the specialty. These can be instructive for practitioners because these circumstance may come up again. It is worth looking at the case papers where medical responsibility can be invoked involving the professional insurance agencies. These cases will increase in numbers in the future. The authors analysed in the light of the decisions that had been made, possible penal, civil and administrative liabilities that could threaten gynaecologists and obstetricians in this field. The study ends by pointing out what can be done to lessen these medico-legal risks by avoiding blood loss in operations, by finding other ways than blood transfusions towards the end of pregnancy, but above all, by reducing and controlling the number of blood transfusions carefully. This has to be done in collaboration with the transfusion centres and the laboratories where the blood is tested. Judges will have to work out where the responsibility lies if the cases come before them.

Blood Transfusion↗
PubMed1991

[Medical and legal implications of cesarean sections in light of jurisprudence].

130 case notes in the records of a large professional insurance society have been looked at to assess and to analyse the medico-legal repercussions of delivery by caesarean operations. These were randomly selected case histories. In 92% of the cases in a consecutive series of complaints, the most frequent were carrying out caesarean operations or hysterotomy too late. This led to legal action that caused the medical experts reason to analyse seriously retrospectively the indications for the method of delivery that was chosen by the doctors at the time. In only 1 out of 10 cases was the complaint made that the caesarean section had been unnecessarily carried out. This only occurred when there were maternal sequelae or more rarely the new borns suffered. In this second category there was no successful action although there may still be some civil actions if late complications develop. There was one single but worrying case that went to the Conseil d'Etat blaming particularly the caesarean operation and over emphasised because the lady who gave birth tried to win her case. There were two other cases of a less serious nature which were judged concerning a hysterotomy that had complications and another that was delayed too long. The authors point out the ways that legal actions could either be reduced in number or that the consequences of the actions could be made less serious both from the criminal and civil aspect when caesarean sections were either carried out or not carried out by obstetricians.

Cesarean Section↗
PubMed1991

[Spontaneous rupture of the membranes before 28 weeks of amenorrhea. Obstetrical and perinatal outcome. Apropos of 28 cases].

The authors studied the outcome of pregnancies after spontaneous rupture of the membranes before 28 weeks of amenorrhoea in a series of 28 women. The mean time of the rupture was at 25 1/2 weeks. The duration of the time of rupture was a mean of 10 days and deliveries occurred between the 19th and the 32nd weeks. In 5 cases with an average term of 22 1/2 weeks the pregnancy was terminated. Caesarean operation was carried out in 4 cases and spontaneous vaginal delivery occurred between the 26th and 30th weeks of amenorrhoea in 19 cases. Chorio-amnionitis was the most common maternal complication (32.1%). Maternal morbidity was high (82%) without important sequelae. Thirty infants were born out of these 28 pregnancies (two sets of twins). 33% of the infants were stillborn, 46.6% died in the neonatal period, all of these from respiratory complications. 20% of the children are still alive, and all of these weighed at least 1,000 grams and were born after 28 weeks. A child that was born at 27 weeks amenorrhoea has serious neurological deficits. Having studied the bibliography on the subject and their own personal experience the authors suggest a routine to carry out in these cases. Although the prognosis is poor, the totality of these factors could encourage obstetrical teams to be conservative so long as they watch very carefully under well defined conditions.

Adolescent↗
PubMed1991

[Value of ultrasonic diagnosis of fetal malformations in the detection of chromosomal abnormalities].

We report 118 foetal karyotypes studied on the basis of ultrasonographic warning signs which appeared in pregnancies with no significant risk of chromosomal abnormalities, judging from the personal and familial histories. Foetal karyotyping was performed either in amniotic fluid (AF) or in foetal blood. The ultrasonographic warning signs fell into 3 categories: (1) intrauterine growth retardation (IUGR) which was harmonious and below the 5th percentile, without foetal malformation at ultrasonography and without maternal cause (doppler examination, normal Pourcelot's index): 30 cases (24.4%). IUGR was isolated in 22 cases and associated in 8 cases with abnormal amounts of amniotic fluid: oligoamnios 6, hydramnios 2; (2) Isolated abnormality of AF volume: 22 cases (18.8%); hydramnios 19 and oligoamnios 3; (3) Foetal malformations in 66 cases (56%), including 16 central nervous system malformations, 4 cystic hygromas, 10 urinary tract malformations, 9 foetal effusions, 9 abdominal wall abnormalities, 7 gastrointestinal malformations, 5 malformations of the limb and 3 cardiac malformations. The mothers' mean age was 27.5 +/- 4.5 years; the mean term of pregnancy at the time of foetal karyotyping was 28 +/- 6.5 AW. In 51% of the cases the ultrasonographic warning sign was discovered after 29 AW. Among the 118 foetal karyotypes studied, 12 chromosomal abnormalities (10.6%) were detected. During the same period, 712 foetal karyotypes were studied in women aged 38 or more and 18 chromosomal abnormalities (2.53%) were detected. This study confirms that more chromosomal abnormalities can be detected by ultrasonographic warning signs than by relying on the mother's age which is the most frequent reason for foetal karyotype studies. Ultrasonography performed during the second trimester of pregnancy is of value to evaluate foetal growth and the amount of AF and to investigate for possible foetal malformations.

Adult↗
PubMed1990

Frequent isolation of capnophilic bacteria in aspirate from Bartholin's gland abscesses and cysts.

Aspirate samples were obtained from 73 patients undergoing surgery for a Bartholin's gland abscess or cyst. Capnophilic bacteria were isolated from 22% of cases, in contrast to previous reports of sporadic isolation. The three Streptococcus pneumoniae isolates were serotype 3 or 4. The eight Haemophilus influenzae isolates could not be serotyped; six of them were biotype II but the electrophoretic band patterns of their outer membrane proteins were heterogeneous, indicating that non-serotypable strains from the same anatomical site may not be related. Four Neisseria gonorrhoeae isolates and one strain of Neisseria subflava were recovered. The role of capnophilic bacteria in the pathogenesis of infections of the Bartholin's gland remains to be clarified.

Abscess↗
PubMed1990

[A misleading breast tumor: a granular cell tumor of the breast].

Granular cell tumours are rare benign neoplasms, that occur infrequently in the vulva or the breast. Two cases of the tumour occurring in the breast observed personally are reported. Emphasis is laid on the clinical radiological and macroscopic aspects of this tumour that can mimic carcinoma of the breast. It is best to carry out frozen section histological examination because this is the only way to make a correct diagnosis. Positive immunohistological staining for S-100 protein which is also found in Schwann cells shows that it may be of neural origin for such lesions. The ultrastructure suggests the same origin. The only treatment should be wide local excision with the frozen section making it possible to avoid more radical surgery. Long term observation should be carried out when the excision is near the tumour because there is a high risk of recurrence if that occurs.

Adult↗