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Biomedical subjects

F Puech

Publications and source records attributed to F Puech.

At least 37 records · Page 2Linked to original sources
PubMed2000

Echographic signs of trisomy 21 in the second trimester of pregnancy: actual value after analysis of the literature.

OBJECTIVE: To evaluate the interest and to compare the major echographic signs of Down syndrome in the second trimester of pregnancy. METHODS: A bibliographic research has been performed for most of the echographic signs known and studied until now. For each study and in average for each sign, we have computed its sensitivity, its specificity, its positive and negative predictive values using the results of the different authors. Then, we have compared the benefits/risk ratio for each of these signs: the number of Down syndrome cases detected versus healthy fetus lost due to amniocentesis complications. RESULTS: The different signs can be ranked according to their benefits/risk ratio from top to bottom as follows: nuchal skinfold thickness, wide space between first and second toe, pyelectasis, large iliac angle, short humerus, short femur, hypoplasia of the middle phalanx of the fifth digit. CONCLUSION: These results suggest that second trimester echographic signs of Down syndrome must be evaluated as a function of the Down syndrome risk in the population under study. The presence of these signs does not always justify an amniocentesis; it should lead to a re-evaluation of the individual risk of a Down syndrome (a chart is given to guide this re-evaluation).

Down Syndrome↗
PubMed2000

[Medical indications of labor induction: a comparison between intravaginal misoprostol and intravenous prostaglandin E2].

OBJECTIVES: To assess the effectiveness and safety of misoprostol compared to dinoprostone at term, in cervical priming and labor induction for medical indications. MATERIAL: and methods. Retrospective analysis of 87 patients. 43 patients received intravaginal misoprostol (50microg) and 44 intravenous dinoprostone (0,225 microg/mn with progressive increasing). RESULTS: The mean time from administration to delivery was significantly shorter in the misoprostol group than in the dinoprostone group (10,2 vs 26,0 hours, p<0,01). A significantly greater number of deliveries occurred within 24 hours following administration of misoprostol ( 95 vs 55%, p<0,01). There was no difference in the rates of cesarean section (21 vs 23%, NS), in the rates of tachysystole (30 vs 27%, NS). Hyperstimulations (excessive uterine response: hypertony or tachysystole with non reassuring fetal heart rate) were increased in the misoprostol group, but not significantly (16 vs 7%, NS). Three cesarean sections were performed for hyperstimulation syndrome in the misoprostol group. There was no significant difference between the two agents administered in neonatal outcome or meconial fluid. CONCLUSION: Misoprostol appears interesting in promoting cervical priming and induction of labour at term, but the increased frequency of hyperstimulation and meconial fluid reported in the literature indicate than larger studies than ours are necessary to accurately define the fine incidence of adverse effect. Moreover, dose and administration modalities should be defined by those studies.

Administration, Intravaginal↗
PubMed2000

[Value of fetopathological examination in medical abortions: comparison of prenatal diagnosis and autopsy results of 300 fetuses].

This 3.5-year retrospective study report 300 fetus autopsies after pregnancy termination because of prenatal diagnosis of malformation. The objective was to evaluate the usefulness of postnatal examination of fetuses and to compare the post mortem findings with the prenatal diagnosis. This study included ultrasonography, radiology, karyotype, microbiology, genetic counseling and detailed pathological evaluation of the fetus: external, macroscopic, microscopic, brain and placenta examination. The results of post mortem examination were of paramount importance: they either changed the prenatal diagnosis hypothesis (20.3%), provided extensive additional information (41%), or confirmed the diagnosis hypothesis (38.7%). This study confirms the need for fetopathology examination after medical abortion. The pathologist's contribution to the multidisciplinary management of prenatally diagnosed fetal abnormalities is fundamental in particular for further genetic counseling; a specialized pathologist should be present in all prenatal diagnosis centers.

Abortion, Induced↗
PubMed1999

[Nuchal translucency: screening for chromosomal abnormalities and congenital malformations. Multicenter study].

OBJECTIVE: To value the rate of chromosomal abnormalities and evolution of children who had a prenatal diagnosis of fetal nuchal translucency in the first trimester. MATERIAL AND METHODS: Multicenter prospective study conducted in 4,582 patients who had a first ultrasonography between 10 and 14 weeks' gestation (abdominal and/or transvaginal sonography). The measurement of fetal nuchal translucency was performed by mid-sagittal section and when it was higher than 2.5 mm a fetal karyotype was made. RESULTS: Three hundred and fifty eight nuchal translucencies (> 2.5 mm) were diagnosed and 334 karyotypes were done. We found 25 chromosomal anomalies (7.4%): 14 trisomies 21; 7 trisomies 18; 2 trisomies 13; one triploidy and one trisomy X. The postnatal examination of children detected three congenital malformations (0.9%): one facial dysmorphia, one complex abnormal heart anatomy and one renal agenesia. CONCLUSION: Nuchal translucency (> 2.5 mm) is therefore a sonography sign associated with 7.4% of chromosomal anomalies. The distribution by size and mother ages is low. It should need superior larger-scale studies are needed for representative data. But this study shows that if fetal karyotype is normal, the incidence of congenital malformations seems to be the same by comparison with the general population.

Chromosome Aberrations↗
PubMed1999

[Diabetes before pregnancy, apropos of 143 cases].

OBJECTIVE: The authors want to appraise the management of diabetes prior to pregnancy in a local population treated in the Lille University Hospital. METHOD: This is a retrospective study of 143 pregnancies occurring in 111 patients with diabetes prior to pregnancy, between 1987 and 1997, in the Obstetrics Department at the Lille University Hospital. RESULTS: Only one-third of the patients benefited from preconception management; the stability of diabetes during the first trimester was satisfactory in 50% of the cases. The maternal complications are represented by preeclampsia (20%), metabolic complications specific to diabetes (hypoglycemia, ketoacidosis), the aggravation or the emergence of a retinopathy (10%) and polyhydramnios (19%). Concerning the termination of the pregnancies, of the 147 fetuses (four twin pregnancies), 140 newborns in good health, two neonatal deaths, three in-utero deaths and two therapeutic terminations of pregnancy were observed. The fetal malformation rate was 9.5% (14 cases/147). The cesarean section rate was 63%, whereas the fetal macrosomatia rate was 35%, with dystocia in 26% of the deliveries (outside of planned cesareans). Three shoulder dystocia were observed (two requiring the Jacquemier's maneuver and one with transitory plexus brachial palsy for a newborn weighing 5,650 g). CONCLUSION: The authors conclude that preconception management (one-third of the patients in this series) and management of during the first trimester of pregnancy (50% in this series) was insufficient. This fact is perhaps due to the confusion, for many practitioners, with gestational diabetes, which is a very mediatized affection, though much less severe for the fetus and mother.

Adolescent↗
PubMed1998

Fetal macrosomia: risk factors and outcome. A study of the outcome concerning 100 cases >4500 g.

OBJECTIVE: Because difficult vaginal delivery is more frequent with macrosomic fetuses, some authors recommend routine caesarean section for the delivery of fetuses >4500 g. The purpose of this study was to evaluate the appropriateness of this recommendation, in particular, to analyze maternal and fetal complications according to the mode of delivery. METHOD: Maternal and neonatal records of 100 infants with weights of at least 4500 g were identified retrospectively from January 1991 to December 1996. Outcome variables included the mode of delivery and the incidence of maternal and perinatal complications. RESULTS: The study sample consisted of 100 infant and mother pairs. Macrosomic fetuses represented 0.95% of all deliveries during this period and only ten were >5000 g. Mean birth weight was 4730 g (maximum, 5780 g). Gestational diabetes was present in nineteen patients. Diabetes was present in three patients. A trial of labour was allowed in 87 women, and elective caesarean delivery was performed in thirteen patients. The overall cesarean rate, including elective caesarean delivery and failed trial of labour, was 36%. Of those undergoing a trial of labour, 73% (64/87) delivered vaginally. Shoulder dystocia occurred fourteen times (22% of vaginal deliveries) and it was the most frequent complication in our series. There were five cases of Erb's palsy, one of which was associated with humeral fracture, and four cases of clavicular fracture. By three months of age, all affected infants were without sequelae. There was no related perinatal mortality and only two cases of birth asphyxia. Maternal complications with vaginal delivery of macrosomic infants included a high incidence of lacerations requiring repair (eleven cases). No complications were noticed in the patients who had a caesarean section. CONCLUSION: Vaginal delivery is a reasonable alternative to elective cesarean section for infants with estimated birth weights of less than 5000 g and a trial of labour can be offered. For the fetuses with estimated birth weight >5000 g, an elective caesarean section should be recommended, especially in primiparous women.

Adult↗
PubMed1998

Early detection of caudal regression syndrome: specific interest and findings in three cases.

Caudal regression syndrome (CRS) is a rare malformative syndrome seen mainly in cases of maternal diabetes with poor metabolic control. Early detection by vaginal ultrasound is possible. The authors describe three cases of CRS, relating the characteristic ultrasound findings which include abrupt interruption of the spine at the dorsal or lumbar level and abnormal position of the lower limbs. The femur bones are fixed in a 'V' pattern, giving a typical 'Buddha's poise'.

Adolescent↗
PubMed1998

Relationships between severe neonatal thrombocytopenia and maternal characteristics in pregnancies associated with autoimmune thrombocytopenia.

In pregnant women with antecedents of autoimmune thrombocytopenia (AITP), no predictive factor for severe fetal thrombocytopenia has been identified. We evaluated the relationships between the course of the maternal disease before and during pregnancy and the risk of severe fetal thrombocytopenia, in 64 pregnant women with known chronic AITP antecedents, over a 12-year period. 28 pregnant women had undergone splenectomy before pregnancy and 17 experienced severe thrombocytopenia (< 50 x 10(9)/l) during pregnancy (monthly determination). Eight infants presented with severe thrombocytopenia at birth (12.5%), and four in the following days (6.25%). No severe haemorrhage was observed. Severe thrombocytopenia at birth was present in 57% (CI 95% 18-90%) of the infants born to mothers with severe pregnancy-associated thrombocytopenia and splenectomy antecedents, and in 0% (CI 95% 0-15%) of the infants born to mothers who presented none of these antecedents (P=0.001). In thrombocytopenic mothers the infant platelet counts at birth were positively correlated to the nadir maternal platelet count during the index pregnancy (r=0.42, P=0.0075). These results suggest that severe autoimmune disease is a risk factor for severe fetal thrombocytopenia, and that pregnant women with no antecedent of splenectomy nor severe thrombocytopenia during pregnancy have a very low risk of severe fetal thrombocytopenia.

Chronic Disease↗
PubMed1998

Risk factors for maternal condition at admission to an intensive care unit: does health care organisation play a role? Study Group of the Maternal Morbidity.

The objective of this study was to analyse the relation between severity of maternal condition at the time of intensive care unit (ICU) admission and various individual and institutional factors. This study analysed data from a retrospective population-based study in three French regions during 1991. The population study included 355 patients who were admitted to an ICU during pregnancy, delivery or within 42 days after delivery, for an obstetrical cause. The main outcome measure was the severity of maternal condition at ICU admission estimated from the level of consciousness and from the Simplified Acute Physiology Score (SAPS). The most severe maternal condition was associated with a change in hospital category (from the initially chosen hospital to the hospital referring for ICU) (OR 3.8, 95% CI 1.5-9.6) and with treatment in a private hospital at ICU referral (OR 3.3, 95% CI 1.3-8.3). Foreign nationality was the only individual factor related to very severe maternal condition. These results suggest that health care organisation during pregnancy affects the prognosis of severe maternal condition. The factors involved appear to include the management of unpredictable disorders, the conditions of maternal transfers before ICU admission, and antenatal care of foreigners.

Adult↗
PubMed1998

[Fetal cerebral ventriculomegaly. Etiology and outcome, report of 141 cases].

OBJECTIVE: To present the different etiologies of fetal cerebral ventriculomegaly (VA) and try to evaluate prognosis. MATERIALS AND METHODS: A retrospective analysis was made in 141 cases of fetal cerebral ventriculomegaly diagnosed in our obstetrics department between January 1988 and December 1996. RESULTS: Mean gestational age at diagnosis was 24.8 weeks. Myelomeningoceles were the most frequent etiology (50 cases, 36%), usually diagnosed late in pregnancy (25 weeks gestation). Termination of pregnancy was the most frequent outcome. Agenesis of the corpus callosum (ACC) was observed in 16 cases (11%), 8 of them being diagnosed before birth. This etiology has been an important diagnostic problem until recent years. The advent of improved imaging techniques has facilitated diagnostic procedures. Thus in 1996, the 4 ACC were all diagnosed by prenatal ultrasound. The 8 live infants presented developmental retardation. Termination of pregnancy has been performed more and more frequently in accordance with parent wishes. In 6 cases (4%), the etiology was congenital infection. When a chromosome anomaly was found (7%), ventriculomegaly was always associated with other ultrasonographic anomalies. Ventriculomegaly was associated with other malformations in 23% of the cases but only 17% were discovered prenatally; all the live infants but one had severe neurological impairment. Ventriculomegaly was considered to be the unique anomaly in 37% of the prenatal cases and was truly unique in 24%, an etiology being found in 6%. No explanation was found in 18%. The outcome of live infants is known in 139 cases (2 children lost to follow-up) after a 6 month to 6 year follow-up. Overall prognosis was severe as among the 42 infants (30%), 14 (10%) are well including 12 who had ventriculomegaly alone. CONCLUSION: Prenatal diagnosis of ventriculomegaly implies a severe prognosis. Only children presenting limited ventriculomegaly alone have normal neurological development. In case of ventriculomegaly, clinicians must search carefully for other anomalies, always associated with poor prognosis.

Agenesis of Corpus Callosum↗
PubMed1998

[Triploidies].

Triploidies are pregnancies that show a 69 chromosome karyotype. This chromosomal abnormality gives rise to early abortion in most cases. Triploid pregnancies, after the first three months, become molar pregnancies (molar changes inside the placenta with identifiable embryonic structures and a preeclampsia) or non molar pregnancies (isolated intauterin growth retardation). Several possibilities concerning the origin of the additional set of chromosomes exist: dispermy (the most common), diandry and digyny. The maternal and fetal clinical manifestations of this chromosomal abnormality are very diverse, which explains the difficulty of finding and recognizing this pathology. Mac Fadden's classification does not explain all the phenotypic triploid physiopathology. Formal diagnosis of triploidy depends on the fetal karyotype. The better the maternal prognosis is, the worst the fetal prognosis is. Postnatal life expectancy is not more than a few weeks. In most cases, maternal associated complications disappear with the molar evacuation. The risk of post molar tumor is discussed. However, good management of triploidy is based on an early diagnosis, before birth if that is possible.

Abortion, Spontaneous↗
PubMed1998

[Prenatal diagnosis of osteogenesis imperfecta. Two cases].

We report two cases of prenatal diagnosis of osteogenesis imperfecta (type S of Marotaux), diagnosed at 23 and 24 weeks of gestation, revealed by of an ultrasound scan which noted an abnormal femoral incurvation. The problem of differential diagnosis with other diseases causing femoral incurvation (notably campomelic dysplasia) is difficult, especially at early stage. This question is debated here. The interest to associate ultrasound scan and uterine contents radiography is so demonstrated.

Adult↗