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Biomedical subjects

G Breart

Publications and source records attributed to G Breart.

At least 55 records · Page 3Linked to original sources
PubMed1989

The use of ultrasound examinations, intrapartum fetal heart rate monitoring and beta-mimetic drugs in France.

We conducted a survey of French obstetricians to document their attitudes towards routine ultrasound, intrapartum fetal monitoring and beta-mimetics in 1987. A questionnaire was sent to 582 obstetricians or gynaecologists who were members of two French medical associations. The response rate was 85%. Of the respondents 92% prescribed two or three routine ultrasound examinations; only one doctor did not use electronic fetal monitoring and 99% of the respondents prescribed beta-mimetics to prevent preterm delivery. Some obstetricians reported a decrease in their use of ultrasound and more dramatically in the use of beta-mimetics. Side-effects were reported to be the major reason for the change in beta-mimetic use. Obstetricians who read English language journals were more likely to have reduced their use of ultrasound and beta-mimetics than those who read only French language journals.

Female↗
PubMed1989

Intra-uterine growth: a comparison of longitudinal and cross-sectional approaches.

The great majority of the fetal growth curves are constructed through a cross-sectional approach. Before the use of ultra-sonography, fetal growth was first evaluated from birthweights of infants born at different gestational ages. More recently, curves were established for different ultrasonographic parameters which combination can provide an immediate but imperfect evaluation of fetal weight. All the curves used as standards of normal growth derive from cross-sectional studies. Several longitudinal studies of fetal growth exist, with two aspects. The first method is to make serial measurements at special intervals, among a group of fetuses with known dates of conception, in order to determine average longitudinal curves. The aim of the standards of fetal growth is obstetric management and the threshold of a percentile, for instance the tenth, of an ultra-sonographic parameter can define the intra-uterine growth retardation. The result of the fetal growth is evaluated with the standards of birthweight which define the small for gestational age infant. Another longitudinal approach is the use of a mathematical growth model to establish an individual growth curve, each fetus is then its own control. This last approach still belongs to the research field.

Birth Weight↗
PubMed1988

Comparison of antihypertensive efficacy and perinatal safety of labetalol and methyldopa in the treatment of hypertension in pregnancy: a randomized controlled trial.

Labetalol was compared with methyldopa in a randomized controlled trial involving 176 pregnant women with mild to moderate hypertension. Diastolic blood pressure below 86 mmHg was obtained in a similar proportion of women given labetalol or methyldopa. Intrauterine death occurred in four women treated with methyldopa, and the one neonatal death on day 1 occurred in the labetalol group. The average birthweight and the proportion of preterm or small-for-gestational-age babies were similar in both groups. Heart rate, blood pressure, blood glucose, respiratory rate, and Silverman score of the babies did not differ between the two treatment groups, whether the comparison was made for all the infants, or only for those that were preterm or small-for-gestational-age. These data indicate that maternal beta-blockade with labetalol is as safe as methyldopa for the fetus and the newborn.

Adult↗
PubMed1987

Distribution of ultrasound examination during pregnancy in France between 1976 and 1981.

In France, between 1976 and 1981, the use of ultrasound examination during pregnancy increased from 11.3 to 81.8%. In spite of this dramatic increase, many inequalities observed in 1976 still exist in 1981. Despite a decrease in 1981 of the differences in practice in public maternity units and private care units, large differences remained between general practitioners and specialists. In a logistic regression, the type of practitioner responsible for care appeared to be the most important factor determining access to ultrasound examination. Independent of other inequalities in the type of antenatal care, three groups of women remained disadvantaged in 1981: women under 20 years old, grand multiparas and women of low educational level. The latter group was particularly disadvantaged. Obstetric pathology has little influence on the overall distribution of ultrasound examinations.

Adult↗
PubMed1987

Pregnancy outcome and social conditions of women under 20: evolution in France from 1972 to 1981.

Two studies based on national samples of births in France in 1972 and 1981 have enabled a comparison of the changes in perinatal risk and social situation of women under 20 years of age with those of women 20 and over. Preterm delivery among women under 20 remained stable during the 10-year period, while it declined significantly among older women. Also, the social situation of teenagers deteriorated in terms of occupational activity, educational level, presence of the child's father in the home, and his occupation. The changes in these social characteristics do not adequately explain the increased relative risk of preterm delivery among women under 20.

Adolescent↗
PubMed1986

Can the number of cesarean sections be reduced without risk? An analysis of rates and indications in a university clinic.

This study concerns women followed from the first trimester of pregnancy, in a university clinic in Paris in 1977, 1979 and 1981. The cesarean section rate was separately analysed for primiparas, and multiparas with and without previous cesarean section. The overall rate of cesarean section was 11.4% in 1977, 17.2% in 1979 and 21.1% in 1981. The 9.6% increase observed between 1977 and 1981 is mainly attributable to an increase in primary cesarean section, particularly among primiparas, between 1977 and 1979. This does not seem to have arisen from sample variations. There is a change in obstetrical attitude and more cesarean sections are performed in cases of hypertension, breech presentation or intrauterine growth retardation. The greater number of previously sectioned women explains the increase in the rate between 1979 and 1981. The main fact among primiparas is the 18.8% increase in diagnosis of dynamic dystocia between 1979 and 1981. Three key areas allow us to envisage a reduction in cesarean section rate: obstetrical attitude towards previous cesarean section, breech presentation, and management of labor, whose perturbations lead to diagnosis of dynamic dystocia.

Academic Medical Centers↗
PubMed1984

Electromyographical study of uterine activity in the human during labour induced by prostaglandin F2 alpha.

In full-term pregnant women, electrical and mechanical activity of the uterus was monitored throughout the course of labour promoted by intravenous infusion of Pg F2 alpha. The recorded potentials were mostly biphasic and characterized by their long duration ranging from 1 to 2s. A wide range of potential amplitudes (100 microV to 1.8 mV) was observed according to the various patients. Early at the beginning of labour induction, the electrical complexes firing at various uterine sites were proved to be in close relationship and also well correlated with the mechanical events. This feature remained unchanged during labour. Potential amplitudes also remained unchanged during the same period of time. Under these conditions, improvement of uterine coordination does not appear to be the mechanism by which the increase of uterine contractile strength, necessary to expel the fetus, is obtained at the end of gestation.

Action Potentials↗
PubMed1984

[A decision problem in perinatology: continuous monitoring of the fetal heart during labor].

Review of evaluative studies on electronic fetal monitoring (E.F.M.) during labour shows that the conclusions of the five published randomized controlled trials have not been applied. There is a discrepancy between the widespread use of the method and the lack of proof of its efficacy in the controlled trials. This discrepancy can be related to methodological problems (insufficient number of cases, judgment criteria, compared types of care). It also shows that the conclusion concerning the possible net benefit or net harm of E.F.M. depends on the absence of such benefit, on the unit chosen to combine advantages and disadvantages. Based upon the same set of estimates for advantages and disadvantages the conclusion is in favor of E.F.M. when the chosen unit is utility whereas the conclusion is different in a cost-benefit analysis.

Adult↗
PubMed1983

Fetal tachycardia and meconium staining: a sign of fetal infection.

A retrospective study was carried out on 72 liveborn babies in whom perinatal infection was suspected. Twenty-nine of the 72 neonates were effectively infected. Analysis of intrapartum FHR recordings showed that tachycardia (base line FHR above 160 beats/min) during labor, occurred more often among infected babies (P less than 0.001). When fetal tachycardia is associated with meconium stained amniotic fluid (MSAF), the relative risk of fetal infection is 51 times as great as in babies without MSAF. Fetal tachycardia is not related to maternal fever nor to prematurity. It is not a sign of limited placental or amniotic fluid infection, but implies infection of the fetus itself. Since most infected babies displayed infectious diarrhea immediately at birth, it is suggested that MSAF may eventually be due to antenatal intestinal infection and intrauterine emission of infected stools. Although great caution is advocated for the management of labor in the presence of fetal tachycardia, MSAF should not be always regarded as a sign of acute fetal distress when antenatal infection of the fetus is suspected.

Bacterial Infections↗
PubMed1983

Fetal growth retardation in gestational hypertension: relationships with blood pressure levels and the time of onset of hypertension.

To evaluate the effects of gestational hypertension on fetal growth, we studied the standardized records of 2996 single live-birth pregnancies. Mothers all had documented diastolic blood pressure of less than 85 mmHg before the 16th wk of amenorrhea and no history of pre-pregnancy hypertension or kidney disease. Diastolic blood pressure readings exceeding 84 mmHg were found later in pregnancy in 38.4% of the mothers, and were associated with an increased number of small-for gestational-age infants: 3.2% in mothers whose diastolic blood pressure had never reached 85 mmHg, 6.3% when peak diastolic blood pressure had been in the 85-94 mmHg range, and 8.5% when it had exceeded 94 mmHg (p less than 0.01). In mothers who had had one or more diastolic readings of more than 84 mmHg, and for all peak diastolic pressures, the rate of small-for-gestational-age infants was higher when hypertension had begun early in third trimester (between the 27th and 36th wk), than in the second trimester or later than the 35th wk (10.2% compared to 5.6 and 6.1% respectively, p = 0.02). This temporal reinforcement of the adverse fetal effects of hypertension when it began in the early third trimester was not explained by differences in the incidence of proteinuria or in maternal age, parity, obstetric history or smoking habits.

Adult↗
PubMed1983

[Preconceptional selection of sex using the ionic method. Dietary regime. Results of a 2 years' prospective clinical study].

45 women out of a total of 58 patients who followed a dietary regime appropriate to the sex they had chosen for their babies were successful in delivering a baby of the wanted sex. This result gives a success figure of 77.6% (the mean between 67 and 89%: p less than 0.001) and from the statistical point of view this difference is significant as compared with the natural sex ratio. The diets were overall well tolerated and the children at birth weighed normal weights. The parents seemed to request approximately equal numbers of girls as of boys--a balanced request. A high number of patients abandoned the method (75%). This is explained by the restrictions that are imposed by the diets and because the method would still appear to be experimental. It does seem that the ability to influence the sex ratio of the future offspring is possible when the ionic balance of the diet is changed. The study should be continued.

Clinical Trials as Topic↗
PubMed1982

[Kidneys, hypertension and pregnancy. II. Hypertension in pregnancy: significance, prognosis, and treatment (author's transl)].

A rise in arterial pressure above 140 mmHg systolic or 85 mmHg diastolic is pathological in pregnant women. Such changes may either reveal chronic hypertension or constitute a purely gestational complication. The persistence or regression of abnormally high BP values 3 months after delivery retrospectively indicates whether the hypertension was chronic or pregnancy-related. When BP values are very high (diastolic above 110 mmHg) the mother is exposed to vascular accidents and the most effective anti-hypertensive drugs are required. In the more common moderate hypertension, both the mother (eclampsia) and the foetus (intra-uterine or neonatal death, low birth-weight) are at risk. The risk is better predicted by proteinuria and hyperuricaemia than by the BP values themselves, and whether anti-hypertensive drugs are warranted is uncertain. Studied comparing patients with treated and untreated moderate hypertension have yielded two valuable results: (1) methyldopa administered to the mother is harmless to the foetus, and (2) abortion during the second trimester of pregnancy is probably prevented when methyldopa is prescribed against chronic hypertension. No study has yet afforded evidence that the use of anti-hypertensive drugs in gestational hypertension benefits the foetus. Further therapeutic trials and a better knowledge of the natural history and mechanisms of hypertension in pregnancy are required before adequate management of this condition can be determined.

Antihypertensive Agents↗