Biomedical subjects

J B De Meeus

Publications and source records attributed to J B De Meeus.

14 recordsLinked to original sources

PubMed1998

C-reactive protein levels at the onset of labour and at day 3 post-partum in normal pregnancy.

OBJECTIVES: To record maternal serum C-reactive protein levels during normal onset of labour and normal puerperium and to evaluate if inflammation or infection could be predicted during these two periods when serum C-reactive protein is increased. METHODS: Eighty-five pregnant women were enrolled in a longitudinal prospective study and had a blood sample to assess serum C-reactive protein levels on admission to the labour ward for normal onset of labour and at day three post-partum. Inclusion criteria were no previous history, a normal single pregnancy, normal vaginal delivery and an uneventful post-partum course. Twelve non-pregnant women of the same age constitued a control group. An automatic Behring Nephelometer was used to measure serum C-reactive protein concentrations. The Student's t-test (significance p < 0.05) was used for statistical analysis. FINDINGS: C-reactive protein was significantly increased during the onset of labour (4.10 +/- 2.79 mg/L) and reached very high levels during the post-partum period (24.07 +/- 18.28 mg/L) compared to the standard normal serum C-reactive protein level in a population of non-pregnant women of the same age (2.39 +/- 0.07 mg/L). INTERPRETATION: Increased serum C-reactive protein has been reported to be a marker for subclinical infection during pregnancy in various situations including premature labour and premature rupture of membranes and for complications occurring during puerperium such as thrombophlebitis, thromboembolism or endometritis. This interpretation depends on which upper limit is considered as abnormal. Because serum C-reactive protein was raised during the onset of labour, values of less than 10 mg/L could not be considered as a marker for infection during this period. Elevated serum concentrations of estrogen, progestogen and prostaglandins during labour might be one explanation for those physiological changes. Normal vaginal delivery could be compared to a surgical procedure and tissue injury consecutive to vaginal birth as reflected by a dramatic increase in C-reactive protein. More studies using nephelometry are needed to determine normal and upper values of C-reactive protein during pregnancy.

Adolescent↗

PubMed1997

Prophylactic intrapartum amnioinfusion: a controlled retrospective study of 135 cases.

OBJECTIVE: To show that intrapartum prophylactic amnioinfusion (AI) in case of oligohydramnios or particulate meconium-stained amniotic fluid could be beneficial. STUDY DESIGN: From the first March 1993 until the 30th June 1995, 4031 women were delivered at the University Hospital of Poitiers. Patients presenting with oligohydramnios (G1) (71 patients with an amniotic fluid index below 5 cm) or a particulate meconium-stained amniotic fluid (G2) (64 patients) were included. Each group was compared to an historical control group constituted retrospectively according to the following criteria: oligohydramnios (CG1), particulate meconium-stained amniotic fluid (CG2), age, parity, gestational age and duration of labor. Statistical analysis was performed using the Student's t-test and the Fisher's exact test when appropriate with a level of significance of P less than 0.05. RESULTS: The mean infused volume was 893 ml in G1 and 734 ml in G2. A significant difference was found in terms of cesarean section between G1 and CG1 (11.3 vs. 24.5%; P < 0.05) and of assisted deliveries for fetal distress between G2 and CG2 (12.5 vs. 23.43%; P < 0.05). No other significant difference was found between the study groups and their control for all other studied criteria. When considering more specifically the presence of meconium below the vocal cords we also could not find any significant difference between G2 and CG2 (1.6 vs. 9.4%; P = 0.05). No neonatal or maternal adverse effect happened in this short study. COMMENT: AI is easy to perform during labour in case of oligohydramnios or particulate meconium-stained amniotic fluid. In case of oligohydramnios, a decreased rate of cesarean sections has been observed in the infused group. Considering patients with particulate meconium-stained amniotic fluid, less interventions for fetal distress and neonates with meconium below the vocal cords has been found in the infused group. Further prospective evaluation is needed to confirm these results in case of particulate meconium-stained amniotic fluid and to compare the advantage of prophylactic versus therapeutic AI performed in case of oligohydramnios and abnormal fetal heart rate.

Adult↗

PubMed1997

Indications of laparoscopic hysterectomy.

OBJECTIVE: To determine when vaginal hysterectomy is contra-indicated and abdominal hysterectomy should be performed. To assess when laparoscopic surgery can avoid the abdominal procedure, and to determine the indications of this new technique in case of benign uterine lesions without prolapse. MATERIALS AND METHODS: A retrospective study of 171 hysterectomies performed by the same surgeon for benign uterine lesions without prolapse. When possible the vaginal route was chosen and the following criteria were studied: indication for hysterectomy, previous surgery, uterine weight, duration of the procedure, intra- and post-operative bleeding, complications and recovery time. Statistical analysis was performed using the Chi2 test and the Fisher's exact test when appropriate with a level of significance of p < 0.05. RESULTS: One hundred and nine vaginal (60.4%) and 62 abdominal (39.6%) hysterectomies were performed and the main indication was menometrorrhagia (respectively 97 (89%) and 49 (79%) cases). The indication for abdominal surgery was an enlarged uterus in 47 patients (76%). In 10 cases (6%) laparoscopy was indicated because of severe endometriosis, previous abdominal surgery or a suspect adnexal cyst. No complications occurred in either group. The duration of the procedure, blood loss and recovery time were lower in the vaginal group (p < 0.05). COMMENTS: Uterine volume limits vaginal hysterectomy, and this cannot be overcome by laparoscopic surgery. Only severe adhesions and endometriosis are more amenable to laparoscopic hysterectomy. The laparoscopic hysterectomy rate should not reasonably exceed 10 to 15%, yet is as high as 63% in some studies. Further studies are needed to determine the value of laparoscopic hysterectomy relative to the vaginal route.

Abdomen↗

PubMed1997

[Prophylactic amnion infusion during labor. Apropos of 195 cases].

OBJECTIVE: To show that intrapartum prophylactic amnioinfusion in case of oligohydramnios or particulate meconium-stained amniotic fluid could be beneficial. STUDY DESIGN: From March 1st, 1993 until December 31st, 1996, 6845 women were delivered at the University Hospital of Poitiers. Patients presenting with oligohydramnios (G1) (118 patients with an amniotic fluid index below 5 cm) or a particulate meconium-stained amniotic fluid (G2)(77 patients) were included. Each group was compared with a historical control group constituted retrospectively according to the following criteria: oligohydramnios (CG1), particulate meconium-stained amniotic fluid (CG2)), age, parity, gestational age, and duration of labor. Statistical analysis was performed using the Student's t test and the Fisher's exact test when appropriate with a level of significance of p < 0.05. RESULTS: The mean infused volume was 883 ml in G1 and 751 ml in G2. A significant difference was found in terms of cesarean section between G1 and CG1 (14% versus 25%, p < 0.05) and of assisted deliveries for fetal distress between G2 and CG2 (5% versus 18%, p < 0.02). No other significant difference was found between the study groups and their control for all other studied criteria. When considering more specifically the presence of meconium below the vocal cords we also find a difference between G2 and CG2 (5% versus 14%) which was not significant. No neonatal or maternal adverse effects happened in this short study. COMMENT: Amnioinfusion is easy to perform during labor in case of oligohydramnios or particulate meconium-stained amniotic fluid. In case of oligohydramnios, a decreased rate of cesarean sections has been observed in the infused group. Considering patients with particulate meconium-stained amniotic fluid, less interventions for fetal distress and neonates with meconium below the vocal cords has been found in the infused group. Further prospective evaluation is needed to confirm these results in case of particulate meconium-stained amniotic fluid and to compare the advantage of prophylactic versus therapeutic amnioinfusion performed in case of oligohydramnios and abnormal fetal heart rate.

Adult↗

PubMed1997

[Biological diagnosis of premature rupture of membranes: respective values of diamine oxidase activity compared to vaginal fluid pH (Amnicator)].

OBJECTIVES: To compare the sensitivity (Se), specificity (Spe), positive predictive (PPV) and negative predictive (PNV) values of 2 tests used routinely for suspected premature rupture of the membranes (PROM) and their implication in the management of such cases. PATIENTS AND METHODS: From 1 November 1995 to 31 July 1996, 87 patients: 16 with obvious PROM on physical examination (group I) and 71 with suspected PROM (group II) were tested with both DAO and Amnicator. PROM was arbitrary confirmed in group II when delivery occurred within 48 hours after the diagnosis was suspected. The corrected chi 2 test was used to compare both tests results in group II. RESULTS: In case of obvious PROM, the sensitivity of the DAO and Amnicator tests were 75 and 87.5% respectively. Eleven patients from group II delivered within 48 hours following admission and the 2 tests results were respectively: Se 90.9 and 81.81%, Spe 100 and 83.33%, PPV 100 and 52.63% and PNV 98.36 and 96.15%. DAO gave better results in terms of Spe and PPV (p < 0.05). COMMENTS: The DAO test remains a reference test when PROM is suspected but when it is not available (during night or week-end), the quite good negative predictive value of Amnicator could avoid unnecessary hospitalisation and permit later DAO test.

Adolescent↗

PubMed1997

[How many abdominal hysterectomies can be avoided by laparoscopic surgery?].

Laparoscopic hysterectomy performed for benign uterine lesions without prolapse is becoming more and more popular. This surgical route has some of the advantages of the vaginal route and could avoid numerous abdominal hysterectomies. Our experience shows that most of abdominal or laparoscopic hysterectomies could be done using the vaginal route which is for us the reference. One question about laparoscopic hysterectomy is: can we perform this technique to avoid abdominal hysterectomy when the vaginal route looks impossible? To answer this question, we retrospectively studied 171 hysterectomies. The laparoscopic hysterectomy rate should not reasonably exceed 10 to 15%, yet is much higher for the promotors of this technique of which advantages compared with vaginal hysterectomy are not clearly demonstrated.

Evaluation Studies as Topic↗

PubMed1994

[Premature rupture of membranes. Prospective study of 218 cases].

OBJECTIVES: To verify the importance of a wait-and-see attitude after premature rupture of the membranes before 34 weeks of amenorrhoea when allowed by the initial physical examination and of an intervening attitude after 34 weeks. STUDY: A prospective study included 218 cases of premature ruptures of the membranes divided into four groups according to the weeks of amenorrhoea: Group 1, before 32 weeks (n = 11); Group 2, between 32 and 34 weeks (n = 26); Group 3, between 34 and 37 weeks (n = 18); Group 4 after 37 weeks (n = 163). RESULTS: Before 34 weeks of amenorrhoea, the frequency of premature rupture of the membranes was 0.72%, of germ-positive infants 8% and of infected infants, 11%. Perinatal mortality was 80% and 17.4% of the infants were delivered by cesarian section. Labour was induced in 100 cases (46%), when there was evidence of infection, after a 24-hour waiting period or at 34 weeks of amenorrhoea. When the aspect of the cervix was unfavourable, cervical maturation was induced by intravenous injection of prostaglandins in 75 cases (34%). CONCLUSION: When the rupture occurred before 34 weeks of amenorrhoea and without signs of infection, tocolysis should be entertained. From 28 to 34 weeks and when a favourable outcome is expected, maturation by corticoids can be proposed. When chorio-amniotic infection is suspected and is not confirmed by the laboratory, antibiotic prophylaxy does not appear to improve fetal outcome. The beneficial effect of a conservative wait-and-see attitude before 34 weeks and of intervening thereafter can only be demonstrated with a large randomized study. Thus each case must be managed individually, making it difficult to establish a standard recommended attitude.

Adrenal Cortex Hormones↗

PubMed1992

[Associated rectal and genital prolapse: value of Delorme's operation. A case report].

Rectal prolapse is a rare disorder, which usually affects patients suffering from genital prolapse (rectal prolapse is associated with genital prolapse in 50% of cases). On the basis of a study of the literature and with regard to one case history, the authors set out to explore the simplest and most effective way of treating these two disorders simultaneously. The treatment remains surgical and should combine treatment of the genital prolapse by vaginal route with treatment of the rectal prolapse by means of the Delorme operation. The mortality and morbidity rates are zero if this operation is used and the relapse rate is only 8 to 11% for the rectal prolapse. It would appear that the two approaches are rarely associated by the authors and would seem to be interesting to reconsider this question by indicating mixed treatment of the two prolapses whenever possible.

Aged↗

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