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Biomedical subjects

J C Pons

Publications and source records attributed to J C Pons.

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

Fetal biometric parameters, twin type and birth weight difference. A longitudinal study.

OBJECTIVE: To examine the relationship between twin type, divided by zygosity, chorionicity, and birth weight difference [more or less than 15% intertwin weight difference at delivery] on fetal biometric measurements, including biparietal diameter, transverse abdominal diameter, head and abdominal circumferences (AC) and head and abdominal areas, femur length (FL), transverse cerebellar diameter, cerebellar circumference and cerebellar area at 18, 23, 28 and 32 weeks of gestational age. STUDY DESIGN: A prospective and longitudinal study was done on 75 twin pairs that did not present the twin-twin transfusion syndrome (150 fetuses) divided into birth weight difference group I (<15%) and group II (>/=15%). The twin pairs were divided into three groups: dizygotic, monochorionic, and dichorionic-monozygotic. In each group the differences in various ultrasound indices were evaluated in reference to discordant growth or concordant growth. RESULTS: In our sample, there were no monozygotic twin pairs with dichorionic placentation with a birth weight difference of more than 15%. Significant associations of group and gestational age were found in dizygotic and monochorionic twins. Intrapair differences were significantly higher in group II (>/=15%) than in group I (<15%) for all fetal parameters studied except for AC, abdominal area and all cerebellar parameters. The value of these discrepancies increased according to gestational age except for FL. Significant interactions between group and zygosity type indicated that intrapair FL differences were more associated with group in monochorionic twins, whereas intrapair transverse cerebellar diameter differences were more associated with group in dizygotic twins. CONCLUSION: Our data show that most fetal biometric parameters are associated with birth weight discordancy. Abdominal area could be a relevant marker for twins with obstetric complications. Note that this is the first research that has studied a twin sample divided by both twin type and birth weight group.

Biometry↗
PubMed2000

Vaginal delivery in a woman with limb-girdle muscular dystrophy. A case report.

BACKGROUND: Limb-girdle muscular dystrophy is a muscular disease determined genetically. Few papers have been published on this disorder in pregnancy. Several authors reported on delivery by cesarean section because of the risk of dystocia. CASE: A woman with limb-girdle muscular dystrophy had two pregnancies with normal vaginal delivery and follow-up. No obstetric complications related to the disease occurred. CONCLUSION: A trial of labor is possible in patients with limb-girdle muscular dystrophy if no obstetric contraindications exist.

Adult↗
PubMed1999

Perinatal mortality in twin pregnancies: a 3-year analysis in Seine Saint-Denis (France).

OBJECTIVES: Our purpose was to evaluate perinatal mortality in twins and to investigate factors associated with this mortality. STUDY DESIGN: A prospective study on the perinatal mortality was performed in the department of Seine-Saint-Denis. Out of all the perinatal deaths, we have retrospectively isolated those arising from twin pregnancies. RESULTS: There were 54 twin pregnancies complicated with perinatal death. The perinatal mortality rate in twin pregnancy was 78.0 per 1000 twin babies delivered. Out of 86 twin deaths, 38 (44.2%) were born before 28 weeks gestation and out of 82 twin perinatal deaths, 37 (45.1%) weighed less than 1000 g. Chorionicity was recorded in 44 twin pairs: 21 (47.7%) were dichorionic and 23 (52.3%) monochorionic. Finally, out of 48 twin sets there were four (8.3%) monoamniotic pregnancies. CONCLUSIONS: The present data show that extreme prematurity represents nearly half of perinatal mortality in twins. This study indicates also a significant proportion of monochorionic placentation among twin pregnancies with poor outcome.

Adult↗
PubMed1998

Management and outcome of triplet pregnancy.

The parameters involved in obstetrical follow-up of triplet pregnancies were evaluated in a retrospective study between 1975-1993 of the follow-up of 91 triplet pregnancies. During this long interval of time, many changes in management of triplets occurred. Considering these differences, two periods in the present study were compared: 1975-1986, which consists of a previously published retrospective analysis of 21 triplet pregnancies; and 1987-1993, during which the modalities of the 7-year follow-up described previously were applied to 70 triplet pregnancies. No improvement was observed between the two periods. Nineteen pregnancies were spontaneous. Thirty-seven allowed treatment with ovulation induction agents and 35 were due to in vitro Fertilization. Early diagnosis of multiple pregnancies allows installation measures for the prevention of prematurity. Management, initiated upon diagnosis, included home rest and a weekly follow-up at home by a midwife every week. Monthly consultations and ultrasounds were performed at the hospital. Hospitalization was not systematic but was done in cases of maternal complications. The mean term for the diagnosis of triplet pregnancy was 13.9 +/- 5.3 weeks. The mean gestational age was 33.4 weeks; 90% of the deliveries were by cesarean section. The mean weight of the neonates was 1716 g. The mean Apgar score at 1 and 5 m was 7.7 and 9.3, respectively. The perinatal mortality was 80 per 1000. The main neonatal complications resulted from prematurity. Authors compared rates of Hyaline Membrane Disease in infants of patients treated with corticosteroids and of patients who were not. Hyaline Membrane Disease occurred in 13% of the corticotherapy group and in 31% of the untreated group. The present study supports systematic corticotherapy between 28 and 34 weeks for triplet pregnancies.

Adult↗
PubMed1998

Twin differences and similarities of birthweight and term in the French Romulus population.

This study was performed to examine the main characteristics of the French Romulus twin population: zygosity, chorionicity, sex, term and birthweight. A sample of 104 pairs of twins was distinguished by zygosity, chorionicity and sex, and divided into concordant and discordant birthweight groups. Fifty-three % (n = 55) of the fetus pairs studied were born at "ideal term" (35-38 weeks), and 25% (n = 26) were delivered at "preterm" (28-34 weeks). The very preterm (< 28 weeks), and "postterm" (> 38 weeks) represented altogether 22% (n = 23) of the sample. Of the 104 twin pairs, 68% (n = 71) differ by less than 15% in birthweight, and 32% (n = 33) have a birthweight difference higher than 15%. In dizygotic (DZ) pairs females had more tendency to be in the discordant group (p = 0.01) while in monochorionic-monozygotic (MC-MZ) pairs males were more discordant (p = 0.07). We found a significant interaction between sex and zygosity type (p = 0.02). Males had a birthweight difference significantly weaker than that of females in dichorionic-monozygotic (DC-MZ) and DZ twins whereas it was higher than that of females in MC-MZ twins. There were no MZ twin pairs with DC placentation over than 15% birthweight difference. Log linear analysis demonstrated a three-way interaction (p < 0.05) between term type, zygosity type and hypotrophy. Our data indicate that in the group of twins born between 35 and 38 weeks' gestation the crucial question still remains unsettled on how term and birthweight are related to zygotism and/or chorionicity.

Birth Weight↗
PubMed1998

[Stripping membranes at term. Review of randomized trials].

Stripping the membranes at term is a method for inducing labor. This method is currently performed but not well analyzed. Most trials were published after 1990 and the half of them since 1996. Seven of the nine randomized trials recently published showed the efficacity of stripping of the membranes performed between 38 and 42 weeks. It seems to become more efficient after 40 weeks. In these trials, increased of maternal (cesarean section rate, chorioamniotitis, premature rupture of membranes) or neonatal morbidity cannot be found. However, in these trials included populations are not enough large to conclude. Given the absence of large studies, it seems unjustified to repeat this intervention.

Female↗
PubMed1998

[Agenesis of the corpus callosum. An example of prognosis uncertainty in fetal medicine].

OBJECTIVE: For an increasing number of fetal pathologies, means of diagnosis have progressed faster than knowledge of the prognosis. Decisions are extremely difficult for the medical staff and the parents each time that outcome is uncertain. Agenesis of the corpus callosum, whose diagnosis may be certain through ultrasonography and MRI illustrates this situation well. METHODS: A historical multicentric study enabled us to analyze 37 cases of agenesis of the corpus callosum with a prenatal diagnosis and 10 cases with a post-natal one. RESULTS: Among the 37 prenatal diagnoses, we found 28 cases of medical abortions according to the French law and 9 newborns. Among the 9 newborns, we observed one neonatal death related to an acute fetal distress and 3 post-natal deaths between 1 and 3 months. Among the 10 cases diagnosed after birth, one died, 7 are in good health with a follow-up from 7 months to 6 years and 2 have neurological disturbances. CONCLUSION: Therefore, it seems essential to deepen knowledge of the prognosis and the evolutivity of this affliction in order to give the parents more precise information. However, knowledge of the prognosis is difficult because of the large number of abortions performed for medical reasons. Only a multicentric study, with a long-term pediatric follow-up, will enable us to better understand the prognosis of corpus callosum agenesis.

Agenesis of Corpus Callosum↗
PubMed1998

[Prevention of prematurity in 842 consecutive twin pregnancies].

OBJECTIVE: To evaluate the effects of a specific management in prevention of prematurity in twin pregnancies. METHOD: The parameters involved in obstetrical follow-up of twin pregnancies were evaluated in a retrospective study of 842 twin pregnancies between 1979-1992. RESULTS: Five-hundred-and-fifteen pregnancies were spontaneous. Two-hundred followed treatment with ovulation induction agents and 127 were due to in vitro fertilization. Early diagnosis of twin pregnancies allowed preventive measures against prematurity. Management of twin pregnancies included rest at home and regular clinical examination of the cervix. Monthly consultations and monthly ultrasounds were performed at hospital. Weekly consultations were made by midwives at home. Hospitalization was not systematic, but was necessary in cases of maternal complications. The diagnosis of twin pregnancy was made before 16 weeks in 82.4% of the cases. The mean gestational age at delivery was 36.2 weeks. The prematurity rate was 45.96%. The mean weight of the neonates was 2,376 +/- 533 g for the first twin and 2,297 +/- 547 g for the second twin. The mean Apgar score at 5 minutes was 9.7 and 9.3, respectively for the first and the second twin. The perinatal mortality was 39.3 per 1,000. The main neonatal complications resulted from prematurity. Twins were hospitalized in the intensive care unit in 20.7 cases. CONCLUSION: The present study supports early diagnosis of multiple pregnancies with systematic ultrasound at 11-13 weeks for each pregnancy, information of the patients, rest at home and regular clinical examination of the cervix.

Bed Rest↗
PubMed1997

Twin zygosity diagnosis by mailed questionnaire below age twelve months. Le Groupe Romulus.

Parents of a sample of 76 same sexed pairs of twins aged 3 to 9 months completed a mailed similarity questionnaire. It included the Bonnelykke et al.'s questionnaire and a four anthropological variable scale. To improve each of these two methods, three other combined methods were carried out and results were compared with the biological zygosity diagnosis. The Bonnelykke et al.'s classification combined with anthropological scale (method 4) gave only 1.2% misclassified in the whole sample. It is concluded that zygosity diagnosis using this type of procedure to distinguish MZ and DZ pairs would be important not only for epidemiological study but also for pediatricians and parents.

Humans↗
PubMed1997

Perception of risk, choice of maternity site, and socio economic level of twin mothers.

The objective of this study was to determine if access to high level health facility (level 3 perinatal center) is related to socio-economic level of the mother and to her perception of risk for a twin birth. A retrospective questionnaire was administrated to the mothers of twins during the first post parum days in each of the 27 maternity sites within a defined geographical district near Paris (Hauts de Seine). The survey instrument was designed to precisely characterize the socioeconomic status of the parents, to measure the perceived risk for the twins expressed by the mother, to measure the relationship between the choice of a maternity site (level 1, 2 or 3) by socioeconomic level, and to measure the fetal and neonatal death rates by socioeconomic status. The opinion of mothers of twins about specific risk for her and for her children is very different by socioeconomic levels, as is the choice of level 3. This is discussed with the rates of fetal and neonatal death rates by socioeconomic level. In the absence of a policy of regionalization of perinatal care, the discriminant factor for access to high level care (level 3 maternity site) is the socioeconomic level.

Cohort Studies↗
PubMed1997

Biparietal diameter in twins at gestational weeks 18-32. Differences and similarities. Le Groupe Romulus.

OBJECTIVE: To examine twin similarities on biparietal diameter (BPD) measurements by zygosity (monozygotic [MZ] and dizygotic [DZ]) and chorionicity (monochorionic [MC] and dichorionic [DC]) and their evolution during pregnancy. METHOD: A sample of 54 pairs of twins (43 DZ sets, 11 MZ sets [7 MC and 4 DC]) was constructed using retrospective data. Despite the small sample size, our data were complete, and, for the first time we measured different fetal parameters on digital ultrasound images outside routine examination. The intraexaminer and interexaminer reliability of BPD measurement was significant (r = .95, P < .001). RESULTS: In this study, developmental results indicate significant linear regression coefficient (R) through the whole period of gestation (r = .96, P < .001), though product moment correlations comparing the periods of gestation two by two are weaker. The distribution of BPD values was slightly wider at the 28th week and markedly wider at the 32nd week than that at the 18th and 23rd weeks. The intraclass correlations of DZ and MZ (MC and DC) twins were examined at the 18th, 23rd, 28th and 32nd weeks of amenorhea. The intraclass correlations of DZ twins were significant through the whole period of gestation (r = .45, P = .001; r = .27, P = .04; r = .36, P = .008; and r = .42, P = .002, respectively), whereas the intraclass correlations of MZ twins were significant only at the 18th, 23rd and 28th weeks (r = .73, P = .002; r = .69, P = .005; r = .49, P = .047, respectively). We found significant within-variance differences not only between DZ and DC-MZ but also between DC-MZ and MC-MZ in late gestation. CONCLUSION: Our analysis of twin BPD development demonstrated that zygosity and chorionicity type are both important determinants of twin fetal development.

Biometry↗
PubMed1996

The course of the SAPHO syndrome during pregnancy.

In this report, we describe a case of a pregnancy in a 29 year old patient suffering from a new syndrome, the SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis). The SAPHO syndrome improved considerably during the course of this pregnancy and treatment with indomethacin ceased during gestation.

Acne Vulgaris↗
PubMed1996

Prenatal exposure to diethylstilbestrol and the mother-daughter relationship.

The psychological consequences resulting from the exposure to diethylstilbestrol (DES), a non-steroidal oestrogen, on the mother-daughter relationship are studied using semi-directive interviews with 43 daughters and 7 mothers treated with DES during their pregnancies. These women referred to gynaecological consultation for DES-related problems. The daughters, exposed to DES during their foetal life, learned about DES after a pregnancy mishap (35% of the cases), or by accident (65% of the cases). All of them were shocked when the existence of DES and its side effects were revealed to them. Consequences on the mother-daughter relationship were absent in 60% of the cases, favourable in 20%, and negative in 20%. Five percent of the women showed hostility towards the medical practice, but 65% were not suspicious of the drugs administered to them during their pregnancies. For 64% of them, administration of DES to their mother had been kept secret. In 7 out of 50 cases, parents alone came for medical assistance in order to manage the secret. Exposure to DES may reveal pre-existing difficulties not only between the mother and the daughter, but sometimes beyond from generation to generation.

Adaptation, Psychological↗