A study comparing transcervical with trans-abdominal chorionic villi sampling (CVS)
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Biomedical subjects
Publications and source records attributed to J Horovitz.
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Direct chromosome analysis was performed on placental villi obtained by ultrasound-guided transabdominal needle aspiration in 30 women at between 23 and 37 weeks gestation. Placental biopsy is simple in the presence of severe oligohydramnios where fetal blood sampling is usually more difficult. Direct karyotyping of placental villi is more rapid than chromosomal analysis from fetal blood and from amniotic fluid. Two chromosomal anomalies were discovered: one trisomy 18 and one 6p+. Villus sampling failed in one woman and two samples obtained at 36 and 37 weeks gestation could not be karyotyped. The procedure did not affect the outcome of the pregnancy.
The pathological features in a case of craniorachischisis with incomplete twinning (diprosopus) are reported. The female fetus was born to a 27-year-old gravida 6, para 3 healthy woman who underwent a medical abortion at 13 week's gestation because of an anencephaly revealed by ultrasound examination. The head showed two fused faces with two mouths, two noses, two lateral completely formed eyes and two medially fused eyes covered by cutaneous tissue. X-ray examination demonstrated the symmetrically doubled spinal column. The brain and the spinal cord were absent (craniorachischisis). The larynx and the oesophagus, the other viscera and the limbs were normal in number, location and morphology as for a female singleton. This case with others from the literature, illustrates the relationship between conjoined twinning, neural tube defects (more particularly anencephaly) and female zygote and constitutes a real entity.
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A late complication of CVS by forceps biopsy is reported. It is the immediate formation of a retroplacental hematoma on the location of the sampling which is revealed by a bleeding across the cervix. During all the pregnancy retroplacental hematoma and bleeding will persist until the delivery by cesarean section at 31 weeks of amenorrhea. Such a late complication has not been reported in the literature.
The authors report a case of rupture of the right cornu of the uterus in the ninth month of pregnancy in a woman who had had her right tube implanted into her uterus. This complication is considered, in the discussion, to be rare. It is very difficult to prevent it happening during pregnancy. It would seem that a prophylactic caesarean operation should be carried out if the insertion of the placenta is in the area of the implantation.
We report the case of a pregnancy associated with severe anorexia nervosa. The patient weighed 33 kg for 1 m 51 at conception. The pregnancy was obtained during a spontaneous cycle. Despite nutritional and psychological case, the patient continued to lose weight and weighed only 28 kgs at 33 weeks of amenorrhea, when she gave birth to a hypotrophic child of 1130 gr after artificial starting. The case provides discussion of the relation ship between anorexia nervosa and pregnancy.
The authors report a preliminary study of chromosomal analysis made on chorionic villosities. The samples were taken by means of biopsy forceps. The "direct" method was used to determine the karyotype. Since then two diagnoses have been made on progressive pregnancies.
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The authors review ten years of caring for pregnant diabetic women. They adhered rigidly in these ten years to two fundamental principles, which were the need to ensure rigorous control of blood sugar levels, and the value of waiting to the 37th or 38th week before starting labour whenever the fetus did not seem to be particularly at risk. Their attitude, which has stayed remarkably constant, is different from that of many other authors who during this same period started by stopping the pregnancy prophylactically between the 34th and 36th week but later allowed labour to start sometimes spontaneously at a later stage as knowledge of feto-maternal mechanisms increased and methods of supervising these patients improved.
The authors report an unusual complication following the correction of a case of stress incontinence by vesico-urethral suspension using the Marshall-Marchetti procedure. They observe the rapid onset of an unilateral uretero-hydronephrosis which was due to oedema of the right vesico-ureteral junction and which was cured by a short treatment, with corticoids.
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OBJECTIVE: One of the concerns of prenatal diagnosis is to find sensitive markers to screen for chromosome abnormalities, such as serum assays or nuchal translucency (NT). This study reports our experience with NT measurement during the first trimester of pregnancy. MATERIALS: The study was performed prospectively on 252 fetuses with either NT > or =3 mm or cystic hygroma. RESULTS: We observed 50 abnormal karyotypes, i.e. 19.8%. The incidence of chromosome abnormalities increased with increasing maternal age and increasing NT thickness. For the 202 fetuses with normal karyotypes, outcome was unfavourable in 32 cases: 23 elective terminations of pregnancy, 8 spontaneous abortions and 1 neonatal death. Outcome was favourable in 141 cases. Twenty-nine pregnancies were lost to follow-up. CONCLUSION: Measurement of NT at 12 weeks' gestation seems to be a good marker for chromosome abnormalities. When the karyotype is normal, the pregnancy outcome remains correlated with the degree of NT thickness. The finding of NT >3 mm between 10 and 14 weeks' gestation dictates rigorous ultrasound monitoring and caution when predicting pregnancy outcome.