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Biomedical subjects

J M Thoulon

Publications and source records attributed to J M Thoulon.

At least 19 recordsLinked to original sources
PubMed2000

[Prenatal diagnosis of congenital diaphragmatic hernia: evaluation of the prognosis].

OBJECTIVE: The aim of this study was to evaluate prognostic prenatal factors of congenital diaphragmatic hernia. MATERIAL AND METHODS: We designed a retrospective study of 34 patients with congenital diaphragmatic hernia. The infants were delivered at the Edouard Herriot Hospital between September 1, 1994 and June 30, 1998. We excluded cases of pregnancy termination. After eliminating 4 cases, we studied 30. The factors studied were: polyhydramnios, transverse abdominal diameter, hepatic and umbilical vein deviation, mediastinal deviation, intrathoracic location of the stomach. Prenatal karyotype and echocardiography were systematically obtained. RESULTS: Total perinatal mortality was 53% and was 48% in case of unique diaphragmatic hernia. Prognosis was poorer if the diaphragmatic hernia was associated with another malformation (perinatal mortality: 80%, 4/5 cases), or in case of preterm delivery (83%, 5/6 cases). Factors associated with poor prognosis were: polyhydramnios, transverse abdominal diameter below the 5(th) percentile and major hepatic deviation. Diagnosis before 25 weeks was not associated with poor prognosis. Intrathoracic stomach was a good diagnostic sign, but did not allow an assessment of prognosis. CONCLUSION: Diagnosis of congenital diaphragmatic hernia was made before 25 weeks in 77% of the cases. It was not a factor of poor prognosis. As other authors, we found that prenatal association with another malformation (especially cardiac malformation) polyhydramnios, deviation of the liver, and abdominal transverse diameter below the 5(th) percentile were factors of poor prognosis. But it was difficult to determine the prenatal prognosis. Improvement is needed.

Adult↗
PubMed1999

European Community multi-Center Trial "Fetal ECG Analysis During Labor": ST plus CTG analysis.

This report form part of the European Community Multi-Center Trial "Fetal ECG Analysis during Labor". Aim of this prospective trial was to identify changes in the fetal ECG waveform with cases of verified fetal hypoxia. In this paper we also report on the use of a newly developed automatic system for identification of ST waveform changes (ST Log). All ECG were recorded with the STAN recorder (Neoventa Medical AB, Gothenburg, Sweden). The ECG information was not displayed during labor in order not to influence the clinical management. This report includes data from 320 cases and include six cases of fetal intrapartum hypoxia. Twenty seven cases showed changes in ST waveform. All five cases with the most marked ST change (a rise in T/QRS of > 0.10 units and lasting more then 10 minutes) had signs of ongoing intrapartum hypoxia. Six out of six cases with evidence of intrapartum asphyxia, showed ST changes. On the basis of our multi-center trial it appears that the combined analysis of CTG and ST waveform changes provides an accurate way to identify adverse events during labor. The work is continuing with a new STAN recorder developed by Neoventa Medical in Göteborg and currently being tested in a Swedish randomized, controlled multi-center trial.

Acid-Base Equilibrium↗
PubMed1999

[Value of cervical echography in the prediction of premature delivery: literature review].

Preterm delivery is the leading cause of neonatal mortality. Thus predicting a preterm delivery is a major obstetrical problem. Endovaginal ultrasonography is a highly reliable and reproducible method of cervical examination. Unlike with a digital cervical examination the entire length of the endocervical canal can be measured. Using this tool, measuring the dilatation of the internal os does not require the examining finger to be placed inside the endocervical canal. Therefore, the internal os can be measured even if the external os is closed. While a digital examination assesses the "dilatability" of the internal os, an ultrasonography assesses the "true degree of dilatation". In a low-risk population endovaginal cervical ultrasonography helps rule out a preterm delivery if cervical length is long enough. It can also detect cervical incompetence. In a high-risk population, women whose cervix is longer than 30 millimeters can be identified. These women have over 80% chance to deliver on or after 36 weeks of pregnancy. Preliminary studies suggest that performing an endovaginal ultrasonography could decrease the number of false positive clinical diagnosis of modified cervix and thus, save long, expensive and inefficient hospital stays. Prospective randomized, controlled studies are needed to confirm these results.

Cervical Ripening↗
PubMed1998

[Oxytocic drugs].

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Drug Costs↗
PubMed1997

European Community Multicentre Trial "Fetal ECG Analysis During Labour": the P-R interval.

The aim of the European Community Multicentre Trial on Fetal ECG Analysis During Labour was to collect a clinical database of electrocardiograms on which the different patterns of ST waveform and time interval changes, so far identified, could be studied. The aim of this paper was to study the PR-RR relationship and the P wave patterns during normal labour. One thousand three hundred fifty accelerations and 350 decelerations were analysed in 618 labours, all with normal fetal outcome. All ECGs were recorded with the STAN recorder and linked to a PC system for data acquisition and analysis. A positive relationship between P-R and R-R intervals was identified in all reactive fetal heart rate traces. A P-R shortening was identified also with all decelerations of more than 40 bpm from the baseline, resulting in a negative PR-RR relationship. Experimental works have described a P-R shortening concurrent with the maximal R-R lengthening during acutely induced hypoxemia in fetal lambs. In our study normal cord acid-base status indicated that the majority of bradycardia episodes recorded were not related to acute hypoxemia: PR-RR relationship changes seem therefore to indicate an intact physiological fetal heart adaptive response to rapid change in the environment of either hypoxemic or haemodynamic origin. A negative PR-RR relationship by itself seems to be nothing more than an indicator of decelerations during labour and seems unable to discriminate between decelerations of different origin. Finally the P wave was no longer detectable during decelerations of more than 800 msec: in this situation the P-R interval can not be reliably measured.

Electrocardiography↗
PubMed1996

[Tocolytic drugs].

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Drug Monitoring↗
PubMed1995

[Prevention of prematurity].

Premature delivery is defined as birth between 22 and 37 weeks of pregnancy. Perinatal mortality and morbidity and their sequellae are strongly linked to gestational age. Minimum prematurity is around 3% of births. Medical risks of premature birth should be detected outside of pregnancy (uterine) or during pregnancy, at the first outpatient visit, the critical moment for establishing factors of risk. Preventive measures include awakening women to their responsibility, before and during pregnancy, and suppressing toxic agents (tobacco and alcohol). Treatment of medical causes of preterm birth is more effective if accompanied by measures acting on the environment, such as rest adapted to fatigue, improved environmental conditions, decentralisation and local situation of medical follow-up and social assistance, hospitalisation at home, telesurveillance and, in severe cases, total hospital rest (for which alternatives such as family hotels should be sought). Every element of the existing structures should be used complementarily.

Female↗
PubMed1994

[Risks of prolonged tocolysis].

Premature delivery menace is still a major issue in obstetrics. It concerns 4 to 5% of the pregnancies. Being responsible of an important fetal morbidity, it implies the use of a rapid and efficient treatment. This treatment uses progestins, prostaglandins inhibitors and beta-mimetics. The more efficient these medicines are, the more dangerous is their use so that their prescription must be weighted thoroughly, after setting apart the absolute counter-indications. Since they may cause severe accidents, especially cardio-vascular ones as for the beta-mimetics, this implies an indespinsable medical follow up during their use. This article, using a review of the literature, enumerates the various pharmacological families prescribed for the treatment of the premature delivery menace. For each, the pharmacological effects, the tolerance, the side effects and the accidents are detailed. The modalities of their prescription as well as the necessary medical follow up are given. Taking into considerations these elementary rules of prescription enhances the chances of lowering down at most the risks related to the use of these treatments.

Adrenergic beta-Agonists↗