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Biomedical subjects

N Berkane

Publications and source records attributed to N Berkane.

34 records · Page 2Linked to original sources
PubMed1999

[Sickle cell anemia and pregnancy. Complications and management].

An increasing number of sickle cell disease patients are deciding to bear children. The high risk of fetal and maternal complications in pregnant sickle cell disease patients mandates multidisciplinary management. Risks include spontaneous abortion, vasculorenal syndrome, fetal growth retardation, and fetal death in utero. The rates of cesarean section, maternofetal infection, and maternal death are higher than in the population at large. The diagnosis should be made prior to conception or during early pregnancy. Frequent visits with the obstetrician, hematologist, and anesthesiologist/intensivist are mandatory. Exchange transfusion or blood transfusion may be indicated in patients with a history of serious obstetrical or hematologic complications. Risks are highest in late pregnancy, during delivery, and in the postpartal period. However, the entire pregnancy is a high-risk period that warrants close monitoring.

Anemia, Sickle Cell↗
PubMed1999

[Clinical importance of fetal pulse oximetry. I. Methodological evaluation. Multicenter study. French Study Group on Oximetry of Fetal Pulse].

OBJECTIVE: To evaluate the feasibility of intrapartum fetal pulse oximetry, the distribution of fetal oxygen saturation values, and the relation with the neonatal outcome in a population with an abnormal fetal heart rate (FHR). STUDY DESIGN: A prospective multicenter observational study, from June 1994 to November 1995. Fetal oxygen saturation was continuously recorded using a Nellcor N-400 fetal pulse oximeter in case of abnormal FHR during labor. Simultaneous readings of fetal oxygen saturation and of fetal blood analysis (FBA) were obtained at inclusion and before birth. Feasibility, adverse effects, distribution of fetal oxygen saturation values and relation with neonatal outcome were assessed. RESULTS: 74 patients were included. From 172 attempted sensor placements, the procedure was impossible in three cases and fetal oxygen saturation values were obtained in 164 cases (95.3%). Physicians considered sensor placement an easier task than FBA attempt (easy in 87.5% vs 78.9% for FBA, p = 0.03). The mean reliable signal time (+/- SD) was 64.7 +/- 32% during the first stage. There were no serious adverse effects in the study population. The mean fetal oxygen saturation during the first stage of labor was 42.2 +/- 8.0% (10th-90th centile range: 30-53%). Fetal oxygen saturation was significantly correlated with scalp pH (r = 0.29; p = 0.01) but not with neonatal umbilical artery pH or gas values. There was a significant association between a low fetal oxygen saturation (< 30%) and a poor neonatal condition. CONCLUSION: The feasibility of fetal pulse oximetry is satisfactory in clinical practice. It is easy to use and provides a fair rate of recorded values, even in a population with suspicion of fetal distress. A low fetal oxygen saturation is significantly associated with an abnormal neonatal outcome.

Adult↗
PubMed1998

Fetal DNA in skin of polymorphic eruptions of pregnancy.

BACKGROUND: Polymorphic eruptions of pregnancy (PEP) are common cutaneous disorders of unknown origin that occur usually after week 34 of gestation. Since pregnancy is associated with peripheral-blood chimerism, particularly during the third trimester, we studied the role of fetal cells in the development of the skin lesions. METHODS: We studied samples of skin from ten women with PEP who were carrying male fetuses and 26 women with normal skin or non-PEP skin disorders (13 carrying male and 13 carrying female fetuses). Epidermis and dermis were dissected from the samples, and the DNA was extracted. PCR with primers specific for the SRY gene was used to detect male DNA. FINDINGS: Male DNA was detected in dermis or epidermis from skin lesions of six of the ten women with PEP. No male DNA was detected in any of the 26 women without PEP. INTERPRETATION: Fetal cells can migrate to skin during gestation, where they seem to be associated with the development of cutaneous disorders of pregnancy.

DNA↗
PubMed1997

Multicenter study on the clinical value of fetal pulse oximetry. I. Methodologic evaluation. The French Study Group on Fetal Pulse Oximetry.

OBJECTIVE: Our purpose was to evaluate the feasibility of intrapartum fetal pulse oximetry, the distribution of fetal oxygen saturation values, and the relationship with the neonatal outcome in a population with an abnormal fetal heart rate. STUDY DESIGN: A prospective multicenter observational study was performed from June 1994 to November 1995. Fetal oxygen saturation was continuously recorded with use of a Nellcor N-400 fetal pulse oximeter in case of an abnormal fetal heart rate during labor. Simultaneous readings of fetal oxygen saturation and fetal blood analysis were obtained at inclusion and before birth. Feasibility, adverse effects, distribution of fetal oxygen saturation values, and relationship with neonatal outcome were assessed. RESULTS: One hundred seventy-four patients were included. From 172 attempted sensor placements, the procedure was impossible in three cases and fetal oxygen saturation values were obtained in 164 cases (95.3%). Physicians considered sensor placement an easier task than an attempt at fetal blood analysis (easy in 87.5% vs 78.9% for fetal blood analysis, p = 0.03). The mean reliable signal time (+/- SD) was 64.7% +/- 32% during the first stage. There were no serious adverse effects in the study population. The mean fetal oxygen saturation during the first stage of labor was 42.2% +/- 8.0% (10th to 90th percentile range 30% to 53%). Fetal oxygen saturation was significantly correlated with scalp pH (r = 0.29, p = 0.01) but not with neonatal umbilical artery pH or gas values. There was a significant association between low fetal oxygen saturation (< 30%) and poor neonatal condition. CONCLUSION: The feasibility of fetal pulse oximetry is satisfactory in clinical practice. It is easy to use and provides a fair rate of recorded values, even in a population with suspicion of fetal distress. A low fetal oxygen saturation is significantly associated with an abnormal neonatal outcome.

Adult↗
PubMed1997

Fetal pulse oximetry and fetal heart rate monitoring during stage II of labour.

OBJECTIVE: This study was designed to assess the changes in fetal oxygen saturation (FSpO2) using fetal pulse oximetry when the fetal heart rate (FHR) monitoring became abnormal during stage II of labour. STUDY DESIGN: FSpO2 was recorded with the Nellcor N400 Oximeter (FS-14 sensor) and was averaged over the last 10 min of the second stage of labour. Second stage FHR patterns were assessed according to Melchior's classification. RESULTS: In terms of FHR patterns, FSpO2-10" measured 41.4% in type 0 (n = 5), 42.4% in type 1 (n = 19), 43.3% in type 2 (n = 6), 34.0% in type 3 (n = 4) and 27.6% in type 4 (n = 7) (P = 0.03). CONCLUSIONS: FSpO2-10" decreases in cases of severe FHR abnormality during the second stage of labour and could help to decide whether to perform an instrumental extraction.

Female↗
PubMed1997

[Severe preeclampsia: management. Is conservative treatment justified?].

Severe preeclampsia is a major contributor to maternal and perinatal morbidity and mortality. This review was performed to assess the fetal and maternal benefits of allowing women presenting with severe preeclampsia between 24 and 32-34 weeks of amenorrhea to continue their pregnancy following antihypertensive treatment. After ultrasound scanning to assess growth and biophysical state of the fetus, patients without deteriorating maternal conditions, were managed with volume expansion, antihypertensive drugs (as hydralazine, labetalol, nifedipine), anticonvulsants and prophylactic steroids to promote fetal pulmonary maturity. Previous studies have indicated that this conservative management is also possible with the HELLP syndrome, without an increase in maternal morbidity.

Anticonvulsants↗
PubMed1997

[Role of nitric oxic in pregnancy and pre-eclampsia].

The mechanisms involved in the physiology of pregnancy and in the pathophysiology of preeclampsia are still largely unknown. Prostaglandins metabolism, especially an imbalance between thromboxane A2 and prostacyclin does not appear sufficient to explain all the observed changes. Recent studies have shown that nitric oxide (NO), a vasodilating and a platelet anti-aggregating factor, could play a pivotal role in inducing hemodynamic changes during pregnancy. NO is produced in excess during pregnancy, mainly in uterine and renal vascular beds. Similarly, NO is in part responsible for the non-responsiveness of the vessels to vasoactive agents and plays a relevant role in peripheral vasodilation and in lowering systemic blood pressure. Furthermore, NO improves blood supply to the fetal-placental unit and to maternal kidneys. An impaired NO metabolism in pregnant rats induces changes similar to those observed in human preeclampsia. NO pathway represents a new approach to the physiology of pregnancy and to the pathophysiology of preeclampsia. Moreover, NO donors might be carefully proposed as new therapeutic agents in this disorder.

Animals↗
PubMed1995

Urinary cGMP levels during pregnancy with and without uterine contractions.

OBJECTIVE: The purpose of this study was to investigate the nitric oxide-cGMP (NO-cGMP) system by urinary cGMP level determinations in pregnant women with and without uterine contractions. DESIGN AND SUBJECTS: cGMP expressed in nmol/mmol of creatinine was performed by radio immuno-assay (Amersham UK) in urine samples obtained from 94 pregnant women with non-complicated pregnancies. Population A without contractions (n = 62) was divided into three groups according to the gestational age (group I, < or = 15 weeks; group II, 16-33 weeks; group III, > 33 weeks). The group III from A population was compared to B population (of the same gestational age) presenting uterine contractions (n = 32). RESULTS: In A population, no significant urinary cGMP level differences were observed whatever the gestational age. Nevertheless, the comparison between patients with or without uterine contractions (A III and B populations) showed a significant difference by a variance analysis (P < 0.05). Lower levels of cGMP were seen when uterine contractions occurred. CONCLUSION: Urinary cGMP levels are significantly decreased in pregnant women with uterine contractions, without any difference from early to late pregnancy. These results, completed by more precise investigations, could suggest that the NO-cGMP system might be implicated in uterine quiescence.

Cyclic GMP↗
PubMedDate not supplied

Fetal impact of cholestasis of pregnancy: experience at Tenon Hospital and literature review.

Cholestasis of pregnancy is a liver disorder that occurs during the second half of pregnancy, causing pruritus and elevated serum bile acid levels. Its etiology remains unknown but probably involves vascular and humoral immune responses, mediated by bile acids. This disorder is associated with substantially increased fetal morbidity and mortality. The most satisfactory treatment consists in delivering the fetus as soon as pulmonary maturation has occurred.

Adult↗
PubMedDate not supplied

Usefulness of fluorescence in situ hybridization for the diagnosis of Turner mosaic fetuses with small ring X chromosomes.

OBJECTIVE: To emphasize the usefulness of fluorescence in situ hybridization (FISH) techniques on uncultured amniocytes for the diagnosis of abnormal mosaic karyotypes. METHODS: In the course of three prenatal diagnoses, specific fluorescent probes, coding, respectively, for chromosomes X, Y, 18, 13, and 21, were applied on amniocyte preparations directly after amniocentesis. At least 50 nuclei were counted in each case. Parallel to the FISH procedure, cell cultures were set up in order to obtain karyotypes. FISH and cytogenetic results were then compared. RESULTS: In each case, FISH showed an abnormal mosaic chromosomal constitution, 45,X/46,XX, which was related to the existence of tiny ring X chromosomes in karyotypes. CONCLUSION: Because very small ring X chromosomes can escape identification when standard cytogenetic techniques are used alone, we show that misdiagnosis can be avoided when FISH is performed beforehand.

Adult↗
PubMedDate not supplied

[Prevalence of factor V Leiden, hyperhomocysteinemia, prothrombin G20210A, and methylene tetrahydrofolate reductase C677T mutations in obstetrical complications].

The etiology and pathogenesis of intrauterine fetal death, preeclampsia or fetal growth retardation remain still unknown in many cases. However, placental thrombosis and/or infarction might lead to inadequate maternal-fetal circulation. So, the relevance of an additional thrombotic risk factor that enhances the physiological hypercoagulable state of gestation has been suggested in the development of these adverse outcomes of pregnancy. Several genetic mutations are newly recognized associated with an increased frequency of venous thrombosis: mutation of adenine to guanine at nucleotide 506 in the factor V gene, mutation of cytosine at nucleotide 677 in the methylenetetrahydrofolate gene and mutation of guanine to adenine at nucleotide 20210 in the prothrombin gene. In this issue, a review of literature has allowed us to evaluate the prevalence of these genetic predisposing thrombotic factors with the development of obstetrical complications. Furthermore, therapeutic approach is considered.

Factor V↗
PubMedDate not supplied

[Pre-eclampsia and oxygenated free radicals].

Preeclampsia, clinically defined by arterial hypertension, oedema and proteinuria is a frequently occurred complication of pregnancy. This disease seems to be linked to oxidative stress within placenta. The local accumulation of lipid peroxides, resulting from free radicals production increase altered prostacyclin/thromboxane synthesis. Increased production of lipid peroxides, thromboxane and/or cytokines triggered vascular and organic dysfunctions observed in preeclampsia. Changes in lipoprotein metabolism, namely increase in plasma very low density lipoproteins concentrations (VLDL) and oxidized low density lipoproteins (LDL) concentrations could participate to endothelial dysfunctions observed during preeclampsia.

Female↗
PubMedDate not supplied

[Comparison of three reactants for the detection of activated protein C resistance due to mutation of factor V Leiden during pregnancy].

The presence of the R506Q mutation of the factor V gene is associated with an increased risk of thromboembolism, particularly during pregnancy. Recently, its involvement in the development of obstetrical complications, such as preeclampsia and fetal losses, has been evoked. The resulting factor VQ506 (factor V Leiden) has arginine 506 replaced by glutamine at the factor Va cleavage site for activated protein C (APC) which induces APC-resistance. During pregnancy, an acquired resistance to APC is observed without the presence of the factor V Leiden mutation which leads to an inappropriate realization of the more expensive DNA analysis. This resistance is at least partly explained by an increase of the factor VIII. In this study, we have compared three reagents: the original test Coatest APC Resistance (Chromogenix) and two modified tests using factor V depleted plasma: Coatest APC Resistance V (Chromogenix) and Accélérimat (BioMérieux). The last test is not influenced by the factor VIII by the adjunction of activated factor X. For each test, the coefficient of discrimination, between carrier and non-carrier of the R506Q mutation of the factor V gene, has been determined on 43 pregnant women (33 non-carriers and 11 heterozygotes) and 51 unselected non pregnant patients with clinically suspected thrombosis (40 non-carriers and 11 heterozygotes). The predilution of the patient's plasma with factor V deficient plasma (Coatest APC Resistance V and Accélérimat) enhances the discrimination between carriers and non-carriers in both groups. However, using Coatest APC Resistance V, a significant difference of results is observed between the two populations in the non-carriers patients. Thus, Accelerimat is probably more efficient than Coatest APC Resistance for the detection of the factor VQ506 during pregnancy.

Activated Protein C Resistance↗