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P Audra

Publications and source records attributed to P Audra.

At least 19 recordsLinked to original sources
PubMed2001

Planned vaginal delivery versus elective caesarean section in singleton term breech presentation: a study of 1116 cases.

OBJECTIVE: To compare neonatal and maternal morbidity and mortality between planned vaginal delivery and elective cesarean section for singleton term breech presentation. STUDY DESIGN: We studied retrospectively all deliveries of singleton breech presentations at term in the public Hospitals of Lyon between 1 January 1991 and 31 December 1995. To take only the effect of delivery on the fetus into account, we eliminated high risk pregnancies and fetal malformations. Fetal parameters were corrected perinatal mortality, Apgar score<7 at 1 and 5 min, umbilical cord arterial pH<7.15, neurological disorders, trauma and need for neonatal intensive care. Maternal parameters were mild, moderate and severe complications. RESULTS: Of the 1116 breech presentations, 702 (62.9%) underwent an elective caesarean section and 414 (37.1%) a planned vaginal delivery. In the latter group, 342 (30.6%) had a vaginal delivery and 72 (6.5%) a non-elective caesarean section. Infants for whom the vaginal route was planned were at higher risk of mortality and morbidity. There were 2 deaths in this group and none in the elective caesarean section group and all fetal parameters were poorer: more Apgar<7 at 5 min (RR: relative risk=3.05; 1.03-9.05), arterial pH<7.15 (RR=1.64; 1.11-2.43), intubations (RR=7.35; 2.10-25.6), neurological disorders, trauma (RR=4.24; 1.66-10.8), transfer to intensive care units (RR=3.23; 1.57-6.64). The overall maternal morbidity was lower in the planned vaginal delivery group (RR=0.65; 0.44-0.94) but this was only because of less mild complications. The moderate and severe complications were the same in the two groups (RR=0.97; 0.59-1.57). CONCLUSIONS: Planned vaginal delivery in singleton term breech presentation increases the risk of death and of neonatal complications. Elective caesarean section increases the risk of only mild maternal complications. For these reasons, elective caesarean section should be preferred for singleton term breech presentations.

Adult↗
PubMed2001

New insights into the postnatal growth of infants born 'idiopathic' small for gestational age.

Infants born small for gestational age (SGA) are defined as those with a birth weight and/or birth length below two standard deviations for gestational age. Postnatal catch-up growth is absent in 8-12% of children born SGA and these children achieve adult heights far below their target height. The objectives of our retrospective study were to confirm the prevalence of catch-up growth and to refine the kinetics of the catch-up process. The 'Lyon series' of patients consisted of 179 children with 'idiopathic' SGA, of whom 8% did not achieve catch-up growth (i.e. their height remained below -2 SD throughout the study). The number of days that the mother was hospitalized before delivery was found to be significantly correlated with lack of catch-up growth. Maternal hypertension, term delivery and postnatal parenteral nutrition were also associated with lack of catch-up growth, but the relationship was not significant. In addition, an oscillatory growth velocity pattern was observed in boys and girls born SGA, with alternating periods of growth acceleration and deceleration. This suggests that catch-up growth is regulated in a sophisticated way by the hypothetical 'Somatostat', although further confirmation of this process is needed.

Female↗
PubMed2000

Renal function of children exposed to cyclosporin in utero.

BACKGROUND: The use of cyclosporin (CsA) has improved graft survival in transplant (Tx) patients despite its potential nephrotoxicity. Children born to transplanted women may present with intrauterine growth retardation (IUGR). On the basis of potential reduced nephron mass both in IUGR and in newborn experimental animals exposed to CsA in utero, we investigated the renal function of children >1 year of age born to women under maintenance immunosuppression, including CsA. METHODS: Fourteen children born to 12 Tx women (nine kidney, one pancreas-kidney, one heart, one liver) were investigated using inulin clearance (C(in)), para-aminohippuric acid clearance (C(PAH)), microalbuminuria, and electrolyte reabsorption rate. RESULTS: Gestational age of the 14 infants was 34+/-3 weeks and birth weight 2018+/-620 g. During pregnancy, CsA trough blood level was 234+/-115 microg/l and plasma creatinine range was 96-136 micromol/l. Two children were excluded from the study because renal investigation led to a diagnosis of hereditary nephritis (one Alport syndrome, one familial dominant focal segmental glomerulosclerosis) that was retrospectively completed in the mother. Renal function tests were finally performed in 12 children at 2.6+/-1.8 years of age: BP 94+/-7/55+/-5 mmHg, C(in) 117+/-28 ml/min/1.73 m(2), C(PAH) 545+/-124 ml/min/1.73 m(2), filtration fraction 0.23+/-0.03, microalbuminuria 4.2+/-3.5 mg/mmol. Electrolyte tubular reabsorption rates and urine concentrating capacity were normal. CONCLUSION: These results suggest that in children born to transplanted women taking CsA, renal function develops normally despite prolonged exposure in utero.

Child↗
PubMed1999

[The migrating intrauterine device. Case report and review of the literature].

We report a case of migration of an intrauterine contraceptive device (IUCD) detected during pregnancy one year after insertion. The advanced gestation of the pregnancy and the absence of symptoms lead to expectant management. There were no complications during the pregnancy or delivery. A CT Scan in the post-partum period suggested that the IUCD was located in the region of the small bowel. Laparoscopy confirmed that the IUCD was superficially embedded in the intestinal wall but with no mucosal lesion. The device was removed with the aid of a mini-laparotomy. The migration of an IUCD into the abdominal cavity is rare. A literature review spanning the past 18 years revealed 165 reported cases. The IUCD was located in the following sites: omentum 45, rectosigmoid 44, peritoneum 41, bladder 23, appendix eight, small bowel two, adnexa one, iliac vein one. The majority of the authors recommend removal of copper containing devices, because of the potential for inflammatory reactions that can cause bowel obstruction and perforation. Initial laparoscopy has mostly superceded laparotomy but conversion may be necessary if difficulties arise.

Adult↗
PubMed1991

The use of micronized progesterone in the treatment of menace of preterm delivery.

The results of a study concerning the treatment of acute menace of preterm labor are given: beta-mimetics were administered intravenously in all cases (44) and micronized progesterone or placebo was administered orally after classical double-blind randomization (22 cases in each group). The mean index of pregnancy prolongation was the same in both groups. However the mean duration of the intravenous perfusion and the mean quantity of beta-mimetics administered intravenously were significantly reduced in the progesterone group (P less than 0.01). The mean duration of hospital stay was also significantly reduced (P less than 0.05). Cost and risks are finally significantly lessened.

Female↗
PubMed1991

[The administration of micronized progesterone in the treatment of threatened premature labor].

A randomised double-blind placebo-controlled trial concerning the treatment of threatened premature labour was undertaken using the following methodology: beta-mimetics were given intravenously to all patients (44) and micronised progesterone or the placebo were prescribed orally after randomisation (22 patients in each group). The mean index of prolongation of pregnancy was similar in both groups. However, the mean duration of the intravenous infusion and the mean dose of beta-mimetics administered intravenously were significantly lower in the oral progesterone group (p less than 0.01). Similarly, there was a significant (less than 0.05) decrease in the mean duration of hospitalisation. The cost and risks of treatment are thus significantly reduced when beta-mimetics and oral progesterone are used in combination.

Administration, Oral↗
PubMed1991

[Management of triplet and quadruplet pregnancies].

The management of multiple pregnancies is analyzed on the basis of the results in a series of 34 triple pregnancies and 5 quadruple pregnancies. Hypertension of pregnancy occurred in 6 of the patients, a threat of severe premature delivery in 15 patients. Severe cardiovascular complications, related to beta-mimetics, occurred in one case. Delivery was virtually always by Caesarian, with a mean gestational age of 31 weeks and 5 days for the triple pregnancies and 30 weeks and 5 days for the quadruple pregnancies. In 8.4% of cases, the offspring showed severely retarded intrauterine growth. The total mortality rate was 11.7% for the triple pregnancies and 15% for the quadruple pregnancies. Most deaths during the neo-natal period occurred in offspring from 4 pregnancies in which delivery occurred before 28 weeks of amenorrhea. After 28 weeks of amenorrhea, the adjusted total mortality was 4.2% for the triple pregnancies and no offspring of a quadruple pregnancy died. The prevention of the risk of threatened very early premature delivery led us to propose routine hospitalization after 26 weeks of amenorrhea, in order to improve the foetal prognosis in this age group. Carrying out a Caesarian later, after about 34 weeks of amenorrhea for the triple pregnancies and 32 weeks of amenorrhea for the quadruple pregnancies, made it possible to reduce the incidence of delayed intra-uterine growth and in utero foetal death and also made it possible to schedule the date of delivery. Good obstetric-pediatric coordination is also an essential factor in improving the prognosis for these high-risk pregnancies.

Adult↗
PubMed1991

[Echographic guided puncture of ovarian cysts. Possibilities and limitations].

Ultrasound-guided puncture is a simple and easy to perform procedure. It would seem to be a good idea to suggest simple puncture as a first intention in cases of an image of ovarian cyst. In theory, the advantages are obvious: a puncture is performed, the liquid is analyzed and an appropriate treatment is administered. Coelio-surgery could surely be avoided in cases of functional cysts and perhaps in some non-malignant ovarian cysts. In fact, it must be remembered that a cancer of the ovary in its early stages may have the appearance of a banal cyst, and that puncture does not allow pathological examination. Cytological examination is insufficient to totally rule out malignancy or to allow detailed histological diagnosis. There is, therefore, a risk of leaving in place the pocket of a cyst which may be organic and which may recur or even develop. For these reasons, ultrasound-guided puncture can be undertaken only in pre-selected patients and in the context of a specific protocol: 1) The ultrasound image of the cyst must be liquid, anechoic, unilocular (or bilocular with a fin wall), with no vegetation, the serum level of CA 125 must be low; 2) it the puncture liquid is oily, tarry or viscous, a celioscopy must be carried out as soon as possible, only a yellow-colored liquid can justify waiting; 3) the analysis of the cyst fluid is not always determinant, and the cytology findings are conclusive only if positive. A high 17 beta-estradiol level suggests a functional cyst.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Infants born to kidney transplant recipients].

Over a period of 24 years, 23 women who had undergone renal transplantation gave birth to 26 children whose gestational ages were above 28 weeks. The average duration of stable kidney function tests before the onset of pregnancy was 34.5 months (6 to 109 months). Immunosuppressive treatment consisted mostly of azathioprine and steroids (20/26), steroids and cyclosporin A (CyA) in one case, and azathioprine, steroids and CyA in 5 cases. Average gestational age at birth was 35.2 weeks (30-40 weeks), average birth weight was 2,330 g (1,160-3,700 g). Caesarean section was performed in 73% of cases. The most frequent neonatal pathological condition was the occurrence of respiratory distress, most often related to prematurity and the mode of delivery. No child presented with any lethal congenital malformation. Children born to mothers who were given CyA did not present with more congenital malformations or renal function impairment.

Adult↗
PubMed1990

[The management of pregnant women presenting with genital HPV infections].

The number of genital HPV infections has increased these past few years and, at present, 1 to 3% of pregnant women are infected. Before all treatment, a precise evaluation of the lesions is essential. The condylomata acuminata, and the plane condylomata associated or not to a slightly atypical lesion can be treated by CO2 laser spraying. This treatment is not recommended in cases of severe dysplasia because of possible adjacent micro-invasion. The questionable conization during the first trimester is not recommended after the latter. Systematic prophylactic caesarian section is indicated only in voluminous and diffuse florid condylomata which have not been treated or which persist after treatment.

Condylomata Acuminata↗