Search PubMed⌕ Search

Biomedical subjects

S Uzan

Publications and source records attributed to S Uzan.

At least 145 records · Page 8Linked to original sources
PubMed1991

Prevention of fetal growth retardation with low-dose aspirin: findings of the EPREDA trial.

The efficacy of low-dose aspirin in preventing fetal growth retardation was tested in a randomised, placebo-controlled, double-blind trial. A secondary aim was to find out whether dipyridamole improves the efficacy of aspirin. 323 women at 15-18 weeks' amenorrhoea were selected at twenty-five participating centres on the basis of fetal growth retardation and/or fetal death or abruptio placentae in at least one previous pregnancy. They were randomly allocated to groups receiving placebo, 150 mg/day aspirin, or 150 mg/day aspirin plus 225 mg/day dipyridamole, for the remainder of the pregnancy. In the first phase of the trial all actively treated patients (n = 156) were compared with the placebo group (n = 73). Mean birthweight was significantly higher in the treated than in the placebo group (2751 [SD 670] vs 2526 [848] g; difference 225 g [95% CI 129-321 g], p = 0.029) and the frequency of fetal growth retardation in the placebo group was twice that in the treated group (19 [26%] vs 20 [13%]; p less than 0.02). The frequencies of stillbirth (4 [5%] vs 2 [1%]) and abruptio placentae (6 [8%] vs 7 [5%]) were also higher in the placebo than in the treated group. The benefits of aspirin treatment were greater in patients with two or more previous poor outcomes than in those with only one. In the second analysis, of aspirin only (n = 127) vs aspirin plus dipyridamole (n = 119), no significant differences were found. There was no excess of maternal or neonatal side-effects in the aspirin-treated patients.

Adult↗
PubMed1991

[Physiopathological elements of pre-eclampsia and the role of the main complementary tests].

The origin of pre-eclampsia lies in uteroplacental ischemia due to an anomaly of the "vascular insertion" of the placenta. Although the cause of this anomaly remains unknown, it would appear to include both a genetic and an immunological origin possibly favourised by special underlying conditions and certain obstetric circumstances. Prostaglandin imbalance (in particular prostacyclins and Thromboxane A2) appears to be one of the chief factors governing these anomalies. One of the consequences of these mechanisms is the onset of hypertension but other disturbances are essential features. In particular, disseminated intravascular coagulation may occur leading to the release of numerous microthrombi which cause placental (leading to chronic fetal distress), renal, hepatic and cerebral lesions.

Disseminated Intravascular Coagulation↗
PubMed1990

[Outcome beyond the 1st trimester of 305 pregnancies conceived by fertilization in vitro].

The obstetrical outcome of 305 pregnancies obtained by in vitro fertilization were reviewed: out of 275 pregnancies following fresh embryo transfers, 205 (74.5%) were single, 64 (23.3%) double and 6 (2.2%) triple). We observed increased frequencies of high blood pressure linked to older maternal age, bleeding in the late pregnancy and breech presentation, which could be associated to abnormal insertion of umbilical cord and/or placenta. Multiple pregnancies, especially the triple ones, are of the highest risk (intra-uterine growth retardation, low birth weight). Nevertheless the total fetal mortality remains low in our experience. Data about 22 pregnancies following cryopreserved embryo transfer, 5 after oocyte donation and 3 therapeutic abortions are also given.

Adult↗
PubMed1990

[The carotid diastolic index: predictive factor for acute fetal distress].

The authors studied 165 patients, 161 of them having been examined at least once for their umbilical diastolic index, uterine diastolic index and carotid diastolic index (CDI) during pregnancy. Four patients have been examined only for the umbilical and carotid indexes. These patients presented either a pathological pregnancy (37% of arterial hypertension; 34% of intrauterine growth retardation; 8% other causes) or previous pathological gestations (21%). Particular emphasis was given to the study of the prediction of CDI with respect to fetal heart rate (FHR) abnormalities or an intrauterine fetal death (IUFD). A mean of 1.4 measurements of CDI per patient were performed, ranging from 1 to 5. The average time lag of the first CDI measurement was of 30 weeks of pregnancy, ranging from 21 to 36.5 weeks. The mean time lag of the children's deliveries was of 35 weeks, ranging from 27 to 40 weeks of pregnancy. The mean time lag of the last CDI measurement with respect to delivery was of 15 days (1 day to 15 weeks). The CDI (CDI = D/S; D = residual diastolic velocity; S = maximal systolic velocity) was considered as pathological when exceeding 22% up to 30 weeks of pregnancy and when exceeding 26% after 30 weeks. 50% of the children born in this series were hypotrophic. When presenting identical umbilical and uterine indexes, the percentage of hypotrophic offspring was the same, whether the carotid index was normal or pathological.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1990

[Attempts to prevent intrauterine growth retardation using platelet anti-aggregants].

Intrauterine underdevelopment is a frequent complication in pregnancies associated with high blood pressure. It can also happen in the absence of this symptom but in a similar context. During these pregnancies, homeostasis problems were often shown to be at the root of placental abnormalities responsible for the development problems. This is why the authors of this article have tried to prevent intrauterine underdevelopment by prescribing antiplatelet drugs as from the start of the 2nd trimester of pregnancy. They compare their encouraging results with those of other teams and conclude that a larger prospective trial is necessary.

Female↗
PubMed1989

[Compared course of clinical, biologic, echographic and speedometric parameters in retroplancetal hematoma].

The authors have studied 27 cases of Abruptio Placentae (A.P.) (for an observation time of 15 months). These 27 patients where divided into 3 groups: 6 patients without pregnancy follow-up, 5 with a regular follow-up and 16 with an intensive pregnancy follow-up. In this last group following parameters were studied: blood pressure, proteinuria, uricemia, hematocrit, platelet count, FDP, plasma volume, Fetal (umbilical artery) and Maternal (uterine artery velocities with doppler reclude Fetal heart Rate. The total number of intra uterine death and post natal death remained very high: 15 over 27 cases. However this rate was lower in the intensive group, where 10 fetuses with were delivered safely. Studying the evolution of clinical, biological and ultrasonic parameters during the last month before the AP we tried to establish curves of their mean value (every week for the last 4 weeks and every day for the last week). Almost all parameters showed a late significant variation (in the last week). Two of them were modified in the last two days: (FDP and Fetal heart rate acceleration). Two of them were "positive" (in 60 p. 100 of cases) 3 of 4 weeks before the AP: Maternal Plasma volume decrease, Presence of a Notch on the uterine artery doppler curve. In conclusion fetal or neonatal death after AB remains high and even with an intensive follow-up 30 p. 100 of the cases cannot be predicted.

Female↗
PubMed1989

[Fetal telemonitoring].

There is a definite increase in the number of cases in which it is helpful to know about the fetal heart rate. These are: intra-uterine growth retardation whether associated with hypertension or not, or whether the patients have lost a fetus in utero before. In these cases it is necessary to hospitalize the patient for a long time or make them come to the clinic very often. Watching these patients at home (using either midwifery or hospital staff) is often difficult, so it seemed useful to us to develop another system of monitoring these patients at home. We have been testing, for the last year and a half, a simple system of recording the fetal heart rhythm that can be used by the patient herself at home. The recordings are transmitted daily or twice daily by telephone. The midwife in the maternity unit can look at the tracing and ask the patient to come if the tracing is insufficient or suspicious. We present here the results of 816 tracings carried out in 402 patients: --the tracings correspond completely to those taken at the same time by the usual machines as far as the fetal ECG is concerned. Their interpretation does not give rise to any problems as compared with those of usual tracings. --about 80% of the tracings could be interpreted. They vary according to how far on the pregnancy has progressed (73% at 32 weeks of pregnancy and 84% at term). Telephone transmission was carried out in 84% of cases. Isolated monitoring of fetal heart rhythm (without recording tracings of uterine contractions) makes it possible to monitor these patients at risk of having chronic fetal distress.

Electrocardiography↗
PubMed1988

[Ripening of the cervix uteri at term by a single intracervical application of prostaglandin E2 gel].

The efficacy and the side effects of an intracervical PGE2 gel application, as compared to placebo, for priming of the cervix have been studied in 208 patients at term (104 PGE2 and 104 placebo) with an unripe cervix (Bishop score less than 5) and with a medical indication for induction of labour. The cervical ripening success rate (as defined in methodology) is significantly higher in the treated group (58.6%) than in the control group (27.8%; p = 0.0001): 38.5% out of the PGE2 treated patients delivered within 12 hours after the gel application; 12 hours after PGE2 or placebo gel application labour was induced in the remaining patients with intravenous oxytocin infusion. Under these conditions there were 13.5% failures in the PGE2 treated group and 16.3% in the placebo group. We observed a statistically significant decrease in the length of labour of the PGE2 treated patients as compared to the control group. Since signs of myometrial hypercontractility were observed in the PGE2 treated group as compared to the control group (p = 0.01), the authors advocate careful cardiotocographic monitoring for at least three hours after the gel application. It is concluded that intracervical application of Prostaglandin E2 followed by intravenous infusion of oxytocin in an effective and safe method for induction of labour with an unfavorable cervix at term.

Adult↗
PubMed1988

[Measurement of maternal plasma volume during pregnancy].

An increased maternal plasma volume (PV) is a characteristic phenomenon of normal pregnancy, which may be related to a physiological decrease of peripheral resistances. The authors have studied the plasma volume of 1,105 patients distributed as follows: normal (387), permanently hypertensive patients (84), hypertensive patients during pregnancy (390), patients with apparently isolated RCIU (154) or with a pathological past-history during previous pregnancies (90). It appears that the PV is a sign of a severe HBP, and presents a rather early and good predictive value regarding the weight of the fetus and some complications such as severe UCIU and fetal death in utero. In case of pathological past events or pre-existing hypertension, the PV enables to differentiate rather well patients who will be prone to a complicated pregnancy. In view of these results, utilization and interpretation criteria of this parameter during pregnancies with hypertension or pregnancies in which there is a suspicion or a risk of intra-uterine growth delay, are defined.

Adult↗
PubMed1987

[The Doppler in obstetrics: experience of the Baudelocque Clinic].

The authors report three years of experience with the use of the Doppler in Obstetrics. Certain notions may be integrated to the principles of clinical decision. The diastolic index D at the umbilical artery increases regularly during a normal pregnancy. It is significantly decreased in case of intra-uterine growth delay (IUGD). When this index reaches zero, it may be considered as a reliable criteria for fetal extraction. Certain notions must be verified: the index seems frequently altered in case of chromosomal abnormality. Some results still depend on research. The index measured at the uterine arteries could predict IUGD and at the level of the fetus' internal carotids, its elevation could be one of the first signs of fetal hypoxia. Finally, the index was measured during normal labor. In case of deceleration it is markedly altered. Thus, this could be an additional element of fetal monitoring.

Blood Volume↗
PubMed1987

[Fetal diastolic index in the internal carotid arteries. Preliminary results in normal and pathologic pregnancies].

The authors studied a series of 87 blood flow measurements in the internal carotid arteries of fetuses. After a brief survey of cerebral blood flow a description is given of the technique for measuring this flow. They use the index D/S just as in measuring umbilical artery flow. In normal pregnancy the carotid diastolic index hardly rises and stays low, which confirms that there is a high resistance in the system. When abnormal flow rates are found in the umbilical artery the carotid diastolic index rises to protect the brain against hypoxia. The rise in the carotid diastolic index could be the last abnormality which precedes the appearance of fetal cardiac rhythm changes.

Blood Flow Velocity↗
PubMed1986

[The menopause. Vasomotor flushing: physiopathology and treatment].

Considered for a long time as an unavoidable phenomenon secondary to a sudden reduction in hormones, the vaso-motor flushes of menopause have generated, these past few years, a renewal of interest for two reasons: 1) A better knowledge of the etiological mechanisms and experimental and therapeutic observations lead to believe at the present time that their origin is at a central level (hypothalamus) with upsetting of the balance of the cerebral neuro-transmitters; this upsetting seems to be the common mechanism of occurrence of the sudden flushes and the hormonal disorders observed during this phenomenon. 2) The possibility to use (beside the classical hormonal means) non hormonal products, especially Veralipride, which acts directly at the level of the cerebral neuro-transmitters.

Animals↗