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Biomedical subjects

Y Ville

Publications and source records attributed to Y Ville.

197 records · Page 11Linked to original sources
PubMedDate not supplied

Management of a case of twin-to-twin transfusion syndrome by a combined surgical approach.

OBJECTIVE: The management of a case of severe twin-to-twin transfusion syndrome at 24 weeks of gestation is presented, using a combined surgical and medical approach. METHODS: Operative fetoscopy was used to coagulate placental vessels crossing the intertwin membranes. Repeated intrauterine transfusions were used to correct recurrent anemia in the donor twin. Selective three-dimensional placental angiography and directed histological analysis were used to study the placenta after delivery. RESULTS: Resolution of twin-to-twin transfusion syndrome was obtained by coagulation of placental anastomoses, but was followed by recurrent anemia in the donor twin. This was successfully treated by serial intrauterine blood transfusions, and 2 healthy twins were delivered at 31 weeks of gestation. One artery-to-vein anastomosis was demonstrated to be the only communication left between the two circulations. CONCLUSIONS: This case illustrates the limitations of placental surgery in twin-to-twin transfusion syndrome and highlights the need for ultrasound and Doppler follow-up of these high-risk fetuses to indicate further treatment. Placental anastomoses can be overlooked by macroscopic examination and injection technique, but can be demonstrated by placental angiography.

Adult↗
PubMedDate not supplied

Twin-to-twin transfusion syndrome: polyhydramnios-associated changes in maternal plasma volume and maternal plasma aldosterone concentrations. A preliminary study.

OBJECTIVE: Our aim was to evaluate the consequences of polyhydramnios on maternal plasma volume and maternal serum aldosterone and atrial natriuretic peptide (ANP) concentrations in monochorionic twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS). METHODS: The maternal plasma volume, ionograms as well as plasma ANP and aldosterone concentrations were compared in normal monochorionic diamniotic twin pregnancies and in TTTS. RESULTS: The maternal plasma volume was normal in TTTS despite severe polyhydramnios. The plasma aldosterone concentration was higher in pregnancies complicated by TTTS. CONCLUSION: The high plasma aldosterone concentration is likely to maintain normal plasma volume despite progressive extravascular volume enhancement. This suggests that TTTS is present early in pregnancy as a chronic phenomenon starting before its clinical expression and may trigger compensatory maternal hyperaldosteronism.

Aldosterone↗
PubMedDate not supplied

Fetal and neonatal hypertension in twin-twin transfusion syndrome: a case report.

We report a case of fetal systemic hypertension. This occurred in an ex-donor twin soon after coagulation of chorionic vessels and amniodrainage performed for severe twin-twin transfusion syndrome during the 2nd trimester of pregnancy. Systemic hypertension was suspected because of a high systolic velocity through the tricuspid valve, and Bernoulli's equation was used to estimate the right intraventricular pressure. As both pulmonary arteries and ductus arteriosus were normal, the pressure in the aorta was considered to be equal to that in the right ventricle (60 mm Hg). Fetal systemic hypertension could have happened either because of a dramatic increase in placental resistances in the territory of the ex-donor twin or by reversal of the fetofetal transfusion pathological process.

Adult↗
PubMedDate not supplied

Efficiency of ultrasound and biochemical markers for Down's syndrome risk screening. A prospective study.

OBJECTIVE: To evaluate the sequential combination of ultrasound screening for fetal aneuploidy at 11-14 weeks with maternal biochemistry at 12-14 and 15-18 weeks of gestation. METHODS: A prospective study including 1,656 women, with a singleton pregnancy booked before 13 weeks of gestation. Nuchal translucency (NT) thickness was measured by transabdominal ultrasound examination. alpha-Fetoprotein, free betahCG and hCG were measured by immunoradiometric (12-14 weeks) or immunometric (15-18 weeks) assays. Derived risks were then calculated. Cutoff risks were chosen first arbitrarily at 1/250 and then adjusted for a 5% false-positive rate. RESULTS: Seven fetal aneuploidies were diagnosed, including 5 Down's syndromes, 1 trisomy 18 and 1 triploidy. Three Down's syndromes had concordant high risk with the 3 screenings. One was at low risk with NT, and another was at low risk by maternal serum screening, but sequential combination of screenings led to a 100% detection rate with cutoffs of 1/240, 1/160 and 1/250 for NT, first- and second-trimester biochemistry, respectively (i.e. for a cutoff adjusted for a 5% false-positive rate). CONCLUSION: This preliminary study suggests a benefit in combining maternal age-related risk together with NT and biochemical markers in the first or the second trimester. The algorithm combining these risks needs to be established in a wide population.

Adolescent↗
PubMedDate not supplied

Lung development in diamniotic twins discordant for complete urinary tract obstruction.

OBJECTIVES: To investigate the effect of anhydramnios on the lung development of 1 twin in the presence of a normal amniotic fluid volume in its diamniotic co-twin. METHODS: Three sets of diamniotic twins, discordant for complete urinary tract obstruction and anhydramnios, were followed prospectively with regular ultrasound scans and after delivery. RESULTS: All 3 twins with complete urinary tract obstruction and anhydramnios died within 2 days after birth, with confirmed severe pulmonary hypoplasia. In every case the twin with a normal amount of surrounding amniotic fluid had a normal postnatal outcome. CONCLUSIONS: The observation that a normal amniotic fluid volume in one sac does not protect the anhydramniotic twin from pulmonary hypoplasia has important implications for the aetiology of the condition and for the possibility of therapeutic septostomy. These results are discussed in relation to previous human and animal studies.

Adult↗
PubMedDate not supplied

Effect of steroids on arterial Doppler in intrauterine growth retardation fetuses.

BACKGROUND: Antenatal steroid administration decreases fetal mortality and morbidity in preterm neonates. However, maternal steroids administration can cause a transient reduction in fetal heart rate variability and can also alter biophysical profile parameters. Other methods to assess fetal well-being in high-risk fetuses are therefore needed, when steroids are given in high-risk pregnancies. OBJECTIVE: To study the effect of betamethasone and dexamethasone on placental and fetal arterial circulation in 40 growth-retarded fetuses. METHODS: Forty fetuses with intrauterine growth retardation were exposed in utero to a single course of betamethasone (n = 25) or dexamethasone (n = 15). Blood flow waveforms were recorded from uterine arteries, umbilical arteries, descending aorta and middle cerebral arteries and analyzed prospectively. Doppler recordings were compared before (baseline), during (24-48 h) and after treatment (4-7 days). RESULTS: No significant changes were found in the pulsatility indices (PI) in any of these vessels during the course and after the treatment was stopped. However, the PI in the middle cerebral arteries showed a trend to decrease 24-48 h and 4-7 days after steroids were given to the mother when compared to pretreatment values. CONCLUSION: Since antenatal steroids do not seem to affect Doppler measurements, they might be useful to assess well-being in high-risk fetuses during the course. It might allow to differentiate transient iatrogenic changes in fetal heart rate variability from the effect of hypoxemia.

Anti-Inflammatory Agents↗
PubMedDate not supplied

Diprosopus associated with neural tube defect and facial cleft in the first trimester.

We report a case of diprosopus presenting with increased nuchal translucency of 5.3 mm at 14 weeks of gestation. Ultrasonographically, the fetus presented with micrognathia, anterior indentation of the cephalic pole, abnormal cerebral hemispheres with a cystic 4th ventricle and angulation of the spine. The fetal karyotype was normal (46,XX). Following termination of pregnancy, postmortem examination established the diagnosis of diprosopus tetraophthalmus with facial cleft of the 2 faces.

Abortion, Induced↗
PubMedDate not supplied

Fetal hydrocephalus and intrauterine cerebral ventriculoscopy: an animal model.

OBJECTIVE: The aim of this study was to create an animal model of obstructive ventriculomegaly in the fetal lamb at 78 days of gestation by injecting maternal blood into the lateral ventricles under ultrasound guidance. METHODS: An endoscope of 1.2 mm housed in a 1.6-mm trocar was introduced into the dilated lateral ventricle. The lambs were sacrificed after delivery. RESULTS: All fetuses diagnosed with ventriculomegaly on ultrasound showed dilatation on the anatomical sections. The ventricles had a dilated aspect when compared to the controls. In 1 fetus the septum between the two ventricles was completely ruptured. Microscopically the ependymal cells were flattened and the cellular lining was disruptured. CONCLUSION: The model proved suitable for ventriculoscopic examination at 128 days of gestation. This should allow to elaborate further on therapeutic studies in this controversial area.

Animals↗
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Fetal tissue dosages of retinoids. Experimental study concerning a case of isotretinoin (Roaccutan) administration and pregnancy.

The authors report the case of a women who took retinoids (Roaccutan, isotretinoin) during the first trimester of pregnancy, and a therapeutic abortion was carried out. The interest in this case report lies in the determination of the concentration of isotretinoin and its metabolites (4-oxo-isotretinoin, and tretinoin) in fetal tissues, using high performance liquid chromatography. The findings show the significant transplacental crossing of isotretinoin, an accumulation of 4-oxo-isotretinoin in the liver, and a low concentration of retinoids in the brain of this 4-month-old fetus. The authors emphasize that contraception must be used during retinoid treatment, and 4 weeks after retinoids have been stopped.

Abortion, Therapeutic↗
PubMedDate not supplied

Fetal-maternal hydrops syndrome in human parvovirus infection.

A case of maternal generalized edema with hyponatremia, hypoosmolality and secondary hyperaldosteronism was associated with pseudomolar plasma human chorionic gonadotropin (hCG) concentrations in a case of fetal and placental hydrops due to parvovirus B19 infection. Digoxigenin in situ hybridization techniques were effective in demonstrating parvovirus B19 infection on fixed tissues. Hydropic changes in the placenta may have massively increased the maternal plasma hCG concentration with subsequent fluid imbalance leading to maternal hydrops mimicking molar pregnancy.

Chorionic Gonadotropin↗
PubMedDate not supplied

Effect of betamethasone on the fetal heart rate pattern assessed by computerized cardiotocography in normal twin pregnancies.

The effects of corticosteroids, given for enhancement of fetal lung maturation, on fetal heart rate (FHR) are controversial and may decrease its variability. FHR patterns were analyzed by computerized cardiotocography in 46 fetuses from 23 normal dichorionic twin pregnancies on days 0, 1 and 4-7 while the mothers received four intramuscular injections of 3 mg betamethasone sodium and 3 mg betamethasone acetate within 48 h to enhance fetal lung maturation. Compared with pretreatment values, FHR showed a decrease in long- and short-term variations; other parameters, e.g. the number of fetal movements, remained unchanged. However, decreased FHR variation was followed by an increase in the acceleration rate after maternal administration of betamethasone. These modifications were transient and should not lead to unnecessary anxiety or intervention in otherwise normal fetuses.

Betamethasone↗
PubMedDate not supplied

Amniotic fluid pressure in twin-to-twin transfusion syndrome: an objective prognostic factor.

Severe twin-to-twin transfusion syndrome presenting before 28 weeks' gestation is associated with a high neonatal mortality and morbidity due to polyhydramnios-related very premature delivery or intrauterine death of one or both twins. Management options include serial amniodrainages or laser coagulation of the intertwin placental anastomoses; however, early antenatal prognostic factors are lacking. Serial amniocenteses were performed in 9 pregnancies with twin-to-twin transfusion syndrome presenting with second-trimester polyhydramnios, and serial measurements of amniotic fluid pressure were made. Although in 8 cases the pre-drainage pressure was above the 95th centile of the normal range for singleton pregnancies, the pressures were lower in the pregnancies resulting in two livebirths than in the cases where one or both babies died. This study suggests that patients presenting with intraamniotic pressure > 17 mm Hg cannot be safely managed by serial amniodrainages.

Amniocentesis↗
PubMedDate not supplied

Effect of laser coagulation on placental vessels: histological aspects.

In order to evaluate the effect of laser coagulation on placental vessels and to define the optimal power density that should be used for this procedure, coagulation of placental vessels and histological examination were performed on freshly delivered placentae. This study suggests that 45- to 55-watt (6,000-7,666 J/cm2) shots can cause adequate placental injury. The extent of vascular lesions depends upon incident beam energy, fiber diameter, distance and angle to the vessel.

Arteries↗
PubMedDate not supplied

Effect of antenatal betamethasone and dexamethasone administration on fetal heart rate variability in growth-retarded fetuses.

PURPOSE: To study the effect of betamethasone and dexamethasone on fetal heart rate in 55 growth-retarded fetuses. MATERIAL AND METHODS: Fifty-five fetuses with intrauterine growth retardation were exposed in utero to betamethasone (group 1, n = 32) or dexamethasone (group 2; n = 17). Six fetuses received both steroids alternatively at weekly intervals. Computerized cardiotocograms were recorded and analyzed retrospectively. Traces were obtained before, 1 day, 2 days and 4-7 days after treatment was started. RESULTS: One day after treatment was started, both steroids were associated with an initial increase in fetal heart rate variation that was higher with dexamethasone. Short-term variation was significantly decreased during the betamethasone course. All parameters returned to their pretreatment values within a week. CONCLUSION: Dexamethasone and betamethasone had similar effects compatible with a transient damping effect on fetal heart rate variability that reached significance only with betamethasone.

Betamethasone↗
PubMedDate not supplied

[Hereditary hypertension in Recklinghausen's disease during pregnancy. A family].

We report the case of a pregnant woman who presented with neurofibromatosis and hypertension the latter revealed by abruptio placentae. Severe hereditary hypertension was noted in the family during pregnancies that were sometimes complicated by intrauterine growth retardation, abruptio placentae and intrauterine foetal death. Thus, neurofibromatosis in a pregnant woman has a poor obstetrical outcome when it is associated with a personal or family history of hypertension. Such women must be treated with extreme care and hospitalized at the end of the third trimester. The advisability of prevention with low-dose aspirin during the first trimester is discussed.

Female↗
PubMedDate not supplied

[Are desquamated trophoblastic cells retrieved from the cervix suitable for a prenatal diagnosis?].

Prenatal diagnosis based on sampling of fetal tissues, amniotic fluid or chorionic villi is associated with the risk of miscarriage and fetal damage. These risks would be avoided if diagnosis could be performed in desquamated trophoblast cells recovered non-invasively from the maternal cervix. We report on our experience of fetal karyotyping on endocervical lavage using in situ hybridization (FISH) and DNA amplification (PCR) fetal sex was correctly predicted in 8/10 cases by FISH and in 6/10 by PCR. FISH appeared to be a reliable technique for karyotyping when trophoblast can be recovered from the maternal endocervix (8/10).

Female↗