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Biomedical subjects

Y Ville

Publications and source records attributed to Y Ville.

At least 127 records · Page 7Linked to original sources
PubMed1999

Trisomy 2 in an acardiac twin in a triplet in-vitro fertilization pregnancy.

A case is reported of twin reversed arterial perfusion (TRAP) sequence in a triamniotic dichorionic triplet pregnancy conceived by in-vitro fertilization which was diagnosed at 25 weeks of gestation by colour Doppler sonography. It highlights the risk of monochorionicity-associated morbidity in multiple pregnancies obtained by assisted conception and stresses the importance of chorionicity determination by early ultrasound examination. Cytogenetic analysis of skin from the acardius showed trisomy 2 in all cells, whereas the karyotype in the monochorionic triplet was normal. This is an example of heterokaryotypic monozygotism where the chromosomal abnormality must have occurred during the early cleavage divisions. Aneuploidy as a possible aetiological factor of TRAP sequence is discussed.

Adult↗
PubMed1999

Amniotic fluid concentrations of interleukin-1beta, interleukin-6 and TNF-alpha in chorioamnionitis before 32 weeks of gestation: histological associations and neonatal outcome.

OBJECTIVES: To test the association between cytokine levels in the amniotic fluid and (i) the vascular invasion phase of intrauterine infection, (ii) the occurrence of periventricular leukomalacia; to assess the correlation between C-reactive protein levels, a recognised biological marker of inflammation in maternal serum and cytokine levels in the amniotic fluid. DESIGN: Prospective clinical study. SETTING: Fetal medicine unit and neonatal intensive care unit, Antoine Beclere Hospital, Clamart, France. SAMPLE: Thirty-one pregnancies complicated by chorioamnionitis leading to birth before 32 weeks of gestation. METHODS: Interleukin 1-beta, Interleukin 6 and TNF-alpha prospectively measured in the amniotic fluid. Histological examination of the placenta. Ultrasound examination and magnetic resonance imaging of the brains of the newborn infants performed within the first week of life. MAIN OUTCOME MEASURES: The occurrence of periventricular leukomalacia was assessed by transfontanellar ultrasound and magnetic resonance imaging. RESULTS: There was a significant positive correlation between the occurrence of histological chorioamnionitis, vascular extension of infection of the membranes, maternal inflammatory syndrome and neonatal sepsis. A strong association was found between maternal serum C-reactive protein concentrations and cytokine levels in the amniotic fluid. Interleukin-1beta was the best predictor of vascular extension of chorioamnionitis, and TNF-alpha was the best predictor of the development of severe early neonatal infection. There was no association between the amniotic fluid levels of cytokines and the development of periventricular leukomalacia. CONCLUSIONS: These data suggest that IL-1beta, IL-6 and TNF-alpha are produced in relation to intrauterine inflammation and infection, but cannot be directly implicated in the development of fetal cerebral white matter lesions.

Amniotic Fluid↗
PubMed1999

Screening for fetal aneuploidies and fetal cardiac abnormalities by nuchal translucency thickness measurement at 10-14 weeks of gestation as part of routine antenatal care in an unselected population.

OBJECTIVES: To evaluate first trimester pregnancy screening for fetal aneuploidy and congenital heart defects by maternal age and nuchal translucency measurement and screening for fetal aneuploidies and congenital heart defects by ultrasound in an unselected population. DESIGN: A prospective study. SETTING: Fetal medicine unit, St George's Hospital, London. SAMPLE: 4523 consecutive viable fetuses at 10-14 weeks with a crown-rump length between 38 and 80 mm were scanned transabdominally (93%) or transvaginally (7%). METHODS: Screening was performed by calculating the background risk from maternal age, gestational age and obstetric history, which was then adjusted with the nuchal translucency measurement in relation to crown-rump length (adjusted risk). MAIN OUTCOME MEASURES: Measurements of crown-rump length and nuchal translucency thickness. An adjusted risk of > 1:270 was considered as a positive screening test. Pregnancy outcome was obtained through karyotyping, outcome questionnaires and examination of the newborn infants. RESULTS: Mean maternal age was 29-4 years and mean gestational age 12.2 weeks. Screening was positive in 230/4523 fetuses (5.1%), when the adjusted risk (mean 1:2649) was > 1:270. Fetal karyotype was abnormal in 23 (0.51%) cases, including twelve with trisomy 21, five trisomy 18, one trisomy 13, one trisomy 10, one monosomy X and two triploidies. For a false positive rate of 4.7%, the sensitivity of this test was 78% in detecting any fetal aneuploidy. Only one out of nine major congenital heart defects in this population was found within the 110 euploid fetuses with increased nuchal translucency thickness (> 2.5 mm). CONCLUSION: Screening for fetal aneuploidy by maternal age and nuchal translucency measurement can be effective in an unselected population. However, our results do not support its effectiveness in the detection of cardiac abnormalities.

Adolescent↗
PubMed1998

[Minimally invasive techniques make fetal surgery possible. Disabling abnormalities can be corrected].

Increases in our knowledge of the fetus and improved skill in early prenatal diagnosis inevitably result in attempts to treat some of the abnormalities detected. Although most fetal malformations diagnosed prenatally in continuing pregnancies are best managed by medical and surgical intervention after planned delivery, some structural defects may require in utero-treatment to forestall subsequent sequelae. The article consists in a review of the current status of ultrasound-guided invasive fetal therapy, including multifetal pregnancy reduction, manipulation of amniotic fluid, drainage and shunting procedures, fetal transfusion therapy, operative fetoscopy, and in utero stem cell transplantation. Future prospects and developments in this rapidly expanding field are also outlined.

Amniocentesis↗
PubMed1998

First-trimester transabdominal fetal echocardiography.

BACKGROUND: Fetal echocardiography is usually done during the second trimester of pregnancy, but waiting until that time can lead to anxiety for the parents if the fetus is at high risk of having cardiac abnormalities. We report the feasibility of transabdominal first-trimester fetal echocardiography for early reassurance of normality or a prenatal diagnosis of a cardiac malformation. METHODS: We did first-trimester fetal echocardiography and colour-flow mapping with a 5 MHz curvilinear transducer at 13 weeks' gestation (range 12-13+6 days) in 15 fetuses at risk of cardiac defects. The fetus was judged to be normal if the investigation showed normal visceral situs, four-chamber view, and two normally related great arteries of similar size. We did second-trimester scans and neonatal follow-up for the women who continued with their pregnancies; necropsy was done in two cases of pregnancy termination. FINDINGS: Ten fetuses had normal hearts at the time of the first scan, which was confirmed during second-trimester assessment. In one fetus, the four-chamber view was asymmetrical and a moderate-sized apical muscular ventricular septal defect (VSD) was diagnosed after birth. In another two fetuses we diagnosed small muscular VSD on the second-trimester scans. A complex cardiac malformation was correctly diagnosed in one fetus at 12 weeks of gestation. Thus, in 11 fetuses, the imaging was of sufficient quality to reassure the family or to diagnose an abnormality. In the other four fetuses, the investigation was judged to be incomplete, but no definite cardiac abnormality was identified. INTERPRETATION: Transabdominal fetal echocardiography in the first trimester of pregnancy is feasible. In most patients the resolution of images is sufficient to allow assessment of basic cardiac anatomy, when normal, or detection of complex malformations, when present.

Echocardiography, Doppler, Color↗
PubMed1998

Influence of pregnancy on the pharmacokinetic behaviour and the transplacental transfer of the piperacillin-tazobactam combination.

The safety/acceptability, blood pharmacokinetics and urinary excretion of the piperacillin-tazobactam (PPR-TZB) combination were studied in six patients between 25 1/7 and 31 5/7 weeks of amenorrhea. The combination was given for a materno-fetal infection due to susceptible organisms i.e. 4/0.5 g/6 h. Whenever possible, the trans-placental transfer (TPT) of the combination was assessed in several sub-compartments of the feto-placental unit i.e. maternal blood sample, cord blood, amniotic fluid, placenta tissue and fetal urine. Two series of nine blood samples were scheduled for each patient, i.e. on D1 (first dose) and D3 (at plateau). Samples were assayed by HPLC and data were analyzed by a non-compartmental method. Safety/acceptability of the treatment proved to be good. The kinetic behavior of both beta-lactams appeared to be identical. Evidence was found during pregnancy of an increase in Vss and Cl of the combination. These increases can be linked to a notable decrease in AUCs. The TPT of the combination was significant. Regarding other accessible compartments (i.e. placenta tissue, amniotic fluid and fetal urine), the ratio of PPR-TZB concentrations was invariably about 8. Maternal circulating levels of PPR-TZB were, by 4 h, less than the MIC of target organisms (i.e. < or = 8 micrograms/ml), both on D1 and at steady state. This raises the question of the pertinence of the dosage regimen. Regarding PPR, it is accepted that antibacterial protection is satisfactory when circulating concentrations are kept at a Css (steady state concentration) of the order of 20 micrograms/ml or more. PPR-TZB combination would be administered by continuous infusion i.e. 8 mg/min to obtain 3 h later a Css of more than 20 micrograms/ml. The daily dosage would then be 12/1.5 g instead of 16/2 g, which is also more satisfactory from a pharmaco-economic standpoint. This proposal must be validated in a sufficient number of patients and, could avoid disqualification of the combination PPR-TZB in the treatment of serious infections during certain pathological pregnancies.

Adult↗
PubMed1998

The effect of nuchal cord on nuchal translucency measurement at 10-14 weeks.

The aim of this study was to determine the incidence of nuchal cord and its possible effect on nuchal translucency thickness at 10-14 weeks' gestation. Out of 316 consecutive pregnancies in which nuchal translucency thickness was measured transabdominally, 26 (8.23%) fetuses were shown to have the umbilical cord around the neck. The umbilical cord can be measured together with the nuchal translucency thickness when it passes around the fetal neck and this adds a mean of 0.8 mm to the actual translucency measurement. After the thickness of the cord was subtracted, the measurements of nuchal translucency thickness did not differ from those in the overall population studied. Of the 22 fetuses available for follow-up, a nuchal cord was found in only one at 20 weeks and in none at delivery. Our findings indicate that the presence of a nuchal cord may bias the results of fetal nuchal translucency measurement and that the use of color Doppler might decrease the false-positive rate in screening for fetal aneuploidy by nuchal translucency measurement at 10-14 weeks' gestation.

Female↗
PubMed1998

The megalovirus.

Explore the source record for details and available documents.

Cytomegalovirus↗
PubMed1998

Stuck twin syndrome without signs of twin-to-twin transfusion.

Twin-to-twin transfusion syndrome represents a dilemma for both diagnosis and management. It has recently been suggested that a difference in contrast on B-mode ultrasound between the placentas is pathognomonic for the syndrome. We describe a case of monochorionic diamniotic twins with normal growth in one twin, the other showing features of stuck twin syndrome. In this case, although the contrast difference between the placentas was marked, twin-to-twin transfusion syndrome was ruled out, rendering this sign unreliable for diagnosis. Furthermore, evaluation of the stuck twin showed excessive adrenal artery flow, a feature that has been described in connection with poor antenatal and neonatal outcome. In this case, serial Doppler ultrasound evaluation of both fetuses enabled optimal timing of delivery.

Adrenal Glands↗
PubMed1998

Prenatal diagnosis of a large fetal arachnoid cyst.

A case of prenatal diagnosis and management of a giant fetal arachnoid cyst is presented. The importance of an accurate diagnosis is highlighted and the use of three-dimensional ultrasound is discussed. The recent literature is reviewed.

Adult↗
PubMed1998

Prenatal diagnosis of atypical cystic lesions of the fetal scalp.

Two cases of cystic lesions of the fetal scalp are described. They were initially thought to be meningoceles, but the brain was normal on ultrasound examination and there were no associated abnormalities. In the first case, by 26 weeks' gestation, the original cystic lesion had regressed to a dense tissue mass; in the second case, the cyst remained as a small anechoic mass. Postnatal assessment in the first case revealed a plexiform skin lesion measuring 40 x 15 mm on the left parietal bone. This was mobile and not attached to the underlying structures. The skull showed no obvious defect and a cranial scan was normal. In the second case, an epidermal cyst was diagnosed.

Adult↗
PubMed1998

The cobweb syndrome: first trimester sonographic diagnosis of multiple amniotic bands confirmed by fetoscopy and pathological examination.

Amniotic band syndrome is a well described clinical entity presenting with deformities of the limbs, thorax, craniofacial skeleton, soft tissues and umbilical cord, but it still lacks a precise definition and a coherent hypothesis for its pathogenesis. We report on a case of first trimester diagnosis of amniotic band syndrome by sonography and fetoscopy. This revealed multiple abnormalities including facial cleft, brain and limb deformities; the appearance of the amniotic cavity was that of a cobweb containing the fetus. Post-mortem examination and histopathological studies confirmed the diagnosis of amniotic band syndrome. These results may enhance the knowledge of its natural course. In addition, based on histological and newly identified ultrastructural features, we present a hypothesis which could help to explain the aetiopathogenesis of the amniotic band syndrome.

Adult↗
PubMed1998

Are neonatal brain lesions due to intrauterine infection related to mode of delivery?

Studies of antenatal and intrapartum factors involved in the development of cerebral palsy have identified intrauterine infection and chorioamnionitis as high risk situations for white matter damage, especially periventricular leukomalacia. To characterise adverse or protective perinatal factors further, we undertook a multiple regression analysis of selected perinatal events in a population of 110 inborn premature neonates with documented chorioamnionitis. In the total population of 110 infants delivered at between 25 and 32 weeks, 101 (92%) survived the first week of life and two were subsequently excluded. Of the 99 remaining infants, 20 (20%) developed periventricular leukomalacia including 16 (80%) cystic lesions. Forty-five (45%) babies were born by lower segment caesarean section, and for 37 of these, this was carried out before labour. Fetal presentation at delivery was breech in 14 (26%) of those born vaginally and 23 (52%) of those born by lower segment caesarean section (OR 3 [95% CI 1.3-7]). Among predetermined perinatal risk factors for periventricular leukomalacia, logistic regression analysis showed that delivery by caesarean section was associated with a dramatic decrease in the incidence of periventricular leukomalacia (OR 0.15 [95% CI 0.04-0.57]). These preliminary results warrant confirmation and preferably a prospective study before considering caesarean section as a protective perinatal factor of periventricular leukomalacia.

Adult↗
PubMed1998

Endoscopic laser coagulation in the management of severe twin-to-twin transfusion syndrome.

OBJECTIVE: To assess the clinical effectiveness of endoscopic laser coagulation of placental vessels in the treatment of severe transfusion syndrome. DESIGN: Prospective study. SETTING: Three referral centres for the management of twin-to-twin transfusion syndrome. POPULATION: One hundred and thirty-two pregnancies complicated by severe twin-to-twin transfusion syndrome, reflected by polyhydramnios and enlarged bladder of one twin and oligoanhydramnios and collapsed bladder of the other twin, presenting before 28 weeks of gestation. METHODS: Prospective collection of data on pre-procedure assessment, the procedure and the follow up were collected prospectively. Laser coagulation of placental vessels crossing the intertwin membrane on the chorionic surface under sono-endoscopic guidance, followed by amniodrainage. MAIN OUTCOME MEASURES: Maternal and pregnancy complications, perinatal death and morbidity were assessed over the last five years with follow up of survivors. RESULTS: Endoscopic laser was carried out at a median gestation of 21 weeks. The total number of surviving infants was 144 (55%) and there was at least one survivor in 97 cases (73%). At a minimum age of one year neurological handicap was suspected in six survivors (4.2%). CONCLUSIONS: The results of this multicentre study are similar to those in our original report on the first 45 cases. In comparison with serial amniodrainage, the survival rate may be similar, but the handicap rate in survivors appears much lower. This study stresses the need for a prospective study comparing these two techniques.

Endoscopy↗
PubMed1998

Pregnancy after heart or heart-lung transplantation: a series of 10 pregnancies.

OBJECTIVE: To evaluate pregnancy after heart or heart-lung transplantation in France. DESIGN: A questionnaire survey of all French centres performing heart and heart-lung transplants provided an exhaustive registry on pregnancy after transplantation. METHODS: A questionnaire was sent to 36 centres. Anonymous reports on transplantation and subsequent pregnancies between 1984 and 1996 were analysed. RESULTS: Of 1290 heart and 120 heart-lung transplantation performed during the study period, 10 pregnancies (seven after heart transplantation and three after heart-lung transplantation) were reported in nine women who were delivered of 11 infants. High blood pressure complicated nine pregnancies and severe pre-eclampsia occurred in two. One woman developed Kaposi sarcoma of the cervix. Delivery at 35 weeks gestation (27-39) was by caesarean section in 50% cases. Mean birthweight was 1990 g (700-2880g) and 50% of the infants had a birthweight < tenth centile. One infant developed cardiomyopathy as a condition inherited from her mother, and congenital hepatitis B was diagnosed in another. CONCLUSIONS: Pregnancy after heart and heart-lung transplantation is feasible and can be successful, but this should be planned when cardiac and respiratory functions are stable. Adequate obstetrical and genetic counselling should be provided.

Adult↗
PubMed1998

Effect of dexamethasone and betamethasone on fetal heart rate variability in preterm labour: a randomised study.

OBJECTIVE: To compare the effects of betamethasone and dexamethasone on fetal heart rate in appropriately grown fetuses. METHODS: Eighty-two pregnant women (97 fetuses) with preterm labour were randomly allocated to receive betamethasone (n=42) or dexamethasone (n=40) for fetal lung maturation in a nonblinded fashion. Computerised cardiotocogram (CTG) parameters were compared before, during and after treatment. RESULTS: A decrease in fetal heart rate variability was found with betamethasone but no significant changes were found with dexamethasone. Fetal heart rate variability returned to pre-treatment values within a week after cessation of treatment with betamethasone. Neonatal outcome was similar in the two groups. CONCLUSIONS: These findings might prove useful in the management of compromised fetuses with decreased fetal heart rate variability in which the CTG should be used together with other parameters to assess fetal wellbeing during corticosteroid treatment. Dexamethasone may be preferable as the drug of choice since it was associated with significantly less alteration in fetal heart rate variability compared with betamethasone.

Betamethasone↗