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Biomedical subjects

Y Ville

Publications and source records attributed to Y Ville.

At least 163 records · Page 9Linked to original sources
PubMed1995

Development of a training model for ultrasound-guided invasive procedures in fetal medicine.

Training in ultrasound-guided procedures in fetal medicine is currently available in a few major fetal medicine units. Unlike elective surgical procedures, cordocentesis is usually performed without sedation as an outpatient procedure and active supervision of the trainee intensifies the anxiety already felt by the patient. In addition, the complication rate is higher in the initial few procedures or when the procedure is not regularly practiced. We have developed a comprehensive method of training for transabdominal invasive procedures using a medical model that simulates the in vivo situation.

Cordocentesis↗
PubMed1995

Ultrasound evaluation of the length of the fetal nasal bones throughout gestation.

Subtle facial abnormalities, including smallness of the nose, are common findings in trisomy 21 and numerous other genetic conditions. The aim of this study was to construct a normal range for the length of the fetal nasal bones with gestation in a Caucasian population. Ultrasound measurements were performed on a strictly mid-sagittal profile in 376 normal singleton fetuses at 14-34 (mean 24) weeks' gestation. It was found that the length of the nasal bones increased from 4 mm at 14 weeks to 12 mm at 35 weeks' gestation, and that there was a linear relationship between the length of these bones and biparietal diameter and femur length. We conclude that the length of nasal bones can easily be measured in fetuses at 14-34 weeks' gestation and that such measurements might prove useful in the evaluation of pregnancies at high risk for associated fetal abnormalities.

Embryonic and Fetal Development↗
PubMed1995

Doppler studies of the fetal circulation in twin-twin transfusion syndrome.

This cross-sectional study investigated the circulatory profile of the donor and recipient fetuses in 20 pregnancies with twin-twin transfusion syndrome presenting with acute polyhydramnios at 17-27 (mean, 22) weeks' gestation. Doppler investigations of the arterial vessels and ductus venosus, inferior vena cava, right hepatic vein, tricuspid and mitral ventricular inflow were performed in both fetuses. Mean values of most blood flow velocities on the venous side showed a significant decrease in both groups of fetuses, and a significant increase in mean values for indices describing waveform pulsatility was found in all three venous vessels in the group of recipients, whereas in the donor group this was only the case in the ductus venosus. Mean values of atrioventricular flow velocities showed a significant decrease in the donor group. The most significant findings on the arterial side were an increased mean umbilical artery pulsatility index and a decreased mean value for aortic blood flow velocity in both groups of fetuses. Five recipients and four donors had absence or reversal of blood flow during atrial contraction in the ductus venosus. All these fetuses showed pulsations in the umbilical vein. Tricuspid regurgitation was present in eight recipients. Absence or reversal of end-diastolic velocities in the umbilical artery was found in four donors.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1995

Preterm prelabour amniorrhexis: intrauterine infection and interval between membrane rupture and delivery.

This study aimed to determine if fetal bacteraemia and amniotic fluid infection at the time of membrane rupture reduces the interval between membrane rupture and the onset of labour in pregnancies complicated by preterm prelabour amniorrhexis. Sixty nine pregnancies with preterm prelabour amniorrhexis at 12-36 weeks' gestation that were managed expectantly had spontaneous onset of labour. In all cases cordocentesis and amniocentesis were performed and fetal blood and amniotic fluid were cultured for aerobic and anaerobic bacteria. In the group with negative fetal blood and amniotic fluid cultures (group 1) the median interval from amniorrhexis to delivery was 41 days (range 1-161) and there was an inverse correlation between gestational age at amniorrhexis and delivery interval. In the group with negative fetal blood but positive amniotic fluid cultures (group 2) the median amniorrhexis to delivery interval was nine days (range 1-37), and in the group with positive fetal blood cultures (group 3) the interval was two days (range 1-5). These findings suggest that pregnancies complicated by preterm prelabour amniorrhexis and fetal bacteraemia undergo spontaneous labour within five days of membrane rupture, and if labour does not occur then infection is unlikely.

Amniotic Fluid↗
PubMed1995

Concentration of fetal plasma and amniotic fluid interleukin-1 in pregnancies complicated by preterm prelabour amniorrhexis.

AIMS: To determine interleukin-1 beta (IL-1 beta) concentration in fetal and maternal plasma and amniotic fluid from pregnancies complicated by preterm prelabour amniorrhexis and to define the relation of this cytokine to intrauterine infection and the onset of labour. METHODS: Cross-sectional study of 23 pregnancies complicated by preterm prelabour amniorrhexis. Enzyme linked immunoassay was used to measure IL-1 beta concentration in fetal and maternal plasma and amniotic fluid. In each case, fetal blood and amniotic fluid were cultured for micro-organisms. RESULTS: In pregnancies with positive fetal blood and/or amniotic fluid cultures, plasma and amniotic fluid concentrations of IL-1 beta were higher and the interval between amniorrhexis and onset of labour was shorter than in the non-infected group. There were no significant associations between fetal plasma IL-1 beta and maternal plasma or amniotic fluid IL-1 beta concentrations, fetal leucocyte count or the interval between amniorrhexis and the onset of labour. CONCLUSIONS: These findings suggest that although intrauterine infection is associated with increased IL-1 beta concentrations in fetal plasma and amniotic fluid, there is no significant association between the concentration of IL-1 beta and the interval between amniorrhexis and the onset of labour.

Amniotic Fluid↗
PubMed1995

Color Doppler ultrasonography in the identification of communicating vessels in twin-twin transfusion syndrome and acardiac twins.

This study evaluates the role of color Doppler ultrasonography in the identification of the communicating placental vessels in pregnancies with twin-twin transfusion syndrome and acardiac twins. In 18 pregnancies with twin-twin transfusion syndrome and two with an acardiac twin, color Doppler studies of the placental vasculature were performed before fetoscopy for laser coagulation of the communicating vessels. In six cases of twin-twin transfusion syndrome the placental attachment of the intertwin membrane could be visualized. Pulsatile arterial blood flow was observed from the donor to the recipient twin that disappeared after laser therapy. In both cases of acardiac twins, one communicating vessel with pulsatile and another vessel with nonpulsatile blood flow in the opposite direction could be identified. Color Doppler imaging is unlikely to play a major role in assisting endoscopic laser separation of chorioangiopagus in patients with acute polyhydramnios, but it may prove to be useful in the early identification of pregnancies at risk of developing twin-twin transfusion syndrome.

Acute Disease↗
PubMed1995

Fetal arterial Doppler studies in twin-twin transfusion syndrome.

This cross-sectional study investigates the circulatory profile of the donor and recipient fetuses in pregnancies with twin-twin transfusion syndrome manifested by acute polyhydramnios during the second trimester of pregnancy. Doppler investigations of the umbilical arteries and of the fetal descending thoracic aortas and middle cerebral arteries were performed in both fetuses of 27 pregnancies with twin-twin transfusion syndrome at 18 to 25 (mean, 21.7) weeks' gestation. Significant differences from normal values were increased umbilical artery pulsatility index and decreased aortic mean velocity in both donor and recipient fetuses, decreased middle cerebral artery pulsatility index in recipients and decreased middle cerebral artery mean velocity in donors. Increased umbilical artery pulsatility index in some donor and recipient fetuses may be the consequence of abnormal placental development and polyhydramnios-related compression, respectively. Doppler findings in the fetal circulation are compatible with hypovolemia in the donor and hypervolemia with congestive heart failure in the recipient.

Acute Disease↗
PubMed1995

Ultrasound-guided injection of methotrexate versus laparoscopic salpingotomy in ectopic pregnancy.

OBJECTIVE: To compare local injection of methotrexate (MTX) under sonographic control to laparoscopic salpingotomy for conservative management of ectopic pregnancy (EP). DESIGN: Prospective randomized study. PATIENTS: Forty patients were randomized into two groups using a random number table. Inclusion criteria were an EP visualized by ultrasound with a pretherapeutic score < or = 13 as assessed by six criteria graded from 1 to 3: gestational age, hCG level, P level, abdominal pain, volume of the hemoperitoneum, and diameter of the hematosalpinx. INTERVENTIONS: Group 1 patients injected transvaginally with 1 mg/kg MTX into the EP without anesthesia versus group 2 patients undergoing laparoscopic salpingotomy. MAIN OUTCOME MEASURES: Postoperative hospital stay, decrease of hCG levels, success rate. RESULTS: The success rates, defined by hCG levels returned to normal (< 10 mIU/mL [conversion factor to SI units, 1.00]), were 19 of 20 in both groups. Medical treatment was associated significantly with shorter postoperative stay (24 versus 46 hours) and a higher initial hCG level. Human chorionic gonadotropin returned to normal more quickly after laparoscopic treatment (14 versus 28 days). CONCLUSIONS: In selected cases of EP with a pretherapeutic score < or = 13, MTX treatment appeared to be as safe and efficient as was conservative treatment by laparoscopy.

Adult↗
PubMed1994

Endoscopic laser coagulation of umbilical cord vessels in twin reversed arterial perfusion sequence.

In monozygotic twin pregnancies with reversed arterial perfusion (TRAP) sequence, the donor twin is ut high risk of perinatal death. This paper describes the use of endoscopic surgery in the management of this condition. In four cases of TRAP sequence presenting at 17, 20, 26 and 28 weeks' gestation, respectively, an endoscope was introduced into the uterus under local anesthesia and a Nd-YAG laser was used to coagulate the umbilical cord vessels of the acardiac twin. Laser coagulation was successful in arresting blood flow to the acardiac fetus in the cases treated at 17 and 20 weeks, and healthy infants were delivered at term. In the pregnancies treated at 26 and 28 weeks, the umbilical cords were very edematous and laser coagulation failed to arrest blood flow; healthy infants were delivered after spontaneous labor at 29 weeks. These findings suggest that, during mid-gestation, endoscopic laser coagulation of the umbilical cord vessels of the acardiac twin is an effective method of treating TRAP sequence. In later pregnancy, alternative methods of treatment are needed.

Journal Article↗
PubMed1994

Amniotic fluid digestive enzymes: diagnostic value in fetal gastrointestinal obstructions.

The diagnostic value of amniotic fluid gamma-glutamyl-transpeptidase (GGTP) and intestinal alkaline phosphatase (iALP) was evaluated in 55 patients who underwent amniocentesis for karyotyping because fetal gastric or small bowel dilatation had been detected by ultrasound. Gastrointestinal malformation was confirmed in 46 cases and there was no gastrointestinal anomaly in nine cases. Prenatal ultrasound was suggestive of gastroduodenal dilatation in 34 cases (group I) and small bowel dilatation in 21 cases (group II). In group I, amniotic fluid GGTP above the 99th percentile was 71 per cent sensitive and 100 per cent specific for a true anatomical defect of the digestive tract (mainly duodenal atresia). In group II, high levels of GGTP and/or iALP were 69 per cent sensitive and 83 per cent specific for a fetal digestive tract anomaly. In other words, when digestive tract dilatations were diagnosed by prenatal sonography, abnormal amniotic fluid enzyme activities were strongly suggestive of such an anomaly, the possibility of which was not precluded by normal amniotic fluid iALP and GGTP activities. But amniotic fluid digestive enzyme activities do not help in defining the prognosis.

Alkaline Phosphatase↗
PubMed1994

Atrial natriuretic factor concentration in normal, growth-retarded, anemic, and hydropic fetuses.

OBJECTIVE: Our purpose was to establish a reference range with gestation for plasma concentrations of atrial natriuretic factor in fetal blood and to examine whether the concentration is altered in fetal anemia, acidemia, or hydrops. STUDY DESIGN: Atrial natriuretic factor was measured in umbilical venous blood taken by cordocentesis from pregnancies complicated by red blood cell isoimmunization (n = 17), intrauterine growth retardation (n = 12), and hydrops fetalis (n = 20) and from controls (n = 66). Additionally, maternal blood atrial natriuretic factor concentration was measured in 40 uncomplicated pregnancies. RESULTS: In the control group detectable levels were found from 16 weeks onward, and the fetal plasma atrial natriuretic factor concentration did not change with gestation. In anemic, acidemic, and hydropic fetuses the concentration was higher than in controls. CONCLUSION: Fetuses are capable of producing atrial natriuretic factor under physiologic conditions, and the concentration is increased appropriately in pathologic states.

Anemia↗
PubMed1994

Prevalence and influence of Mycoplasma hominis and Ureaplasma urealyticum in 218 African pregnant women and their infants.

OBJECTIVES: To estimate the prevalence of Ureaplasma urealyticum (Uu) and Mycoplasma hominis (Mh) in the lower genital tract of pregnant women, their evolution during pregnancy, and the effect of these pathogens on the outcome of pregnancy in Equatorial Africa. STUDY DESIGN: 218 pregnant women were followed from before 20 weeks gestational age through delivery. Samples were taken from the cervix at every visit and from the newborn at delivery and tested for Uu and Mh. The data were analysed using Student's t-test, the Mann-Whitney, or the chi 2-test. RESULTS: The prevalence of cervical colonization by Ureaplasma urealyticum and Mycoplasma hominis in pregnant women was 79% and 41% respectively. Colonization with Uu and Mh increased significantly throughout pregnancy (P < 0.001). Their presence was associated with lower gestational age at delivery, lower birth weight and increased neonatal morbidity and mortality (P < 0.05). Erythromycin therapy did not have any effect on the evolution of Uu and Mh colonization during pregnancy. CONCLUSION: Uu and Mh are additional factors that might contribute to poor pregnancy outcome in a country where neonatal health is already impaired by many other microorganism.

Africa↗
PubMed1994

Umbilical venous pressure in normal, growth-retarded, and anemic fetuses.

OBJECTIVE: Our purpose was to establish a reference range with gestation for umbilical venous blood pressure and to examine possible changes in intrauterine growth retardation and red blood cell isoimmunization. STUDY DESIGN: Umbilical venous pressure was measured at cordocentesis in pregnancies complicated by intrauterine growth retardation (n = 20) and red blood cell isoimmunization (n = 61) both before and after intravascular fetal blood transfusion. The values were compared with a reference range that was constructed from the study of 111 pregnancies undergoing prenatal diagnosis at 18 to 40 weeks' gestation. RESULTS: In the control group the mean umbilical venous pressure increased significantly with gestation. In the growth-retarded fetuses umbilical venous pressure was higher, normal, or decreased, and there was no significant association between umbilical venous pressure and either fetal size or degree of acidemia. In the pregnancies complicated by red blood cell isoimmunization umbilical venous pressure increased with anemia but decreased to normal in the most severely anemic and hydropic fetuses. After intravascular blood transfusion umbilical venous pressure in proportion to the improvement in fetal hemoglobin concentration. CONCLUSION: Umbilical venous pressure is not the equivalent of central venous pressure but reflects both left and right heart function and placental resistance.

Case-Control Studies↗
PubMed1994

Treatment of unruptured tubal pregnancy with methotrexate: pharmacokinetic analysis of local versus intramuscular administration.

OBJECTIVE: To determine the optimal dose and route of methotrexate (MTX) in the treatment of ectopic pregnancy (EP). DESIGN: Prospective randomized study. SETTING: Department of Obstetrics and Gynecology (A. Béclère Public Hospital, Clamart, France, Paris-Sud University). PATIENTS AND METHODS: Forty-eight patients with unruptured EP clearly visualized by ultrasound were randomly allocated into four groups of treatment (12 patients in each group): group 1, 1 mg/kg injected locally in the ectopic gestational sac and 1 mg/kg by IM administration 48 hours later; group 2, 1 mg/kg locally; group 3, 0.5 mg/kg locally; group 4, 1 mg/kg by IM administration. Inclusion criteria used a pretherapeutic score < or = 12. Blood samples were collected at time 0.25, 0.5, 1, 2, 6, 12, 24, 36, and 48 hours after MTX administration. Pharmacokinetics of MTX plasma levels were measured by fluorescence polarization immunoassay. Kinetic parameters were compared by Wilcoxon test and Mann-Whitney test. Plasma hCG concentrations were assessed on days 2, 5, and 10 and then weekly until they returned to undetectable levels. RESULTS: Success rate was 12 of 12, 11 of 12, 10 of 12, and 10 of 12 in groups 1, 2, 3, and 4, respectively. Six patients in group 3 required an additional MTX IM injection because of an inadequate decrease of hCG plasma levels. Five patients underwent surgery for abdominal pain or inadequate decrease of hCG. Area under the curve decreased more rapidly after injection in the gestational sac alone than after IM injection and was similar in groups 1 and 2 after local injection and lower in group 3. Terminal half-life and mean residence time remained similar in the four groups. Systemic side effects of MTX therapy occurred in three cases in groups 1 and 4. The regression curve of hCG plasma levels appeared similar in the four groups with a decrease to pretreatment values between days 6 and 8 after an initial rise after MTX was given. CONCLUSION: Area under the curve found after injection in the ectopic sac may be related to a decrease in bioavailability of MTX that links to trophoblastic cells. Patients in group 3 were clearly undertreated by 0.5 mg/kg MTX and required additional therapy. Residual values of MTX plasma levels were always below the limit of detection of our assay and confirmed that citrovarum factor rescue is unnecessary. Injection of 1 mg/kg of MTX in the ectopic sac appears as effective as systemic (IM) injection with less side effects for the patients.

Chorionic Gonadotropin↗
PubMed1994

Aldosterone concentration in normal, growth-retarded, anemic, and hydropic fetuses.

OBJECTIVE: To establish a gestational age reference range for fetal plasma aldosterone concentration and to determine whether anemia, growth retardation, or hydrops are associated with abnormal levels. METHODS: Aldosterone concentration was measured in umbilical venous blood obtained by funipuncture from pregnancies complicated by red blood cell isoimmunization (n = 17), fetal growth retardation (n = 8), and nonimmune hydrops fetalis (n = 17). Values were compared to reference ranges constructed from the study of samples obtained by funipuncture or at elective cesarean delivery from 40 essentially normal fetuses and maternal blood from 33 uncomplicated pregnancies. RESULTS: In the control group, the fetal plasma aldosterone concentration increased linearly with gestation, reaching adult levels at term. In nonimmune hydrops and red blood cell isoimmunization, the aldosterone concentration was increased. In the growth-retarded fetuses, the levels were not significantly different from normals. CONCLUSION: The gestational age-related increase in fetal plasma aldosterone concentration presumably reflects maturation of adrenal function. In certain abnormal pregnancies, fetal aldosterone concentrations increase.

Aldosterone↗
PubMed1994

Umbilical artery steal syndrome and distal gangrene in a case of twin-twin transfusion syndrome.

BACKGROUND: Vascular accidents in the survivor from pregnancies with twin-twin transfusion syndrome have been attributed to the release of thromboplastin from the dead fetus. CASE: In a woman presenting at 22 weeks' gestation with acute polyhydramnios due to twin-twin transfusion syndrome, endoscopic laser coagulation of the communicating vessels was performed. At endoscopy, the toes of the left foot of the recipient fetus were noted to be gangrenous. This fetus had only a left umbilical artery, which was markedly dilated, and Doppler studies demonstrated impaired perfusion of the left leg. In four control fetuses with a single umbilical artery, Doppler studies demonstrated normal waveforms in both legs. CONCLUSION: In twin-twin transfusion syndrome, fetal peripheral gangrene may occur before the death of one twin. The ischemic necrosis of the toes probably resulted from the combined effect of polycythemia and umbilical artery steal syndrome. Interruption of twin-twin transfusion syndrome caused resolution of the polycythemia and prevented further damage by removing one of the components of the peripheral ischemia.

Adult↗