Foetal scalp blood sampling during labour for pH and lactate measurements

Second-line methods of foetal monitoring have been developed in an attempt to reduce unnecessary interventions due to continuous cardiotocography (CTG), and to better identify foetuses that are at risk of intrapartum asphyxia.Very few studies directly compared CTG with foetal scalp blood (FBS) and CTG only. Only one randomised controlled trial (RCT) was published in the 1970s and had limited power to assess neonatal outcome. Direct and indirect comparisons conclude that FBS could reduce the number of caesarean deliveries associated with the use of continuous CTG.The main drawbacks of FBS are its invasive and discontinuous nature and the need for a sufficient volume of foetal blood for analysis, especially for pH measurement, resulting in failure rates reaching 10%. FBS for lactate measurement became popular with the design of test-strip devices, requiring <0.5 mL of foetal blood. RCTs showed similar outcomes with the use of FBS for lactates compared with pH in terms of obstetrical interventions and neonatal outcomes.In conclusion, there is some evidence that FBS reduces the need for operative deliveries. However, the evidence is limited with regard to actual standards, and large RCTs, directly comparing CTG only with CTG with FBS, are still needed

Risk of invasive breast cancer after lobular intra-epithelial neoplasia: Review of the literature

International audienceLobular intraepithelial neoplasia (LIN) is a rare breast disease that has been regarded alternately as a risk factor for invasive breast cancer in both breasts or a true breast cancer precursor. The controversy is largely dependent on the estimation of the IBC (Invasive Breast Cancer) risk after LIN; however a systematic review of the published data has not been previously performed. We aimed to review the IBC after LIN and the characteristics of those cancers

VEB-1 Extended-Spectrum β-lactamase–producing Acinetobacter baumannii, France1

VEB-1 extended-spectrum β-lactamase–producing Acinetobacter baumannii was responsible for an outbreak in hospitals in France. A national alert was triggered in September 2003 when 4 hospitals reported clusters of A. baumannii infection with similar susceptibility profiles. Case definitions and laboratory guidelines were disseminated, and prospective surveillance was implemented; strains were sent to a single laboratory for characterization and typing. From April 2003 through June 2004, 53 hospitals reported 290 cases of A. baumannii infection or colonization; 275 isolates were blaVEB-1-positive and clonally related. Cases were first reported in 5 districts of northern France, then in 10 other districts in 4 regions. Within a region, interhospital spread was associated with patient transfer. In northern France, investigation and control measures led to a reduction of reported cases after January 2004. The national alert enabled early control of new clusters, demonstrating the usefulness of early warning about antimicrobial drug resistance

Hypoxia-activated genes from early placenta are elevated in preeclampsia, but not in Intra-Uterine Growth Retardation.

BACKGROUND: As a first step to explore the possible relationships existing between the effects of low oxygen pressure in the first trimester placenta and placental pathologies developing from mid-gestation, two subtracted libraries totaling 2304 cDNA clones were constructed. For achieving this, two reciprocal suppressive/subtractive hybridization procedures (SSH) were applied to early (11 weeks) human placental villi after incubation either in normoxic or in hypoxic conditions. The clones from both libraries (1440 hypoxia-specific and 864 normoxia-specific) were spotted on nylon macroarrays. Complex cDNAs probes prepared from placental villi (either from early pregnancy, after hypoxic or normoxic culture conditions, or near term for controls or pathological placentas) were hybridized to the membranes. RESULTS: Three hundred and fifty nine clones presenting a hybridization signal above the background were sequenced and shown to correspond to 276 different genes. Nine of these genes are mitochondrial, while 267 are nuclear. Specific expression profiles characteristic of preeclampsia (PE) could be identified, as well as profiles specific of Intra-Uterine Growth Retardation (IUGR). Focusing on the chromosomal distribution of the fraction of genes that responded in at least one hybridization experiment, we could observe a highly significant chromosomal clustering of 54 genes into 8 chromosomal regions, four of which containing imprinted genes. Comparative mapping data indicate that these imprinted clusters are maintained in synteny in mice, and apparently in cattle and pigs, suggesting that the maintenance of such syntenies is requested for achieving a normal placental physiology in eutherian mammals. CONCLUSION: We could demonstrate that genes induced in PE were also genes highly expressed under hypoxic conditions (P = 5 x 10(-5)), which was not the case for isolated IUGR. Highly expressed placental genes may be in syntenies conserved interspecifically, suggesting that the maintenance of such clusters is requested for achieving a normal placental physiology in eutherian mammals

Non-random, individual-specific methylation profiles are present at the sixth CTCF binding site in the human H19/IGF2 imprinting control region

Expression of imprinted genes is classically associated with differential methylation of specific CpG-rich DNA regions (DMRs). The H19/IGF2 locus is considered a paradigm for epigenetic regulation. In mice, as in humans, the essential H19 DMR—target of the CTCF insulator—is located between the two genes. Here, we performed a pyrosequencing-based quantitative analysis of its CpG methylation in normal human tissues. The quantitative analysis of the methylation level in the H19 DMR revealed three unexpected discrete, individual-specific methylation states. This epigenetic polymorphism was confined to the sixth CTCF binding site while a unique median-methylated profile was found at the third CTCF binding site as well as in the H19 promoter. Monoallelic expression of H19 and IGF2 was maintained independently of the methylation status at the sixth CTCF binding site and the IGF2 DMR2 displayed a median-methylated profile in all individuals and tissues analyzed. Interestingly, the methylation profile was genetically transmitted. Transgenerational inheritance of the H19 methylation profile was compatible with a simple model involving one gene with three alleles. The existence of three individual-specific epigenotypes in the H19 DMR in a non-pathological situation means it is important to reconsider the diagnostic value and functional importance of the sixth CTCF binding site

Phenotypic spectrum of fetal Smith-Lemli-Opitz syndrome.

International audienceThe Smith-Lemli-Opitz syndrome (SLOS) is an autosomal recessive multiple congenital malformation syndrome caused by dehydrocholesterol reductase deficiency. The diagnosis is confirmed by high 7- and secondarily 8-dehydrocholesterol levels in plasma and tissues and/or by detection of biallelic mutations in the DHCR7 gene. The phenotypic spectrum of SLOS is broad, ranging from a mild phenotype combining subtle physical anomalies with behavioral and learning problems, to a perinatally lethal multiple malformations syndrome. The fetal phenotype of SLOS has been poorly described in the literature. We report a series of 10 fetuses with molecularly proven SLOS. Even in young fetuses, the facial dysmorphism appears characteristic. Genital abnormalities are rare in 46,XX subjects. Gonadal differentiation appears histologically normal and in agreement with the chromosomal sex, contrary to what has been previously stated. We observed some previously unreported anomalies: ulnar hypoplasia, vertebral segmentation anomalies, congenital pulmonary adenomatoid malformation, fused lungs, gastroschisis, holomyelia and hypothalamic hamartoma. This latter malformation proves that SLOS phenotypically overlaps with Pallister-Hall syndrome which remains clinically a major differential diagnosis of SLOS

Pronostic des grossesses après antécédent de mort fœtale in utero (A propos de 110 grossesses suivies à l hôpital Saint Antoine)

La mort fœtale in utero est un évènement très traumatisant et pourvoyeur de nombreuses questions pour la patiente et pour l obstétricien. En particulier l avenir obstétrical des ces patientes est assez mal connu. C est pourquoi nous avons voulu nous baser sur l expérience d une dizaine d années au sein d une même maternité pour étudier le pronostic des grossesses après antécédent de mort fœtale.Nous avons suivi 110 grossesses chez 64 patientes ayant un antécédent de mort fœtale in utero au 2ème ou 3ème trimestre. Nous avons proposé à toutes ces patientes:un bilan étiologique complet et standardisé de l antécédent de mort foetaleune prise en charge standardisée concernant le suivi et le traitement éventuelNous avons ainsi pu classer les antécédents de MFIU en 6 catégories : vasculaire avec thrombophilie (37%), vasculaire sans thrombophilie (25%), annexiel (15%), malformatif (4,5%), métabolique (1,5%), inexpliqué (17%).Le taux de récidive de MFIU a été de 6,5%. Seules 2 patientes sur 64 n ont eu aucune naissance vivante. Les patientes les plus à risque de récidive étaient celles du groupe ayant un antécédent vasculaire sans thrombophilie avec un taux de récidive de 18,5%.En l absence de récidive, le taux de complications obstétricales (RCIU et/ou accouchement prématuré) est de 22 ,5%. Le groupe le plus à risque de complication obstétricale était celui des patientes vasculaires avec thrombophilie , dont le taux de complications obstétricales était de 40%.Les grossesses après antécédent de MFIU nécessitent une prise en charge adaptée et standardisée. L expérience de notre maternité nous permet d apporter une information objective et montre qu une prise en charge standardisée permet d obtenir des taux faibles de récidives et limités d autres complications obstétricalesFetal death in utero is a very traumatic event and the supplier of many issues for the patient and the obstetrician. In particular the obstetrical future of these patients is poorly known. That's why we wanted to build on the experience of ten years within the same maternity to study the prognosis of pregnancy after a history of fetal death. We followed 110 pregnancies in 64 patients with a history of fetal death in utero in the 2nd or 3rd quarter. We proposed to these patients: - A comprehensive and standardized etiological history of fetal death - A standardized management for monitoring and possible treatment We were able to classify the history of IUFD in 6 categories: vascular with thrombophilia (37%), vascular without thrombophilia (25%), adnexal (15%), malformations (4.5%), metabolic (1.5%) , unexplained (17%). The recurrence rate of fetal death was 6.5%. Only 2 of 64 patients had no live birth. Patients at highest risk for recurrence were those with a history of the group "without vascular thrombophilia" with a recidivism rate of 18.5%. In the absence of recurrence, the rate of obstetric complications (IUGR and / or preterm birth) is 22, 5%. The group most at risk of obstetric complication was that the patients' vascular with thrombophilia, whose rate of obstetric complications was 40%. Pregnancy after a history of IUFD require appropriate care and standardized. The experience of our maternity allows us to provide objective information and shows that a standardized management achieves low rates of recurrence and limited other obstetric complicationsPARIS12-CRETEIL BU Médecine (940282101) / SudocSudocFranceF

Groupes sanguins rares et grossesse

Une femme enceinte peut avoir un groupe sanguin rare dont la fréquence est inférieure à 4/1000.Se posent alors deux problèmes médicaux majeurs : le risque d incompatibilité materno-fœtale et la difficulté transfusionnelle pour la mère en cas d hémorragie de la délivrance. La future mère peut présenter dans son sang des anticorps anti-érythrocytes naturels correspondant à son groupe sanguin rare, ou acquis suite à une allo-immunisation. Suivant le type d anticorps et la quantité d anticorps contenus dans le sang maternel, une anémie hémolytique fœtale, de gravité variable peut se développer en cas d incompatibilité du groupe foetal avec celui de la mère. Le CNRHP (Centre National de Référence en Hémobiologie Périnatale) peut être contacté afin d évaluer au mieux le risque d hémolyse fœtale du fait de la présence d un anticorps anti-érythocytaire maternel particulier. Une surveillance stricte de la grossesse, grâce aux bilans sanguins maternels et aux échographies fœtales, est alors nécessaire. Les signes d anémie fœtale sont activement recherchés avec notamment la mesure de la vitesse du pic systolique lors du doppler de l artère cérébrale moyenne du fœtus (PSV-ACM). En cas d apparition de signes de mauvaise tolérance fœtale (une PSV-ACM supérieure à 1,5MoM pour le terme), un traitement par transfusion intra-utérine peut être envisagé. A la naissance, la prise en charge du nouveau-né est active avec le dépistage précoce d un ictère, reflet de l anémie hémolytique. Un ictère majeur pouvant être responsable de séquelles psycho-motrices, le nouveau-né est traité rapidement par photothérapie et surveillance régulière de la diminution de sa bilirubinémie. En cas d inefficacité de ce traitement, une exanguino-transfusion peut être effectuée. L autre problème majeur causé par la présence d un groupe sanguin rare est la difficulté transfusionnelle. Le CNRGS (Centre National pour les Groupes Sanguins) est contacté précocément pour évaluer la rareté du groupe sanguin considéré et les réserves en sang disponibles. L accouchement étant une période à risque hémorragique, l un des objectifs durant la grossesse va être d obtenir en ante-partum une hémoglobine supérieure à 12g/dl chez la mère grâce aux perfusions de fer et d érythropoïetine (EPO). Un programme de conservation de sang autologue est aussi mis en place afin de faciliter une transfusion éventuelle. La recherche de donneurs compatibles est entreprise auprès des banques de sangs rares française et étrangères. Enfin, la prise en charge active de l accouchement a pour but l économie maximale en pertes sanguines maternelles afin d éviter le risque d impasse transfusionnelle, dramatique pour la mère.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

Facteurs prédictifs d'acidose néonatale sévère (Etude rétrospective sur 154 nouveau-nés à terme)

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Fièvre et grossesse (prise en charge en médecine générale)

PARIS6-Bibl. St Antoine CHU (751122104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF