Cornual heterotopic pregnancy: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cornual heterotopic pregnancy is a very rare condition; its incidence remains unknown. We report a case of cornual heterotopic pregnancy managed by laparoscopy and guided methotrexate injection into the cornual sac.</p> <p>Case presentation</p> <p>A cornual heterotopic pregnancy was diagnosed at 9 weeks of amenorrhoea in a 31-year-old healthy woman. Ultrasound examination showed a well-formed intrauterine gestation without detectable fetal heart pulsation, together with a gestational sac situated in the right cornual region. After uterine evacuation under ultrasound guidance, the diagnosis of cornual pregnancy was confirmed on laparoscopy followed by methotrexate injection into the cornual gestational sac.</p> <p>Conclusions</p> <p>Cornual heterotopic pregnancy is a very rare and potentially dangerous condition. Diagnosis of cornual pregnancy could be made on ultrasound examination in this patient. Laparoscopy was useful as an alternative in confirming the diagnosis and aided further treatment.</p

Maternal outcomes and risk factors for COVID-19 severity among pregnant women.

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease

Analyse simultanée de l'ECG (STAN®) et de l'oxymétrie de pouls dans l'évaluation du bien-être foetal au cours du travail

REIMS-BU Santé (514542104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Nausées et vomissements du premier trimestre de la grossesse (les petits maux de la grossesse vus par les patientes et leurs médecins)

Contexte : Les nausées et vomissements du premier trimestre de la grossesse (NVG) sont peu étudiés en France. L'objectif de l'étude était d'appréhender la fréquence réelle des NVG versus celle estimée par les médecins généralistes, et de connaître ce que les femmes mémorisaient de ces troubles, en termes d'intensité et de qualité de vie. Matériel et Méthodes : Une étude descriptive observationnelle prospective réalisée par auto-questionnaires, a été menée dans le Centre Hospitalier de Vendée du 3 décembre 2012 au 4 avril 2013, auprès de femmes venant d'accoucher. Ces dernières ont été notamment interrogées sur leur perception de l'intensité des NVG et de la qualité de vie induite, grâce aux scores de PUQE-modifié et NVP-QOL. D'un autre côté des médecins généralistes de Vendée ont été interrogés concernant la fréquence estimée des NVG dans leur patientèle et leurs prescriptions. Résultats : 420 femmes et 59 médecins ont répondu aux questionnaires. 61.7% des patientes avaient eu des NVG. Les scores d'intensité étaient modérés à légers . La qualité de vie était altérée. On retrouvait une peur de la récidive des NVG chez des patientes. Le médecin généraliste apparaissait comme le professionnel le plus souvent consulté par les femmes. Les traitements proposés différaient des recommandations. Conclusion : Les résultats suggéraient que les échelles d'intensité et de qualité de vie pouvaient être utilisables à distance des NVG. Le score de PUQE-modifié pourrait permettre une aide à la décision de prescription en médecine ambulatoire.Context: Nausea and vomiting in the first trimester of pregnancy (NVP) have been little studied in France. The aim of this study was to assess the actual frequency of NVP compared to that estimated by GPs and to know what women retained from these disorders in terms of intensity and quality of life. Materials and methods: A prospective observational descriptive study using self-assessment questionnaires from women having just given birth was carried out in Vendée Hospital from 3 December 2012 to 4 April 2013. They were asked in particular about their perception of the intensity of NVP and the quality of life induced, thanks to modified-PUQE and NVP-QOL scores. On the other hand GPs from Vendée were asked about the estimated frequency of NVP both among their patients and in their prescriptions. Results: 420 women and 59 GPs answered the questionnaires. 61.7% of the patients had experienced NVP. Their intensity scores ranged from "moderate" to "mild". The quality of life was altered. Fear of repeating NVP was found in of patients. The GP appeared to be the professional who was the most-frequently consulted by the women. Conclusion: The results implied that intensity and quality of life scales could be used once the symptoms are over. The modified-PUQE score could provide help for prescription decision for GPs.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

Systematic Kleihauer–Betke Test after External Cephalic Version for Breech Presentation: Is It Useful?

The incidence of fetomaternal hemorrhage (FMH) after external cephalic version (ECV) has been poorly reported. In this study, we evaluated the frequency of FMH, diagnosed by positive Kleihauer&ndash;Betke test (KBT), after ECV attempt and then evaluate the relevance of its routine use after procedure. A total of 282 women with a term breech presentation and who had ECV attempt were recruited from January 2014 and December 2018. After ECV attempt, women were systematically screened for FMH using KBT. Data on ECV attempt, KBT results, perinatal and neonatal outcomes were collected and compared between women with positive (cases) and negative KBT (controls) after ECV. The success rate of ECV was 22.0% (62/282). Eight women (2.9%) experienced transient fetal heart rate (FHR) abnormalities after ECV. In five (1.8%) women, KBT was positive after ECV. Obstetrical management was modified for two of these five women due to continuous positivity of KBT at day 1 and day 7 controls after ECV attempt. A cesarean section was planned 7 days earlier due to persistent high FMH on day 7 (6 mL fetal blood) in one woman and the labor was induced for persistent high FMH on day 7 (20 mL fetal blood) for another woman. No newborns have signs of fetal anemia at birth and there was no significant difference in neonatal status between two groups. FMH after ECV attempt are rare, and no negative fetal or neonatal outcomes were observed when KBT was positive, even strongly (&gt;5 mL fetal blood). It appears that systematic KBT after attempted ECV is probably not useful

Neonatal Morbidity after Cervical Ripening with a Singleton Fetus in a Breech Presentation at Term

Vaginal delivery in women with a breech presentation is part of common practice in France despite much debate, and the induction of labor (IOL) with a fetus in a breech presentation at term remains uncommon. Little is known about the effectiveness of cervical ripening and its neonatal and maternal safety in these women. We present a retrospective study of 362 women who gave birth to a live singleton fetus in a breech presentation at term. The objective was to compare severe maternal and neonatal morbidity according to the planned mode of labor (spontaneous labor or the induction of labor (IOL) with a favorable cervix, cervical ripening, or elective cesarean delivery) and, specifically, to compare cervical ripening to the other modes of labor. The rate of severe neonatal morbidity was 3.0% and was significantly higher after the IOL compared to elective cesarean delivery (p = 0.02), and the severe maternal morbidity rates were similar. Multivariable logistic regression analysis found no significant association between cervical ripening and either composite severe neonatal (adjusted odds ratio [aOR] 2.80, 95% confidence interval [CI] 0.10–43.6) or maternal morbidity (aOR 1.29, 95% CI 0.05–11.5). Our results support a policy of offering cervical ripening to the appropriately selected candidates with a singleton fetus in a breech presentation at term without increasing the incidence of severe maternal and neonatal morbidity

Biomarkers and algorithms for diagnosis of ovarian cancer: CA125, HE4, RMI and ROMA, a review

Abstract Ovarian cancer is the 5th leading cause of death for women with cancer worldwide. In more than 70% of cases, it is only diagnosed at an advanced stage. Our study aims to give an update on the biological markers for diagnosing ovarian cancer, specifically HE4, CA 125, RMI and ROMA algorithms. Serum CA125 assay has low sensitivity in the early stages and can be increased in certain conditions such as menstruation or endometriosis. The level of HE4 is overexpressed in ovarian tumors. Its specificity is 94% and its level is not affected by endometriosis cysts. The combined measures of CA125 and HE4 have proved to be highly efficient with an area under the curve (AUC) of up to 0.96. Furthermore, this combined measure of CA125 can correct the variations in HE4 which are due to smoking or contraception combining estrogen plus progestin. While the specificity of RMI sometimes reaches 92%, the rather low AUC of 0.86 does not make it the best diagnostic tool. The specificity of ROMA is lower than HE4 (84% compared to 94%). To date, the most efficient biological diagnostic tool to diagnose ovarian cancer is the combination of CA125 and HE4

A Prospective Study of Association of Micronutrients Deficiencies during Pregnancy and Neonatal Outcome among Women after Bariatric Surgery

Little is known about the association of micronutrients deficiencies during pregnancy and neonatal outcome among women after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). We present a prospective study of 87 consecutive women with a history of RYGB (n = 37) or SG (n = 50) who underwent complete and regular clinical and biological nutritional assessments during pregnancy. Data on maternal characteristics, biological nutritional parameters, antenatal management, and perinatal outcome were collected. The objective was to evaluate serum levels of micronutrients at the second trimester, and to assess the association between micronutrients deficiencies and neonatal outcome. After RYGB, maternal age (34.3 ± 4.9 vs. 31.1 ± 4.6 years; p = 0.003) and pregnancy timing after surgery (64.5 ± 47.0 vs. 38.1 ± 28.1 months; p = 0.002) were significantly higher, and pre-pregnancy BMI was significantly lower (29.8 ± 5.6 vs. 32.9 ± 7.1 kg/m2; p = 0.03). Maternal and neonatal outcomes were similar. Additional supplementations after blood tests were similar in groups. Zinc, selenium, vitamins A1, B1, B6, C, and E levels were not different depending on the type of surgery. Zinc deficiency (7/87) was significantly more frequent after RYGP (18.9% vs. 0%; p = 0.02) and selenium deficiency (15/87) was similar in groups (21.6% after RYGB and 14.0% after SG; p = 0.36). The mean birth weight was significantly lower in selenium deficiency cases (3137 ± 550 vs. 3535 ± 737 g; p = 0.04). Selenium deficiency was negatively correlated with birth weight (r = −0.23; p = 0.03) and with birth weight z-score (r = −0.26; p = 0.01), but not correlated after adjustment for the procedure. The levels of micronutrients surveillance along pregnancy in women with a history of bariatric surgery is necessary to decrease the risk of inadequate fetal growth in the patients

Pelvic Floor Disorders 6 Months after Attempted Operative Vaginal Delivery According to the Fetal Head Station: A Prospective Cohort Study.

To evaluate the effect of the fetal head station at attempted operative vaginal delivery (aOVD), and specifically midpelvic or low aOVD, on urinary incontinence (UI), anal incontinence (AI), and perineal pain at 6 months.Prospective cohort study.1941 women with singleton term fetuses in vertex presentation with midpelvic or low aOVD between 2008 and 2013 in a tertiary care university hospital.Symptoms of urinary incontinence (UI) using the Bristol Female Lower Urinary Tract Symptoms questionnaire, and symptoms of anal incontinence (AI) severity using Fecal Incontinence Severity Index (FISI) were assessed 6 months after aOVD. We measured the association between midpelvic or low aOVD and symptoms of UI, AI, and perineal pain at 6 months using multiple regression and adjusting for demographics, and risk factors of UI and AI, with adjusted odds ratios (aORs) and 95% confidence intervals (95% CI).The study included 907 women (46.7%) who responded to the questionnaire; 18.4% (167/907) had midpelvic aOVD, and 81.6% (740/907) low; and none of women with symptoms of UI (26.6%, and 22.4%, respectively; p = 0.31), AI (15.9%, and 21.8%; p = 0.09), the FISI score, and perineal pain (17.2%, and 12.7%; p = 0.14) differed significantly between groups. The same was true for stress, urge, and mixed-type UI, severe UI and difficulty voiding. Compared with low pelvic aOVD, the aORs for symptoms of UI in midpelvic aOVD were 0.70 (0.46-1.05) and AI 1.42 (0.85-2.39). Third- and fourth-degree tears were a major risk factor of symptoms of UI (aOR 3.08, 95% CI 1.35-7.00) and AI (aOR 3.47, 95% CI 1.43-8.39).Neither symptoms of urinary nor anal incontinence differed at 6 months among women who had midpelvic and low pelvic aOVD. These findings are reassuring and need further studies at long-term to confirm these short-term data