Management of placenta accreta.

International audienceCesarean hysterectomy is considered the reference standard treatment for placenta accreta. In young women who want the option of future pregnancy and agree to close follow-up monitoring, conservative treatment is a valid option. Several key points of both cesarean hysterectomy and conservative treatment remain debatable, such as timing of delivery, attempted removal of the placenta, use of temporal internal iliac occlusion balloon catheters, ureteral stents, prophylactic embolization, and methotrexate. In cases of placenta percreta with bladder involvement, conservative treatment may be the optimal management. Regardless of the chosen option, the woman and her partner should be warned of the high risk of maternal complications related to an abnormally invasive placenta

: groupe d'étude PREMODA

International audienceOBJECTIVES: In agreement with national guidelines published in 2007, limiting duration of expulsive efforts to 30 minutes is a common obstetrical practice in France. In many other countries, there is no fixed limit for pushing duration. The objective of our work is to analyze mode of delivery and neonatal issues according to duration of expulsive efforts. PATIENTS AND METHODS: It is a secondary analysis of an observational prospective study, among low-risk primiparous women, in 138 French maternity units. According to duration of expulsive efforts, we determined proportions of spontaneous and instrumental vaginal deliveries. Then, we analyzed the risk of neonatal asphyxia (defined by p

Multilocus-based phylogeny and species recognition within the cosmopolitan Peltigera neopolydactyla-dolichorhiza complex

The Peltigera neopolydactyla/dolichorhiza complex is broadly distributed, growing in boreal and temperate regions from northern Norway to southern Chile, as well as in tropical mountains. Observed morphotype and chemotype variation within this complex suggested the presence of multiple undescribed species. We inferred the phylogeny of Peltigera section Polydactylon with a special focus on the Peltigera neopolydactyla/dolichorhiza complex to determine the full breadth of this species complex, and to assess if taxa from different parts of the worlds but with similar morphological features share a most recent common ancestor. About 525 ITS sequences representing 104 distinct haplotypes were generated for representatives of Peltigera section Polydactylon. We selected a representative of each broadly defined phylotype for which three protein-coding loci: RPB1.1, b-tubulin and EFT2.1 were sequenced. Each of the three protein coding loci provided equivalent or more resolution and support than the ITS locus. The greatest proportion of significantly supported nodes across the tree resulted from β-tubulin alone. Many specimens identified as P. neopolydactyla and P. dolichorhiza are placed outside of this species complex. As currently defined both species represent polyphyletic assemblages of taxa including several potentially undescribed species. Our phylogenies suggest the presence of putatively new species within several complexes across the section.REVSYS: Phylogenetic revision of the lichen-genus Peltigera (Ascomycota): Disentangling cryptic speciation, phenotypic plasticity, and hybridization

Population-based evaluation of a suggested anatomic and clinical classification of congenital heart defects based on the International Paediatric and Congenital Cardiac Code

<p>Abstract</p> <p>Background</p> <p>Classification of the overall spectrum of congenital heart defects (CHD) has always been challenging, in part because of the diversity of the cardiac phenotypes, but also because of the oft-complex associations. The purpose of our study was to establish a comprehensive and easy-to-use classification of CHD for clinical and epidemiological studies based on the long list of the International Paediatric and Congenital Cardiac Code (IPCCC).</p> <p>Methods</p> <p>We coded each individual malformation using six-digit codes from the long list of IPCCC. We then regrouped all lesions into 10 categories and 23 subcategories according to a multi-dimensional approach encompassing anatomic, diagnostic and therapeutic criteria. This anatomic and clinical classification of congenital heart disease (ACC-CHD) was then applied to data acquired from a population-based cohort of patients with CHD in France, made up of 2867 cases (82% live births, 1.8% stillbirths and 16.2% pregnancy terminations).</p> <p>Results</p> <p>The majority of cases (79.5%) could be identified with a single IPCCC code. The category "Heterotaxy, including isomerism and mirror-imagery" was the only one that typically required more than one code for identification of cases. The two largest categories were "ventricular septal defects" (52%) and "anomalies of the outflow tracts and arterial valves" (20% of cases).</p> <p>Conclusion</p> <p>Our proposed classification is not new, but rather a regrouping of the known spectrum of CHD into a manageable number of categories based on anatomic and clinical criteria. The classification is designed to use the code numbers of the long list of IPCCC but can accommodate ICD-10 codes. Its exhaustiveness, simplicity, and anatomic basis make it useful for clinical and epidemiologic studies, including those aimed at assessment of risk factors and outcomes.</p

Emerging therapeutic options for breast cancer chemotherapy during pregnancy

Rak piersi jest najczęstszym guzem litym obserwowanym u kobiet w ciąży. Antracyklina jest jednym z leków, które można stosować w chemioterapii ciężarnych w drugim i trzecim trymestrze ciąży. Istnieje niestety mało danych dotyczących możliwości stosowania w terapii w tym okresie ciąży nowych i bardzo skutecznych leków, takich jak taksany, winorelbina czy czynniki anty-HER-2. W celu oceny profilu bezpieczeństwa stosowania tych leków u ciężarnych pacjentek przeprowadzono wszechstronny przegląd dokumentacji dostępnej w piśmiennictwie anglojęzycznym na temat użycia taksanów, winorelbiny, trastuzumabu oraz lapatinibu podczas ciąży. Opisano 24 przypadki ciąż, w których nie zaobserwowano efektów toksycznych 3&#8211;4 stopnia u matki ani malformacji u płodu. Mimo iż tylko w jednej z tych prac oceniano farmakokinetykę paklitakselu (Taxol) podczas ciąży, liczne przeprowadzone badania przedkliniczne wskazują, że łożyskowa P-glikoproteina może zapobiegać przezłożyskowemu transferowi taksanów i winorelbiny. Stosowanie trastuzumabu w 3 z 6 przypadków wiązało się z występowaniem bezwodzia. W czasie drugiego i trzeciego trymestru ciąży istnieje możliwość stosowania nowych leków charakteryzujących się korzystnym profilem toksyczności, takich jak taksany i winorelbina, natomiast czynniki anty- HER-2 mogą zaburzać prawidłowy rozwój nerek u płodu i nie powinno się ich stosować u kobiet w ciąży.Breast cancer is the commonest solid tumor observed during pregnancy. Anthracycline-based chemotherapy is feasible during the 2nd and 3rd trimesters of pregnancy, but few data are available on recent and highly active drugs taxanes, vinorelbine and anti-HER-2 agents in this setting. We carried out a comprehensive review of reports documenting the use of taxanes, vinorelbine, trastuzumab and lapatinib during pregnancy in the English literature, in order to evaluate their safety profile in pregnant patients. Twenty-four pregnancies are described, in which no grade 3&#8211;4 maternal toxicity nor malformation in the offspring was reported. Whereas only one report studied the pharmacokinetics of paclitaxel (Taxol) during pregnancy, several preclinical reports indicate that the placental P-glycoprotein could prevent the transplacental transfer of taxanes and vinorelbine. The use of trastuzumab was associated with the occurrence of anhydramnios in three of six cases. The administration of recent drugs taxanes and vinorelbine seems feasible during the 2nd and 3rd trimesters of pregnancy, with a favorable toxicity profile. In contrast, anti-HER-2 agents may obscure the normal development of the fetal kidney, and should be avoided during pregnancy

Maternal periodontitis and the causes of preterm birth: the case-control Epipap study.

International audienceAIM: To analyse the association between maternal periodontitis and preterm birth ( or =37 weeks) at six French maternity units were included. Periodontal examinations after delivery identified localized and generalized periodontitis. Cases were classified according to four causes of preterm birth. Polytomous logistic regression analysis was used to control for confounders (maternal age, parity, nationality, educational level, marital status, employment during pregnancy, body mass index before pregnancy, smoking status) and the examiner. RESULTS: Localized periodontitis was identified in 129 (11.6%) cases and in 118 (10.8%) control women and generalized periodontitis in 148 (13.4%) and 118 (10.8%), respectively. A significant association was observed between generalized periodontitis and induced preterm birth for pre-eclampsia [adjusted odds ratio 2.46 [95% confidence intervals (95% CI)1.58-3.83]. Periodontitis was not associated with spontaneous preterm birth or preterm premature rupture of membranes or with the other causes. CONCLUSION: Maternal periodontitis is associated with an increased risk of induced preterm birth due to pre-eclampsia

French Experience of 2009 A/H1N1v Influenza in Pregnant Women

BACKGROUND: The first reports on the pandemic influenza 2009 A/H1N1v from the USA, Mexico, and Australia indicated that this disease was associated with a high mortality in pregnant women. The aim of this study was to describe and compare the characteristics of severe critically ill and non-severe pregnant women with 2009 A/H1N1v-related illness in France. METHODOLOGY/PRINCIPAL FINDINGS: A national registry was created to screen pregnant women with laboratory-confirmed 2009 A/H1N1v influenza. Three hundred and fifteen patients from 46 French hospitals were included: 40 patients were admitted to intensive care units (severe outcomes), 111 were hospitalized in obstetric or medical wards (moderate outcomes), and 164 were outpatients (mild outcomes). The 2009 A/H1N1v influenza illness occurred during all pregnancy trimesters, but most women (54%), notably the severe patients (70%), were in the third trimester. Among the severe patients, twenty (50%) underwent mechanical ventilation, and eleven (28%) were treated with extracorporeal membrane oxygenation. Three women died from A/H1N1v influenza. We found a strong association between the development of a severe outcome and both co-existing illnesses (adjusted odds ratio [OR], 5.1; 95% confidence interval [CI], 2.2-11.8) and a delay in oseltamivir treatment after the onset of symptoms (>3 or 5 days) (adjusted OR, 4.8; 95% CI, 1.9-12.1 and 61.2, 95% CI; 14.4-261.3, respectively). Among the 140 deliveries after 22 weeks of gestation known to date, 19 neonates (14%) were admitted to a neonatal intensive care unit, mainly for preterm delivery, and two neonates died. None of these neonates developed 2009 A/H1N1v infection. CONCLUSIONS: This series confirms the high incidence of complications in pregnant women infected with pandemic A/H1N1v observed in other countries but depicts a lower overall maternal and neonatal mortality and morbidity than indicated in the USA or Australia. Moreover, our data demonstrate the benefit of early oseltamivir treatment in this specific population