Long-term outcome of children born after a first-trimester measurement of nuchal translucency at the 99th percentile or greater with normal karyotype: a prospective study.

OBJECTIVE: This study was undertaken to assess the long-term outcome of children born after a first-trimester measurement of nuchal translucency (NT) at the 99th percentile or greater during routine first-trimester screening in an unselected population. STUDY DESIGN: One hundred sixty-two infants were born alive. Clinical examination as well as a questionnaire to the parents (Ages and Stages Questionnaires [ASQ]) at the age of 2 years were obtained in 160 children. Our study population was compared with an external control group made of the 370 term control children. RESULTS: The prevalence of abnormal clinical pediatric examination and ASQ results at 2 years were not associated with NT thickness. Comparison with an external control group did not demonstrate an increased incidence of developmental delay. CONCLUSION: Parents should be informed that when the fetus is shown to be normal by ultrasound at 22-24 weeks of gestation the risk of adverse neonatal outcome or developmental delay in early childhood is not increased

Analyse des modes de défaillance, de leurs effets et de leur criticité dans le circuit du médicament : revue de littérature

RESUMÉContexte : L’analyse des modes de défaillance, de leurs effets et de leur criticité (AMDEC) est une méthode d’analyse systématique et proactive des risques permettant de déterminer les défaillances majeures de processus complexes. Objectif : Recenser tous les articles concernant l’utilisation de l’analyse des modes de défaillance et de leurs effets (AMDE), de l’AMDEC et de l’AMDEC en santé (AMDECS) dans le cadre du circuit du médicament.Sources des données, sélection des études et extraction des données : La base de données MEDLINE a été interrogée pour la période de janvier 1990 à janvier 2017. La stratégie de recherche a inclus les études appliquant intégralement ou partiellement la méthode AMDEC et traitant d’un ou de plusieurs volets du circuit du médicament. Une recherche manuelle complémentaire a permis d’inclure les références pertinentes des articles consultés. Synthèse des données : Les chercheurs ont trouvé 171 articles. Ils en ont retenu 39, soit 32 décrivant l’utilisation de l’approche AMDE ou AMDEC et sept décrivant l’utilisation de l’approche AMDECS. Ils ont répertorié de quatre à 378 modes de défaillance, selon les études publiées. Dix des 39 articles font état d’une analyse avant et après la mise en vigueur de mesures correctives. Dans quatre de ces 10 articles, l’analyse a été réalisée de façon théorique, soit avant la mise en vigueur réelle des mesures. À partir des articles retenus, un tableau-synthèse a été élaboré avec les éléments suivants : année de publication, premier auteur, pays, objectif principal, objectifs secondaires, description de la méthode, description des résultats, commentaires. Le tableau-synthèse a permis de commenter l’état d’utilisation des analyses de type AMDEC dans le cadre du circuit du médicament.Conclusions : Cette revue de la littérature a retenu 39 articles publiés ayant utilisé l’approche AMDE, AMDEC ou AMDECS dans le cadre du circuit du médicament. La plupart des études ont utilisé l’approche AMDE ou AMDEC, tandis que l’AMDECS n’était que rarement employée. Seule une minorité des études ont évalué les effets de mesures correctives mises en œuvre. Cette approche permet la cartographie d’un processus de soins, la détermination des modes de défaillance et la priorisation des actions correctives. Il faudrait encourager son usage pour l’évaluation du circuit du médicament.ABSTRACTBackground: Failure mode, effects, and criticality analysis (FMECA) is a systematic and proactive risk analysis method to determine major failures in complex processes. Objective: To identify all articles involving the use of failure mode and effects analysis (FMEA), FMECA, or FMECA in health care within the medication use system.Data Sources, Study Selection, and Data Extraction: The MEDLINE database was searched, for the period January 1990 to January 2017. The search included studies using the FMECA method, in part or in full, and dealing with one or several components of the medication use system. The reference lists of articles identified in the initial search were checked manually for additional pertinent references. Data Synthesis: The researchers identified 171 articles, and retained 39 for analysis: 32 describing use of the FMEA or FMECA approach and 7 describing use of the FMECA in health care approach. They identified between 4 to 378 failure modes, according to the published studies. Among the 39 articles, 10 reported a pre- and post-implementation analysis of corrective measures. In 4 of those 10 articles, the analysis was conducted on a theoretical basis, that is, before the corrective measures were actually implemented. Using the articles retained for analysis, a summary table was developed with the following elements: publication year, main author, country, primary objective, secondary objectives, descriptions of both method and results, and comments. The summary table gave the opportunity to comment on the use of the FMECA-type analysis within the medication use system. Conclusions: This literature review included 39 published articles using an FMEA, FMECA, or FMECA in health care approach within the medication use system. Most studies used either the FMEA or the FMECA approach, whereas the FMECA in health care approach was used only rarely. Only a minority of studies assessed the effects of corrective measures that were implemented. This overall approach allows for mapping of a care process, determination of failure modes, and prioriti-zation of corrective measures. Its use for the assessment of the medication use system should be promoted

Women’s Attitudes Toward Invasive and Noninvasive Testing When Facing a High Risk of Fetal Down Syndrome

International audienceImportance: Noninvasive prenatal testing (NIPT) using cell-free DNA in maternal blood is increasingly common compared with invasive testing (IT) in routine antenatal detection of Down syndrome (DS).Objective: To assess attitudes and decision making in pregnant women facing a risk of fetal DS greater than 1 in 250 as established by combined first trimester screening at 11 to 14 weeks of gestation.Design, Setting, and Participants: Survey study in which data were collected from pregnant women at high risk of fetal DS participating in a randomized clinical trial. Data were collected from April 8, 2014, to April 7, 2016, in 57 prenatal diagnosis centers in France. Data were analyzed in 2018.Interventions Data on attitudes were collected prior to offering randomization between NIPT and IT, whereas data on decision making and test results were collected as part of the clinical trial.Main Outcome and Measures: The primary outcome related to attitudes. A hierarchical cluster analysis was conducted to identify clusters with contrasting attitudes. Logistic regression analyses were used to identify factors associated with attitudes.Results: All 2436 consecutive women to whom the study was proposed (mean [SD] age, 36.3 [5.0] years) answered the questionnaire: 515 (21.1%) expressed preference toward IT with complete karyotyping, whereas 1843 (75.7%) favored NIPT with almost certain but limited information. Hierarchical cluster analysis yielded 4 different clusters that mainly differed in attitudes toward risk taking and extent of information seeking. Factors likely associated with attitudes driven by risk aversion were mostly age and religious beliefs (adjusted odds ratio [aOR], 1.03; 95% CI, 1.00-1.05; P = .03 and aOR, 1.62; 95% CI, 1.29-2.04; P < .001, respectively), whereas higher nuchal translucency measurements by ultrasonography were associated with attitudes driven by ambiguity aversion (aOR, 1.67; 95% CI, 1.27-2.20; P < .001). For attitudes involving both risk and ambiguity aversion at different extents, lower education was associated with highly valuing all possibilities of getting information on pregnancy, whereas higher education was associated with highly valuing information on fetal DS as a primary concern (aOR, 0.54; 95% CI, 0.44-0.67; P < .001 and aOR, 1.44; 95% CI, 1.20-1.74; P < .001, respectively). In all, decision making was in line with attitudes.Conclusions and Relevance: Aversion to risk of fetal loss related to IT and aversion to ambiguity generated by incomplete information from NIPT played a major role in shaping attitudes and decision making. Informed decision making should require pregnant women at high risk of DS to receive extensive information on targeted abnormalities by both tests

Impact of Monochorionicity and Twin to Twin Transfusion Syndrome on Prenatal Attachment, Post Traumatic Stress Disorder, Anxiety and Depressive Symptoms.

Monochronioric (MC) twin pregnancies are considered as high-risk pregnancies with potential complications requiring in-utero interventions. We aimed to assess prenatal attachment, anxiety, post-traumatic stress disorder (PTSD) and depressive symptoms in MC pregnancies complicated with Twin-To-Twin-transfusion syndrome (TTTS) in comparison to uncomplicated monochorionic (UMC) and dichorionic pregnancies (DC). Auto-questionnaires were filled out at diagnosis of TTTS and at successive milestones. Prenatal attachment, PTSD, anxiety and perinatal depression were evaluated respectively by the Prenatal Attachment Inventory (PAI) completed for each twin, the Post-traumatic Checklist Scale (PCLS), the State-Trait Anxiety Inventory (STAI) and the Edinburgh Perinatal Depression Scale (EPDS). There was no significant difference in the PAI scores between the two twins. In the DC and UMC groups, PAI scores increased throughout pregnancy, whilst it didn't for TTTS group. TTTS and DC had a similar prenatal attachment while MC mothers expressed a significantly higher attachment to their fetuses and expressed it earlier. At the announcement of TTTS, 72% of the patients present a score over the threshold at the EPDS Scale, with a higher score for TTTS than for DC (p = 0.005), and UMC (p = 0.007) at the same GA. 30% of mothers in TTTS group have PTSD during pregnancy. 50% of TTTS- patients present an anxiety score over the threshold (STAI-Scale), with a score significantly higher in TTTS than in UMC (p<0.001) or DC (p<0.001). The proportion of subject with a STAI-State over the threshold is also significantly higher in TTTS than in DC at 20 GW (p = 0.01) and at 26 GW (p<0.05). The STAI-state scores in UMC and DC increase progressively during pregnancy while they decrease significantly in TTTS. TTTS announcement constitutes a traumatic event during a pregnancy with an important risk of PTSD, high level of anxiety and an alteration of the prenatal attachment. These results should guide the psychological support provided to these patients

MRI based morphological examination of the placenta

International audienceUltrasound is widely used as the initial diagnostic imaging modality during pregnancy with both high spatial and temporal resolution. Although MRI in pregnancy has long focused on the fetus, its use in placental imaging has greatly increased over recent years. In addition to the possibilities of evaluating function, MRI with a wide field of view and high contrast resolution allows characterization of placental anatomy, particularly in situations that are difficult to specify with ultrasound, especially for suspected placenta accreta. MRI also appears to be a particularly useful examination for the anatomical evaluation of the placenta independent of maternal body habitus or fetal position. Indeed, surprisingly little attention is paid to the placenta in MRI when the indication for the examination is fetal. Thus, some aspects of the placenta seem to us to be important to be recognized by the radiologist and to be described on the MRI report. In this review, we will describe MRI sequences used for, and common features seen in, imaging of i) the normal placenta, ii) abnormal aspects of the placenta that should be identified on MRI performed for fetal reason, and iii) placental anomalies for which placental MRI may be indicated

Effets indésirables et effets hémodynamiques de la nifédipine utilisée comme tocolytique

International audienceObjectives: To describe maternal and fetal adverse effects, in particular cardiorespiratory, of nifedipine as tocolytic, as well as effects on hemodynamic parameters.Materials and methods: A retrospective evaluative study describing the use of nifedipine as tocolytic at CHU Sainte-Justine in Montreal. Demographic data as well as maternal blood pressure and adverse effects, and maternal and fetal heart rate were collected from medical records of women treated with nifedipine following our tocolysis protocol between January 1st 2004 and March 1st 2007.Results: The medical records of 213 pregnant women were included in the study. Cardiorespiratory adverse effects were noted in 69 (32.4%); of these, 19 (8.9%) had serious cardiorespiratory adverse events, including 6 acute pulmonary edema or overload. Mean maternal systolic and diastolic blood pressures were significantly decreased and mean maternal and fetal heart rates were significantly increased after the bolus dose. Other adverse effects were reported for 100 (46.9%) women.Conclusion: Nifedipine may cause cardiorespiratory adverse effects warranting a close monitoring.But. — Décrire les effets indésirables notamment cardiorespiratoires et les effets hémodyna-miques de la tocolyse par nifédipine sur la mère et son fœtus.Patientes et méthodes. — Étude rétrospective évaluative descriptive analysant les dossiers desfemmes traitées par nifédipine selon le protocole de tocolyse du CHU Sainte-Justine (Montréal,Canada) entre le 1er janvier 2004 et le 1er mars 2007. Les fréquences cardiaques maternelle etfœtale, la tension artérielle maternelle ainsi que les effets indésirables maternels répertoriésont été colligés.Résultats. — Des effets indésirables ont été retrouvés chez 61 % des 213 femmes traitées avecnifédipine et des effets indésirables cardiorespiratoires chez 32,4 %. Des effets indésirables car-diorespiratoires graves ont été notés chez 8,9 % des femmes, incluant 6 cas d’œdème aigu dupoumon ou de surcharge pulmonaire. La moyenne des tensions artérielles maternelles systoliqueet diastolique était significativement diminuée et les moyennes des fréquences cardiaques maternelle et fœtale étaient significativement augmentées après la dose de charge de nifédi-pine. Des effets indésirables autres que cardiorespiratoires ont été observés chez 46,9 %.Conclusion. — La nifédipine est un tocolytique dont l’utilisation peut être associée à des effetsindésirables cardiorespiratoires justifiant une surveillance étroit

Dynamic contrast enhanced magnetic resonance imaging: A review of its application in the assessment of placental function

International audienceIt is important to develop a better understanding of placental insufficiency given its role in common maternofetal complications such as preeclampsia and fetal growth restriction. Functional magnetic resonance imaging offers unprecedented techniques for exploring the placenta under both normal and pathological physiological conditions. Dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) is an established and very robust method to investigate the microcirculatory parameters of an organ and more specifically its perfusion. It is currently a gold standard in the physiological and circulatory evaluation of an organ. Its application to the human placenta could enable to access many microcirculatory parameters relevant to the placental function such as organ blood flow, fractional blood volume, and permeability surface area, by the acquisition of serial images, before, during, and after administration of an intravenous contrast agent. Widely used in animal models with gadolinium-based contrast agents, its application to the human placenta could be possible if the safety of contrast agents in pregnancy is established or they are confirmed to not cross the placenta

PAI inter-groups.

<p>PAI inter-groups.</p

PAI during pregnancy in the Total group.

<p>PAI during pregnancy in the Total group.</p