Perinatal grief following neonatal comfort care for lethal fetal condition

BACKGROUND: The objective of the study was to assess perinatal grief experienced after continuing pregnancy and comfort care in women diagnosed with lethal fetal condition compared with termination of pregnancy for fetal anomaly (TOPFA). METHODS: This was a retrospective observational study which included women who chose to continue their pregnancy after the diagnosis of lethal fetal condition with comfort care support at birth at the Prenatal Diagnosis Center of Rennes Hospital from January 2007 to January 2017. Women were matched with controls who underwent TOPFA for the same type of fetal anomaly, gestational age at diagnosis and year. Women were evaluated by a questionnaire including the Perinatal Grief Scale. RESULTS: There were 28 patients in the continuing pregnancy group matched with 56 patients in the TOPFA group. Interval between fetal loss and completion of questionnaire was 6±3 years. Perinatal grief score was similar at 61±22 vs 58±18 (p = 0.729) in the continuing pregnancy and TOPFA groups, respectively. Women in the TOPFA group expressed more guilt. The cesarean-section rate in the continuing pregnancy group was 25% . CONCLUSION: Perinatal grief experienced by women opting for continuing pregnancy and comfort care after diagnosis of a potentially lethal fetal anomaly is not more severe than for those choosing TOPFA

Comparaison du pronostic obstétrical des tentatives d’accouchement par le siège : travail spontané versus déclenchement.

National audienceObjectives Delivery mode in breech presentation (BP) is often controversial. Spontaneous labor, when vaginal birth seems safe, allows to better estimate uterus contractility, fetus’ accommodation to maternal pelvis and optimize monitoring with a partograph. Induced labor in BP was usually contra-indicated. Lack of strong scientific evidence on this matter has permitted a progressive and careful evolution in obstetrical management, with the introduction of induced labor in BP. The aim of our study is to compare vaginal birth rates when labor is induced versus when spontaneous in BP. Maternal and fetal morbidity and mortality parameters were also evaluated. Methods In this retrospective study were included 206 patients carrying fetuses in BP, between June 2012 and June 2017. 182 of them had spontaneous labor and 24 experienced induced labor. Inclusion criteria were singleton pregnancy, BP after 34 weeks of gestation and vaginal delivery authorized by a senior obstetrician. Multiple pregnancy, birth before 34 weeks of gestation, uterine scar, planned caesarian section for BP, intra-uterine fetal death and medical termination of pregnancy were excluded. Induction of labor was performed for medical reason on a favorable cervix. Results There was no significant difference in cesarean section rates between the two “induced” and “spontaneous” labor groups in BP (OR = 1.69 [CI95%: 0.71–4.04]). We observed no difference between the two groups in neither perineum trauma nor post-partum hemorrhage. No difference was found between the two groups in rates of Apgar score < 7 5 minutes after birth, neonatal transfer, fetal trauma and pH at birth. Conclusion Despite our small population, it seems acceptable to propose induced labor for medical reason if cervix is favorable in BP if a protocol is available stating acceptability criteria for vaginal birth. It can avoid unnecessary caesarian section and allow better obstetrical outcome. It would be interesting to study fetal and maternal morbidity and mortality criteria in induced labor versus planned cesarean section when patients could be eligible for induced labor in BP.Objectifs La voie d’accouchement des fœtus en présentation podalique est souvent débattue. L’accouchement par voie basse, lorsqu’il est accepté, concerne le plus souvent un travail spontané pour mieux apprécier la qualité de la contractilité, de l’accommodation fœtopelvienne et du partogramme. Le déclenchement des fœtus en présentation du siège était classiquement contre-indiqué ou jugé avec méfiance par les experts. L’absence de niveau de preuve concernant une contre-indication permet une prudente et progressive évolution des pratiques obstétricales, avec l’arrivée des déclenchements du siège. L’objectif de cette étude est d’analyser le taux de succès d’accouchement par voie basse lors des déclenchements versus lors des mises en travail spontané dans les déclenchements du siège. Les critères de morbi-mortalité maternels et fœtaux sont également analysés. Méthodes Cette étude rétrospective a inclus 206 patientes avec des fœtus en présentation du siège : 182 en travail spontané et 24 déclenchements, entre juin 2012 et juin 2017. Les critères d’inclusions étaient toutes les patientes présentant une grossesse unique avec un fœtus en présentation du siège après 34 semaines d’aménorrhée et avec un accord d’accouchement par voie basse par un sénior d’obstétrique. Les grossesses multiples, les termes inférieurs à 34 semaines d’aménorrhées, les utérus cicatriciels, les césariennes programmées pour présentation du siège et absence d’accord voie basse, les morts fœtales in utero et les interruptions médicales de grossesse étaient exclus. Les déclenchements étaient réalisés pour raison médicale sur un col favorable. Résultats Il n’y avait pas de différence significative sur le taux de césariennes des accouchements des sièges entre le groupe « déclenchement » et le groupe « travail spontané » (OR = 1,69 [IC95 % : 0,71–4,04]). Concernant les critères de morbidité maternels, il n’y avait pas de différence significative entre les deux groupes concernant le taux de périnée lésé ni sur le taux d’hémorragie de la délivrance. Pour les paramètres de morbi-mortalité néonataux, aucune différence n’a été mise en évidence entre les deux groupes concernant le taux de score d’Apgar < 7 à 5 minutes, de transfert en néonatologie, de traumatisme fœtal et de la valeur du pH. Conclusion Dans la limite de notre effectif, il paraît acceptable de proposer des déclenchements pour raison médicale sur les présentations du siège sous réserve d’un protocole précis de service avec des critères d’acceptabilités. En effet, cela permet d’éviter un certain nombre de césariennes de précaution, et ainsi de préserver le pronostic obstétrical des patientes pour des grossesses ultérieures. Il serait intéressant d’étudier les critères de morbi-mortalité maternels et néonataux lors des déclenchements à ceux des césariennes programmées alors que le déclenchement aurait été envisageable

XAS, ESR and potentiometric studies of three dinuclear N,N′-para-xylylenebis(tetraazamacrocycle)copper(II) complexes - X-ray crystal structure of [N,N′-p-xylylenebis(cyclen)]copper(II)

cited By 21International audienceDicopper complexes with N,N′-p-xylylenebis(cyclam or cyclen) and with the heteroditopic N,N′-p-xylylenebis(cyclam-cyclen) were synthesized. An X-ray study of the N,N′- p-xylylenebis(cyclen)dicopper complex showed that the copper(II) ion is five-coordinate with an H2O molecule in apical position. With this ligand, a polymeric chain was also obtained in the presence of KSCN. The terminal donor atoms of the bridging NCS- anion are coordinated in apical position to the square-pyramidal copper(II) ion. Two alternating kinds of Cu2L4+ moieties are present in the chain, the first with two N4S chromophores and the second with two N5 chromophores. EXAFS and XANES results are in agreement with a five-coordinate copper ion in the cyclen unit and a six-coordinate copper ion in the cyclam unit. Thermodynamic constants were determined by potentiometry. The existence of dinuclear Cu2L4+ species (ligand/metal ratio &lt; 1) and mononuclear CuLHn(2+n)+ species (ligand/metal ratio &gt; 1) were confirmed by an ESR study at variable pH. © Wiley-VCH Verlag GmbH &amp; Co. KGaA, 69451 Weinheim, Germany, 2003

XAS, ESR and potentiometric studies of three dinuclear N,N′-para-xylylenebis(tetraazamacrocycle)copper(II) complexes - X-ray crystal structure of [N,N′-p-xylylenebis(cyclen)]copper(II)

cited By 21International audienceDicopper complexes with N,N′-p-xylylenebis(cyclam or cyclen) and with the heteroditopic N,N′-p-xylylenebis(cyclam-cyclen) were synthesized. An X-ray study of the N,N′- p-xylylenebis(cyclen)dicopper complex showed that the copper(II) ion is five-coordinate with an H2O molecule in apical position. With this ligand, a polymeric chain was also obtained in the presence of KSCN. The terminal donor atoms of the bridging NCS- anion are coordinated in apical position to the square-pyramidal copper(II) ion. Two alternating kinds of Cu2L4+ moieties are present in the chain, the first with two N4S chromophores and the second with two N5 chromophores. EXAFS and XANES results are in agreement with a five-coordinate copper ion in the cyclen unit and a six-coordinate copper ion in the cyclam unit. Thermodynamic constants were determined by potentiometry. The existence of dinuclear Cu2L4+ species (ligand/metal ratio &lt; 1) and mononuclear CuLHn(2+n)+ species (ligand/metal ratio &gt; 1) were confirmed by an ESR study at variable pH. © Wiley-VCH Verlag GmbH &amp; Co. KGaA, 69451 Weinheim, Germany, 2003

Magnetic measurements, UV-Vis spectroscopy, and XAS of dinuclear nickel(II) complexes of bistetraazamacrocycles

cited By 11International audienceThe nickel(II) complexes of N,N′-xylylenebis(tetraazamacrocycles) have been isolated. The description of these dinuclear bismacrocyclic complexes have been carried out by means of magnetic measurements and spectrophotometric experiments (UV-Vis). The metal environment and the ligand shape have been specified by XANES and EXAFS experiments, since attempts to obtain suitable crystals failed. © 2004 Elsevier Ltd. All rights reserved

Differences in nuclear positioning of 1q12 pericentric heterochromatin in normal and tumor B lymphocytes with 1q rearrangements.

The frequent rearrangement of chromosome band 1q12 constitutive heterochromatin in hematologic malignancies suggests that this rearrangement plays an important pathogenetic role in these diseases. The oncogenic mechanisms linked to 1q12 heterochromatin are unknown. Constitutive heterochromatin can epigenetically regulate gene function through the formation of transcriptional-silencing compartments. Thus, as a first step toward understanding whether 1q12 rearrangements might compromise such activity in tumor cells, we investigated the 3-D organization of the 1q12 heterochromatin domain (1q12HcD) in normal and tumor B lymphocytes. Strikingly, in normal B cells, we showed that the 1q12HcD dynamically organizes to the nuclear periphery in response to B-cell receptor engagement. Specifically, we observed an almost twofold increase in 1q12Hc domains at the extreme nuclear periphery in activated versus resting B lymphocytes. Remarkably, 1q12Hc organization was noticeably altered in tumor cells that showed structural alterations of 1q12; the 1q12Hc domains were significantly displaced from the extreme nuclear periphery compared to normal activated B lymphocytes (P > 0.0001), although overall peripheral localization was maintained. In a case in which there was a translocation of IGL enhancer to 1q, the altered nuclear positioning of the 1q12HcD was even more pronounced (5% of the 1q12Hc domains at the nuclear periphery compared to 20% in other lymphoma lines), and we were able to mimic this effect in two additional B-cell tumor lines by treatment with trichostatin A, a histone deacetylase (HDAC) inhibitor. Taken together, these results point to the 1q12HcD having a specific, nonrandom, and regulated peripheral organization in B lymphocytes. This organization is significantly disrupted in lymphoma cells harboring 1q rearrangements

Mono- and dinuclear CuII and ZnII complexes of cyclen-based Bis(macrocycles) containing two aminoalkyl pendant arms of different lengths

cited By 17International audienceThe basicity and coordination properties towards CuII and ZnII of the bis(macrocycles) L1, L2 and L3 have been investigated by means of potentiometric, 1H NMR and UV/Vis spectroscopic titrations in aqueous solutions. The synthesis of L1 and L3 is also described. The three ligands are composed of two [12]aneN4 units separated by a p-phenylene spacer and differ in the length of the aminoalkyl pendant arms linked to each macrocyclic unit. L1-L3 form mono- and dinuclear complexes in aqueous solutions; in the dinuclear species each metal ion is coordinated by one of the two identical [12]aneN4 ligand moieties, as shown by the crystal structures of the complexes [Cu2L1]Cl 4·8H2O, [Zn2L2](ClO4) 4 and [Zn2L3](ClO4)4·H 2O. In all structures the metal ion is penta-coordinate, and is bound to the four nitrogen donors of the cyclic unit and to the amine group of the side arm. The stability of both the [ML]2+ and [M 2L]4+ complexes in aqueous solution decreases in the order L1 &gt; L2 &gt; L3. At the same time, both the [Cu2L] 4+ and [Zn2L]4+ complexes show a different ability in proton binding among the three ligands, with the [M 2L1]4+ complexes displaying the highest basicity. These results are explained in terms of the decreasing number of nitrogen donors involved in CuII or ZnII binding on passing from L1 to L3; in other words, while in the L1 dinuclear complexes each metal ion is coordinated to the four amine groups of a [12]aneN4 moiety and to the amine group of the side arm, in the L3 ones the metal cations are bound only to the four donor atoms of a cyclic moiety, the aminobutyl group not being coordinated. © Wiley-VCH Verlag GmbH &amp; Co. KGaA, 69451 Weinheim, Germany, 2005