Valeur pronostique des doppler ombilicaux et cérébraux en cas de retard de croissance intra-utérin chez les jumeaux

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Pregnancies and Gynecological Follow-Up after Solid Organ Transplantation: Experience of a Decade

In recent years, solid organ transplantations, such as kidney or lung grafts, have been performed worldwide with an improvement of quality of life under immunosuppressive therapy and an increase in life expectancy, allowing young women to consider childbearing. In the current study, we conduct a retrospective study in two French centers for kidney and lung transplantations to evaluate the rate and outcomes of pregnancies, contraception and gynecological monitoring for women under 40 years old who underwent solid organ transplantation. Among 210 women, progestin was the most widely used contraceptive method. Of the 210 women, 24 (11.4%) conceived 33 pregnancies of which 25 (75.8%) were planned with an immunosuppressant therapy switch. Of the 33 pregnancies, 7 miscarried (21.2%) and 21 (63.7%) resulted in a live birth with a high rate of pre-eclampsia (50%). No graft rejections were observed during pregnancies. Among the deliveries, 19 were premature (90.5%, mostly due to induced delivery) and the C-section rate was high (52.4%). No particular pathology was identified among newborns. We conclude that pregnancies following solid organ transplantation are feasible, and while they are at an increased risk of pre-eclampsia and prematurity, they should still be permitted with close surveillance by a multidisciplinary care team

Mode of delivery and neonatal condition for live births.

<p>weeks: weeks of gestation; composite "poor neonatal condition" criterion: 5-min Apgar ≤ 7 or pH < 7.20 or admitted to NICU or died in the delivery room</p><p>^a early intervention for delivery: multiple indications possible for induction or cesareans</p><p>^b premature rupture of the membranes, post-term, threatened preterm delivery, contraindication to vaginal delivery, indication for second twin</p><p>^c missing data for 5: 1 twin, 4 singletons</p><p>^d missing data for 3 in each group</p><p>Mode of delivery and neonatal condition for live births.</p

Maternal and fetal characteristics at diagnosis at diagnosis at SGA.

<p>^a N = 162</p><p>BMI: Body mass index, AC: Abdominal circumference, UAD: umbilical artery Doppler, weeks: weeks of gestation</p><p>Composite “UAD abnormalities “criterion: abnormal umbilical Doppler, absent or reverse flow</p><p>Maternal and fetal characteristics at diagnosis at diagnosis at SGA.</p

Comparison of fetal Doppler flow abnormalities, gestational age at their onset, and interval between onset and birth.

<p>The analysis covers all subjects, including the <i>in utero</i> deaths</p><p>AC: abdominal circumference, UAD: umbilical artery Doppler, F: female, M: male, d: days</p><p>Composite "UAD abnormalities" criterion: any UAD abnormality, including abnormal UAD with positive diastolic flow and absent or reverse diastolic. Calculation of interval until birth: number of days from the abnormal Doppler findings to the birth.</p><p>Comparison of fetal Doppler flow abnormalities, gestational age at their onset, and interval between onset and birth.</p

Case Report: Post-Partum SARS-CoV-2 Infection After the First French Uterus Transplantation

International audienceAbsolute uterus factor infertility, whether congenital or acquired, renders the woman unable to carry a child. Although uterus transplantation (UTx) is being increasingly performed as a non-vital procedure to address this unfortunate condition, the immunosuppression required presents risks that are further compounded by pregnancy and during the puerperium period. These vulnerabilities require avoidance of SARS-CoV-2 infection in pregnant UTx recipients especially during the third trimester, as accumulating evidence reveals increased risks of morbidity and mortality. Here we describe a successful UTx case with delivery of a healthy child, but in which both mother and neonate developed asymptomatic SARS-CoV-2 infection seven days after RNA vaccination, on day 35 post-partum. Although the patient was successfully treated with a combination therapy comprised of two monoclonal antibodies, this case highlights the challenges associated with performing UTx in the era of Covid-19. More broadly, the risks of performing non-vital organ transplantation during a pandemic should be discussed among team members and prospective patients, weighing the risks against the benefits in improving the quality of life, which were considerable for our patient who achieved motherhood with the birth of a healthy child. Copyrigh