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OBJECTIVES: In a regional study of preterm infants born before 35weeks of gestation, the aim was to propose a new classification of preterm births into three groups, and to describe the pregnancy complications and fetal disorders in each group. PATIENTS AND METHODS: In two areas covered by a perinatal network, all preterm births, live births and stillbirths, which occurred between 22 and 34 completed weeks were recorded over a 21-month period. Each case was classified either in the medically-indicated preterm birth (I) group, or in the accepted spontaneous preterm birth (ASp) group or in the non-accepted spontaneous preterm birth (NASp) group. RESULTS: One thousand and sixty cases of preterm births were included; among them, 981 were live births or ended with per partum infant death. Forty-nine percent of these births were medically indicated, 32 % were ASp and 19 % were NASp. The distribution of pregnancy complications and fetal disorders differed between preterm birth groups: ischemic placental diseases were present in 38,2 % of medically-indicated births; preterm premature rupture of membranes occurred twice more often in I and ASp preterm births than in NASp preterm births. CONCLUSION: This classification is based on the medical decision; it allows to compare medical practices in given obstetrical situations. It appears to be reproducible and easy to use.

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OBJECTIVE: Campomelic dysplasia (CD) is a rare skeletal dysplasia characterized by marked femoral and tibial angulations, hypoplasic scapulae, normal upper limbs and sex reversal in 3/4 of 46,XY fetuses. Most cases are lethal in the neonatal period. Heterozygous mutations in the SOX9 gene are responsible for CD. The diagnosis is not usually made until the mid-second trimester or later. METHODS: We describe 2 cases of CD suspected by ultrasonography in the first trimester. RESULTS: The 2 cases presented with hygroma colli along with anomalies in the lower but not the upper limbs. Terminations of pregnancy were obtained at 14+3 and 20+6 gestational weeks. Fetopathological examinations confirmed sonographic findings. CONCLUSION: When first trimester hygroma colli is accompanied by specific findings of the lower limbs, the diagnosis of CD can be investigated through SOX9 mutation analysis.

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A 24-year-old woman with type 3 (characterised by a blood level of von Willebrand factor less than 1%) was admitted to the surgical intensive care unit with an haemorrhagic shock. She was pregnant (Beta HCG = 115 Ul.L-1), the echography of the abdomen, soon after admission, revealed a haemoperitoeum. She underwent abdominal surgery after substitution treatment. The surgeon found an ovarian haemorrhagic cyst. Later the course of pregnancy was normal and she was delivered by caesarean section. We describe the therapeutic strategy of that care.

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OBJECTIVE: The aim of this study was to evaluate prognostic prenatal factors of congenital diaphragmatic hernia. MATERIAL AND METHODS: We designed a retrospective study of 34 patients with congenital diaphragmatic hernia. The infants were delivered at the Edouard Herriot Hospital between September 1, 1994 and June 30, 1998. We excluded cases of pregnancy termination. After eliminating 4 cases, we studied 30. The factors studied were: polyhydramnios, transverse abdominal diameter, hepatic and umbilical vein deviation, mediastinal deviation, intrathoracic location of the stomach. Prenatal karyotype and echocardiography were systematically obtained. RESULTS: Total perinatal mortality was 53% and was 48% in case of unique diaphragmatic hernia. Prognosis was poorer if the diaphragmatic hernia was associated with another malformation (perinatal mortality: 80%, 4/5 cases), or in case of preterm delivery (83%, 5/6 cases). Factors associated with poor prognosis were: polyhydramnios, transverse abdominal diameter below the 5(th) percentile and major hepatic deviation. Diagnosis before 25 weeks was not associated with poor prognosis. Intrathoracic stomach was a good diagnostic sign, but did not allow an assessment of prognosis. CONCLUSION: Diagnosis of congenital diaphragmatic hernia was made before 25 weeks in 77% of the cases. It was not a factor of poor prognosis. As other authors, we found that prenatal association with another malformation (especially cardiac malformation) polyhydramnios, deviation of the liver, and abdominal transverse diameter below the 5(th) percentile were factors of poor prognosis. But it was difficult to determine the prenatal prognosis. Improvement is needed.

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We report the case of a 26 year-old woman, with an uncomplicated type 1 IDDM of 17 yr duration followed for her first pregnancy. At conception, HbA1c (measured by HPLC) was 6.5% and fructosamine was 280 u.mol.l (normal range below 285). During the follow-up, 15-days-interval frutosamine never exceeded the normal range and HbA1c values were under 6.5% excepted in the third trimester (7.0 +/- 0.8%) coinciding with a bad control of the 2 hours post-prandial blood glucose. A fetal macrosomy was discovered at 34 weeks of gestation and a heavy-for-date 4680 g baby was delivered by caesarean section at 38 weeks of gestation. Our case report outlines again the need to achieve the recommended target of metabolic control for the diabetic pregnant woman (blood preprandial glucose: 3.9-5.6 mM; post-prandial 2 h < 6.7 mM) specially during the third trimester of pregnancy. The use of computer databases might be helpful for precise monitoring during this narrow window period.

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A case of non immunologic hydrops fetalis associated with parvovirus B19 infection is reported. Viral etiology was suspected by the pattern of overstimulated lymphocytes in fetal ascites and confirmed later by identification of parvovirus B19 by PCR. The cytologic finding center helps the precocious diagnosis.

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Based on a few previous studies, intra-peritoneal hyperthermic perfusion (IPHP) with Mitomycin C could become a beneficial treatment for peritoneal carcinomatosis. Twenty eight patients with peritoneal carcinomatosis arising from intra-abdominal cancers were treated by IPHP, Mitomycin C, diluted in 3 liters of saline solution warmed to a mean temperature of 45 degrees C, was injected into the abdominal cavity for one hour. Median survival for the whole series (postoperative mortality included) was 260 days. For patients with incomplete resection, median survival was 104 days. For patients with complete resection of carcinomatous nodules larger than 3 mm (19 patients), it was 450 days. In this group, actuarial survival was 56% at 1 year and 42% at 2 years. Only 5 (18%) of the 28 patients developed ascitic effusion during follow-up. These results confirm the efficacity of IPHP on ascitic effusion and on survival rate in patients with nearly complete resection of peritoneal carcinomatosis.

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The increasing utilization of coelioscopic interventions has needed the use of a larger number of trocars, which involves in some cases (especially at the beginning of personal experience) longer operations. In our clinical experience we have met hypothermies that compelled us to modify our way of working. The use of conventional means (like warming cushion, warming of irrigation fluids) could limit the temperature loss only moderately. So we imagined to warm and moisten the gases insufflated into the peritoneal cavity. We give a description of the accessories and the results with some patients.

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Ventilatory and waking responses to laryngeal stimulation were studied in six chronically tracheostomized lambs breathing through an endotracheal tube. A balloon catheter inserted in the rostral tracheal segment allowed application of distilled water onto the larynx. Apnea, the main primary ventilatory response, was shorter in wakefulness (7.9 sec) than in quiet (10.7 sec) or active sleep (10.6 sec, residual variance = 3.29), where the response to laryngeal stimulation was poorly reproducible. Arousal delay measured from the neck muscle EMG was longer in active (21.1 sec) than in quiet sleep (5.4 sec, residual variance = 9.05). Arousal preceded apnea termination more often in quiet than in active sleep. When breathing resumed a sigh frequently occurred following prolonged apneas. We conclude that laryngeal stimulation elicits apnea in all states in mature lambs. The termination of apnea is related to waking up in quiet but not in active sleep, where arousal is depressed. A comparison of our results with data from preterm and adult mammals strongly suggests that the ventilatory response to laryngeal stimulation during active sleep is unaffected by maturation.

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