RESUMEN
Although deaths caused by infection during pregnancy and the postpartum period are rare in France, mortality rates have increased in several countries of the European community. In France, the rate of maternal mortality by infectious cause has decreased over the last 12 years. Infectious causes are currently in fifth place of maternal deaths. Over the period 2007-2009, 18 deaths occurred, eight by direct infectious causes and 10 by indirect infectious causes. Among the 18 deaths, 17 were examined by the National Expert Committee on Maternal Mortality (CNEMM) with the objectives to determine the direct or indirect link with pregnancy, the adequacy of care and the preventability of death. Among 8 deaths from direct infectious causes, four deaths were deemed "preventable" or "possibly preventable" because of inadequate care. Among nine deaths from indirect infectious causes, preventability could not be established in two deaths, five were non-preventable and two were preventable due to non-optimal care. These cases of puerperal septicemia show that when sepsis is clinically manifest, infection is already well established and widespread deterioration is therefore often irreversible. Maternal mortality is preventable in most cases if several points are observed: early diagnosis, probabilistic antibiotics targeting most frequently involved bacteria including Escherichia coli and Streptococcus A, early transfer to ICU, control septic portal entry, simple preventive measures, influenza vaccination. A "microbiological clinical diagnosis" approach must be initiated at the first clinical signs.
Asunto(s)
Infecciones/mortalidad , Mortalidad Materna , Complicaciones Infecciosas del Embarazo/mortalidad , Trastornos Puerperales/mortalidad , Adulto , Causas de Muerte , Femenino , Francia/epidemiología , Edad Gestacional , Humanos , Recién Nacido , Mortalidad Materna/tendencias , Embarazo , Factores Socioeconómicos , Mortinato/epidemiología , Adulto JovenAsunto(s)
Encuestas Epidemiológicas , Atención Perinatal , Complicaciones del Embarazo/prevención & control , Femenino , Trastornos del Espectro Alcohólico Fetal/epidemiología , Trastornos del Espectro Alcohólico Fetal/prevención & control , Francia/epidemiología , Humanos , Mortalidad Infantil , Recién Nacido , Bienestar Materno , Embarazo , Nacimiento Prematuro/epidemiología , Fumar/efectos adversos , Fumar/epidemiologíaRESUMEN
Every year, in France, about 70 women die during their pregnancy or the delivery. Any maternal death during labour is a traumatic event for the medical team and the family. The medical team has to face many "new" problems. We try to identify all the problems which the medical team has to face in front of a maternal death and try to solve them by a medical literature and French laws review. The medical team often feels powerless when a maternal death occurs. This work was made to be a guideline.
Asunto(s)
Mortalidad Materna , Complicaciones del Trabajo de Parto/mortalidad , Grupo de Atención al Paciente , Complicaciones del Embarazo/mortalidad , Adulto , Causas de Muerte , Cultura , Femenino , Humanos , Embarazo , ReligiónRESUMEN
Fifty percent of young women are not immunized against Parvovirus B19 and may be infected during their pregnancy. Because of the scarcity of the foetal complications, the behaviour to be held in case of Parvovirus B19 exposure is badly known. In this view, we realized a review of the literature to answer the questions put by Parvovirus B19 during pregnancy, in particular in case of maternal exposure. About 33% of Parvovirus B19 infections of the pregnant women are complicated by foetal contamination. This foetal infection does not always result in foetal complications. The foetal complications are more frequent before 20 weeks of gestation (11 to 15% of spontaneous abortion and foetal death, 3% of foetal hydrops). After 20 weeks of gestation, it remains 1% of foetal hydrops. Without treatment, they may sometimes lead to foetal death. In the case of Parvovirus B19 exposure, it is advisable to control the maternal serology to know its initial status. According to the result, a weekly ultrasonographic supervision will be proposed to detect foetal anaemia (ascites, pericardial effusion). In the case of foetal hydrops, an in utero transfusion reduce the risk of foetal loss. The long-term outcome of infected foetuses is mostly good. Authors describe a survival without after-effect in 90% of the cases. More ample studies are necessary to evaluate long-term neurodevelopmental outcome of hydropic foetuses.
Asunto(s)
Transmisión Vertical de Enfermedad Infecciosa , Infecciones por Parvoviridae/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Anticuerpos Antivirales/sangre , Femenino , Edad Gestacional , Humanos , Hidropesía Fetal/epidemiología , Hidropesía Fetal/etiología , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Infecciones por Parvoviridae/terapia , Parvovirus B19 Humano/inmunología , Parvovirus B19 Humano/aislamiento & purificación , Embarazo , Complicaciones Infecciosas del Embarazo/terapia , Resultado del Embarazo , Diagnóstico Prenatal , Remisión EspontáneaRESUMEN
OBJECTIVES: Exclusive hepatocele is defined as a hernia containing in majority the liver with possibly some intestinal loops. This study was undertaken to evaluate neonatal morbidity and mortality in this series of exclusive hepatoceles. MATERIALS AND METHODS: We reviewed 11 cases of exclusive hepatoceles with delivery at the hospital Jeanne-de-Flandre in the CHRU of Lille, in France. RESULTS: The mean gestational age of diagnosis was 14.5+/-3.4 weeks of gestation. Karyotype determination was performed in 100% of cases: it was abnormal in one case of 11. One termination of pregnancy was performed because of trisomy 13. The mean gestational age at delivery was 38+/-1.8 weeks of gestation. Cesarean deliveries were performed in nine cases. Morbidity was important with: one case of fetal growth retardation on total hepatocele, three cases of severe respiratory distress, two cases of severe digestive complications. The mean length of stay was 42.8 days. The mean length of parenteral feeding was 14.4 days. Postnatal mortality concerned one child, which died because of a severe respiratory distress due to pulmonary hypoplasia. CONCLUSION: In this series, morbidity is thus important, making of exclusive hepatoceles a full entity among the omphaloceles. The multidisciplinary take care is more complex but conceivable.
Asunto(s)
Enfermedades Fetales/diagnóstico , Hernia Diafragmática/diagnóstico , Hepatopatías/diagnóstico , Adulto , Cesárea , Femenino , Edad Gestacional , Humanos , Embarazo , Resultado del Embarazo , Pronóstico , Estudios RetrospectivosRESUMEN
OBJECTIVES: Our purpose was to study a non-invasive management of fetomaternal alloimmune thrombocytopenia (FMAIT). PATIENTS AND METHODS: Between 1996 and 2005, 18 women were treated. The population was divided into 2 groups: patients with a history of intracranial haemorrhage (ICH) in the older sibling received weekly intravenous immunoglobulin (IVIG) therapy to the mother (1 g/kg per week) without initial cordocentesis whereas patients with a history of neonatal thrombocytopenia did not undergo any treatment. RESULTS: All pregnancies with a previous FMAIT were monitored with serial ultrasound scans without cordecentesis. 15 patients had HPA-1, 2 HPA-3 and 1 HPA-5 immunizations. Weekly intravenous immunoglobulin therapy was administered in 5 patients with a history of ICH in the older sibling. Two of these delivered thrombocytopenic children; one had a platelet count < 50 x 10(9)/l. For the 13 women (one twin) who had a sibling with neonatal thrombocytopenia, 11/14 newborns had a platelet count < 50 x 10(9)/l. Predelivery fetal blood sampling were performed in 8/18 pregnancies. The neonatal periods of the 19 children were uncomplicated and no ICHs were observed. DISCUSSION AND CONCLUSION: Our results suggest that a non-invasive strategy avoiding serial cordocentesis may be an effective therapy in patients who are at risk of fetal and neonatal alloimmune thrombocytopenia.
Asunto(s)
Enfermedades Fetales/tratamiento farmacológico , Inmunoglobulinas Intravenosas/uso terapéutico , Trombocitopenia/tratamiento farmacológico , Adulto , Cordocentesis , Femenino , Sangre Fetal/citología , Enfermedades Fetales/inmunología , Humanos , Recién Nacido , Hemorragias Intracraneales/etiología , Hemorragias Intracraneales/prevención & control , Masculino , Intercambio Materno-Fetal , Embarazo , Resultado del Embarazo , Factores de Riesgo , Trombocitopenia/complicaciones , Trombocitopenia/inmunología , Resultado del TratamientoRESUMEN
AIMS: The aim of our study was to evaluate the possibility of identifying the fetal RhD status in maternal plasma using conventional hemi nested PCR analysis. SUBJECTS AND METHODS: After informed written consent, 20 mL of peripheral blood were collected in 99 D-negative pregnant women either at an amniocentesis for prenatal diagnosis or at a prenatal checkup. Fetal DNA extracted from 400 microL of maternal plasma was analyzed by two different operators with a hemi-nested PCR extending an area of the RhD gene exon 10. The results were compared to the fetal RhD status obtained by PCR amniotic fluid analysis or blood analysis of newborns after delivery. The influence of mother's and baby's phenotype were also studied. RESULTS: Among the 99 D-negative pregnant women, all Caucasian, 47 were in their second trimester and 52 in their third trimester (mean: 27.20 weeks of gestation +/-8.25). Sixty-nine fetuses were D-positive and thirty D-negative. The sensitivity and specificity of our technique were respectively 100% and 86.7% and 15% of discordant results were observed between the two operators. Four false positives were observed. According to maternal phenotype, a fetal unexpressed RHD gene was suspected in only one case because of a particular fetal phenotype (ddCcEe). CONCLUSION: A conventional hemi nested PCR analysis of maternal plasma could be used for accurate fetal RhD status. However this procedure is difficult to apply for routine analysis because of the importance of anti-contamination measures required to obtain good results. Real time quantitative PCR analysis on fetal DNA is more suitable. Whatever the operating procedure used, polymorphism of RhD gene may follow in either false negative from presence of rearranged gene or false positive from occasional presence of a non functional RHD gene.
Asunto(s)
ADN/sangre , Enfermedades Fetales/diagnóstico , Reacción en Cadena de la Polimerasa/métodos , Isoinmunización Rh/diagnóstico , Estudios de Factibilidad , Femenino , Humanos , Valor Predictivo de las Pruebas , Embarazo , Sistema del Grupo Sanguíneo Rh-Hr/genética , Sensibilidad y EspecificidadRESUMEN
We relate the embolization of a hematoma of the broad ligament which developed suddenly in the post-partum period. The radiological intervention could be considered as an alternative treatment. The decision for embolization must be a multidisciplinary decision involving all the specialists concerned (interventional radiologist, intensive care specialist, and obstetrician).
Asunto(s)
Ligamento Ancho/irrigación sanguínea , Embolización Terapéutica , Hematoma/terapia , Trastornos Puerperales/terapia , Adulto , Femenino , Hematoma/diagnóstico , Humanos , Trastornos Puerperales/diagnósticoRESUMEN
Management of HELLP syndrome is still controversial. In order to improve maternal and foetal prognosis, 2 approaches are usually considered: immediate termination of pregnancy (risk of foetal complications related to prematurity) or conservative treatment (maternal risk of complications related to hematologic disorders). Choice of treatment needs to be taken after evaluation of the maternal and fetal risk/benefit ratio.
Asunto(s)
Aborto Terapéutico , Síndrome HELLP/diagnóstico , Síndrome HELLP/terapia , Resultado del Embarazo , Femenino , Humanos , Embarazo , PronósticoRESUMEN
In spite of the fact that there are many articles considering that intrauterine depressed skull fractures are caused essentially by instrumental extraction, literature is scarce about spontaneous foetal head injuries. Here, we report the case of two depressed skull fractures and one of linear fracture not associated with any known trauma during the pregnancy or delivery. The etiological process leading to the idiopathic character of such lesions, the aetiology, the treatment and the prognostic will be discussed. The forensic problem raised by such cases is very important.
Asunto(s)
Fracturas Craneales/etiología , Medicina Legal , Humanos , Recién Nacido , Pronóstico , Fracturas Craneales/diagnóstico , Fracturas Craneales/terapiaRESUMEN
The progression of addiction to smoking among young women is particularly alarming. The fatal effects of the nicotine-poisoning on the pregnancy and on the child constitute a serious public health issue. For young women, the period of maternity plays an essential educational role. Contact with medical care during pregnancy offers a special opportunity to establish a sound basis for health. Clinicians must strive to help women become fully aware of the fatal effects of smoking, providing methods and support for abstinence through a global, structured strategy of health care. The "Maternity without tobacco" network was developed to achieve these objectives. Expired CO analysis can be an interesting tool to search for active or passive addiction to smoking, and more generally carbon monoxide poisoning.
Asunto(s)
Atención Perinatal/normas , Efectos Tardíos de la Exposición Prenatal , Prevención del Hábito de Fumar , Femenino , Ginecología , Humanos , Obstetricia , EmbarazoRESUMEN
OBJECTIVE: Adaptation to extra-uterine life requires dramatic increase in pulmonary blood flow. Mechanisms that induce pulmonary vasodilatation at birth are incompletely understood but include alveolar ventilation, increase in PaO2, and production of vasoactive mediators. We hypothesized that antenatal glucocorticoids (GC) increase pulmonary vasodilatation to birth-related stimuli. STUDY DESIGN: To test this hypothesis, we studied the pulmonary hemodynamic response at birth to mechanical ventilation with low (<10%) and then with high (100%) FiO2 in chronically prepared late-gestation fetal lambs treated or not by antenatal maternal steroids. RESULTS: Basal mean aortic and pulmonary artery pressure (PAP), left pulmonary blood flow, pulmonary vascular resistance (PVR), and blood gas were similar between control and dexamethasone-treated animals (GC group). During mechanical ventilation with low FiO2, mean PVR decreased by 40% in the control group (from 0.44 +/- 0.01 to 0.25 +/- 0.01 mm Hg/ml/min) and by 60% in the GC group (from 0.44 +/- 0.02 to 0.19 +/- 0.02 mm Hg/ml/min) (p < 0.01). When subsequently ventilated with 100% O2, there was no difference in PVR decrease between groups (0.15 +/- 0.02 mm Hg/ml/min in the GC group vs. 0.14 +/- 0.01 mm Hg/ml/min in the control group). CONCLUSION: Antenatal GC enhance pulmonary vasodilatation induced by alveolar ventilation at birth but do not alter the pulmonary vascular response to O2. We speculate that antenatal steroids exposure improve adaptation at birth through acceleration of both parenchymal and vascular lung maturation.
Asunto(s)
Adaptación Fisiológica/efectos de los fármacos , Dexametasona/farmacología , Glucocorticoides/farmacología , Circulación Pulmonar/efectos de los fármacos , Animales , Animales Recién Nacidos , Femenino , Feto/efectos de los fármacos , Hemodinámica , Oxígeno/análisis , Embarazo , Preñez , Ovinos , Vasodilatación/efectos de los fármacosRESUMEN
The fetus is able to exhibit a stress response to painful events, and stress hormones have been shown to modulate pulmonary vascular tone. At birth, the increased level of stress hormones plays a significant role in the adaptation to postnatal life. We therefore hypothesized that pain may alter pulmonary circulation in the perinatal period. The hemodynamic response to subcutaneous injection of formalin, which is used in experimental studies as nociceptive stimulus, was evaluated in chronically prepared, fetal lambs. Fetal lambs were operated on at 128 days gestation. Catheters were placed into the ascending aorta, superior vena cava, and main pulmonary artery. An ultrasonic flow transducer was placed around the left pulmonary artery. Three subcutaneous catheters were placed in the lambs' limb. The hemodynamic responses to subcutaneous injection of formalin, to formalin after fetal analgesia by sufentanil, and to sufentanil alone were recorded. Cortisol and catecholamine concentrations were also measured. Pulmonary vascular resistances (PVR) increased by 42% (P < 0.0001) after formalin injection. Cortisol increased by 54% (P = 0.05). During sufentanil infusion, PVR did not change significantly after formalin. Cortisol increased by 56% (P < 0.05). PVR did not change during sufentanil infusion. Norepinephrine levels did not change during any of the protocols. Our results indicate that nociceptive stimuli may increase the pulmonary vascular tone. This response is not mediated by an increase in circulating catecholamine levels. Analgesia prevents this effect. We speculate that this pulmonary vascular response to nociceptive stimulation may explain some hypoxemic events observed in newborn infants during painful intensive care procedures.
Asunto(s)
Feto/fisiología , Dolor/fisiopatología , Circulación Pulmonar/fisiología , Analgésicos Opioides/farmacología , Animales , Presión Sanguínea/fisiología , Formaldehído/toxicidad , Dolor/inducido químicamente , Circulación Pulmonar/efectos de los fármacos , Ovinos , Sufentanilo/farmacología , Vasoconstricción/fisiologíaRESUMEN
SL25.1131 [3(S),3a(S)-3-methoxymethyl-7-[4,4,4-trifluorobutoxy]-3,3a,4,5-tetrahydro-1,3-oxazolo[3,4-a]quinolin-1-one] is a new, nonselective, and reversible monoamine oxidase (MAO) inhibitor, belonging to a oxazoloquinolinone series. In vitro studies showed that SL25.1131 inhibits rat brain MAO-A and MAO-B with IC50 values of 6.7 and 16.8 nM and substrate-dependent Ki values of 3.3 and 4.2 nM, respectively. In ex vivo conditions, the oral administration of SL25.1131 induced a dose-dependent inhibition of MAO-A and MAO-B activities in the rat brain with ED50 values of 0.67 and 0.52 mg/kg, respectively. In the rat brain, duodenum, and liver, the inhibition of MAO-A and MAO-B by SL25.1131 (3.5 mg/kg p.o.) was reversible, and the recovery of MAO-A and MAO-B activities was complete 16 h after administration. SL25.1131 (3.5 mg/kg p.o.) increased tissue levels of dopamine (DA), norepinephrine, and 5-hydroxytryptamine and decreased levels of their deaminated metabolites 3,4-dihydroxyphenylacetic acid, homovanillic acid, and 5-hydroxyindolacetic acid. In mice, SL25.1131 induced a dose-dependent potentiation of 5-hydroxytryptophan-induced tremors and phenylethylamine-induced stereotypies with ED50 values of 0.60 and 2.8 mg/kg p.o., respectively. SL25.1131 was able to reestablish normal striatal dopaminergic tone and locomotor activity in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-lesioned mice. In addition, when coadministered with L-DOPA, SL25.1131 increased the available DA in the striatum and the duration of L-DOPA-induced hyperactivity. The duration of the effect of L-DOPA on circling behavior in 6-hydroxydopamine-lesioned rats was also increased. The neurochemical profile of SL25.1131 demonstrates that this compound is a mixed, potent, and reversible MAO-A/B inhibitor in vitro, in vivo, and ex vivo. SL25.1131 has therapeutic potential as a symptomatic treatment during the early phase of Parkinson's disease and as an adjunct to L-DOPA therapy during the early and late phases of the disease.
Asunto(s)
Aprendizaje por Laberinto/efectos de los fármacos , Inhibidores de la Monoaminooxidasa/farmacología , Monoaminooxidasa/metabolismo , Enfermedades del Sistema Nervioso/metabolismo , Oxazoles/farmacología , Quinolinas/farmacología , Ácido 3,4-Dihidroxifenilacético/metabolismo , Animales , Benzofenonas/farmacología , Encéfalo/efectos de los fármacos , Encéfalo/enzimología , Cuerpo Estriado/efectos de los fármacos , Cuerpo Estriado/metabolismo , Modelos Animales de Enfermedad , Dopamina/metabolismo , Interacciones Farmacológicas , Levodopa , Intoxicación por MPTP/metabolismo , Ratones , Ratones Endogámicos C57BL , Inhibidores de la Monoaminooxidasa/uso terapéutico , Enfermedades del Sistema Nervioso/inducido químicamente , Enfermedades del Sistema Nervioso/tratamiento farmacológico , Nitrofenoles , Oxazoles/uso terapéutico , Oxidopamina , Corteza Prefrontal/efectos de los fármacos , Corteza Prefrontal/metabolismo , Quinolinas/uso terapéutico , Ratas , Ratas Sprague-Dawley , Serotonina/metabolismo , Conducta Estereotipada/efectos de los fármacos , Tolcapona , Temblor/inducido químicamente , Temblor/tratamiento farmacológico , Tiramina/farmacologíaAsunto(s)
Enfermedades Pulmonares/congénito , Enfermedades Pulmonares/diagnóstico , Pulmón/anomalías , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Pulmón/embriología , Embarazo , Diagnóstico Prenatal , PronósticoRESUMEN
Cytomegalovirus (CMV) screening during pregnancy has been widely discussed for several years, but still no consensus has been agreed. With a number of live births of 750,000 per year in France, we would expect 7500 infected infants at birth per year (rate of congenital infection of 1%). Among infected infants at birth, the number of severely infected foetuses would be approximately 75, the number of infants with severe sequelae would be 480, 675 approximately would present with hearing loss and the number of asymptomatic infants would be 6270. Five different preventive methods for congenital CMV infection are possible: (1) Routine CMV screening at the beginning of pregnancy for primary prevention. (2) Secondary prevention by antenatal diagnosis of congenital CMV infection complications. (3) Tertiary prevention by serological testing during pregnancy. (4) Tertiary prevention by serological screening at birth. (5) Tertiary prevention: Hearing loss screening at birth. The aims of this review are to define the advantages and disadvantages of these different methods of CMV screening during pregnancy and to determine if the current available information would make systematic testing acceptable.