Characterization of enzymes of catecholamine synthesis and metabolism in human fetal membranes at birth.

We looked for the presence of the enzymes monoamine oxidase, catechol-O-methyltransferase, and phenylethanolamine-N-methyltransferase in human fetal membranes at term. The activity of all three enzymes was detected via highly sensitive and selective radiometric enzyme assays. The most novel finding was the extremely high level of monoamine oxidase activity in the chorion compared with that in the amnion.

The very tiny baby, multiple births, and other questions about preterm deliveries.

The progressive change of the limit of viability accepted for very preterm babies has resulted in a progressive improvement of survival, but also in costs for days spent in intensive care and for numbers of severely handicapped babies. Multiple births, including twins but especially triplets and quadruplets, result in severely premature births, high death rates, high costs, and severe risk of handicap. As most supermultiple pregnancies are the result of ovulation-inducing drugs, this rise has to be limited.

Vaginal infections, cervical ripening and preterm delivery.

A prospective study is presented which addresses the relative effect of cervicovaginal infection and precocious maturation of the uterine cervix on preterm delivery. From April 1981 through December 1983, a total of 5758 pregnant women were checked by means of a vaginal examination at every prenatal visit and a research for bacterial cervicovaginal infection whenever abnormal signs were observed. The study reveals that vaginal infection has no measurable effect when observed during the second trimester of pregnancy, and a small effect during the third trimester.

[Fast determination of pulmonary surfactant in amniotic fluid using fluorescent polarization (FLM test Abbott)].

A study of 60 amniotic fluids obtained by amniocentesis shows that the measurement of total surfactant phospholipids by the TDX Fetal Lung Maturity assay makes it possible to predict accurately fetal lung maturity. A sensitivity of 100% is similar to that of other tests currently used but with a higher specificity (93% instead of 65% for the L/S ratio and 55% for the phosphatidylglycerol). The phospholipid/albumin ratio is carried out automatically by means of a fluorescence polarization method with the TDX Abbott apparatus.

[Risk factors of ectopic pregnancy. A case-control study at 7 maternity units in the Paris area].

A case-control study was conducted in seven maternity hospitals in the Paris area in 1988 to evaluate the role of several risk factors in ectopic pregnancy (EP). A total of 279 cases and 307 controls were compared for sociodemographic characteristics, cigarette smoking, sexual reproductive and surgical histories and for the conditions under which conception occurred. Many factors were found to be associated with an increased risk of EP: cigarette smoking related to the number smoked at the time of conception (Odds Radio (OR) 1.

[System of decision support in obstetrics. The computerization of prenatal consultations].

The aim of this study was to realize a prototype of a computer-aided decision support for prenatal visits. He has been developped on a microcomputer. We used procedural programming to represent the medical knowledge.

Advanced combined intra-uterine and ovarian gestations: case report.

Combined intra-uterine and ectopic gestations are uncommon. Heterotopic gestations in which the ectopic pregnancy is located in the ovary are exceptional. We are reporting a 22 week heterotopic gestation with two live fetuses, one fetus was developing in the uterus and one in the ovary.

Racial differences in pregnancy duration and its implications for perinatal care.

The average length of gestation is about 5 days shorter in black populations than in white populations. Although some of this difference is accounted for by higher preterm delivery rates in blacks, the most common gestational week of delivery at term is the 39th in black populations, the 40th in white. Black gestational age specific neonatal mortality is lower than that of whites until the 37th week of gestation, but higher thereafter.

The Guadeloupean perinatal mortality audit: process, results, and implications.

In 1983, we implemented an ongoing perinatal mortality audit in Guadeloupe to identify factors underlying the current level of poor perinatal outcome and to stimulate increased provider motivation. The audit was part of an active research approach to document the specific nature of the perceived perinatal health problem, to modify provider behavior through the use of this acquired information, and, ultimately, to decrease avoidable perinatal deaths. We investigated all 320 perinatal deaths in Guadeloupe during 1984 and 1985.

Anamnestic pregnancy risk assessment.

Based on data obtained from the 1984-1985 Guadeloupean Perinatal Audit, a pregnancy risk scoring system was developed using maternal demographic, socioeconomic, obstetric history and risk characteristics recorded at the first prenatal visit. Various combinations of risk factors were identified for four distinct pregnancy outcomes (perinatal mortality, low birth weight, preterm delivery and intra-uterine growth retardation). The findings emphasize the importance of developing risk assessments for discrete pregnancy outcomes within specific populations.

Suspected postpartum endometritis: a controlled clinical trial of single-agent antibiotic therapy with Amox-CA (Augmentin) vs. ampicillin-metronidazole +/- aminoglycoside.

Endometritis is the commonest postpartum complication and is one of the leading causes of maternal morbidity, if not mortality. The object of the present clinical trial was to assess the efficiency of single-agent therapy with Amox-CA (Augmentin) (formulation which includes a beta-lactamase inhibitor), against standard treatment which necessarily combines two or three antibiotics depending on the clinical severity of the case. 101 patients were evaluated in this comparative prospective randomized study.

[The Zavanelli maneuver: use during breech retention of the head in the birth canal. Apropos of a case].

A case is presented where Zavanelli's manoeuvre was carried out when the chin of the fetus was caught up above the symphysis pubis. This new concept for managing partially born infants that cannot be delivered vaginally, by Cesarean section improves greatly the prospect for survival of the fetus with minimal extra risk for the mother. It is easier to carry out the manoeuvre when the patient is under epidural analgesia.

[Peritonitis and cerclage of the cervix uteri].

Authors report a case of peritonitis following uterine cervical cerclage in a patient with twins. This observation leads to two problems: complications of cerclage and its real indications. Two recent controlled studies conclude that in a singleton pregnancy, there is no advantage in cervical cerclage in prolonging the gestation period and in decreasing the perinatal mortality.

[Sports and pregnancy. A review of the literature].

A review of the literature concerning sport during pregnancy is presented. The mother's heart rate, arterial blood pressure, systolic ejection fraction and cardiac output undergo the same changes during exercise in the pregnant and non-pregnant patient. The increase in the fetal heart rate during maternal physical exercise does not adversely affect the fetal outcome.

[Utero-ovarian mucoid carcinoma, of presumed wolffian duct origin (pure mesonephrotic carcinoma). Apropos of a case and review of the literature].

This is a case report of a rare tumour of the ovary originally developing from the embryonal vestiges of the Wolffian duct and becoming a pure mesonephrotic carcinoma. Although initially considered to be benign, the course of the tumour is one of a potential low grade long term malignancy. Histological changes are of a pure mesonephrotic carcinoma or of a female adnexal tumour probably of wolffian origin (FATWO).

In vivo and in vitro repertoire of CD3+CD4-CD8- thymocytes.

CD4-CD8- thymocytes contain a cell subset which expresses the complete CD3-TCR complex (alpha/beta or gamma/delta) of which the ontogeny and filiation are unknown. One of the questions is whether this population can be intrathymically selected, an obligatory step for the mature CD4+ and CD8+ cell differentiation pathway, or if the absence of CD4 an CD8 allows them to escape thymic selection. The repertoire of CD3+CD4-CD8- (CD3+ DN) thymocytes was analyzed in different strains of mice with different combinations of H-2 and Mls expression.

The cost effectiveness of preventing preterm delivery in twin pregnancies.

As an extension of previous work on the risk of prematurity in singletons and on the social cost of twin births, an analysis has been carried out into the cost effectiveness of preventing premature delivery in twin pregnancies. The cost of prevention is assessed in terms of early diagnosis through ultrasound screening and of an extra 11 weeks of work leave to expectant mothers. When this cost is compared to the social cost involved in the transfer of newborns to neonatal intensity care units and in supporting handicapped children, it is concluded that the total cost of prevention corresponds to one-third of the long-term costs associated to lack of prevention.

[Antenatal diagnosis and ethical problems].

The fast development of techniques detecting diseases or malformations of the fetus during the 2nd third of pregnancy has led to a real evolution in our knowledge. We can recognize minor or major abnormalities, as well as many hereditary or acquired diseases. This revolution raises considerable ethical problems because, at the same time, our ability to receive and operate the children with malformations as early as birth is ever improving.

Social acceptability of HIV screening among pregnant women.

The paper presents the results of a survey about risk perception, knowledge, and attitudes towards HIV infection among 397 pregnant women in France. The survey was carried out between December 1987 and March 1988 in two Paris-region maternity hospitals where HIV testing is routinely proposed during the first prenatal visit. Uptake of HIV prenatal testing has been rapid in France: before coming to the maternity hospitals, 26.

Transfusion syndrome in a triplet pregnancy.

A case is reported of a transfusion syndrome in a triplet pregnancy with intrauterine death of two of the fetuses. This is an exceptional occurrence in a triplet pregnancy and raises the problem of the management of multiple pregnancies associated with the death of one or more of the fetuses. The problem of the method of delivery and the complications arising in triplet dizygotic pregnancies is discussed.