[Prophylaxis of thromboembolic complications in obstetrics and gynaecology].

Venous thromboembolism is a leading cause of maternal mortality in many countries, including France. Most enquiries have repeatedly demonstrated that many deaths could be avoided, suggesting the need to update and ensure a wider diffusion of recommendations. Although thromboembolism-induced maternal death plays a major role, the absolute incidence of events remains low, reducing the ability to perform well-designed research and the level of recommendations presented.

Pulmonary vascular effects of nitric oxide-cGMP augmentation in a model of chronic pulmonary hypertension in fetal and neonatal sheep.

Persistent pulmonary hypertension of the newborn (PPHN) is partly due to impaired nitric oxide (NO)-cGMP signaling. BAY 41-2272 is a novel direct activator of soluble guanylate cyclase, but whether this drug may be an effective therapy for PPHN is unknown. We hypothesized that BAY 41-2272 would cause pulmonary vasodilation in a model of severe PPHN.

Prenatal findings in epidermolysis bullosa with pyloric atresia in a family not known to be at risk.

Epidermolysis bullosa with pyloric atresia (EB-PA) is a rare autosomal recessive genetic disease with a poor prognosis. We report a case of EB-PA in a non-consanguineous couple with a non-contributory family history. The primigravid woman was referred to us because of polyhydramnios associated with fetal gastric dilatation at 33 weeks of gestation.

[Polycythemia vera and pregnancy: difficulties for diagnosis and treatment].

Polycythemia vera is a myeloproliferative syndrome. This clonal disorder involves a pluripotent stem cell capable of differentiating into red blood cells, granulocytes, and platelets. Polycythemia vera is characterized by the overproduction of mature red blood cells in the bone marrow.

Effects of antenatal glucocorticoids on circulatory adaptation at birth in the ovine fetus.

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.

Effects of nociceptive stimuli on the pulmonary circulation in the ovine fetus.

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.

Effects of BAY 41-2272, a soluble guanylate cyclase activator, on pulmonary vascular reactivity in the ovine fetus.

Nitric oxide (NO)-cGMP signaling plays a critical role during the transition of the pulmonary circulation at birth. BAY 41-2272 is a novel NO-independent direct stimulator of soluble guanylate cyclase that causes vasodilation in systemic and local circulations. However, the hemodynamic effects of BAY 41-2272 have not been studied in the perinatal pulmonary circulation.

Perineal cellulitis following trans-obturator sub-urethral tape Uratape.

Objective: We report two cases of perineal cellulitis due to the surgical treatment of female stress urinary incontinence with a trans-obturator sub-urethral tape of Uratape (Porgés).

Methods: Treatment and follow up of their complication were performed at the CHRU of Lille.

Results: In both cases, this complication is related to prolonged vaginal exposition of the tape.

Could the consequences of premature delivery be further attenuated by means of new prenatal strategies?

The last 10 years have already seen improvements in the short- and long-term prognosis for premature neonates. Nevertheless, progress in the prenatal evaluation of predictive factors for neonatal diseases and more detailed and reliable knowledge of fetal physiology could allow the development of new treatments with consequent expectations of further improvements in the prognosis for such premature newborns. Global strategies for the management of preterm labour, ranging from a policy for prenatal transfer to centres offering the appropriate level of perinatal care, should continue to be expanded, and long-term evaluations must also be continued.

[Vaginal birth after caesarean delivery in twin gestation: is trial of labor allowed?].

Objective: To determine if a trial of labor in twin pregnancy with previous cesarean section is an acceptable alternative to systematic cesarean section.

Patients And Methods: Based on a retrospective and comparative study from 1st January 1996 to 30th June 2003 in Maternite Jeanne-de-Flandre (Lille) and Pavillon Paul-Gelle (Roubaix), 35 trials of labor in twin pregnancies with previous cesarean section have been compared with 35 twin gestations attempting vaginal delivery without a prior cesarean. This comparative study has been led by sorting out the patients according to their gestational age, parity and maternity.

Maternal Bartter's syndrome in pregnancy treated by amiloride.

Background: Bartter's syndrome is a rare condition during pregnancy. The prenatal management is difficult to maintain normal potassium serum levels.

Case: We describe a 26-year-old woman with Bartter's syndrome.

[Maternal and fetal consequences of increased gestational weight gain in women of normal prepregnant weight].

Objective: To study the effects of increased gestational weight gain in women of normal prepregnant weight.

Patients And Methods: We compared 174 patients gaining more than 18 kg to 174 patients gaining between 9 and 15 kg. Body mass index was normal for every woman included in the study.

[Comparative analysis of rate scales of urinary incontinence in women].

Objective: Rate scales are used to analyse urinary incontinence. There are many scales making it difficult to compare the different studies of urinary incontinence. The purpose of this study was to evaluate and compare the rate scales pertaining specifically to urinary incontinence.

Effects of antenatal glucocorticoids on pulmonary vascular reactivity in the ovine fetus.

Objectives: Although mechanisms of glucocorticoids-induced parenchymal lung maturation have been largely studied, little is known about the pulmonary vascular effects of antenatal glucocorticoids (GCs). We therefore hypothesized that antenatal GCs may alter the hemodynamic response to vasodilatory agents in the fetal lung.

Study Design: We tested the hemodynamic response to acetylcholine, increased PaO(2), and norepinephrine infusion before and after maternal GC administration in chronically prepared, late-gestation fetal lambs (135-137 days of gestational age, term = 147 days).

Role of the alpha2-adrenoceptors on the pulmonary circulation in the ovine fetus.

Recent in vitro studies reported that nitric oxide release and pulmonary vasorelaxation can be mediated by endothelial alpha2-adrenoceptor activation. As norepinephrine (alpha1-,alpha2-, and beta1-adrenoceptor agonist) was found to induce pulmonary vasodilation in the ovine fetus, we hypothesized that alpha2-adrenoceptors may modulate basal pulmonary vascular tone and mediate the vascular effect of norepinephrine during fetal life. To determine the role of alpha2-adrenoceptors and the mechanisms of norepinephrine-mediated vasodilation in the fetal pulmonary circulation, we tested, in chronically prepared late-gestation fetal lambs, the hemodynamic response to 1).

[Hyperemesis in the first trimester of pregnancy: role of biological hyperthyroidism and fetal sex].

Objectives: Our objectives were to link hyperemesis gravidarum with biochemical hyperthyroidism and hormonal modification (HCG and estradiol) and to test the hypothesis that biological abnormalities (ionogram and liver enzyme) are more often reported in hyperemesis gravidarum with biochemical hyperthyroidism.

Study Design: Thirty three patients admitted in "Hôpital Jeanne de Flandre" with hyperemesis gravidarum were studied prospectively.

Results: Twenty-two patients (66.

Preclinical phase of polycythemia vera in pregnancy.

Background: In some cases, complications of pregnancy are related to thrombophilia. We describe a preclinical phase of polycythemia vera.

Case: A woman, who experienced perinatal deaths in her first two pregnancies, was diagnosed with polycythemia vera during antenatal counseling for a third pregnancy.

[Diagnosis of endometrial cancer].

Endometrial cancer, a hormone-related disease with unopposal hyperestrogenemia as one of its major risk factor is usually diagnosed during post menopausal bleeding. Pathologic examination after endometrial biopsy or curettage is mandatory for the diagnosis before any treatment. The 2 first line procedures in the work up are transvaginal ultrasound with colour Doppler and hysteroscopy.

[Antenatal diagnosis of limb body wall complex].

The "limb body wall complex" or LBWC is a rare polymalformative syndrome. Two distinct phenotypes of which were recently described: one form with "placento-cranial" adhesion and the other with "placento-abdominal" adhesion. Coelosomia is found in all cases, it variably coexists with encephalic, vertebral, visceral or limb anomalies.