[Pathophysiology of preeclampsia: some recent data].

Placental ischemia is the background of the pathophysiology of preeclampsia. It is mainly - but not exclusively - caused by an immunological conflict between maternal NK cells of the decidua and of the uterine junctional zone, and the HLA-C antigens shared by interstitial trophoblast. The maternal disease is the consequence of the placental ischemia, and is characterized by an inflammatory syndrome with an oxidative stress and an endothelial cell dysfunction.

Instrumental delivery: clinical practice guidelines from the French College of Gynaecologists and Obstetricians.

Routine use of a partograph is associated with a reduction in the use of forceps, but is not associated with a reduction in the use of vacuum extraction (Level A). Early artificial rupture of the membranes, associated with oxytocin perfusion, does not reduce the number of operative vaginal deliveries (Level A), but does increase the rate of fetal heart rate abnormalities (Level B). Early correction of lack of progress in dilatation by oxytocin perfusion can reduce the number of operative vaginal deliveries (Level B).

[Postpartum urinary retention].

Postpartum urinary retention is an uncommon event that occurs in 0.7 to 0.9% of vaginal deliveries.

[Fetal-pelvic disproportion and X-ray pelvimetry].

Objectives: X-ray pelvimetry is a method that not only allows exploring the pelvic inlet but also would partially explain the "fetal-pelvic disproportion". The aims of this study are to estimate this capacity to actually explain the aforementioned disproportion, assessing as well its influence on the follow-up of later pregnancies.

Patients And Methods: A retrospective study was performed in Angers' hospital, France.

Perineal infiltration with lidocaine 1%, ropivacaine 0.75%, or placebo for episiotomy repair in parturients who received epidural labor analgesia: a double-blind randomized study.

Background: Episiotomies are performed in approximately 20% of vaginal deliveries and may result in postpartum pain. Perineal infiltration with lidocaine during the episiotomy is widely used, despite an early study showing no difference when compared with saline. Ropivacaine has increasingly been used in the obstetric setting, although not for episiotomies.

[Very premature births: Dilemmas and management. Part 1. Outcome of infants born before 28 weeks of postmenstrual age, and definition of a gray zone].

With very preterm deliveries, the decision to institute intensive care, or, alternatively, to start palliative care and let the baby die, is extremely difficult, and involves complex ethical issues. The introduction of intensive care may result in long-term survival of many infants without severe disabilities, but it may also result in the survival of severely disabled infants. Conversely, the decision to withhold resuscitation and/or intensive care at birth, which is an option at the margin of viability, implies allowing babies to die, although some of them would have developed normally if they had received resuscitation and/or intensive care.

[Very premature births: Dilemmas and management. Second part: Ethical aspects and recommendations].

In the first part of this work, the outcome following very premature birth was assessed. This enabled a gray zone to be defined, with inherent major prognostic uncertainty. In France today, the gray zone corresponds to deliveries occurring at 24 and 25 weeks of postmenstrual age.

Early intra-articular hip disease presenting with posterior pelvic and groin pain.

Objective: To determine whether posterior pelvic pain is associated with intra-articular hip abnormalities (labral tears and early degenerative changes) in patients with minimal-to-no radiographic abnormalities.

Design: A retrospective observational study of prospectively collected data collected from patients with an arthroscopy-confirmed diagnosis of acetabular labral tear or femoral and/or acetabular chondrosis, without severe deformity.

Setting: An academic orthopedic clinic at a tertiary hospital.

[Indications and prerequisites for operative vaginal delivery: when, how and where?].

Objective: To determine the indications and prerequisites for operative vaginal delivery.

Methods: Articles were searched using PubMed and Cochrane library.

Results: Indications for operative vaginal delivery are non-reassuring fetal status (NP4), no progress from 30minutes of adequate active pushing, maternal exhaustion (NP5), or medical indications to avoid Valsalva (NP5).

[Two observations of evisceration after caesarean section performed according the so-called Stark procedure].

Two cases of evisceration after caesarean sections performed according the Misgav Ladach General Hospital procedure (Stark's procedure) are reported. In these cases, omentum was sutured between the edges of fascia recti, creating a weakness of the abdominal sheath. These cases claim about a strict procedure for fascia suture.

[Pregnant women and smoking: descriptive study and prognostic factors to stop smoking during pregnancy].

Unlabelled: Nicotine addiction (NA) is a serious public health problem. Today, smoking effects on the foetus and the mother are well known; however, studies into smoker's behaviour are lacking. The aim of our paper was to identify factors which influence either NA stopping or continuation during pregnancy.

[Information in perinatal medicine: ethical aspects].

Besides the undeniable need to respect parental autonomy, providing information is a legal and moral obligation, to be informed a basic right. The act of informing should be considered as an exchange and necessarily begins by listening to the other. According to the jurisprudence of the Court of Cassation that draws on Article 35 of the Deontological Code, information has to be clear (implying an educational effort, availability and to check that the information has been well understood), appropriate (adapted to each situation and person) and honest (which supposes a moral contract between parents and physicians).

[Postpartum contraception: medical guidelines, women's point of view].

Purpose: Postpartum contraception is subjected to specific medical guidelines related to the suckling mode. The practitioner must conciliate prescription rules with women's expectations. The purpose of this work was to estimate the medical practice in the maternity centre at a local hospital and the actual practice of women at home, in immediate postpartum and during the year that followed the childbirth.

[The fundal height measurements in single pregnancies and the detection of fetal growth retardation].

Symphysis fundus measurements are a reliable mean for screening of fetal growth retardation. The techniques of the measurements, the curves of normality, and the efficiency of this method are discussed. A single formula is put forward to identify the patients witch can profit by extra ultrasound examinations and special clinical surveillance.

Reassessment of von Willebrand factor (VWF), VWF propeptide, factor VIII:C and plasminogen activator inhibitors 1 and 2 during normal pregnancy.

The use of von Willebrand factor [VWF antigen (WF:Ag)] measurement as a marker of endothelial cell activation for monitoring hypertensive pregnancies is limited by the poor definition of reference values. We reassessed these reference values using different assays, and those of the propeptide (VWF:Ag II) and factor VIII coagulant activity (factor VIII:C), in a large population of normal pregnancies, at 3-week intervals of gestational age. Plasminogen activator inhibitors (PAI-1 and PAI-2) were measured in parallel.

[Induce or not induce labor in gestational diabetes].

The most serious hazard of gestational diabetes is shoulder dystocia, which sometimes is complicated by Erb's palsy and maternal lacerations. This risk is linked to fetal weight, and is more frequent in cases of diabetes. So, a caesarean section performed when macrosomia is present is required and an induction of labor before severe macrosomia is proposed.

[Ultrasound monitoring].

Ultrasound investigation is peculiar when pregnancy is complicated by gestational diabetes. One have to study interventricular septal thickness and to predict macrosomia. Before delivery septal thickness should be under 6 mm.