High syphilis but low HIV prevalence rates among pregnant women in New Caledonia.

Sexually transmitted infections have been described as one of the major health problems in several countries of the Pacific Region. The objective of the study was to estimate the prevalence of pregnant women infected with HIV and/or syphilis in New Caledonia. HIV and syphilis test results were obtained from women attending antenatal clinics. From 2008 to 2011, 3353 pregnant women were tested with a mean prevalence of active syphilis found at 5.6/100,000. No pregnant women tested positive for HIV. Despite available resources and public health strategies similar to those existing in France, active syphilis prevalence is high in New Caledonia. Surprisingly, HIV seroprevalence remains far below the figures reported in mainland countries. However, social and economic changes as well as the looming referendum on independence scheduled in 2014 may have a potential negative impact on public health resources. The need for action to control syphilis and other curable sexually transmitted infections is pressing in order to prevent further spread of HIV in New Caledonia.

Notching of the umbilical artery waveform associated with cord entanglement in a monoamniotic twin pregnancy.

Cord accidents are the principal cause of the high rates of morbidity and mortality associated with monoamniotic twins. Observation of an umbilical artery notch might be a highly specific sign for cord entanglement involving a tight cord knot. It thus justifies the implementation of intense surveillance and should be one of the factors taken into account in deciding on early delivery of the twins.

Medical treatment of ectopic pregnancies: a randomized clinical trial comparing methotrexate-mifepristone and methotrexate-placebo.

BACKGROUND: Medical treatment of ectopic pregnancies is common. To increase the efficacy of methotrexate, the association of mifepristone has been proposed. METHODS: We performed a large prospective multicentre double-blind sequential randomized trial in order to compare the efficacy of methotrexate and mifepristone (600 mg given orally) versus methotrexate and placebo. RESULTS: A total of 212 ectopic pregnancies was randomized. There was no significant difference in the initial characteristics between the two groups. There was no significant difference in the success rate of medical treatment between the methotrexate-mifepristone (n = 113) and the methotrexate-placebo group (n = 99): 79.6% (90/113) versus 74.2% (72/97) respectively, RR (95% CI): 1.07 (0.92-1.25), P = 0.41, non-significant. However, there was a quantitative interaction between progesterone level and effect of treatment: when progesterone level was >/=10 ng/l, the efficacy of the combination of mifepristone and methotrexate was significantly higher than the combination of methotrexate and placebo, with an 83.3% success rate (15/18) versus 38.5% (5/13) respectively. CONCLUSIONS: Our study failed to demonstrate any benefit of the addition of mifepristone to methotrexate. By contrast, the quantitative interaction between treatment effect and baseline serum progesterone suggested that this combination could be limited to ectopic pregnancies associated with high serum progesterone concentrations.