Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 17 de 17
Filter
1.
Gynecol Obstet Fertil ; 39(4): 205-10, 2011 Apr.
Article in French | MEDLINE | ID: mdl-21450510

ABSTRACT

OBJECTIVE: To evaluate the management and outcome of pregnancy in women with essential thrombocytemia. PATIENTS AND METHODS: We conducted a retrospective study including all the pregnant women with essential thrombocytemia followed between January 2000 and January 2008 in a University Hospital (hôpital Jeanne-de-Flandre, Lille, France). We report our experience of 18 pregnancies in 13 women. The management and the complications of these pregnancies were reported. RESULTS: All the patients were treated with low dose aspirin during the pregnancy. We observed one intrauterine death, one premature delivery at 29 weeks of gestation and six maternal haemorrhages at delivery (33%). DISCUSSION AND CONCLUSION: It is essential to treat these patients with low dose aspirin as soon as the pregnancy begins. Aspirin will be continued in postpartum with anticoagulant treatment. This management appears to improve the obstetric outcome and decrease the thrombotic complications usually described. A national register seems to be necessary to evaluate the complications occurring during pregnancy and the optimum follow-up.


Subject(s)
Aspirin/therapeutic use , Platelet Aggregation Inhibitors/therapeutic use , Pregnancy Complications, Hematologic/drug therapy , Thrombocythemia, Essential/drug therapy , Adult , Female , Hospitals, University , Humans , Pregnancy , Pregnancy Outcome , Retrospective Studies , Young Adult
2.
Ann Fr Anesth Reanim ; 24(8): 911-20, 2005 Aug.
Article in French | MEDLINE | ID: mdl-16039089

ABSTRACT

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. Many personal or pregnancy-related factors have been identified as increasing the risk of thromboembolism in pregnant patients but few of them have been associated with a significantly increased risk. A history of thromboembolic event and some thrombophilic factors (including antithrombin deficiency and antiphospholipid syndrome) carry the greatest risk. Pregnancy itself, caesarean delivery and the postpartum period, although associated with an increased risk play a minor role when not combined with other risk factors. Prophylactic treatment relies mainly on low molecular weight heparins which safety is now well established in pregnant patients. Dose and duration of treatment should be adapted to the perceived level of risk. The occurrence of a thromboembolic event is also increased after gynaecological surgery but major and cancer surgery carry the greatest risk. Here also, low molecular weight heparins play a leading role, although non pharmacologic means are useful. Dose and duration should be dependent on the level of risk.


Subject(s)
Delivery, Obstetric , Gynecologic Surgical Procedures , Intraoperative Complications/prevention & control , Thromboembolism/prevention & control , Adult , Female , Humans , Pregnancy , Risk Assessment
3.
Gynecol Obstet Fertil ; 33(5): 331-7, 2005 May.
Article in French | MEDLINE | ID: mdl-15878688

ABSTRACT

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. Myeloid and megakaryocytic elements are also often increased. Polycythemia vera (PV) is rarely associated with pregnancy. About 20 cases have been reported. Prognosis of PV is not influenced by pregnancy. Conversely, pregnancy outcome is poor, due to the occurrence of gestational hypertension, stillbirth and induced prematurity. During pregnancy, clinical management needs to be close including a collaborative approach between obstetricians, hematologists and anesthesists. The risk of poor outcome may be reduced by the association of antiaggregant and anticoagulant therapy. Phlebotomy can be provided in order to maintain hemoglobin level under 42%.


Subject(s)
Polycythemia Vera/therapy , Pregnancy Complications/therapy , Adult , Female , Humans , Patient Care Team , Polycythemia Vera/diagnosis , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Outcome , Prognosis
4.
Am J Physiol Regul Integr Comp Physiol ; 288(2): R547-53, 2005 Feb.
Article in English | MEDLINE | ID: mdl-15637175

ABSTRACT

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.


Subject(s)
Fetus/physiology , Pain/physiopathology , Pulmonary Circulation/physiology , Analgesics, Opioid/pharmacology , Animals , Blood Pressure/physiology , Formaldehyde/toxicity , Pain/chemically induced , Pulmonary Circulation/drug effects , Sheep , Sufentanil/pharmacology , Vasoconstriction/physiology
5.
Rev Med Interne ; 23(7): 607-21, 2002 Jul.
Article in French | MEDLINE | ID: mdl-12162216

ABSTRACT

PURPOSE: Pregnancy in a patient with systemic sclerosis (SSc) may pose a double problem to the medical team: influence of SSc on pregnancy and consequences of pregnancy to SSc manifestations. CURRENT KNOWLEDGE AND KEY POINTS: Concepts have evolved. SSc was considered for a long time not only as not very propitious for pregnancy but also as a strict contraindication for procreation because risks for the mother and the baby were thought to be major. Currently, fertility is thought to be normal. Miscarriages and small-for-gestation age infants rate do not seem to be higher in SSc. Maternal and perinatal mortality is also not higher in SSc without severe visceral manifestations, i.e. without either pulmonary hypertension, or cardiac or respiratory insufficiency. Conversely, there is a significantly higher frequency of premature infants in SSc. As regards influence of pregnancy on SSc, the greatest fear is the occurrence of renal crisis, which may be life threatening for both mother and child. Each elevation of blood pressure, even if this increase is mild, should be considered as potentially very serious. However, pregnancy itself does not seem to increase the risk of renal crisis. Consequences of pregnancy to SSc manifestations are various but usually mild. FUTURE PROSPECTS AND PROJECTS: SSc is not a strict contraindication for pregnancy only if severe organ involvement, diffuse subset of SSc or recent onset of the disease has been ruled out. Physicians should be aware of specific problems, which SSc is possibly posing during pregnancy. Finally, it has been recently suggested that pregnancies could be involved in the pathogenesis of SSc through persisting microchimerism of fetal origin.


Subject(s)
Pregnancy Complications , Scleroderma, Systemic/complications , Acute Disease , Adult , Female , Humans , Infant, Newborn , Infant, Premature , Infertility, Female/etiology , Kidney Diseases/etiology , Pregnancy , Pregnancy Outcome , Severity of Illness Index
7.
Obstet Gynecol ; 92(3): 416-9, 1998 Sep.
Article in English | MEDLINE | ID: mdl-9721781

ABSTRACT

OBJECTIVE: To report our experience with high doses (0.1-0.2 mg per 10 kg pregnant weight) of intravenous (IV) nitroglycerin as a uterine relaxing agent for managing internal podalic version of the second twin in transverse lie with unruptured membranes. METHODS: Between August 1994 and December 1997, we managed 22 cases of internal podalic version of the second twin with the administration of high doses of IV nitroglycerin. RESULTS: Twenty internal podalic versions were completed successfully, and two cases failed. One failure was considered not related to IV nitroglycerin because the patient had a panic attack, requiring general anesthesia for sedation. The internal podalic version then succeeded. The patient with true failure of IV nitroglycerin required emergency cesarean because of acute fetal bradycardia and a nonrelaxed uterus. This was the only nontransverse lie, but with a very high face presentation. One internal podalic version was complicated by hemorrhage (2000 mL). CONCLUSION: Intravenous nitroglycerin to induce uterine atonia, with epidural analgesia, avoids general anesthesia and makes internal podalic version easier. In 22 cases (with success in 20) of internal podalic version of the second twin in transverse lie with unruptured membranes, IV nitroglycerin induced transient and prompt uterine relaxation without affecting maternal and fetal outcomes.


Subject(s)
Nitroglycerin/administration & dosage , Parasympatholytics/administration & dosage , Twins , Version, Fetal/methods , Adult , Female , Humans , Injections, Intravenous , Pregnancy
11.
Article in French | MEDLINE | ID: mdl-8463571

ABSTRACT

Pregnancy is an aggravating factor for brain tumours on which it acts by three mechanism: acceleration of tumour growth, increase of peritumoral oedema and the immunotolerance to foreign tissue antigens that is proper to pregnancy. Histologically, the brain tumour most frequently encountered is glioma, usually revealed during the third trimester. Brain tumours is pregnant women have no special clinical features, and their diagnosis rests on computerized tomography or nuclear magnetic resonance completed, if required, by stereotactic biopsy. Following a review of the literature, the authors present an updated description of the neurological and obstetrical actions to be taken, illustrated by a report of eight personal cases. The indications for surgery depend on the site and histological nature of the tumour. As regards obstetrical measures, induced therapeutic abortion and caesarean section, no longer routinely performed, are now being replaced by vaginal delivery with systematic instrumental extraction. In both mother and foetus the prognosis has improved over the last ten year, but it remains very sombre.


Subject(s)
Brain Neoplasms , Pregnancy Complications, Neoplastic , Adult , Astrocytoma/pathology , Brain Neoplasms/pathology , Cerebellar Neoplasms/pathology , Cerebral Aqueduct/pathology , Cesarean Section , Female , Frontal Lobe/pathology , Glioma/pathology , Hemangiosarcoma/pathology , Humans , Neuroblastoma/pathology , Pregnancy , Pregnancy Complications, Neoplastic/pathology , Pregnancy Outcome
12.
Article in French | MEDLINE | ID: mdl-8228015

ABSTRACT

The authors report a case of a patient who in the 24th week of a twin pregnancy became sero-positive for toxoplasmosis. This was diagnosed by cordocentesis as being infected, and the treatment was therefore started with pyrimethamine and sulfadiazine and folic acid at the 28th week of pregnancy. At 35 weeks, the patient had an acute medullary aplasia due to the absence of the folates. The mother's state was improved rapidly by giving her folinic acid and the twins were normal haematologically. In this case, the authors point out how important the folates are in a pregnancy, especially in twin pregnancies, and point out the precautions that have to be taken when treatment with pyrimethamine and sulfadiazine is started for congenital toxoplasmosis.


Subject(s)
Anemia, Aplastic/chemically induced , Folic Acid Deficiency/complications , Folic Acid/therapeutic use , Pregnancy Complications, Infectious/drug therapy , Pregnancy, Multiple , Pyrimethamine/adverse effects , Sulfadiazine/adverse effects , Toxoplasmosis/drug therapy , Adult , Anemia, Aplastic/blood , Anemia, Sideroblastic , Cordocentesis , Female , Folic Acid Deficiency/drug therapy , Humans , Leucovorin/pharmacology , Leucovorin/therapeutic use , Pregnancy , Pregnancy Complications, Infectious/blood , Pregnancy Trimester, Second , Pyrimethamine/pharmacology , Spiramycin/therapeutic use , Toxoplasmosis/blood , Toxoplasmosis/complications , Twins
13.
Article in French | MEDLINE | ID: mdl-8228021

ABSTRACT

There have only been thirty cases of total post-partum hypopituitarism published in the literature and these have nearly all been secondary to Sheehan's syndrome. The authors report a case of partial anterior hypopituitarism associated with diabetes insipidus which arose after an uneventful Caesarean operation and the origin of which seems to lie in auto-immune hypophysitis. The authors first describe the morphological and endocrine changes that the hypophysis undergoes during pregnancy and then point out that auto-immune hypophysitis seems to have been only recently recognised. This can be used to explain some cases of post-partum hypophyseal insufficiency occurring almost silently without any history of third haemorrhage. Research has been made systematically for anti-hypophyseal antibodies and for specific antibodies of the organ, but has not always been positive. So the diagnosis of auto-immune hypophysitis is often made only after eliminating other reasons for it. A brief review of the physiopathological mechanisms of diabetes insipidus makes it possible to suggest that vasopressinase coming from the placenta together with prostaglandins could play a role.


Subject(s)
Autoimmune Diseases , Diabetes Insipidus , Hypopituitarism , Puerperal Disorders , Adult , Autoimmune Diseases/complications , Autoimmune Diseases/diagnosis , Autoimmune Diseases/immunology , Autoimmune Diseases/physiopathology , Autoimmune Diseases/therapy , Cesarean Section , Cystinyl Aminopeptidase/physiology , Deamino Arginine Vasopressin/pharmacology , Deamino Arginine Vasopressin/therapeutic use , Diabetes Insipidus/complications , Diabetes Insipidus/diagnosis , Diabetes Insipidus/immunology , Diabetes Insipidus/physiopathology , Diabetes Insipidus/therapy , Diagnosis, Differential , Female , Humans , Hypopituitarism/complications , Hypopituitarism/diagnosis , Hypopituitarism/immunology , Hypopituitarism/physiopathology , Hypopituitarism/therapy , Magnetic Resonance Imaging , Pituitary Gland, Anterior , Pregnancy , Prostaglandins/physiology , Puerperal Disorders/complications , Puerperal Disorders/diagnosis , Puerperal Disorders/immunology , Puerperal Disorders/physiopathology , Puerperal Disorders/therapy
15.
Article in French | MEDLINE | ID: mdl-1491142

ABSTRACT

Haemorrhagic cerebral accidents are the commonest neurosurgical diagnoses made in pregnancy. The state of pregnancy makes it more likely that an arterial or an arteriovenous aneurysm will rupture and this is the principal cause of most haemorrhages. They occur more often in primiparae in the third trimester of pregnancy. The clinical picture is classical. The conformation of the diagnosis is made by scanning and angiography. The main differential diagnosis is eclampsia. Neurosurgical treatment should be carried out immediately whenever possible in order to avoid the two great risks that follow, namely recurrence of haemorrhage and secondly ischaemia. As far as the obstetric side is concerned, Caesarean section would only be indicated if: the clinical state of the mother is severe with coma and brain stem damage when the child is viable, if there is symptomatic vascular malformation diagnosed at term, if there is haemorrhagic arteriovenous malformation which is highly liable to occur and cannot be operated on without risks for the child if viable, if, finally, the interval between the surgical treatment of the condition and labour is less than 8 days. In all other cases a vaginal delivery is preferable under epidural anaesthetic which should be given if medical induction is carried out, and where instrumental delivery is being carried out systematically, unless radical treatment is being performed. The prognosis which is, in spite of all steps that may be taken, poor, depends on the initial neurosurgical stage and the nature of the causes of lesion and the possibilities of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Intracranial Aneurysm/diagnosis , Pregnancy Complications, Cardiovascular/diagnosis , Adult , Diagnosis, Differential , Female , Humans , Intracranial Aneurysm/epidemiology , Intracranial Aneurysm/surgery , Maternal Mortality , Pregnancy , Pregnancy Complications, Cardiovascular/epidemiology , Pregnancy Complications, Cardiovascular/surgery , Prognosis , Risk Factors
16.
Article in French | MEDLINE | ID: mdl-1491143

ABSTRACT

During pregnancy 50% of all cases with a ventriculo-peritoneal shunt malfunction. This is because of anatomo-physiological changes associated with the pregnant state, and shows itself as a rise in intracranial tension. There were no acute neurological complications at term; with the malfunction of the shunt distally, vaginal delivery is preferable. It is not necessary routinely to carry out instrumental delivery.


Subject(s)
Cerebrospinal Fluid Shunts/standards , Hydrocephalus/therapy , Pregnancy Complications/therapy , Adolescent , Diagnosis, Differential , Female , Humans , Hydrocephalus/diagnosis , Hydrocephalus/physiopathology , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/physiopathology , Pregnancy Outcome , Prognosis
17.
Ann Fr Anesth Reanim ; 10(3): 242-7, 1991.
Article in French | MEDLINE | ID: mdl-1906689

ABSTRACT

The anaesthetic management of pregnant women who suffered from systemic lupus erythematosus (SLE) was reviewed retrospectively. During the ten-year period studied, there were nineteen pregnancies in eighteen women (mean age 27 years) who had either SLE or an isolated lupus type anticoagulant (LAF). Four pregnancies were stopped before the third trimester, two spontaneously, and the other two because of the mother's condition. Of the fifteen remaining pregnancies, eight children were born with a weight less than 2,500 g. One child, birth weight 750 g, died after three days. None of the fourteen living children had neonatal lupus. Six epidural and twelve general anaesthetics were carried out for four abortions, nine Caesarian sections, and five deliveries. Epidural anaesthesia was often contraindicated by neurological and haemostatic complications of the SLE: recent meningitis, thrombocytopaenia, prolonged bleeding, anticoagulant therapy. In fact, management of SLE patients required extensive preanaesthetic clinical and paraclinical assessment, as all the systems may be involved in this condition; moreover, it may worsen during pregnancy (seven times in this series). The most frequent complications were cardiovascular, renal, and haematological. Possible intubation difficulties must also be looked for. A LAF was associated with a great number of venous thromboses. An isolated LAF does not contraindicate epidural anaesthesia, as long as there is no associated haemostatic defect, such as a thrombocytopaenia. Furthermore, the patient should not have had prolonged episodes of unexplained bleeding, or require anticoagulants. In the present series, epidural anaesthesia was contraindicated in three of the four patients with LAF. Finally, prevention of thromboembolism, postoperative infection and adrenal failure (in those patients with long-term steroid therapy) must be carried out.


Subject(s)
Anesthesia, Obstetrical/methods , Lupus Erythematosus, Systemic , Pregnancy Complications , Adult , Anesthesia, Epidural , Anesthesia, General , Blood Coagulation Factors/immunology , Blood Coagulation Factors/isolation & purification , Female , Humans , Intubation, Intratracheal , Lupus Coagulation Inhibitor , Lupus Erythematosus, Systemic/immunology , Postpartum Period , Pregnancy , Pregnancy Complications/immunology , Retrospective Studies , Risk Factors , Thromboembolism/prevention & control
SELECTION OF CITATIONS
SEARCH DETAIL
...