[Amniotic infection and neonatal bacterial infection. Search for clinical and bacterial predictive arguments]. / De l'infection amniotique à l'infection bactérienne néonatale. Recherche d'arguments cliniques et bactériologiques prédictifs.

Amniotic fluid infection and its principal sequel bacterial infection of the newborn are major problems in obstetric pathology. The authors hav analysed prospectively 346 obstetrical casenotes over a period of 18 months in order to try to describe and specify the clinical features and to try and work out using bacteriological tests the risk of infecting the neonate by materno-fetal transmission. They compared a control group (27 case histories) and the group at risk (235 cases). 4% of the control group and 18.7% of the "at risk" group were biologically infected (p less than 10(-2)). The following are among the classical clinical criteria to correlate this risk: maternal pyrexia, premature delivery, urinary tract infections and fetal distress; an apparent lessening in active fetal movements is also well correlated to the risk of infection. The bacteriological criteria are: the presence of quantities of altered polymorphonuclear cells in the amniotic fluid--this seems to be more important than others (sensitivity = 70%, specificity = 89%, but positive predictive value = 60% and negative predictive value = 93%). From this study it should be possible to work out antenatally whether the newborn baby will be at high risk of developing an infection in order to consider giving antibiotics to prevent materno-fetal transmission.

[Ultrasonic prenatal diagnosis of lip and palate cleft. Report of 10 cases]. / Diagnostic échographique anténatal des fentes labiales et labio-palatines. A propos de 10 observations.

Hare-lips and cleft palates are the most frequent manifestations of facial malformations (approximately 1 in 1,000 deliveries). The authors point out their technique for ultrasound assessment of the normal and pathological fetal face in the antenatal period. The antenatal examination gives an excellent diagnostic approach of the site and the nature and the extent of the abnormality. The screening for facial defects can be carried out routinely when studying the morphology in the second trimester of pregnancy or when there are other indications for doing this. Although the malformation is usually an isolated one, the management of these cases really depends mainly on any associated malformations than on the normality of the karyotype.

[Evaluation of fetal lung maturity with the measurement of enzymatic activities in amniotic fluid: comparison of three ratios]. / Evaluation de la maturité pulmonaire foetale par la mesure d'activités enzymatiques du liquide amniotique: comparaison de trois rapports.

Measurement, in amniotic fluid, of gamma-glutamyl-transferase (GGT) alkaline phosphatase and of thermostable and thermolabile (TLAP) isoenzyme allows to anticipate the unexpected risk of hyaline membrane disease. ROC method adapted to three ratio of these enzymatic activities shows that TLAP/GGT is the most performant at the level of 0.9 with a sensitivity of 96% and a specificity of 60%.

[Value of amniotic gamma-glutamyl-transpeptidase assay in the diagnosis of fetal digestive stenosis after 24 weeks of amenorrhea]. / Intérêt du dosage de la gamma-glutamyl-transpeptidase amniotique dans le diagnostic des sténoses digestives foetales après 24 semaines d'aménorrhée.

In 18 women compared with 1,181 controls, foetal digestive tract stenoses were discriminated, independently of the gestational age, by a more than 50 IU/l level of gamma-glutamyl transpeptidase in the amniotic fluid. This test had a specificity of 99% and a sensitivity of 85% which was accounted for by the inclusion in the study of distal stenoses and oesophageal atresias, all conditions where the gamma-glutamyl transpeptidase level is normal. In cases with ultrasonically detected abdominal wall abnormalities, this test is also useful in the diagnosis of subjacent digestive tract stenosis.

[HELLP syndrome. Apropos of a series of 9 cases without disseminated intravascular coagulation]. / Le Hellp syndrome. A propos d'une série de 9 observations sans coagulation intravasculaire disséminée.

The Hellp syndrome defined as the association of micro-angiopathic haemolytic anemia, hepatic cytolysis and thrombocytopenia, correspond to a severe form of gravidic toxemia, combined to manifestations of classic-pre-eclampsia. This retrospective study, conducted over 6 years, concerns 9 cases of Hellp syndrome, including 2 occurring during the immediate post-partum. Only cases where this biological triad was obvious and not associated with manifestations of disseminated intravascular coagulation, were considered in this study. In addition to the usual criteria of gravidic toxemia, the early clinical manifestation occur, in this study, between 28 and 38 weeks of amenorrhea and gastrointestinal manifestations are predominant. The physiopathogenic hypotheses of this syndrome remain variable and management varies depending on the authors. Treatment is that of pre-eclampsia. Medical treatments (steroids, heparin, immunosuppressants,...) are discussed, but severe feto-maternal complications require, most of the time, a surgical approach, depending on the number of pregnancies, the obstetrical conditions, the stage of the pregnancy and the severity of the syndrome.

[Contribution of pelvic echography to the diagnosis of malformations of the utero-vaginal tract]. / Apport de l'échographie pelvienne au diagnostic des malformations du tractus utéro-vaginal.

Pelvic ultrasound has become very important in the diagnostic planning of utero-vaginal malformations. Having studies 93 congenital malformations of the utero-vaginal tract, the authors used ultrasound investigations as a first or second line of approach. They are able to describe the way ultrasound can be used for each type of malformation. Ultrasound is undeniably reliable for diagnosing bilateral incomplete aplasia of the uterus; so avoiding the need for laparoscopy. When failure of the uterus to develop on one side occurs it is possible to look for a closed or canalized rudimentary uterine nodule to confirm the diagnosis of a pseudo-unicorn uterus. The diagnosis by ultrasound of a bifid uterus shows up by the appearance of a "V" shape on the bladder. An intra-uterine septum can be diagnosed according to how serious the embryological abnormality is on ultrasound. Similarly the difference between a bicornuate uterus that is really just arcuate or partially septate cannot always be made with ultrasound because the embryological defect is a relatively minor one. Ultrasound examination is able to give a lot of information in diagnosing and calculating how much of the menstrual fluid is held back either on one side or completely. Its value is less when the two sides of the uterus communicate with one another. Although this way of examining patients may make it possible quite often to avoid carrying out hysterosalpingogram and laparoscopy, its greatest value is found when all methods of diagnosis are combined and interpreted in the context of a clinical situation.

[Children of hyper- and hypothyroid mothers]. / Les enfants des mères hyper et hypothyroïdiennes.

A multicenter study was able to utilize 120 medical files of children born from mothers who presented an abnormal thyroid function, 67 euthyroid goiters, 29 hyperthyroidisms, and 24 hypothyroidisms. In the first case, whether or not an inhibiting treatment was initiated, all children were perfectly normal. In case of maternal hyperthyroidism, the risk of malformations is not increased, deaths in utero and mostly in utero growth delays (1 case in 2) are more frequent. At birth, the child may present a hyperthyroidism due to the effect of SAT with elevated TSH and a goiter, sometimes compressing and impairing breathing, or also a hyperthyroidism due to transplacental crossing of stimulating immunoglobulins with possibility of thyreotoxic crises and heart failure. The diagnosis could be made in utero in the presence of tachycardia or with T4 and TSH assays in the cord. In case of maternal hypothyroidism, usually the children have no problems and the risk of neonatal hypothyroidism is mostly present in premature infants if the maternal balance is poor (2 in 24 cases in our series). Finally, in the reference population, the risk of neonatal hypothyroidism remains 1 in 3600 and justifies systematic screening on the 5th day of life.

[Dysthyroidism and fertility]. / Dysthyroïdies et fertilité.

The role of the thyroid gland in sterility is not well known; hyperthyroidism may have an effect upon estrogen secretion by decreasing the level of the free forms of estradiol, resulting in a lowering or disappearance of the LH ovulatory peak. Clinically, severe hypothyroidism would cause a retarded sexual development but simple hypothyroidism and hyperthyroidism do not seem to have a major effect upon sexual maturity. During the period of genital activity, hyperthyroidism may result in amenorrhea and dysovulation phenomena reminding of ovarian dystrophy; hypothyroidism results in the same phenomena, with decreased libido, but with a better screening process and a better adjusted substitute treatment, these disorders are rare. Finally, systematic evaluation of the thyroid function in unexplained sterilities, appears unnecessary most of the time.

[Communicating uteri. Study and review of the literature. Apropos of 11 cases]. / Les utérus communicants. Etude et revue de la littérature. A propos de 11 cas.

The authors are reporting 11 communicating uteri's cases. This class of uterine malformation present 1 a 2% of the malformation. They report Musset's classification and Toaff too. The Musset's type 2 is more frequent. After a summary of diagnostic, the authors describe the treatment during and outside the pregnancy.