[Unusual behavior of serum markers in risk evaluation for trisomy 21]. / Comportements particuliers des marqueurs sériques d'évaluation du risque de trisomie 21.

Screening of Down syndrome using serum markers is based on statistic risk determination calculated from the results of markers. An increased risk of fetal Down syndrome is associated with high hCG levels and low AFP levels in maternal serum. In the daily practice, the use of these two markers also leads to observation of different analytical patterns. We reviewed these patterns according to published data and our own experience. Some patterns are well documented (neural tube defects or trisomy 18) some of them remain unexplored. Numerous difficulties are encountered in the clinical use of these markers patterns: lack of consensus for their analytical definition, problems in interpretation, lack of regular dispositions.

Comparative study of three vaginal markers of the premature rupture of membranes. Insulin like growth factor binding protein 1 diamine-oxidase pH.

OBJECTIVE: To assess the diagnostic value of three vaginal markers-insulin-like growth factor binding protein 1 (= IGFBP1), diamine-oxidase (= DAO) and pH-for diagnosis of the premature rupture of membranes. STUDY: One hundred pregnant women participated in the study. They were divided into three groups: group A (34 cases with intact membranes), group B (35 cases with total rupture of the membranes), group C (31 cases of suspected rupture of the membranes). Each patient underwent three successive tests for each of the three markers. The test order was allocated at random. For pH the reaction is colorimetric, for DAO the reaction is radio-enzymatic and for IGFBP1 the reaction is immuno-chromatographic. All three reactions are qualitative in nature. The parameters studied were conventional statistical parameters (sensitivity = SN, specificity = SP, positive predictive value = PPV and negative predictive value = NPV). RESULTS: The analysis of the statistics gave the following results in percentages for SN, SP, PPV and NPV respectively; pH: 90.7%, 77.2%, 75%, 91.7%. DAO: 83.7%, 100%, 100%, 89%. IGFBP1: 95.3%, 98.2%, 97.6%, 96.5%. CONCLUSION: The determination of variations in pH is not satisfactory. IGFBP1 is at least better than DAO with, additionally, advantages of rapidity and simplicity.

[Ascites with "activated" lymphocytes in a case of hydrops fetalis related to a parvovirus B19 infection]. / Ascite avec lymphocytes "activés" dans un cas d'anasarque foetale liée à une infection par le parvovirus B19.

A case of non immunologic hydrops fetalis associated with parvovirus B19 infection is reported. Viral etiology was suspected by the pattern of overstimulated lymphocytes in fetal ascites and confirmed later by identification of parvovirus B19 by PCR. The cytologic finding center helps the precocious diagnosis.

Micro-albuminuria analysis and pregnancy. An approach to detect placentary insufficiency?

OBJECTIVE: To assess the value of micro-albuminuria analysis (MA) in predicting clinical complications of placentary insufficiency in women with no known risk factor. STUDY DESIGN: A blind prospective investigation 20-24 weeks into pregnancy in a nulliparous population with no known risk factor. A reactive strip with a positive threshold value of 10 mg/l is used to detect MA. Judgment criteria concerning the progress of pregnancy are based on blood pressure during the 8th and 9th month of pregnancy and on the 2nd day after delivery, on albuminuria analysis in the 8th and 9th month of pregnancy and by the existence of fetal hypotrophia at birth. RESULTS: Some 218 patients participated in the investigation. MA was positive in 62 cases (28.4%). Of the 197 births which occurred 54 (27.4%) cases of positive MA, 34 (17.2%) cases presented positive judgment criteria indicating placentary insufficiency. The 21 others pregnancies are in course. MA sensitivity was thus 79.4% and specificity 83.4%. Negative predictive value (NPV) was 95.1% and positive predictive value (PPV) 50%. CONCLUSION: Our test is a reliable, simple and easily reproducible indicator of micro-albuminuria. In comparison with other tests it gives a good detection rate of a risk group for complication of placentary insufficiency. NPV is excellent, virtually excluding the occurrence of excessive blood pressure or intra-uterine growth retardation. PPV is less good.

Transvaginal ultrasound studies of vascular and morphological changes in uteri exposed to diethylstilbestrol in utero.

The aim of this prospective study was to establish complementary data of uteri exposed to diethylstilbestrol (DES) in utero for transvaginal analysis and vascularity changes during the menstrual cycle. A total of 28 women with DES-exposed uteri were compared with 60 non-exposed women. Transvaginal ultrasound and colour Doppler imaging were performed on days 5 and 22 of the menstrual cycle. Uteri were measured on sagittal and transverse scans. Uterine length, width, thickness and uterine cavity length and width were measured. Uterine volume and uterine cavity area were calculated. DES-exposed uterine volume was equal to 31.84 +/- 3.37 cm3. The cavity area of DES-exposed uterus was equal to 35.85 +/- 3.93 cm2. Cervix length of DES-exposed uterus was significantly smaller than that of non-exposed uterus. The uterine artery pulsatility index (PI) of DES-exposed uterus was significantly higher than that of normal uterus. Blood flow remained stable throughout the menstrual cycle. The PI of DES-exposed uterus remained stable during the menstrual cycle, as in non-exposed uterus, and it decreased during the luteal phase. This lack of modification in vascularity of DES-exposed uterus may explain miscarriages and obstetric complications such as intrauterine growth retardation or pre-eclampsia. The data may have implications for the assessment of reproductive status and the design of future studies on disorders of implantation in DES-exposed uterus.

Comparative study of three amniotic fluid markers in premature rupture of membranes: fetal fibronectin, alpha-fetoprotein, diamino-oxydase.

BACKGROUND: To study the comparative diagnostic value in premature rupture of membranes (PRM) of three amniotic components: fetal fibronectin (fFN), alphafetoprotein (AFP), diamino-oxydase (DAO). METHODS: 131 pregnant women took part in our prospective study. Three samples were obtained successively for each patient in a random order. Two clinical situations were studied: group A of 68 women with clinical certain PRM and group B of 63 women with a highly unlikely PRM. RESULTS: fFN is the best marker for diagnosis of PRM (sensitivity of 94% and specificity of 97%). AFP and DAO are complementary: the NPV is greater for AFP (87% against 84%) whereas the PPV is greater for DAO (95% against 86%). CONCLUSION: Apart from its value in predicting premature labor, vaginal fFN represents a diagnostic test of PRM with good specificity and sensitivity.

Diagnosis of premature rupture of the membranes by the identification of alpha-feto-protein in vaginal secretions.

Premature rupture of membranes (PROM) is sometimes difficult to diagnose. This report proposes the use of alpha-feto-protein (AFP) values in vaginal secretions for diagnostic tests. Our investigation took place in two separate phases. The first phase validated the AFP test using an immuno-enzymatic assay method and determined a threshold value from a sample of 167 female patients (Group 1: 133 patients with an extremely low probability of PROM, and Group 2: 54 patients with confirmed PROM). In the second phase the test was applied to a sample of 145 female patients (Group 3) with suspected, but unconfirmed, PROM. Results from alpha-feto-protein (AFP) evaluation were compared with data obtained from clinical, echographic and other tests. The positive/negative threshold adopted was an AFP concentration of 30 micrograms/l. For the two first groups, 1 and 2, sensitivity and specificity was in the 98% to 99% confidence level. For Group 3, sensitivity and specificity results at the 30 micrograms/l threshold value were 94.5% and 95.4% respectively. Quantitative measurement of AFP determined by immuno-enzymatic assay of vaginal secretions with a threshold of 30 micrograms/l is a reliable, simple and rapid diagnostic test. Results obtained are significantly better than the measurement of pH, the determination of prolactin, and more practical than diamino-oxidase (DAO) assays.

[Electrophoresis of cholinesterases of the cerebrospinal fluid in the Guillain-Barré syndrome]. / Electrophorèse des cholinestérases du liquide céphalorachidien dans le syndrome de Guillain-Barré.

Polyacrylamide gel electrophoresis of cholinesterase from cerebrospinal fluid was performed in 22 patients with Guillain-Barré syndrome. Fifteen of these patients had an abnormal cerebrospinal fluid with emergence of a second electrophoretic migration band corresponding to non-specific cholinesterase. Among 182 patients with a variety of diseases who served as controls, only one presented with this abnormality. From these data the sensitivity and specificity of cerebrospinal fluid cholinesterase electrophoresis were calculated at 68 and 99 percent respectively. The second migration band seems to appear early in the course of the disease and disappears when the patient is cured. Moreover, the occurrence of this band is correlated with the severity of the condition, as shown by a greater number of patients under artificial ventilation and by a longer stay in intensive care unit. Cerebrospinal fluid electrophoresis could be used as a prognosis factor.

[Level of alpha-fetoprotein in maternal serum before and after chorionic villus sampling]. / Taux d'alpha-foetoprotéine du sérum maternel avant et après ponction de villosités choriales.

To evaluate incidence and severity of feto-maternal transfusion post-chorionic villus sampling (CVS), maternal serum AFP (MSAFP) were determined for 88 patients before and 15 minutes after CVS. To know whether MSAFP elevation could have clinical implications, a questionnaire was sent to the patients researching if they have had haemorrhages, temperature, spontaneous abortion or premature delivery in the period post CVS. Results of the present study indicate that 44.7% of patients present MSAFP significative elevation (greater than or equal to 8 micrograms/l), a variable elevation (from 8 to 423 micrograms/l). There is no relation between MSAFP elevation and unfavourable events post CVS.

[Results of pregnancies characterized by a decrease in the level of alpha-fetoprotein in the maternal blood]. / Suivi de grossesses caractérisées par une diminution du taux d'alpha-foetoprotéine dans le sang maternel.

Pregnancy outcome was followed in 123 women showing maternal serum alpha-fetoprotein, less than or equal to 0.50 MOM. In 28 cases AFP was secondarily considered as normal either after ultrasonography and correction of gestation age or after a second sample normal result. In 95 cases AFP level was confirmed lowered; perinatal outcome was normal in 70 cases and abnormal in 25. Among these 25 cases, 3 autosomal trisomies occurred, 2 trisomies 18 and 1 trisomy 21; in the 22 other cases, we observed antepartum risk factors (10 cases with impending premature labor or premature labor, 9 cases with chronic hypertension, 2 cases with Ag HBs hepatitis and 1 case with diabetes).

[Biochemical markers of neural tube closure defects during the second half of pregnancy]. / Les marqueurs biochimiques des défauts de fermeture du tube neural au cours de la deuxième moitié de la grossesse.

Increasing number of amniocentesis done during the second half of gestation with indication "signe d'appel" made necessary for authors to study amniotic fluid markers in late pregnancy. Normal evolution curve must be established with samples obtained after 20 weeks gestation. Study reveals more false-negative results with AFP than before 20 weeks. AChE remains constantly positive in cases with NTD, band aspect being specific. For other malformations, AChE positivity seems inconstant, with a different aspect. Some normal gestation cases can be associated with faint AChE band.

[Alpha-fetoprotein and trisomy 21]. / Alpha-foetoprotéine et trisomie 21.

In 31 affected pregnancies with Down syndrome, the median maternal serum alpha-fetoprotein value was lower than normal, 0.76 MoM, and median amniotic fluid value was quite normal, 0.98 MoM. Selecting an arbitrary cutoff-point of 0.5 MoM, 4.1 percent of normal gestations show values less than 0.5 MoM. Authors discuss problems about screening for fetal Down's syndrome by measuring maternal serum AFP levels.