[Prevention of early-onset group B Streptococcus infections. 2. Efficiency of the ANAES guidelines]. / Prévention des infections maternof0etales à streptocoque B. 2. Efficacité des recommandations de l'Anaes.

OBJECTIVES: To examine the efficiency on early-onset neonatal infections of the ANAES guidelines for early-onset infections prophylaxis, based on a systematic prenatal vaginal swab aiming Group B Streptococcus and/or infection risk factors during delivery. PATIENTS AND METHODS: This is a retrospective cohort study of early-onset infections during a period of 28 months (6125 deliveries) compared to an earlier period (6141 deliveries). RESULTS: The number of newborns admitted for suspected infection and the rate of sepsis have been unchanged. But the total number of infections has decreased (1.50 vs 2.02 %, p=0,024), without increase of the number of infections due to other germs such as Escherichia coli. Furthermore, a strategy based only on risk factors would not have allowed the early screening and treatment of 23 Streptococcus B infected newborns. CONCLUSION: We have proved the efficiency of the protocol in terms of prevention of early-onset infections. However, it has led to a dramatic increase in the consumption of antibiotics, which is worrying concerning maternal and neonatal bacterial ecology.

[Prevention of early-onset group B Streptococcus infections. 1. Application of the ANAES guidelines]. / Prévention des infections maternofœtales à streptocoque B. 1. Application des recommandations de l'Anaes.

OBJECTIVES: To examine adherence to the Anaes guidelines for early-onset infections prophylaxis, based on a systematic prenatal vaginal swab aiming group B Streptococcus and/or infection risk factors during delivery. PATIENTS AND METHODS: Retrospective study of 6125 consecutive deliveries through a 28-month period. Data were collected from the patients files recorded in a computer database. RESULTS: Overall, a vaginal swab was performed on 88.3% of the patients. Among these, 79.1% were performed according to the guidelines. Among the patients, 90.2% with a positive swab received intrapartum antibiotics. In accordance to the national guidelines, we noticed a 40% increase in the consumption of antibiotics, without any severe complication during the study. Certain points must be improved though: time of the sampling, antibiotic therapy in case of quick delivery, management of patients with allergy to penicillin. CONCLUSION: Concordance with the national guidelines is feasible in a department with a high obstetrical activity.

[Atypical abdominal pain in the first trimester of pregnancy]. / Douleurs abdominales atypiques au premier trimestre de la grossesse.

We report the case of a 22-year-old woman who presented a violent epigastric pain at eight-weeks gestation. Superior mesenteric vein thrombosis was detected, with an extension to portal vein and remaining blood flow. Screening for thrombophilia revealed a heterozygote prothrombin gene mutation. Portal vein thrombosis is uncommon and difficult to diagnose. Diagnosis is made by Doppler ultrasound, a second intention test to be done in case of unusual upper abdominal pain during pregnancy.

[Magnesium sulphate and severe preeclampsia: its use in current practice]. / Sulfate de magnésium et pré-éclampsie sévère. Innocuité en pratique courante dans des indications ciblées.

OBJECTIVE: To evaluate indications, mode of administration and safety of magnesium sulphate in severe preeclampsia. MATERIAL AND METHODS: We conducted a retrospective descriptive study from January 2000 to December 2002, including patients with severe preeclampsia which was defined as elevated blood pressure >or=140 and/or 90 mmHg with proteinuria >or=0.3g per day, associated with one or more of the following: elevated blood pressure >or=170 and/or 110 mmHg, proteinuria>3g per day, functional symptoms such as headache, hyperreflexia, oliguria<500 ml per day, thrombocytopenia, creatinine level>100 micromol/l, HELLP syndrome. We studied a group of 57 women treated by magnesium sulphate (intravenous bolus of 4.5g during 20 minutes followed by a perfusion of 1.5g/h) associated or not with an antihypertensive treatment. RESULTS: Treatment by magnesium sulphate was started antenatally in 53 women or during immediate postpartum in 4, associated (n=25) or not (n=32) with an antihypertensive treatment. Hyperreflexia was the main indication to start magnesium sulphate treatment (75%). About half (47%) of the cases occurred before 33 weeks of gestation No eclampsia occurred in this group. There was one overdosage which regressed when perfusion was stopped. One patient presented minor side effects attributed to magnesium sulphate. CONCLUSION: Providing a rigorous protocol, indications of magnesium sulfate therapy in severe preeclampsia are well defined. It seems that this treatment could be easily used without severe complications and major side effects.