[Artificially induced labor. Experience of the maternity unit of the Besançon teaching hospital]. / Le déclenchement artificiel du travail. Expérience de la maternité du CHU de Besançon.

The authors describe 190 cases in which labor was artificially induced between 29 and 42 weeks. They compare different methods (120 induced by oxytocin-like agents, 70 by prostaglandins) in some cases associated with mechanical methods. Various parameters were investigated, notably the Bishop score at the time labor was induced, the method of delivery and the impact on the offspring of these techniques.

[Tocokinetics of infected newborn infants]. / Tococinétique des nouveau-nés infectés.

The diagnosis of fetal infection, other than in association with premature rupture of the membranes, requires the evaluation of various parameters. Children suspected are four to five times greater in number than those truly threatened. A new and important parameter has emerged as a result of tocokinetic investigation: in one case out of two 48 hours before birth and in three cases out of four during the day before birth, fetal motility, together with cardiac reactivity or not, appear to be very markedly decreased when the newborn will in fact be found to be infected. Tocokinetic study is thus a new source of help in the obstetric/pediatric decisions which must be taken in this context.

[Update on delayed births]. / Mise au point sur la naissance différée.

Sixteen (16) cases of delayed births have been reported in the literature. All of these patients obtained at least one live child. This method can, therefore, be suggested in cases of premature birth after less than 28 weeks of amenorrhea for patients who present with a multiple, pluriamniotic pregnancy.

[Influence of the initial treatment of endometriosis and results obtained by in-vitro fertilization]. / Influence du traitement initial de l'endométriose et résultats obtenus en fécondation in vitro.

The authors have investigated the results obtained by in-vitro fertilization in cases of pelvic endometriosis. Fifty-eight (58) stimulation cycles have been analyzed in function of the previous curative treatment, which may have been a combine medico-surgical treatment or a conventional surgical treatment. Six pregnancies which progressed to full term were achieved in the 8 patients who had previously received medico-surgical treatment. Twenty punctures were performed. In patients who received an initial medical treatment, there were no pregnancies carried to full term and three clinical terminations of pregnancy for a total of 15 punctures. A celioscopy check-up revealed persistent endometriosis in 10 of the patients involved. No clinical pregnancy was observed following primary surgical treatment. In all these cases, there were lesions affecting the ovary and the numbers of ovocytes and embryos were significantly reduced.

[Telephonic surveillance of pregnant women at risk of premature labor after hospitalization]. / Surveillance téléphonique des gestantes après hospitalisation pour menace d'accouchement prématuré.

Manual evaluation of uterine contractility through the abdominal wall performed twice a day for 1 hour and reported by telephone every other day keeps pregnant women at risk of premature labour in a state of continual attention. When the women are disciplined, the recommendations, prescriptions and encouragements they receive in return result in a statistically significant reduction in the number of premature deliveries. More generally, this new and relatively inexpensive method leads to substantial savings. Such were the results obtained by comparing the courses of 2 series of pregnancies after hospitalization for the indispensable intravenous tocolysis.

[Antenatal diagnosis of achondrogenesis. Two successive cases in the same family]. / Diagnostic anténatal de l'achondrogenèse. A propos de deux cas successifs dans une même fratrie.

Achondrogenesis is a rare case of fetal skeletal dysplasia. Achondrogenesis in lethal. That is a autosomal recessive fetal skeletal dysplasia. There is a very important dwarfism with extreme micromely, macrocephalia and brevity of chest. The authors enumerate the echographics, radiologics and histologics symptoms of this chondro-dysplasia. The authors comment rapidly the others diagnosis of lethal fetal skeletal dysplasia. Genetic consul is a necessity.

[Neonatal alloimmune thrombocytopenia following immunization against the platelet antigen ZWA (PLA/1). 3 case reports in the same family and analysis of the literature]. / Les thrombopénies néonatales allo-immunes par immunisation contre l'antigène plaquettaire ZWA (PLA/1). A propos de trois cas d'une même famille et analyse de la littérature.

Allo-immune neonatal thrombopenia is to platelets what rhesus hemolytic disease is to red blood cells. There is a risk of haemorrhage when fetal platelets decreases below 50,000 per mm3. Such haemorrhage may occur at any time during the thrombopenia period. However they are mostly due to obstetrical traumatisms during delivery. Lethal complications and severe neurologic sequellae is estimated to affect about 30% of newborns: 1/3 these complications occur in utero and 2/3 during delivery. The authors have studied 3 familial cases of foeto-maternal allo-immunisation occurring with the PLA 1 system. They have made a briefing of the physiological, the pathological and the epidemiological aspects of such immunisation before insisting upon case findings of such affected fetus. A capillary blood sample taken from the scalp of the fetus at the beginning of labour allows a safe natural delivery if fetal blood count shows more than 50,000 platelets per mm3. A fetal blood sampling under ultrasonographic guidance will bring about to an early diagnosis and prognosis, this allowing an adequate treatment for fetus with a high risk of thrombopenia.

[Birth delayed by 23 days after premature delivery in a triplet pregnancy obtained by in vitro fertilization]. / Naissance différée de 23 jours après un accouchement prématuré sur une grossesse triple obtenue par fécondation in vitro.

At 26 weeks' gestation, the patient gave birth to 2 premature infants who did not survive. Following this delivery, under general anaesthesia and infusions of tocolytic drugs and antibiotics the uterus was washed with Ringer's lactate solution and cerclage of the cervix was performed after ligation and section of the two umbilical cord flush with the cervix. The "second delivery" was delayed by 3 weeks; the child weighed 1,150 grams at birth and survived. Six similar cases (including ours) have been published, and in each of them one living child was obtained. The above technique can therefore be recommended, in case of premature delivery before 28 weeks of gestation, for women with multiple pluriamniotic pregnancy.

[Significance of periods of fetal hyperactivity and hypoactivity at the end of pregnancy as demonstrated by tococinon. New series]. / Signification des périodes d'hyperactivité et d'hypoactivité foetales en fin de grossesse objectivées par le tococinon. Nouvelle série.

The objective study of fetal movements, using tococinon, enables to simplify the monitoring of high risk pregnancies. If the fetal activity is normal, no abnormality is noticed. On the contrary, in pregnancies where the fetus is threatened, there is always a fetal hyper or hypo-activity. Hyperactivity requires a thorough sonogram to look for a fetal malformation. Hypo-activity requires an increased surveillance which enables to rule out transient abnormalities and permits to diagnose permanent and pathological abnormalities which must be treated rapidly.

[Accelerations of the fetal cardiac rhythm and fetal movements. Significance of their association recorded on the cardiotocogram by the Tococinon]. / Accélérations du rythme cardiaque foetal et mouvements foetaux. Signification de leur association marquée sur le cardiotocogramme par le tococinon.

Recording all fetal movements on the cardiotocogram using tococinon showing forty minutes observations adds a new dimension to the old and new methods of monitoring the fetus. A group of 53 pregnancies without any risk was compared to a group of 37 pregnancies of high risk in which were also found sub-groups as designated by the aetiology and the severity of the fetal risk. Furthermore we have carried out a longterm study of 5 cases over six days. We propose a choice of the best parameters to be used according to their reliability, accuracy, sensitivity and predictability. The number of accelerations that coincided with the movements that were recorded was not very reliable or sensitive but it was accurate enough and predictive. The number of movements that accompanied the accelerations when added to the overall activity did become precise and predictive. Adding the two together make it more accurate and sensitive. New methods of monitoring are suggested, and these appear to be more simple and more efficient.

[Recording of fetal movements during pregnancy. Aid to the diagnosis and prognosis ascertained by Tococinon]. / Le recensement des mouvements foetaux au cours de la grossesse. Aide au diagnostic et perspectives offertes par le tococinon.

Objective recording of fetal movements has become operational since the use of the tococinon. At the beginning of pregnancy, from the twelfth week of amenorrhoea onwards, aberrant values seem to be linked to several factors such as mother's anxiety, urinary infection and anesthesia. If they are repeated that suggests there are abnormalities, such as trisomies or malformations in the central nervous system, and implies that other diagnostic methods must be used to make the diagnosis such as ultrasound or amniocentesis. A new definition for lowered activity by the fetus is proposed for the end of pregnancy. If these recordings are repeated before or at the same time as other signs of fetal distress have been found we must think of pathological features such as intrauterine growth retardation, post-maturity, infections, rhesus incompatibility and diabetes. Pharmacological influences, too, have to be thought of and they are usually correlated with rises in the fetal pulse rate and with using the apparatus when the patient is walking about.

[Fetal motor activity]. / L'activité motrice du foetus.

The authors propose a physiological classification of foetal motor activity. The methods of analysis of the play activity of the foetus are evaluated. The authors stress the enormous gap between the richness of foetal semiology and the poverty of the clinical deductions at the beginning and at the end of pregnancy. A simple and reliable system between the useless complexity of ultrasonography and the unreliability of subjective analysis is essential.