Predictive value of uterine Doppler waveform during pregnancies complicated by diabetes.

Diabetes, whether or not it is insulin deficient, is frequently associated with vascular complications during pregnancies. It is accepted nowadays that the uterine artery velocity waveform is predictive concerning pregnancy-induced hypertension (PIH) and its complications. It thus seemed interesting to analyse the predictivity of vascular complications of diabetes by using uterine artery velocity waveforms. We have thus explored 37 diabetic patients [group 1: insulin-deficient diabetes (IDD), n = 10; group 2: gestational IDD, n = 6; and gestational non-IDD, n = 21). We have found vascular complications for 10 patients, divided between all 2 groups: 2 pre-eclampsia, 2 fetal suffering before any labour, 2 cases of intra-uterine growth retardation (including a trisomy 18) and 5 PIH. The uterine artery velocimetry measurement has been found to be pathological 5 times, and always in patients who later developed vascular complications. Among this selected population and excluding the trisomy 18, the sensitivity is of 44.5%, the specificity of 100%, the positive predictive value of 100%, and the negative predictive value of 84.3%. If these results are confirmed, this examination could be an excellent marker of the vascular risk and thus would have its place during systematic survey of pregnancies complicated by diabetes.

[Deficiency in placental sulfatase. Description of a recent case]. / Déficit en sulfatase placentaire. Description d'un nouveau cas

Synthesis of oestrogens occurs, during the greater part of pregnancy, in the placenta starting with two fetal precursors: DHA-S and 16 OH DHA-S. In the case of a deficit in sulphatase, an enzyme which is mainly localised in the placenta, these precursors cannot be transformed so that the level of oestrogens stays very low, without the level of secretion of progesterone being altered. Faced with such hormonal abnormalities it is worth while remembering the diagnosis of placental enzyme deficiency. In fact, this abnormality has no repercussions on the progress of the pregnancy and carries no danger for the fetus. It is therefore unnecessary to carry out untimely treatments thinking: fetal distress or adrenal agenesis be it primary or secondary (due to anencephaly) will occur. The diagnosis depends on simple dynamic tests: the mother receives an injection of free DHA and DHA-S, and enzyme study of the placenta can be confirmed in vitro. There seems to be a link between this abnormality and the sex of the fetus. All cases were followed by the birth of a normal boy. Finally, placental suphatase deficiency is rare, but it would appear that increased usage of hormone levels will reveal a rising number of such cases.

[Variation in total and unbound plasma cortisol levels throughout labor in normal and anencephalic pregnancies]. / Etude des variations de la Cortisolémie totale et non-conjuguée au cours du travail, dans les grossesses normales et avec anencéphalie

Total and unbound plasma Cortisol levels have been evaluated throughout labour in women delivering normal and anencephalitic infants. The sharp increase in total Cortisol usually observed in maternal plasma during labour does not occur in women bearing an anencephalitic foetus. This Cortisol binding capacity of Transcortin being the same, both in the normal and the pathological groups, it is shown that in anencephaly, unconjugated Cortisol levels are also lowered. The maternal contribution to the plasma Cortisol increase being identical in all cases, our data suggest that in anencephaly, a lack of foetal contribution might be responsible for the low Cortisol levels observed throughout labour.

Delayed ovulation and monozygotic twinning.

Aiming to show that delayed ovulation may induce MZ twinning, follicular maturation was induced in the rabbit by a small quantity of Pregnant Mare Serum Gonadotropin (16 UI four times): coitus, which induces ovulation in the rabbit, was delayed 60 hours after the last injection. From the 387 blastocysts obtained after this treatment, 6 (1.5%) were pairs of MZ twins, twinning being otherwise exceptional in the rabbit. Other anomalies were shown by the embryos, apparently related to a deficient quality of the eggs: high embryonic mortality (62% vs. 27% in controls) and chromosomal anomalies (20%) such as trisomies, triploidies, and chimaeras. The relation between MZ twinning, chromosomal anomalies, and embryonic mortality induced by delayed ovulation, could be connected and related to the poor perinatal conditions frequently observed in human MZ twins.

[Pelvimetry (author's transl)]. / La pelvimétrie

A simple and precise technique for pelvimetry, delivering only a low dose of irradiation, is described. It includes the usual lateral view, but for the AP uses that of Fernstroëm. The technique and results are described.

[Cerebral damage in the full-term newborn infant. Causes and outcome]. / La souffrance cérébrale du nouveau-né à terme

Modern obstetrics can no longer be content to statistically analyse deaths only but must also concern itself with injuries. Cerebral damage in the new-born at term may result in grave sequelae. A study was made in the maternity department of the Port-Royal hospital of 65 infants, born at 38 weeks or later, with neurological signs, over the period 1968/69. The study was aimed at clarifying neonatal neurological signs, analysing the obstetric circumstances in which the complications occurred and observing future development of the children involved. In most instances a combination of neurological signs was present, falling into three broad clinical categories on the basis of severity. These neurological signs may appear during the hours after birth even when the Apgar score was satisfactory. Analysis of the cases showed that obstetric factors were responsible for the neurological disorder in 45 cases. The obstetric circumstances were almost always identical: abnormalities of presentation, dynamic problems during labour, and trials of labour. Modern methods for in-utero foetal surveillance are excellent but can nerve replace a perfect and hard won understanding of basic obstetric principles. Follow-up showed that sequelae remained in 7 children. It would appear, then, that in addition to "high risk" pregnancies, there exist "high risk" deliveries in part unpredictable before the onset of labour. There exists also a group of children in whom risk is increased and in whom surveillance over many years is indicated.