[Pregnancy toxemia. Review and management]. / La maladie gravidique. Essai de synthèse et conduite à tenir.

The author reviews the literature on pre-eclamptic toxaemia, and seeks to ascertain established pathophysiological facts. He points out that the diversity of names used by different authors and in different countries all cover a specific pathological entity, in pregnancy in the human. He looks at causes that may be considered specifically human: the upright position with consequences for the blood circulation, food eaten without regard to the woman's needs, stress factors due to the environment and also to imagination. He considers the relationship between the trophoblast and the maternal body which is specific to pregnancy. From these considerations he describes a synthesis of pathophysiological conditions which give to this specific human disease of pregnancy: One cause: the presence of trophoblasts. Two centres of activity: intravenous disseminated coagulation and platelet activity. Three syndromes: haemodynamic, vascular and renal. Four cardinal signs: albuminuria, raised blood pressure, oedema, hyperuricaemia. Five areas to which prophylaxis, prevention and treatment can be directed: hypovolaemia, hypoalbuminaemia, vasoconstriction, platelet activity, presence of trophoblastic tissue. He suggests a possible sequence for prophylaxis, prevention and treatment to be worked out from these features.

[Obstetrical mechanics. Intermediate stage and childbirth stage]. / Mécanique obstétricale. Phase intermédiaire et phase d'enfantement.

It is possible to divide the classical second stage of labour--the stage of expulsion--into two different anatomical and functional parts. The one phase is the intermediate phase where dilatation of the cervix is almost complete and where there is an instinctive reflex that delivery is going to take place and this is very strong, and this is what starts off the oscillation (contra-nutation) of the sacrum and full engagement. Then there is the phase of the delivery itself where the sacrum must slide and rotate, and which cannot be accomplished without perineal relaxation. The utero-sacral ligaments demonstrate at the end of pregnancy and in early labour that they are the true tendons into which the back of the gravid uterus is inserted. They take part in the oscillation of the sacrum. Low backache that occurs at the end of pregnancy and in labour is due to strong tension on the utero-sacral ligaments, when it is difficult for the head to engage, and can only be relieved when the pelvis tips forward. When delivery is taking place it is important to be rid of all expulsive efforts that may cause contraction of the anterior part of the pelvis.

[Variations of the coefficient of glucose assimilation in normal pregnancy]. / Les variations du coefficient d'assimilation glucidique au cours de la grossesse normale.

Three hundred eleven intravenous glucose tolerance tests were performed in normal pregnant women between the 8th and the 40th week, and compared with similar tests performed in two groups of non-pregnant women, one group on oral contraceptives, the other not. There was a relative improvement in glucose tolerance at the beginning of pregnancy followed by marked loss of tolerance after the 24th week. This evolution is due to the physiologic adaptation of the maternal pancreas to fetal and placental metabolism. The range of normality for the glucose disappearance rate differs before and after the 24th week of pregnancy, and this must be recognised in setting diagnostic criteria for gestational diabetes. Consideration of simultaneous studies of glucose tolerance and insulin secretion at various periods of pregnancy suggests that changes in K value are more closely correlated with variations in peripheral insulin effects than with changes in insulin secretory function of the maternal pancreas.

[Comparative study of oral and intravenous glucose tolerance test during pregnancy (author's transl)]. / L'hyperglycémie provoquée par voie orale et l'hyperglycémie provoquée par voie intraveineuse au cours de la grossesse: étude comparative.

The glucose tolerance has been studied in 140 non diabetic pregnant women by successively oral and intravenous glucose tolerance test, as described respectively by O'Sullivan and Conard. The results of both tests are grossly similiar, and are affected on the same way by the evolution of the pregnancy. The intravenous glucose tolerance test is the easiest and the most reproducible; however some extra diabetic factors can interfere and mainly this test is not sensitive enough to discriminate between the pathologic and borderline situations. For all these reasons the intravenous glucose tolerance test can be used as a screening test for diabetes mellitus during pregnancy. The oral glucose tolerance test is necessary only when the K value is abnormal or subnormal.

[The oral glucose tolerance test during normal pregnancy (author's transl)]. / L'épreuve d'hyperglycémie provoquée par voie orale au cours de la grossesse normale.

Physiological changes in carbohydrate tolerance were studied between the beginning and end of pregnancy. Amongst 145 oral glucose tolerance tests performed between the 9th and 40th weeks, results indicated that carbohydrate tolerance evolved throughout pregnancy. The first 24 weeks were characterised by a change in the shape of the glucose tolerance curve, in the form of horizontalisation of the terminal part, but with no increase in early blood glucose figures. It was only after the 24th week that mean blood glucose levels were seen to be increased. The interpretation of glucose tolerance tests during pregnancy should take these physiological changes into account. Critical values, above which diabetes must be suspected, are different at the beginning and end of pregnancy. The critical point would appear to be around the 24th week.

[Alpha fetoprotein and neonatal jaundice. Contribution to the study of a physiopathologic mechanism]. / Alpha-foeto-protéine et ictère néonatal. Contribution à l'étude d'un mécanisme physiopathologique.

The increase in the maternal plasma A.F.P. level is due to an hypoxia of the foetus. The prospective study of 851 single pregnancies shows that there is a significant rise in the A.F.P. levels during the last days of the pregnancy if the babies are going to exhibit a so-called physiological jaundice at birth: the decrease of the A.F.P. levels in these cases is four times slower than in normal cases. The prospective study of another group of 404 pregnancies gave the same results for the A.F.P. level of the blood of the umbilical cord. Statistical analysis showed that the pathological conditions capable of increasing the A.F.P. levels are related to neo-natal jaundice. The neo-natal jaundice may be due to a factor of foetal hypoxia capable of inducing an over stimulation of the foetal erythropoiesis. The results of this mechanism would be a quantitative disequilibrium between an increased hemolysis and a reduced bilirubine fixation capacity during the neo-natal period.

[Alpha feto protein. Normal pregnancies and maternal diseases. Apropos of 3,010 radioimmunologic determinations]. / L'alpha-foeto-protéine. Grossesses normales et pathologies maternelles. A propos de 3010 dosages radio-immunologiques

Using an immunological technique limits of normal levels of AFP in maternal blood have been worked out during pregnancy from a series of 3010 samples of blood. Comparing mean curves for the levels of AFP in mothers suffering from anaemia and diabetes with normal curves shows that there is a significant rise in these levels in the third trimester of pregnancy. The possible mechanisms and their relationship to the variation levels of AFP are discussed.

[Diagnosis of fetal distress during labor with the aid of the Hammacher cardio-tocographic score and fetal pH determination]. / Diagnostic de la souffrance foetale au course du travail à l'aide due score cardio-tocographique de Hammacher et de la mesure du pH foetal

The authors study the value of the Hammacher tocographic scoring system in the diagnosis of fetal distress in labour. This score gives equal value to three components of the fetal heart rate: the base line, transient variations (dips) and fluctuations (oscillations). There is a statistically very significant (p less than 0.001) relationship between the cardio-tocographic score and the fetal pH as has been found in 106 labours with a coefficient of correlation of 0.67. The score can only be carried out usefully when a "beat to beat" to heart rate is registered and when this is not influenced by the administration of drugs to the mother. The score has been demonstrated to be particularly useful in the diagnosis of fetal distress when the membranes are still intact.