[Prenatal monitoring of a primipara in 1988]. / Surveillance prénatale d'une primipare en 1988.

Prenatal monitoring is advocated by the medical profession since Hippocrates and has a major role in decreasing perinatal mortality and psychomotor lesions secondary to birth.

Study of the vaginal mucous membrane following tampon utilisation; aspect on colposcopy, scanning electron microscopy and transmission electron microscopy.

The effect of periodic tampons was studied in 17 young women during the menstrual and inter-menstrual cycle. Biopsies (n = 19) were analysed on scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The effect of medium absorbant tampons was compared with that of super-absorbant tampons. On colposcopy, dryness was noted in 89% cases, peeling in 47% cases. Microulcerations were observed only once (5%). Dryness and peeling was most often encountered with the super-absorbant tampons and during the inter-menstrual phase. TEM revealed cellular destruction affecting all layers of the epithelium: lysis of superficial and intermediate cells, destruction of desmosomes accompanied by the creation of inter-cellular spaces, lipidic vacuoles in the lysed cells. SEM revealed epithelial peeling with cleavage and severe cellular desquamation. Cellular anomalies were common at the level of the cytoplasmic membrane, which presented either defects, a porous aspect, or appeared swollen by air-bubbles.

Anti-HBc screening for the prevention of perinatal transmission of hepatitis B virus in France.

As anti-HBc screening has been proposed for blood donor testing, we investigated its effectiveness during pregnancy. Among 4,023 successive pregnant women screened for anti-HBc, 539 (13.4%) were positive and further tested for HBsAg and anti-HBs. HBsAg was found in 73 (1.81%) and anti-HBc only was positive in 66 (1.64%). Among the 73 women positive for HBsAg, HBV DNA was found in the serum of seven, the cord blood of two, the placenta of three. Of the 58 infants given HBV immunoglobulins and vaccine, only four had transient HBsAg. None of the 66 women positive for anti-HBc only had anti-HBc IgM, HBeAg, or HBV DNA in serum, cord blood or placenta but five women became HBsAg positive before, at, or after delivery. Among the infants born of these 66 mothers, three had high ALT, two had HBsAg and one HBV DNA without HBsAg. Screening for anti-HBc may be cost effective, at least in low HBV prevalence areas, since there is evidence for infectivity of pregnant women positive for anti-HBc only.

[Renal hypoplasia, polydactyly, cardiopathy: a new syndrome?]. / Hypoplasie rénale, polydactylie, cardiopathie: un nouveau syndrome?

The occurrence of a polymalformation pattern associated with a polydactyly indicates a mendelian inheritance. We report a case with renal hypoplasia, polydactyly, congenital heart defects. A large literature review makes the differential diagnosis and brings this case nearer to an anterior observation of the literature. We discuss an eventual new syndrome with autosomal recessive inheritance.

[Fetal bradycardia during pregnancy. Apropos of 2 cases without fetal distress]. / Bradycardie foetale en cours de grossesse. A propos de deux cas sans souffrance foetale.

The authors report two cases of fetal bradycardia discovered at the beginning of the 8th month. The pregnancy history was normal. Sonography was helpful in the etiological diagnosis. It concerns a case of atrial extrasystole and another case of physiological bradycardia. The evolution was satisfactory with normal, spontaneous, vaginal delivery. During the pregnancy, the tracing combined a severe bradycardia around 80, a flat rhythm and an areactive rhythm. There was alternation with normal rhythms. The pregnancy history was reassuring. At the beginning of labor, the cardiac rhythm was normal. In the opposite case, vaginal delivery could only be advocated after determination of the capillary pH.

[Early amniocentesis: accidents and incidents. Study of a series of 681 single pregnancies]. / Amniocentèse précoce: accidents et incidents. Etude d'une série de 681 grossesses uniques.

The authors studied the outcome of 681 single pregnancies after amniocentesis. The advantage of this study is to determine the exact risk of this procedure, especially as far as spontaneous miscarriage is concerned. 82% of the taps are carried out between 17 and 18 weeks of amenorrhea. A maternal age over 38 years (56%) represent the essential indication. Questionable cases are presented are presented by cases of intrapartum and neonatal mortality (a case of hypotrophy with death in utero at 39 weeks; a case of per-partum death during a cesarean section). There are cases of fetal death in utero where the time between the tap and the diagnosis of fetal death exceeds 4 weeks and where there is no argument for an infectious etiology. Finally, there are several cases where the responsibility of the amniocentesis is unlikely. It often seems that the amniocentesis induces the spontaneous miscarriage of an already compromised pregnancy. Other incidents of amniocentesis are reviewed. A review of the literature has enabled us to draw certain conclusions. In light of their results and the data from the literature, the authors conclude that amniocentesis is not innocuous. At any rate, it is indicated for specific patients and these pregnancies must be considered as risk pregnancies.

[Variations in birth weight as a function of various fetal and maternal characteristics. The application to the diagnosis of hypotrophy]. / Variations du poids de naissance en fonction de diverses caractéristiques foetales et maternelles. Application au diagnostic d'hypotrophie.

The known variations in weight for gestational age as well as compounding maternal and/or fetal factors, puts into question the usual definition of small for gestational age (SGA) which is based on gestational age alone. On the basis of more than 20,000 births studied in 4 maternity hospitals from 3 separate regions in France, the authors propose a new definition for growth retardation in full-term babies, taking into account 4 factors: gestational age, sex, birth rank, height and usual weight of mothers. This definition allows constitutionally SGA newborns to be considered normal, while some babies previously classified as normal would now lead one to suspect intra-uterine growth retardation (IUGR). This approach tries to take constitutional and environmental risk factors into account in fetal growth hopefully allowing for help better detection of IUGR.

[Evaluation of 100 autopsies performed in the maternity service of the Hôtel-Dieu in Lyon during an 18 month period]. / Bilan de 100 autopsies pratiquées dans le service de maternité de l'Hôtel-Dieu de Lyon sur une période de 18 mois.

100 Necropsies have been performed from January 1983 to June 1984, on 53 abortus and stillborn and 47 therapeutic terminations of pregnancy. All fetuses came from the same obstetric unit. Half spontaneous fetal deaths remained of unknown aetiology; in 18 cases (34%) placental, maternal or pregnancy pathology existed; fetal abnormalities were discovered in 10 (18%). As for therapeutic interruptions of pregnancy (the indications of which are detailed) the importance of ultrasonography emphasized since this technique allowed 25 of the 47 prenatal diagnosis. The importance of necropsy to help precise diagnosis and subsequent counselling is also recalled.

[Repeated spontaneous abortion]. / Les fausses-couches spontanées à répétition.

This review of the causes of recurrent spontaneous abortion is combined with a statistical evaluation of the frequency of abortion and of the probability of abortion according to the way in which previous pregnancies have ended.

[Postoperative paralysis of the leg]. / Paralysie crurale post-opératoire.

Gynaecologists and bowel surgeons should realise that paralysis of the muscles of the lower limb following operation, although rare, is a definite risk which can be avoided by pre- and post-operative measures, especially as nowadays it is customary to operate through small narrow scars of aesthetic appearance. This does increase the risks, particularly when heavy retractors are used.

[Diagnosis and treatment of fetal supraventricular tachycardia. Apropos of 2 cases]. / Diagnostic et traitement de la tachycardie supraventriculaire foetale. A propos de deux cas.

The authors report two cases of foetal supra-ventricular tachycardia. They stress the value of two-dimensional ultrasonography in identifying the type of rhythm disorder and the population most likely to benefit from screening for this type of defect.

[Weight, height, skull and chest circumferences, biparietal diameter in the newborn infant as a function of gestational age, weight, height and weight gain of the mother]. / Poids, taille, perimetres cranien et thoracique, diametre biparietal du nouveau-ne en fonction de l'age gestationnel, du poids, de la taille et de la prise ponderale de la mere.

The weights, heights, skull and chest circumferences and biparietal diameters were measured in 7,905 newborns in 1972, in the 5 maternity hospitals of Lyon. These data were studied with respect to the gestational ages of the children and according to the usual weights, heights and weight gains of the mothers. The evolution of these parameters was compared to each other; tentative explanations are given.