[Placental abruption: Background and revisited pronostic factors about a series of 171 cases]. / Hématome rétroplacentaire : terrain et facteurs pronostiques revisités à propos d'une série de 171 cas en Guyane francaise.

OBJECTIVE: To describe the epidemiological, clinical and prognostic factors of placental abruption and fetal death in utero and to investigate possible risk factors for their occurrence. PATIENTS AND METHODS: Observational retrospective study including the women having presented a placental abruption between January 2001 and January 2012, in a IIB maternity. Women's sociodemographic characteristics, clinical symptoms and the method used to detect placental abruption were collected. Patient data of those whose pregnancy resulted in fetal death were compared to those with more favorable outcomes. RESULTS: There were 171 cases of placental abruption among 21,913 patients having delivered, which represents a 0.78% incidence. Diagnosis was rarely based on clinical data (30%). The rate of fetal death in utero represented 25% of the pregnancy's outcomes. A history of fetal death in utero increased the risk of placental abruption (P<0.001). This complication was more frequent for patients who did not have pregnancy monitoring (P=0.054) and before 37 weeks of amenorrhoea (P=0.005). CONCLUSION: Placental abruption is an important cause of perinatal mortality and maternal morbidity. Among the observed risk factors, only regular pregnancy monitoring can be an easy way to prevent these complications.

[Geophagy and pregnancy: current knowledge and management. Clinical experiences of an obstetrical department in French Guiana]. / Géophagie et grossesse: état des connaissances et conduite à tenir. Expérience d'une maternité de Guyane française.

OBJECTIVE: To provide an overview of the current state of knowledge concerning the determinants and consequences of geophagy during pregnancy. METHOD: Bibliographic searching of articles published in English or French and included in the Scopus database, and reporting of our experience with the management of geophagic pregnant women at the maternity unit of Saint-Laurent-du-Maroni (French Guiana). RESULTS: Geophagy is a little known practice initiated by various stimuli, including nausea and iron deficiency. Sustained geophagy during pregnancy has many consequences, due to complex ionic interactions with the digestive tract. Clay consumption may lead to iron deficiency, which may even be life-threatening in cases of post-partum haemorrhage in severely anaemic women. For the foetus, in addition to the known risk of preterm birth associated with maternal anaemia, maternal geophagy may lead to overexposure to heavy metals, including aluminium in particular. This practice should therefore be considered potentially damaging to the neurological development of the child. The ionic imbalances caused by the ingestion of clay over a long period should be systematically evaluated and corrected, given the secondary malabsorption they may cause, often necessitating parenteral feeding.

[Value of the Linton-Nachlas balloon for the management of post-partum hemorrhage: a series of 25 cases]. / Intérêt de la sonde de Linton-Nachlas dans la prise en charge des hémorragies du post-partum : une série de 25 cas.

OBJECTIVES: Post-partum hemorrhage (PPH) is the first cause of maternal mortality in France. Uterine tamponade is an alternative in the management of PPH. We investigated the efficiency of the Linton-Nachlas balloon in treating severe PPH in a French Guiana center where interventional radiology is not available. MATERIALS AND METHODS: In this retrospective study, 25 women with severe PPH were included. Severe PPH is defined by the persistence of PPH despite sulprostone treatment. All women included in the study gave birth by vaginal delivery. The Linton-Nachlas balloon (Coloplast(®), France) used for digestive hemorrhage was inserted transvaginally. The primary endpoint for the efficiency was stopping PPH. RESULTS: The use of this balloon stopped the bleeding for 24 out of 25 patients (96 %). There was one case in which the treatment by the balloon was a failure. In that case, vaginal packing stopped the hemorrhage. No patient needed any complementary surgical treatment. CONCLUSION: This technique is a non-invasive, inexpensive, easy and efficient treatment. Most of the time, its use can stop hemorrhage and preserve fertility of young women wishing further pregnancies.

[Complications of association magnesium sulfate with nicardipine during preeclampsia: report of 2 cases]. / Complications de l'association sulfate de magnésium et nicardipine au cours de la prééclampsie : à propos de 2 cas.

The authors report a heart failure and a collapse following concurrently administration of nicardipine and magnesium sulfate. These two drugs have potential negative inotropic effect and decrease systemic vascular resistance. Magnesium sulfate is the first-line treatment for the prevention of primary and recurrent eclamptic seizures. Combination with calcium channel blockers should be used cautiously.

[Use of injectable urapidil in pregnancy-induced hypertension and preeclampsia]. / Utilisation de l'urapidil injectable dans l'hypertension gravidique et la prééclampsie.

OBJECTIVE: To evaluate the efficacy and tolerance of injectable urapidil (Eupressyl(®)) for the treatment of severe pregnancy-associated arterial hypertension. MATERIALS AND METHODS: We carried out a prospective study of 100 cases encompassing the various types of severe pregnancy-associated arterial hypertension, with clinical and biological monitoring of the mother and the collection of neonatal data. Treatment was initiated if the blood pressure was higher than 160/110mmHg and efficacy was defined as a lowering of blood pressure to 150/100mmHg or below. RESULTS: Treatment with urapidil alone was effective in 80 cases (80%). In 20% of cases, essentially the most severe forms of preeclampsia, efficacy was achieved only if urapidil was associated with labetalol or if urapidil was replaced with nicardipine. We observed no material complications other than two cases of hypotension due to excessively rapid administration of a bolus of nicardipine to replace urapidil treatment. CONCLUSION: Injectable urapidil seems to be an antihypertensive agent that is easy to use and effective in 80% of cases and that has very few secondary effects on the mother or the foetus. Further comparative studies are required to determine the potential of this drug for use in the management of pregnancy-associated hypertension.

[Treatment of gestational diabetes with oral hypoglycemic agents]. / Traitement du diabète gestationnel par hypoglycémiants oraux.

AIM: To study the accuracy of an oral therapy for gestational diabetes (GD) and literature review. PATIENTS AND METHODS: Glibenclamide (Daonil) was prescribed in pregnant women with GD diagnosed by O'Sullivan test and hyperglycemic tolerance test. Capillary glycemic control follow up was performed to check the accuracy of the oral treatment all along the pregnancy. RESULTS: Thirty-seven pregnant women have been involved at an average of 26.7 weeks of amenorrhea. Five of them had a non insulin dependent diabetes mellitus previously diagnosed. The glycemic control was obtained in 64.8 % and two women required metformin in addition. Hypoglycaemia has been noticed in 17 % of cases. In 18.9 %, macrosomia (birth weight upper than 4000 g) was reported. We carried out a cesarean section in 31.8 %. A short hypoglycaemic episode was observed in 10.8 % of new born babies. CONCLUSION: Oral therapy for GD is more and more often used and demonstrates an efficacy around 80 % and safety similar as insulin therapy. Our experience showed glibenclamide was useful in two third of cases and easier than insulin in clinical practice.