Genital herpes and pregnancy--preventive measures.

Genital herpes is particularly dangerous during pregnancy because of the risk of neonatal infection. This is discussed in four situations of genital herpes associated with pregnancy. Choosing the most appropriate method of delivery, i.e. carrying the least risk of transmission from mother to baby, is based on our knowledge of the natural history of genital herpes infection, the risk to the newborn (estimated from epidemiological studies), and, lastly, the possible preventive measures available.

[The health of foreign populations in France]. / La santé des populations d'origine étrangère en France.

In France, 8% of the population are foreign. They come from the lowest socio-economic level. In distinguishing the new arrivals from those who have lived in France for several years, the migrant related health patterns are applied. Health problems of foreigners in France can be examined in a number of different ways: --Foreign workers are found in unskilled work and in jobs where they are constantly subjected to hazards of the workplace, occupational health risks and accidents. --The quality of maternal and child health care among foreign women is lower than among the French. --Foreign children are hospitalized more often and for longer than French children. The types of illness are not specific. The truancy rate is more significant than the national mean. --Restrictions on the opportunities for enjoying certain social rights, administrative and financial obstacles encountered as well as difficulties in communication all make it harder to meet the needs of this section of the population.

[Herpes in the pregnant woman and the newborn infant]. / L'herpès chez la femme enceinte et le nouveau-né.

Herpesvirus infection of the newborn is a rare though extremely grave disease that poses difficult problems for the obstetrician. It is nearly always due to genital herpes during pregnancy though in more half the cases this was unsuspected by the mother. Prophylactic measures exist--disinfection of the genital tract, elective cesarean section, administration of antivirals and Acyclovir in particular. The main difficulty resides in making the correct decision and the excessive recourse to cesarean section should not be replaced by the unreasoned prescription of antivirals taking into account the current uncertainly about their real efficacy and their long-term effects after administration in early life. The risk of neonatal herpes should therefore be evaluated from the clinical findings and 4 categories of women may be defined: those with the clinical manifestations of primary genital herpes on delivery or during the month before; those with the clinical manifestations of recurrent genital herpes on delivery or during the week before; those with only a previous history of genital herpes and finally all other women with no clinical manifestations or history of genital herpes. Only first two categories benefit from cesarean section and Acyclovir is only prescribed in exceptional cases as complementary therapy for the newborn infant. In the third category, clinical and virological monitoring alone is required and is currently prescribed during the perinatal period as it is reasonable to stop the systematic weekly virological monitoring at the end of pregnancy when this has been shown to be inappropriate. However, it remains true that more than half the cases of neonatal herpes arise in women in the fourth category. The only means of prevention that can be proposed is that they refrain from sexual or orogenital relationships during the last two months of pregnancy. According to our current knowledge, Acyclovir remains contraindicated during pregnancy except in exceptional cases when the mother's life is in danger.

Protein-bound and free plasma phenytoin during pregnancy.

In a clinical study using low doses of phenytoin as an ovulation inducer, the plasma levels and the binding percentages of this drug and the plasma level of its main metabolite, p-hydroxyphenytoin, were monitored. The results show that during pregnancy, plasma levels of both remain stabile and low as compared with those observed in epilepsy treatment. This could be one explanation for the absence of teratogenic effects observed in this and other studies using phenytoin for the same therapeutic aim.

[Late gestation amniocentesis: value and risk assessment (author's transl)]. / Amniocentèse en fin de gestation: intérêt, appréciation du risque.

Over a 6-year period, 2165 amniocenteses were performed in 1168 women between the 32nd and 42nd weeks of gestation. There was no injury to the foetus. Premature rupture of the membranes was observed in 11.13% of the cases, which is less than the risk of spontaneous rupture (12.5%). The incidence of premature delivery was 2.8% during the first 3 years of the study and 2.6% during the next 3 years; these figures are lower than in women who do not undergo amniocentesis. The risks of amniocentesis are therefore quite acceptable, particularly when weighed against the benefits of data on foetal maturity and foetal distress obtained by the procedure. During the last 4 years no respiratory distress syndrome nor post-maturity were observed.

Antenatal diagnosis in three pregnancies at risk for mannosidosis.

Three pregnancies were monitored in two families at risk for mannosidosis, alpha mannosidase and alpha fucosidase were determined on extracts from white blood cells of several members of these families, on fibroblast cell lines from the index cases and on uncultured and cultured amniotic cells of the foetuses. Two foetuses were diagnosed as affected and one as being free from the disease. The conclusions were confirmed on the affected foetuses after interruption of the pregnancy. The noticeable residual activity of alpha mannosidase found in some fibroblasts and cultured amniotic cells required complementary investigations (heat lability and dependency of substrate concentration) to reach a reliable diagnosis. Invesitgation of uncultured amniotic cells may give useful additional information.

[Effect of ergot alkaloid derivatives on milk secretion in the immediate postpartum period]. / Effet de dérivés des alcaloïdes de l'ergot de seigle sur la sécrétion lactée dans le post-partum immédiat.

30 women received an intramuscular injection of 0.2 mg of methylergobasine immediately after delivery and then 3 tablets of 1 mg of ergotamine tartrate per mouth daily for 6 days post-partum. 28 women received no treatment after delivery. The selection of the two groups was random. The treatment with rye ergot derivatives did not have a significant effect on the quantity of milk that the infant took, nor on the infant's weight gain in the 6 first days of life.

[Attempt at evaluation of the risk of mortality in utero]. / Tentative d'appréciation du risque de mortalité

An analysis was made of the obstetric history of 1,360 patients who were delivered in 1971. It involved 3,185 pregnancies. The aim of the study was to evaluate the risk of spontaneous termination of the pregnancy, worked out from its demographic aspect. Several ideas are worthy of consideration. The risk of spontaneous intra-uterine death is cumulative, sharply increased by a repetition of such cessation of pregnancy. The same patients often undergo intentional abortion repeatedly. The respective risks of spontaneous and provoked interruption of pregnancy have been studied in greater detail as a function of parity.

[Drug heritage of the newborn infant]. / L'héritage médicamenteux du nouveau-né

The medicamental heritage of the new-born baby is a reality that we are more and more realizing. During intra-uterine life, the foetus is placed under different maternal influences that the new-born baby is done an "old" and unsafe one who can present, as early as his birth, modifications of his own metabolism. To know if this heritage is really a dotation or an empoisoned gift, is an important question that we are going to study in light of experimental data and constatations of clinical pharmacology.

[Evaluation of fetal maturity at birth]. / Evaluation de la maturité foetale a la naissance

It is very important to evaluate the degree of maturity of a new-born infant in order: - to appreciate the chronological age when the date of the last period is unknown or doubtful, - to compare the degree of maturation with the weight and size of the infant, in regard of estimating the intra-uterine growth and detecting early a lateness or advance of this growth.