[A case of a dizygotic twin pregnancy where superfetation seems indisputable]. / A propos d'un cas de grossesse gémellaire dizygotique où la superfoetation paraît peu contestable.

A case of superfoetation is presented. Difference of age (3 weeks) between twins was established by ultrasound at 10 weeks, and persisted through subsequent echographic surveillance up to delivery at 39 of amenorrhea with twin 39 and 36 weeks old. Only three publications in recent international literature are related to superfoetation. An attempt is made to try to understand superfoetation and to clearly differentiate it from superovulation.

[Tubular sterilization in the immediate postpartum period using local anesthesia and laparoscopy]. / Stérilisation tubaire dans le post-partum immédiat sous anesthésie locale par voie endoscopique.

Puerperal laparoscopic sterilization was performed in 732 women under anaesthesia at the Maternity of Noumea (New-Caledonia). There were no complications. Among the per-operative and postoperative incidents which occurred, there were 0.8% pregnancies, 3.6% bleeding of the broad ligament which was controlled during laparoscopy and 3% events (adhesion, pain) which required general anaesthesia. It was concluded that the described technique of puerperal laparoscopic sterilization is a safe, simple, rapid, inexpensive and reliable surgical technique in expert hands.

[Genital infections with Chlamydia trachomatis in pregnant women in New Caledonia]. / Les infections génitales a Chlamydia trachomatis chez la femme enceinte en Nouvelle-Calédonie.

Chlamydia trachomatis was researched from 400 pregnant women. 76 of them were found infected and 129 carried serological signs of infection. We purpose a detection at the end of pregnancy interesting women with sexually transmitted diseases background and those with serological positive results (greater than 1/64). Then, treatment of the mother will be an useful method of prevention against neonatal infection.

[AIDS and pregnancy. Management of the seropositive pregnant female]. / SIDA et grossesse. Conduite à tenir chez une femme enceinte séropositive.

The population of women, HIV positive, and susceptible to become pregnant, increases with time. Pregnancy must be contra-indicated in seropositive women. A termination of pregnancy must be performed in the first trimester and a therapeutic abortion may be offered but left to the mother's decision. Delivery must be carried out via natural passages in the absence of obstetrical dystocia. Nursing is contra-indicated. A number of precautions must be taken by the medical and para-medical personnel during obstetrical procedures.

[The elderly primipara]. / La primipare âgée.

From the analysis of 190 case histories of elderly primiparas, the following conclusions were drawn concerning their pregnancy and delivery. Frequency = 0.6%. The high frequency of spontaneous abortion (26.8%) and infertility treatment (20.5%) should be stressed. Age-related obstetric pathology in the sample group is dominated by the high frequency of toxaemia (32.4%), premature delivery (14.3%) and uterine fibromata (17.3%). Dystocia is frequent: normal, unassisted vaginal deliveries: 32%; forceps: 33.2%; Caesarean section: 34.2%. Neonatal mortality remains high: 5.2% as does morbidity (Apgar less than 7: 29.6%).

[Contraception in North-African immigrants (author's transl)]. / Contraception chez la nord-africaine immigree.

PIP: The authors have studied the use and the trend of contraception among North African women who emigrated into France, by consulting a series of 500 medical files. The socioeconomic status of the women is generally very low; request for contraception on the part of married women was only 14% in 1979; parity is not high, and age mostly between 20-30. Women usually approach contraception after delivery or after a spontaneous abortion, when in the hospital, and away from the influence of the Muslim community in which they live. OC (oral contraception) is utilized in 60% of cases, but the continuation rate is very low; in this series there were 52 unwanted pregnancies under OC use, or a Pearl index of 11%. The use of an IUD increased from 20% to 52%, and it is now the method most requested. Expulsion rate is 4% and removal for desire of pregnancy is 22%; in this series the Pearl index with IUD use was 2.6%. 12% of women chose injectable contraception with Depo-Prodasone, which had a Pearl index of 2.7%. Only 6 women chose tubal ligation, although it had been recommended to over 12 women. Mechanical vaginal contraception is not even considered by this particular group of women, among whom resistance toward contraception comes from a traditional way of life in which the husband is the absolute master, and by a misinterpretation of the rules of the Koran.^ieng

[Plasma levels of HCS and beta SP1 in normal and pathological pregnancies]. / Dosage plasmatique de HCS et betaSP1 dans les grossesses normalies et pathologiques.

A study was carried out on 599 pregnant women from whom 2,991 levels were estimated of HCS and beta SP1 to determine their variations. The control group was of 400 normal pregnancies (1,770 couples of levels of HCS and beta SP1. The pathological population was in two groups: - non-complicated pathological pregnancies, from whom 510 coupled levels were estimated in 77 women, and - complicated pregnancies, from whom 711 coupled levels were estimated in 122 patients. This pathological group was compared with the control population statistically. The results conform to those that have already been published. This work shows two original features: - very high levels of beta SP1 and HCS ;are an index of the severity of the prognosis of fetuses and hydramnios, - a drop in the level of beta SP1 towards the end of pregnancies is a warning that fetal distress may occur in labour.

[Evolution of plasmatic apolipoprotein B, cholesterol and triglyceride levels in fourty-five long-term combined oral contraceptive users (author's transl)]. / Evolution des taux plasmatiques de l'apolipoproteine B, du cholesterol et des triglycerides chez 45 femmes prenent des oestro-progestatifs contraceptifs oraux au long cours.

PIP: This study investigates the long-term evolution of plasmatic levels of apolipoproteine B (Apo B) and total cholesterol as compared to triglyceride (TG) levels in a group of 47 healthy oral contraceptive (OC) users and in 15 nonusers (control group). The patients were divided into 4 groups; the first group had been exposed to OC for a duration of 1-3 months, the second for a duration of 4-12 months, the third for a duration of 12-24 months, and the fourth for a duration of over 24 months. Plasmatic concentrations of Apo B in the control group were 0.90 +or- 0.10 g/l, while the average concentration for the group of users was 0.69 +or- 0.19 g/l, a decrease of 23% as compared to the control group. Decrease was higher after 3 months of use, and it varied between 53% and 11% among group 1 subjects. Average levels increased between the 3rd and 24th month, but remained significantly lower as compared to the control group, at least in groups 2 and 4. Apo B decrease seemed to be associated with total plasmatic cholesterol, which also takes about a year to normalize while it takes about 2 years for Apo levels to reach those of the control group. The evolution of plasmatic TG levels presented an opposite pattern; the highest level, +29%p 0.01, was reached after 3 months of OC use, and the elevation was then maintained. Some authors consider the decrease of Apo B and plasma cholesterol as a reflex of the decrease in low density lipoprotein concentrations. In the present study the observed metabolic variations were probably due to ethinyl estradiol. The apparent normalization of Apo B and of cholesterol, and the increase in TG levels in long-term OC administration may represent a metabolic adaptation whose mechanism is still unknown.^ieng

Human erythrocyte monoester lipase: characterization and radiochemical assay of the cell-bound enzyme in normal subjects.

A monoester lipase (MEL) activity (EC 3.1.1.3) is described in human red blood cells (RBC). The lipase acts as a cell-bound enzyme and is able to exert its catalytic activity in vitro toward an exogenously added emulsified substrate. The enzyme activity, which appears to be confined to the cell membrane, is inhibited by Triton X-100. The MEL activity of human RBC is assayed using intact RBC as the enzyme source, with an emulsion of ethyl [3H]oleate (2 mM) as the substrate. The optimum pH for the reaction is 7.8 at 37 C. Lipolytic rates are monitored by quantitation of the amount of [3H]oleic acid released during 20 min of incubation after extraction by means of a liquid-liquid partition system. Suspensions of purified RBC obtained from 161 healthy adult subjects had a MEL activity of 1022 +/- 134 microunits/10(12) RBC (mean +/- SD), with a normal range (+/- 2 SD) between 754-1290 microunits. The individual activity values varied from 733-1490 microunits. The median of the 161 subjects was 1010 microunits/10(12) RB. There was no significant difference between the mean activities of RBC samples from men and women. MEL activity in RBC from the cord blood of 16 normal infants was found to be 43% higher than that in adults, with an average activity of 1458 +/- 174 microunits (mean +/- SD).

Characterization of triacylglycerol lipase activity in human amniotic fluid.

A radiochemical assay was used to measure the triacylglycerol lipase activity found in normal human amniotic fluid at term. Enzyme activity was characterized in a partially purified extract of amniotic fluid and was found to be optimal at pH 8.0 +/- 0.2 in the presence of 5mM sodium taurocholate, with the use of emulsified tri-[3H]oleoyl glycerol as the substrate. The assay described made it possible to determine the lipase activity in as little as 25 microliters of a 12,000 x g supernatent of whole amniotic fluid as the source of enzyme. The lipase appeared to be distinct from another triacylglycerol lipase measurable in fetal membranes. In turn, it was shown that the amniotic fluid enzyme exhibited several catalytic properties which resembled those of pancreatic lipase. i.e., its substrate specificity, the bimodal effect of bile salt, and the influence of authentic pancreatic colipase on the catalytic process. The results suggest that the assay of triacylglycerol lipase activity may be clinically useful in the detection of enzyme abnormalities in human amniotic fluid.

Evolution of plasma levels of apolipoprotein B, cholesterol and triglycerides in women during long-term oral contraception.

Apolipoprotein B (apo B) was measured by a sensitive and specific double antibody radioimmunoassay in plasma from 15 normal women and 47 women taking oral contraceptives. The plasma apo B concentration in normal women was 0.90 +/- 0.10 g/l (mean +/- S.D.) whereas the overall value for all women taking contraceptives was 0.69 +/- 0.19 g/l. The maximum decrease (p less than 0.001) occurred in women investigated within three months after the beginning of the steroid intake, whose mean apo B value was 0.60 +/- 0.12 g/l (n = 12); decreases found after 3--24 months of contraception were of lesser magnitude. Apo B decreases were associated with significant decreases (p less than 0.01) in total plasma cholesterol, although the latter regained normal values after one year of contraception. Apo B and cholesterol values were in the normal range in women investigated after two years of steroid intake. An inverse trend was observed for plasma triglycerides, which showed a mean increase of 29% (p less than 0.01) after three months of steroid intake, and then stayed elevated without significant change with time.

[Viral hepatitis and pregnancy]. / Hépatite virale et grossesse.

When nine cases of viral hepatitis had been analysed they showed that the normally held pessimism of this infectious pathological condition associated with pregnancy was ill-founded. The natural outcome for viral hepatitis in our country is not any worse in pregnancy than when the patients are not pregnant. The outlook for the fetus is above all determined by its prematurity, since we have not observed any cases of abortion, malformations or small-for-dates fetuses. On the other hand the neo-natal progress is slow with anaemia and jaundice frequent signs. Treatment of threatened early labour with beta-mimetic drug has been carried out carefully because of the risks for the fetuses.

[Cholestasis in pregnancy]. / Cholostase gravidique.

It has been possible by seeing twenty cases of cholestasis in pregnancy to define certain characteristics of the condition. This pathology of pregnancy is frequently associated with twin pregnancy. The prognosis for the fetus is especially affected by prematurity. There is no evidence of small-for-dates babies, but the neonate gains weight slowly. Anaemia and jaundice in the neonates are common. The treatment of threatened premature labour using beta-mimetic drug is useful and of no danger to the mother.