[Management of lymphoblastic lymphomas during pregnancy]. / Prise en charge des lymphomes lymphoblastiques au cours de la grossesse.

Lymphoblastic lymphoma (non-Hodgkin lymphoma) is a highly uncommon but serious condition during pregnancy. With multidisciplinary management (obstetrics, pediatrics, hematology and anesthesia), outcome is generally good for both mother and child. Chemotherapy must be initiated rapidly, during pregnancy. Consequences depend on the stage of the disease, its progressive nature and the of pregnancy. During the first trimester, medical termination should be proposed in order to initiate chemotherapy cannot be started until the second trimester using alkaloids. Chemotherapy has little effect on the fetus during the second trimester. During the trimester, extraction should be discussed as soon as the fetal maturity is sufficient.

[Uncontrolled retrospective study of 75 pregnancies in women treated for epilepsy]. / Etude rétrospective non contrôlée de 75 grossesses chez des femmes épileptiques traitées.

OBJECTIVE: Our purpose was to study pregnancies and birth outcomes in a population of women treated for epilepsy. STUDY DESIGN: A retrospective uncontrolled study of 75 pregnancies in 55 epileptic women under treatment was conducted in the nursery of CHU Angers. The course of pregnancies and deliveries, the frequency of congenital malformations and the clinical state of the neonates during the first 6 days of life were recorded. RESULTS: There was a high rate of prematurity (15%) especially in patients treated by phenobarbital, a 10.5% rate of intra-utero growth retardation, a 11% rate of major congenital malformations and a 9% rate of isolated minor congenital malformations. Congenital malformations were mainly facial dysmorphia, cardiopahties, urogenital tract abnormalities. The neonatal symptomatology was associated with a high level of antiepileptic drugs in neonates or to a withdrawal syndrome or to hypovitaminosis. CONCLUSION: Overall results justify implementing prevention and detection measures.

[Serum alkaline phosphatase levels in pregnancy]. / Taux sérique gravidique des phosphatases alcalines.

Serum levels of total alkaline phosphatase increase during pregnancy but the presently available methods are not very precise. We used the CHEM 1 Bayer Diagnostic test in all the consecutive patients admitted to our unit between June 1 and October 16, 1990. Exclusion criteria were twin pregnancies, pruritus, liver disease or parasitosis. A multifactorial analysis was used to discriminate between general, obstetric, pathologic and drug parameters. There were 373 serum samples, 91% were obtained during the last three months of pregnancy. The mean serum alkaline phosphatase level was 68.2 U/l and 75.9 U/l during the first two trimesters respectively and rose to 126.7, 178.8 and 234 U/l during the last three months respectively. The elevation was greater in cases of vomiting during the first trimester, alpha-methyldopa intake. It was less after hypodroxyapatite intake and was positively correlated with weight gain. Age, parity, pregestational weight, neonatal weight, other pathologies and other drug intake did not affect the results. Knowledge of these physiological levels will be useful for evaluating most liver diseases occurring during pregnancy. Assay of the enzyme fractions would be ordered secondarily.

[Occurrence of hepatic hemangiomas in pregnancy]. / Survenue d'hémangiomes hépatiques au cours de la grossesse.

We report on the case of a 29-year-old woman, who had been on oral contraceptive steroids for 10 years, in whom four liver haemangiomas were found. At least two of them, and probably a third, have occurred during her second pregnancy. To our knowledge, this is the first report suggesting the occurrence of liver haemangioma during pregnancy. This case suggests that sexual hormones, especially estrogens, could play a role in the development or the occurrence of hepatic haemangioma.

[Antenatal prognostic factors in sacrococcygeal teratomas]. / Facteurs pronostiques anténatals des tératomes sacro-coccygiens.

The authors report 5 cases of sacrococcygeal teratoma, 4 of which were diagnosed by routine ultrasonography. In view of the poor prognosis of sacrococcygeal teratomas discovered antenatally, certain ultrasonographic severity criteria have been defined. The following are felt to be relevant in this light of present knowledge: a tumour size greater than the biparietal diameter of the fetus at the time of diagnosis; rapid tumour growth. This latter parameter summarises in itself the criteria taken into account in the past: placentomegaly, hydramnios, anasarca. Colour coded Doppler should make it possible in the future to identify a group which might benefit from treatment in utero.

[Hydrops fetalis of non-immunological origin. Study of 24 cases and review of the literature]. / Anasarques foetoplacentaires d'origine non immunologique. Etude de 24 cas et revue de la littérature.

Twenty-four cases of Schriddes' disease of non-immunological origin were observed between 1973 and 1990 in the Gynecology-Obstetrics Service at Angers (France). These cases are analyzed and the results are compared with those published in the literature. This disorder must be diagnosed before birth. Three examinations are currently essential for foetal assessment: obstetrical ultrasound, ultrasonic cardiography and amniocentesis. As a result of improved antenatal diagnosis, the question of the indications for in-utero treatment and medical termination of pregnancy now arises. Despite progress in neonatal resuscitation, the prognosis generally remains very poor.

[Prognostic factors in delivery with breech presentation. Apropos of 357 single-fetus pregnancies at term]. / Facteurs pronostiques de l'accouchement en présentation du siège. A propos de 357 grossesses monofoetales à terme.

For a better definition of the factors which could be at the origin of neonatal distress, 357 cases of mono-fetal term pregnancies with breech presentation were retrospectively studied between January 1st, 1984 and December 31st, 1989. The population is identical to that of all deliveries except for a higher percentage of first pregnancies. The risk of emergency caesarean section mostly concerns large primiparous women, underweight, with normal or large pelvis. Caesarean section is absolutely necessary if the biparietal diameter exceeds 100 mm, if the head is positioned in hyper-deflection and/or if the pelvis is defective. Without being mandatory, the procedure is preferable in case of chronic fetal distress or scarred uterus. On the contrary, neither the age of the mother nor the age of the pregnancy, nor the type of the breech, nor the number of pregnancies have any effect on the prognosis. The current rate of caesarean section is 47.9 per cent with almost complete disappearance of the large breech extraction (0.6 per cent) and the Mauriceau's maneuver (0.3 per cent). The corrected mortality rate is 0.28 per cent. In addition to the parameters considered in our coefficient of risk of breech delivery, it was noted that a pre-pregnancy weight exceeding 70 kg or a weight gain of more than 15 kg represent unfavorable factors. It is desirable to calculate prospectively the severity of the risk in small size cases, when the biparietal diameter ranges between 96 and 100 mm, or when one of the diameters of the bony pelvis is decreased.