[Acute-placental dysfunction by villous-maturation defect and late-fetal mortality]. / Dysfonction placentaire aiguë par retard de maturation villositaire et décès foetal tardif.

INTRODUCTION: The placental histological examination is essential in the assessment of stillbirths, especially those of third trimester, which are often of placental origin by chronic placental dysfunction and sometimes by acute dysfunction. The physiopathogenesis of the latter remains obscure. MATERIAL AND METHOD: Three stillbirths, one per partum and two after 38 and 39 weeks gestation, caused by acute-placental dysfunction by villous maturation defect were studied. The maternal aetiological investigations and the fetal autopsies were normal. Placentas were pale. Villi were numerous, normal size but fibrous, showing a severely reduced vascularization and a lack of syncytium-capillary membranes. RESULTS: Only one author studied the villous maturation defect. He defines this entity by the same characteristics as that noted in our observations. Its incidence would be of 5.7% and would be associated with fetal death only after the eighth month in 2.3 % of cases, with a risk of recurrence estimated at 10%. CONCLUSION: This entity, probably underestimated, must be indexed systematically in any late fetal death and any unexplained per partum asphyxia, in order to help the couple overcome a fetal death and to give doctors a medicolegal support.

[The HELLP syndrome: report of 11 cases]. / Le HELLP syndrome: a propos de 11 cas.

Being an independent entity or a type of eclampsia, the HELLP syndrome always represent a serious complication of the renovascular disease. This retrospective study realised during five years revealed 11 cases including 3 cases occurring in the post partum. For all this patients, this complication happened during the 3rd term of pregnancy. The mean period of gestation when it occurred was the 34th week of pregnancy. In 36% of cases, the discovery of the HELLP syndrome was fortuitous by routine laboratory tests. The symptoms and signs are dominated by the digestive ones. In case of severe maternal complication or when the foetal lungs reach maturity, the interruption of pregnancy is the rule. In the other cases, expectative attitude with an intense observation may be proposed when the 32nd week of pregnancy isn't reached.