Polyhydramnios: a warning sign in the prenatal ultrasound diagnosis of foetal malformation?

PURPOSE: To propose polyhydramnios seen during prenatal diagnosis as a warning sign of foetal malformation. PATIENTS AND METHODS: A retrospective multicentre study over a three-year period carried out in Ivory Coast and Burkina Faso. We reviewed 3903 obstetric ultrasound reports. All cases of foetal malformation and polyhydramnios were counted. The instances of foetal malformation associated with polyhydramnios were compared to those of foetal malformation without polyhydramnios and to polyhydramnios only. RESULTS: A list of 72 cases of polyhydramnios was made (equating to 1.8%). In 55 cases (76.4%), polyhydramnios was combined with foetal malformation. These were lethal abnormalities in 33 cases and non-lethal in 22 cases. In 17 cases, polyhydramnios was not associated with any foetal malformations and in eight cases, foetal malformation was discovered in the absence of polyhydramnios. Polyhydramnios had a positive predictive value of 76.4% for the presence of foetal malformation. The negative predictive value was 99.8%. Sensitivity was 87.3% and specificity was 99.5%. CONCLUSION: Polyhydramnios is a highly sensitive and specific sign for prenatal diagnosis of foetal malformation. If it is identified, then this should lead to a very careful search for foetal malformation.

Grossesse et risques d'irradiations en radiodiagnostic : etat des connaissances des usagers au CHU de Yopougon

Objectifs : Evaluer l'etat des connaissances des usagers et des professionnels de la sante sur les risques d'irradiation de la femme enceinte au cours des explorations radiologiques et l'observation de l'application des regles de radioprotection relative a la femme enceinte par les utilisateurs de rayons X. Materiel et methodes : Notre etude prospective; realisee au CHU de Yopougon; a dure 6 mois. Nous avions interroge 60 femmes en grossesse ou susceptibles de l'etre; 30 medecins prescripteurs non radiologues; 29 techniciens d'imagerie medicale et 21 aides soignants sur les risques d'irradiation et les mesures de protection de la femme enceinte avant et pendant la realisation d'un examen radiologique utilisant les rayons X. Resultats : 73;68des medecins prescripteurs n'avaient pas de culture en radioprotection chez une femme enceinte ou en age de procreer. 93;10des patientes enceintes ou en age de procreer ignoraient l'existence des rayons X en radiodiagnostic et leur nocivite pour une femme enceinte ou susceptible d'etre enceinte. 80des manipulateurs de radiologie respectaient pas les regles elementaires de radioprotection. Conclusion : La sensibilisation des usagers des rayons X sur les risques d'irradiations chez une femme enceinte ou susceptible de l'etre est necessaire au CHU de Yopougon

[Ultrasound and epidemiological features of ectopic pregnancy in a suburb of Abidjan (Cote d'Ivoire)]. / Profil echographique et epidémiologique des grossesses extra-utérines dans une banlieue d'Abidjan (Côte d'Ivoire).

OBJECTIVE: The aim of our study was to describe current ultrasound and epidemiological features of ectopic pregnancy in Abidjan, Côte d'Ivoire. PATIENTS AND METHODS: This prospective study was carried out over a 24-month period (February 2006 to January 2008) at Nanglé Medical Clinic, i.e., a private clinic located in Abidjan's Yopougon suburb. RESULTS: A total of 32 cases of ectopic pregnancy were discovered by suprapubic and/or endovaginal ultrasound scan. The estimated frequency of ectopic pregnancy was 1.7%. Mean patient age was 26.2 years. The main risk factors were prior history of abortion (32%) and adnexal infection (20%). Most patients (52.5%) were nulliparous. The most frequent indication for ultrasound scan was metrorrhagia. Diagnosis of ectopic pregnancy was made at the ruptured stage in 65.6% of cases and nonruptured stage in 34.4%. The presenting lesions was hematosalpinx in 40.6% of cases and embryonate ectopic gestational sac in 31.3%. Salpingectomy and salpingorrhaphy were successful in 65.6% and 34.4% of cases respectivlely. CONCLUSION: In Abidjan, ectopic pregnancy involves young nulliparous women with a prior history of abortion and adnexal infection. Ultrasound allowed early diagnosis and, consequently, tube preservation in 34.4% of cases.