Blandine Courbiere

Fertility and obstetric outcome after conservative management of placenta accreta

To determine the fertility and obstetric outcomes after conservative management of placenta accreta.

Ultrastructural Interactions and Genotoxicity Assay of Cerium Dioxide Nanoparticles on Mouse Oocytes

Cerium dioxide nanoparticles (CeO2 ENPs) are on the priority list of nanomaterials requiring evaluation. We performed in vitro assays on mature mouse oocytes incubated with CeO2 ENPs to study (1) physicochemical biotransformation of ENPs in culture medium; (2) ultrastructural interactions with follicular cells and oocytes using Transmission Electron Microscopy (TEM); (3) genotoxicity of CeO2 ENPs on follicular cells and oocytes using a comet assay. DNA damage was quantified as Olive Tail Moment. We show that ENPs aggregated, but their crystal structure remained stable in culture medium. TEM showed endocytosis of CeO2 ENP aggregates in follicular cells. In oocytes, CeO2 ENP aggregates were only observed around the zona pellucida (ZP). The comet assay revealed significant DNA damage in follicular cells. In oocytes, the comet assay showed a dose-related increase in DNA damage and a significant increase only at the highest concentrations. DNA damage decreased significantly both in follicular cells and in oocytes when an anti-oxidant agent was added in the culture medium. We hypothesise that at low concentrations of CeO2 ENPs oocytes could be protected against indirect oxidative stress due to a double defence system composed of follicular cells and ZP.

Obstetric outcome of women with in vitro fertilization pregnancies hospitalized for ovarian hyperstimulation syndrome: a case-control study

OBJECTIVE To evaluate the obstetric outcome of women with IVF pregnancies hospitalized for ovarian hyperstimulation syndrome (OHSS). DESIGN A case-control study. SETTING Department of Obstetrics-Gynecology and Reproductive Medicine. PATIENT(S) All IVF patients hospitalized for OHSS with a positive pregnancy test matched to an IVF pregnancy control group who did not develop OHSS. INTERVENTION(S) Retrospective study of all clinical and laboratory data. MAIN OUTCOME MEASURE(S) OHSS morbidity, early pregnancy outcome, and obstetric complications. RESULT(S) The incidence of OHSS requiring hospitalization was 1.14% among 3,504 IVF cycles. Forty patients (31 singletons, 8 twins, and 1 triplet) hospitalized for severe OHSS with a mean duration of hospitalization of 10.2 ± 7.2 days were compared with a control group of 80 IVF pregnancies (48 singletons, 15 twins, and 2 triplets). Early OHSS occurred in 22.5% of patients, and late OHSS in the remaining 77.5% patients. In the OHSS group, 10% had thromboembolic complications. The miscarriage rate was similar for the OHSS group and the control IVF group (17.5% vs. 16%). Concerning ongoing clinical pregnancies, pregnancy-induced hypertension (PIH) and preterm labor were significantly higher in the OHSS group (respectively, 21.2% vs. 9.2% and 36% vs. 10.7%). In the subgroup of singletons, PIH was significantly higher for OHSS pregnancies than for controls. CONCLUSION(S) Pregnancies after IVF and OHSS are associated with a greater risk of adverse obstetric outcome.

Prognosis factors of pregnancy after intrauterine insemination with the husband's sperm: conclusions of an analysis of 2,019 cycles

OBJECTIVE To identify the prognostic factors for pregnancy after intrauterine insemination with the husbands sperm (IUI-H). DESIGN Retrospective study. SETTING A single university medical center. PATIENT(S) 851 couples, for 2,019 IUI-H cycles. INTERVENTION(S) After controlled ovarian stimulation, IUI-H performed 36 hours after ovulation triggering or 24 hours after a spontaneous luteinizing hormone (LH) surge. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate per cycle (PR) and delivery rate per cycle (DR). RESULT(S) The overall PR was 14.8% and DR 10.8%. Higher PR and DR were observed for patients presenting with ovulation disorders (particularly polycystic ovary syndrome) or with male infertility. Secondary infertility in the woman appeared to be a positive prognostic factor as did a basal follicle-stimulating hormone (FSH) level ≤ 7 IU/L and ovulation triggering over spontaneous LH rise. The other parameters influencing the results were the womens age, the number of mature follicles obtained (≥ 2), the endometrial thickness (10-11 mm), and the number of progressive motile spermatozoa inseminated (>1 million). CONCLUSION(S) In women aged ≤ 38 years, IUI-H should be considered as an option, particularly in cases of female infertility from ovulation disorders, in cases of a normal ovarian reserve, in cases of secondary infertility, or when ≥ 1 million progressive sperm are inseminated. Bifollicular stimulation is required. In other cases, in vitro fertilization should be discussed as the first-line treatment.

Delayed diagnosis of Sheehan's syndrome in a developed country. A retrospective cohort study.

BACKGROUND Little is known about Sheehans syndrome (SS), even though it is believed that its incidence is low. The aims of this study were to determine the clinical features and diagnostic delay of SS and to ascertain whether early signs could have allowed earlier diagnosis. SUBJECTS AND METHODS All patients with SS diagnosed in reference units in the southeast of France between 1980 and 2011 were recruited for this study. Data on obstetrical history, clinical symptoms suggestive of hypopituitarism, early signs, hormone analysis, and magnetic resonance imaging were collected. RESULTS Of the 40 women found to have SS, 39 were studied. Mean delay in the diagnosis of SS was 9 ± 9.7 years. We found that four of the 35 assessable patients were diagnosed with agalactia, 16 of the 29 assessable ones with amenorrhea, 19 of the 39 with hypothyroidism, eight with acute adrenal insufficiency, and 15 with asthenia. Among the patients for whom there was a diagnostic delay of more than 1 year (n=28), seven had headaches during the postpartum period, all assessable patients had agalactia, six of the 22 assessable ones had amenorrhea, seven of 28 had hypothyroidism, and 12 of 28 had asthenia. CONCLUSION Most signs of SS are aspecific and classical signs such as agalactia and amenorrhea are often difficult to detect, which can explain the long diagnostic delay. We suggest that all women failing to lactate after postpartum hemorrhage (PPH) should be evaluated by measuring prolactin levels and women with signs such as amenorrhea and asthenia, even several years after PPH, should undergo a blood test including assessment of thyroxine, TSH, 0800  h ACTH-cortisol, and IGF1 levels.

Cornual resection for interstitial pregnancy by laparoendoscopic single-site surgery

OBJECTIVE To present two cases of interstitial pregnancy treated successfully by use of laparoendoscopic single-site surgery (LESS). DESIGN Case series. SETTING Department of obstetrics and gynecology at a tertiary health care facility. PATIENT(S) Two women with interstitial pregnancy requiring surgical treatment. INTERVENTION(S) Laparoscopy by use of LESS with the single-incision laparoscopic surgery (SILS) system. MAIN OUTCOME MEASURE(S) Feasibility of LESS with the SILS system. RESULT(S) Two patients were treated successfully by use of LESS with the SILS system. After laparoscopic confirmation of the interstitial pregnancy, a cornual resection was performed with bipolar forceps and scissors for the first patient and with an automatic stapler for the second. CONCLUSION(S) Laparoscopic treatment of interstitial pregnancy by use of LESS seems feasible. Larger series are necessary to confirm these findings.

Cerium dioxide nanoparticles affect in vitro fertilization in mice

Abstract Due to their catalytic and oxidative properties, cerium dioxide nanoparticles (CeO2NPs) are widely used as diesel additive or as promising therapy in cancerology; yet, scarce data are available on their toxicity, and none on their reproductive toxicity. We showed a significant decrease of fertilization rate, assessed on 1272 oocytes, during in vitro fertilization (IVF) carried out in culture medium containing CeO2NP at very low concentration (0.01 mg.l−1). We also showed significant DNA damage induced in vitro by CeO2NP on mouse spermatozoa and oocytes at 0.01 mg.l−1 using Comet assay. Transmission Electron Microscopy did not detect any nanoparticles in the IVF samples at 0.01 mg.l−1, but showed, at high concentration (100 mg.l−1), their endocytosis by the cumulus cells surrounding oocytes and their accumulation along spermatozoa plasma membranes and oocytes zona pellucida. We did not observe any nanoparticles in the cytoplasm of spermatozoa, oocytes or embryos. This study demonstrates for the first time the impact of CeO2NP on in vitro fertilization, as well as their genotoxicity on mouse spermatozoa and oocytes, at low nanoparticle concentration exposure. Decreased fertilization rates may result from: (1) CeO2NP’s genotoxicity on gametes; (2) a mechanical effect, disrupting gamete interaction and (3) oxidative stress induced by CeO2NP. These results add new and important insights with regard to the reproductive toxicity of nanomaterials requesting urgent evaluation, and support several publications on metal nanoparticles reprotoxicity. Our data highlight the need for in vivo studies after low-dose exposure.

Respiratory distress syndrome after elective caesarean section in near term infants: a 5-year cohort study

Objective: to assess the incidence of respiratory distress syndrome (RDS) in late preterm (340/7–366/7) and just term (370/7–376/7) infants born via elective caesarean section (CS) in a tertiary care maternity facility. Methods: retrospective cohort study between 2005 and 2009. Hundred and eighty-eight near term infants, divided in two groups: group A: 125 late preterm (340/7–366/7) and group B: 63 just term (370/7–376/7), from elective CS (except CS after pre-mature rupture of membranes and foetuses presenting congenital malformation) were included. Results: In group A the overall incidence of RDS (RDS at or shortly after birth, requiring respiratory support or oxygen therapy) was 44% (n = 55) vs. 15.9% (n = 10) in group B (p < 0.01). The incidence of SRDS (requiring admission in the neonatal intensive care unit (NICU)) in group A was 13.6% (n = 17) and 3.2% (n = 2) group B (p < 0.01). The risk decreased significantly as gestational age (GA) increased: for RDS, 50.9% at 34 weeks of gestation (WG), 52.5% at 35 WG, 21.5% at 36 WG, and 15.9% at 37 WG; for admission, 30.2% at 34 WG, 25% at 35 WG, 9.4% at 36 WG, and 6.3% at 37 WG. Among late preterm infants with RDS, 30.9% (n = 17) developed severe RDS (SRDS). Conclusions: Late preterm infants born via elective CS are at high risk for RDS and NICU admission. The risk is influenced by each additional week spent in utero. As the incidence of CS is increasing within this population, new preventative strategies must be sought.

Genotoxicity assessment of mouse oocytes by comet assay before vitrification and after warming with three vitrification protocols

OBJECTIVE To assess the genotoxicity of three oocyte vitrification protocols. DESIGN Murine assay. SETTING Biogenotoxicology research laboratory. ANIMAL(S) CD1 female mice. INTERVENTION(S) Three mouse oocyte groups were exposed to three commercialized human oocyte vitrification protocols. Protocols 1 and 2 contained dimethyl sulfoxide and ethylene glycol (EG), and protocol 3 contained EG and 1,2-propanediol (PrOH). DNA damage was first evaluated by comet assay after oocyte exposure to the three different equilibration and vitrification solutions. Comet assay was also performed after full vitrification and warming procedure and compared with a negative control group (oocytes stored in medium culture only) and a positive control group (oocytes exposed to hydrogen peroxide just before comet assay). MAIN OUTCOME MEASURE(S) DNA damage was quantified as Olive tail moment (OTM). Statistical analysis consisted of a Shapiro-Wilk test. Then, median protocol OTM was compared with the negative control group with the Mann-Whitney U test. The difference was considered to be statistically significant if the P value was <.05. RESULT(S) In both parts of our study, protocols 1 and 2 did not induce significant DNA damage, whereas protocol 3 induced statistically higher DNA damage compared with the negative control group. CONCLUSION(S) Vitrification protocols containing PrOH induced significant DNA damage on mouse oocytes, both before cooling and after warming. Therefore, for the moment, we prefer vitrification techniques without PrOH while we await more studies on PrOH toxicity and long-term evaluation.

Is uterine-sparing surgical management of persistent postpartum hemorrhage truly a fertility-sparing technique?

Among 23 women who underwent diagnostic hysteroscopy after triple uterine artery ligation with or without hemostatic multiple square suturing for the management of postpartum hemorrhage (PPH), five had abnormal findings. Endometritis was statistically significantly associated with abnormal diagnostic hysteroscopy findings. Twelve patients developed subsequent pregnancies, and four had abnormal obstetric outcomes: one placenta percreta, one placenta accreta, one recurrent postpartum hemorrhage, and one intrauterine growth retardation.