Chrystele Rubod

Long-term prognosis for infants after massive fetomaternal hemorrhage.

OBJECTIVE: To evaluate the fetal, neonatal, and long-term prognosis of massive fetomaternal hemorrhage (20 mL or more). METHODS: This series includes all patients with Kleihauer test values of 40 per 10,000 or higher over an 8-year period at two university hospitals. We examined obstetric, neonatal, and subsequent outcome data for the children. RESULTS: During the study period, 48 patients had massive fetomaternal hemorrhage (crude incidence 1.1 per 1,000; corrected incidence for Rh-negative women 4.6 per 1,000). Six fetal deaths were observed, representing 1.6% of all fetal deaths during the period. Nine newborns (18.7%) were transferred to neonatal intensive care unit (NICU) and five (10.4%) had transfusions. Fetomaternal hemorrhages of 20 mL/kg or more significantly increased the risk of fetal death, induced preterm delivery, transfer to NICU, and neonatal anemia requiring transfusion. Long-term follow-up was not associated with neurological sequelae (0%, 95% confidence interval 0.0–11.6%). CONCLUSION: When the transfused volume equals or exceeds 20 mL/kg, massive fetomaternal hemorrhage may lead to severe prenatal or neonatal complications. LEVEL OF EVIDENCE: III

Successful in utero treatment of chronic and massive fetomaternal hemorrhage with fetal hydrops.

Background: Massive fetomaternal hemorrhage is an uncommon cause of chronic fetal anemia. Without treatment, hydrops fetalis can occur and progress toward death. In some cases, an early diagnosis can improve the management. Case: A patient was found to have a fetus with non-immune hydrops related to massive and early fetomaternal hemorrhage successfully treated with serial fetal intravascular transfusion. After the treatment, ultrasonographic signs of hydrops disappeared and the pregnancy resulted in a good fetal outcome. There was no need for neonatal transfusion. Neurological examination at 1 month post-natal was normal. Conclusion: When massive fetomaternal hemorrhage is diagnosed early in the pregnancy, serial fetal intravascular transfusion may be an alternative to immediate delivery.

Adénocarcinome endométrioïde résultant de foyers d’adénomyose: À propos d’un cas et revue de la littérature

In spite of many references to carcinoma arising from endometriosis, there are few documented cases in the literature of endometrioid adenocarcinoma developed in association with adenomyosis. We report a case of endometrioid adenocarcinoma arising from adenomyosis. Carcinogenic and prognostic factors as well as the therapeutic consequences of this unusual situation are discussed. The use of hormonal replacement therapy by patients with a prior history of adenomyosis is also examined.Resume Alors qu’il existe de nombreux articles rapportant des observations de carcinome sur foyers d’endometriose ; l’adenocarcinome endometrioide, developpe aux depens d’adenomyose, est une situation inhabituelle qui a ete rarement documentee. Nous rapportons le cas d’une patiente presentant un adenocarcinome endometrioide resultant de foyers d’adenomyose. Les facteurs impliques dans la carcinogenese, le pronostic et les consequences therapeutiques de cette situation inhabituelle seront discutes a travers une revue de la litterature. Le probleme de la prescription du traitement hormonal substitutif aux patientes porteuses d’adenomyose sera souleve.

Macrotransfusion fœto-maternelle spontanée révélée par une diminution de la perception des mouvements actifs fœtaux

Resume La macrotransfusion fœto-maternelle est une entite rare. En dehors d’un contexte favorisant, le diagnostic precoce est difficile a realiser. Les manifestations cliniques et paracliniques sont peu specifiques et dependent des possibilites de compensation fœtale. La realisation d’un test de Kleihauer permet de confirmer le diagnostic. Nous rapportons deux observations de macrotransfusion fœto-maternelle spontanee revelee par une diminution de la perception des mouvements actifs fœtaux. La realisation d’une cesarienne en urgence a permis la survie d’un enfant, malgre un bilan clinique et paraclinique rassurant, une mort fœtale in utero n’a pu etre evitee. Un diagnostic precoce et une prise en charge en milieu specialise sont indispensables a une amelioration pronostique. Ces observations confirment l’interet de realiser un test de Kleihauer devant toute diminution des mouvements actifs fœtaux.