Gilles Grangé

Dating biometry during the first trimester: accuracy of an every-day practice

OBJECTIVE The goal of this study was to determine the accuracy of an every-day practice for assessing gestational age by ultrasound measurement of the greatest embryonic length (GEL). DESIGN This retrospective study used measurements taken during the first trimester. SUBJECTS We considered all births in this hospital between 1 January 1992 and 31 December 1994 from pregnancies that began by an in-vitro fertilization procedure (IVF). We examined 143 consecutive files, containing 257 measurements made by 72 different operators. METHODS The precision of seven embryo growth curves was compared. We calculated for each curve its ability to predict (95% prediction interval) the date the pregnancy began, using these dated pregnancies. RESULT For GEL measurements between 3 and 80 mm, which includes most of our population, Robinson and Wisser (2) were the most appropriate curves. The 95% prediction interval was 9.5 and 10.2 days respectively. CONCLUSION Dating pregnancies in every-day practice with GEL is nearly as accurate as prospective studies with only one or two scanners.

Validity of sonographic formulas for estimating fetal weight below 1,250 g : A series of 119 cases

Objective: The aim of this study was to determine the accuracy of sonographic methods for estimating fetal weight <1,250 g on the basis of ten published formulas falling into two principal categories: general formulas applied to all fetuses, and formulas specifically developed for very-low-weight fetuses. Methods: Recent biometric data (obtained less than 7 days before birth) on 119 fetuses weighing <1,250 g were used retrospectively. Estimated fetal weights derived from ten published formulas were compared to actual weights. For each equation, the errors in predicting fetal weight were used to calculate mean percentage error and standard deviation of the mean error. The t test was used to determine whether the mean errors were significatively different from zero. The F test was used to determine if there were significant differences in the standard deviation of the mean errors. Results: The mean birth weight of infants was 956 ± (SD) 183 g at a gestational age of 29 ± (SD) 2.3 weeks. The best three formulas were the Hadlock, Sabbagha and Mielke which generated a mean error of –0.25, 2.81 and 0.29 not statistically different from zero with standard deviations of 13.02, 9.14 and 11.96, which were not statistically different. Conclusion: In our population of very-low-birth-weight infants, the use of specific formulas targeted to those fetuses does not provide a more accurate estimation of fetal weight.

Vascularization of the placenta and the sub-placental myometrium: feasibility and reproducibility of a three-dimensional power Doppler ultrasound quantification technique. A pilot study.

Objective. To assess the feasibility of placental and myometrial vascularization quantification using 3D power Doppler ultrasonography. Methods. 3D standardized acquisition was performed in the mid part of the utero-placental unit, once, in 38 patients undergoing normal pregnancies between 15 and 39 weeks. Vascularization parameters (VI, FI, and VFI) of placentae and myometrium were measured. Intra and inter-observer, as well as inter-acquisition reproducibility were evaluated. Results. Intra-class Correlation Coefficient of vascularization measurements were at least 0.94 for intra-observer, 0.92 for inter-observer, and 0.56 for inter-acquisition reproducibility. There was no significant difference for placental measurements for VI, FI and VFI between the second trimester and the third trimester pregnancies. Concerning the myometrium, we observed no significant difference between second and third trimester for FI. However, VI (28.090 vs. 19.374) and VFI (17.691 vs. 11.336) was significantly lower in the third trimester (p < 0.01). Conclusion. 3D quantification of placental and myometrial vascular parameters is feasible with a high intra and inter-observer reproducibility. Evaluating a potential myometrial vascular impairment appears to be as relevant as studying the placenta alone and might be of great clinical interest. We believe that this technique should therefore be evaluated in clinical observational studies.

Factors associated with regular cervical cancer screening

To identify the factors associated with regular cervical screening (CS) in the French female population.

Prognosis and outcome of pregnancies exposed to renin–angiotensin system blockers

To study pregnancy outcomes and fetal renal prognosis markers in cases of exposure to renin–angiotensin system blockers.

Giant dural venous sinus ectasia in neonates.

In this report, the authors describe 4 recent cases of posterior giant dural venous sinus ectasia in neonates diagnosed during pregnancy and encountered at 3 different institutions. Posterior giant venous sinus ectasia was diagnosed in 4 patients using antenatal ultrasonography and confirmed in 2 patients using prenatal MR imaging and in 3 patients using postnatal MR angiography. In 2 children angiography was performed at the age of 6 months. The pregnancy was terminated in 1 case, and the fetus underwent an autopsy. The 3 children who were born presented with various degree of cardiac insufficiency and were admitted to the intensive care unit after birth. Signs of increased intracranial pressure were present immediately after birth, including a bulging fontanel. No endovascular treatment was used in these cases. Surgery was performed in 2 cases as an attempt to alleviate increased intracranial pressure symptoms, without any real benefit. A slow venous flow in the ectasia was shown by ultrasonography in the case in which the pregnancy was terminated. Angiography or MR angiography did not show an obvious arteriovenous malformation in any of the cases, but an arteriovenous fistula secondary or contributing to the formation of the venous ectasia is one of the physiopathological hypotheses of the cause of this condition. Interestingly, spontaneous progressive thrombosis and regression of the intravascular component of the venous sinus ectasia was observed in all cases. The clinical outcome was acceptable in 1 child (who had a moderate handicap after the surgery) and good for the other 2 children (who had normal neurological development). Stratified thrombi of different ages are found in these giant venous ectasias and develop within the leaves of the dura close to the confluence of the major posterior venous sinuses. Therefore, it appears that the formation of a progressive thrombosis represents the normal evolution of these giant dural venous sinus ectasias, which explains the favorable outcome in some cases without specific surgical treatment, except for resuscitation techniques.

Fetal Loss after Amniocentesis in a Series of 5,780 Procedures

Objectives: Counseling on prenatal diagnosis requires accurate knowledge of the associated risks, including fetal loss. The objective of our study was to assess this risk of amniocentesis in a single center with several operators. Methods: This retrospective analysis concerns only women with singleton pregnancies who underwent amniocentesis between 14+0 and 23+6 weeks’ gestation. Results: During this 4.5-year period, 5,780 amniocenteses were performed, of which we analyzed 5,319. The rate of fetal loss was 70 in 4,858 tests (1.4%), with a lost-to-follow-up rate of 3.8%. Conclusion: Our results for fetal loss are comparable to those in the largest series with fewer operators already published.

Taux de sevrage tabagique chez la femme enceinte en fonction des trimestres

OBJECTIVE To investigate the smoking cessation period during pregnancy. PATIENTS AND METHODS Questionnaire-based, descriptive study of 979 pregnant women in four regions of France. The variables analysed included the characteristics of the mother and neonate at delivery, the smoking habits of the mother before and during pregnancy, the perception of risk linked to smoking, and the reasons for giving up smoking. RESULTS Eighteen percent of women smoked until delivery. Forty-five percent of women gave up smoking during pregnancy, usually in the first trimester. More precisely, about one woman who smoked out of 50 gives up in order to prepare pregnancy. The proportion of women who stop smoking in each of the three trimesters of pregnancy is 84,1, 8,8 and 7,1% respectively. DISCUSSION AND CONCLUSION Most women appear to stop smoking before any intervention therapy is possible. The first contact with a midwife or an obstetrician takes place whereas smoking cessation is already successful.

Is Rapid Aneuploidy Screening Used Alone Acceptable in Prenatal Diagnosis? An Evaluation of the Possible Role of Ultrasound Examination

Objective: The objectives of this study were to use a factual basis to: (1) determine the number, nature, and probable phenotypic consequences of karyotype anomalies that would probably be missed (structural anomalies, uncommon aneuploidies and mosaic aneuploidies) by rapid aneuploidy screening (RAS), and (2) appraise whether RAS can replace traditional karyotyping when amniocenteses are performed for increased risk of Down’s syndrome by maternal serum screening or advanced maternal age in the absence of ultrasound abnormality. Methods: This retrospective cohort study analysed the indications, results and outcomes of 5,713 consecutive amniocenteses over a 5-year period at a single prenatal diagnosis centre in Paris. Results: Advanced maternal age and increased Down’s risk with maternal serum marker were the most common indications. Chromosome abnormalities were detected in 3.64% of the pregnancies tested, and unexpected structural anomalies in 0.63% (n = 36). Translocations were more likely to be reciprocal, balanced and of parental origin. There were 6 mosaic gonosomal aneuploidies. Overall, 4 mosaic autosomal aneuploidies and 36 structural aberrations would not have been recognised by RAS alone. Of the 4 mosaic autosomal aneuploidies, all were terminated, one had major malformations and the others had discrete signs that a good quality ultrasound examination would probably not detect. Of the 36 structural aberrations, 24 would be undetected by ultrasound scan, from which 6 would be associated with a significant risk of an abnormal phenotype outcome. Conclusion: In conclusion, our data do not provide evidence that RAS can replace the traditional karyotype. It is probably impossible to arrive in a universal conclusion of which approach (karyotype or RAS) is definitely better than the other. Each prenatal centre could have its own approach depending on the local data analysis, including quality control of ultrasounds.

Sonographic Measurement of the Fetal Iliac Angle Cannot Be Used Alone as a Marker for Trisomy 21

The fetal iliac wings angle was studied in 255 fetuses before amniocentesis at 16.7 weeks (± 1.3), using a sonographic axial view of the fetal pelvis. The measurement could be performed in 208 fetuses (81.6%), of whom 4 had trisomy 21 (T 21). The mean iliac angle was greater in fetuses with T 21 than in normal fetuses (69.8° vs. 88.7°; p = 0.03). This measurement is subject to significant intra- and interexaminer variability (interclass correlation coefficient: 0.65 and 0.23, respectively). When a 90° value is used as a threshold, specificity, sensitivity, positive and negative predictive values are, respectively, 80, 75, 7.0 and 99.4%. The 20% rate of false-positives rules out the use of this measurement as the sole criterion for the indication of amniocentesis for T 21 antenatal diagnosis.