Jean-Michel Faure

Cervical ripening with mifepristone before labor induction: a randomized study.

Objective To determine the efficacy and safety of mifepristone for cervical ripening in post-term pregnancies. Methods Women with post-term pregnancies and Bishop scores less than 6 were assigned randomly to mifepristone (41 patients) or placebo (42 patients). Mifepristone was given orally in a dose of 400 mg. Efficacy was assessed by change in the Bishop score within 48 hours after treatment; a score of 6 or greater was considered a “strict” success. An “extended” success rate was defined, including all patients with scores of at least 6 or those who delivered within 48 hours of treatment. Antenatal safety was assessed by fetal heart rate testing before and throughout labor. Neonatal safety was assessed by Apgar score, arterial or venous pH of cord blood, and blood glucose level during the first 48 hours. Analysis used Student t test for continuous variables, Kruskal-Wallis test for ordinal data, and χ2 for categoric variables. Results Strict success was achieved in 10 of 18 mifepristone patients (55%) evaluated for Bishop score on day 2 versus 8 of 29 placebo patients (27.5%) (P = .004). Extended success was achieved in 33 mifepristone patients (80.5%) and 21 placebo patients (50.0%) (P = .004). There were no statistical differences with regard to number of cesareans or fetal and neonatal safety. Conclusion Mifepristone proved effective for cervical ripening and reduced the time to delivery compared with placebo, but it did not improve the rate of cesarean. Our study did not include enough pregnancies to reach conclusions about fetal or neonatal safety.

The effects of mifepristone on uterine sensitivity to oxytocin and on fetal heart rate patterns

OBJECTIVE To compare the incidences of tachysystole, hypertonia and fetal heart rate (FHR) abnormalities in women treated by mifepristone plus prostaglandins (PGs), mifepristone alone or PGs alone for an unfavourable cervix. STUDY DESIGN In this retrospective study, all women between 37 and 42 weeks were eligible for the study if they had undergone cervical ripening prior to labour induction. In group 1, the women were treated with mifepristone plus PGs (n=103). Group 2 women were treated with mifepristone alone (n=96) and group 3 women with PGs alone (n=100). Incidences of tachysystole, hypertonia and FHR abnormalities were compared. RESULTS During induction of labour, tachysystole and hypertonia occurred more frequently in women treated with mifepristone. Severe bradycardia and recurrent late decelerations were more frequent after the initiation of oxytocin in groups 1 and 2 than in group 3. CONCLUSIONS In this study, mifepristone increased the incidences of tachysystole, hypertonia and FHR abnormality.

Ultrasound-assisted laparoscopic creation of a neovagina by modification of Vecchietti's operation

BACKGROUND In performing Vecchiettis operation laparoscopically, it is important to ensure bladder and rectum integrity. We report new techniques of ultrasonography and suture retrieval that simplify and improve the ease and speed of this operation. TECHNIQUE The pneumoperitoneum is emptied and the bladder filled with 200 mL of sterile water. The ultrasound probe is placed on the suprapubic wall for a sagittal image. The needle progresses medially through the vesicorectal space, with ultrasound guidance, and its emergence into the pelvis is controlled with laparoscopy. The nylon sutures carrying the dilation ball are threaded through the needle and brought back through the abdominal wall. EXPERIENCE Seven patients with vaginal aplasia had this procedure. There were no complications, and the mean operative time was 43 minutes (range 35-55). Mean vaginal length was 7 cm (range 6-10). Four women defined sexual intercourse as very satisfying and two as moderately satisfying. CONCLUSION This original technique was used for easy, safe, and rapid creation of neovaginas.

Anatomy and growth of the fetal soft palate: a cadaveric study to improve its ultrasonographic observation.

Objective: To determine the anatomy of the soft and hard palate during fetal growth in order to improve its ultrasonographic prenatal visualization. Design: Anatomic study in human formalin-fixed fetus. Methods: The heads of 18 second and third trimester fetuses were studied in the median sagittal plan. Measurements of the soft palate, the velopharynx, the root of the tongue, and the oral floor were taken. The hard palate/soft palate angle and the anterior cranial base/soft palate angle were measured. Results: The growth of the hard palate was linear, and the growth of the soft palate was polynomial (second order) during the period studied. The hard palate/soft palate angle was 150.33° ± 7.62 and 150.20° ± 6.67 in the second and third trimester, respectively. The anterior position of the soft palate in relation to the anterior cranial base was 48.8° ± 3.13 in the second trimester and 52.26° ± 3.31 in the third trimester. Its posterior position was 89.66° ± 5.51 in the second trimester and 92.97° ± 4.01 in the third trimester. Throughout the fetal period, the soft palate moved downward relative to the clivus and cervical spine. Conclusions: Despite the nonlinear growth and downward displacement of the soft palate during fetal life, its position remains stable. These results may be useful to explore the fetal soft palate using 2D and 3D ultrasonography and to improve the prenatal diagnosis of isolated cleft palate.

B19 parvovirus-induced fetal hydrops : Good outcome after intrauterine blood transfusion at 18 weeks of gestation

We report a successful treatment of a B19 parvovirus-induced fetal hydrops diagnosed at 16 weeks of gestation. This disease could be corrected by means of a unique intraperitoneal blood transfusion performed at 18 weeks, once diagnosis was established. The delivery occurred at 36 weeks, leading to the birth of a healthy baby. This case suggests that transfusion should be attempted, as the spontaneous fetal recovery remains uncertain and shows that intraperitoneal blood transfusion is an effective therapeutic option of the B19 parvovirus-induced anemia, in the absence of a viral myocarditis.

Prevalence and timing of pregnancy termination for brain malformations

Objective To determine the prevalence and the timing of pregnancy termination relative to the type of central nervous system (CNS) malformations. Design Retrospective cohort study. Setting Multidisciplinary centre for prenatal diagnosis in the Languedoc-Roussillon region, France. Population A cohort of 481 pregnancy terminations performed between 2005 and 2009. Methods Detailed post-termination fetal and neuropathological analyses were carried out to identify the CNS malformations. Then, the prevalence and timing of pregnancy termination were assessed relative to the identified malformations. Results About one-third of pregnancy terminations (143/481) were performed for severe CNS malformations. Up to 24 weeks of gestation (WG), pregnancy terminations (56.6%) were carried out mainly for defects occurring during the two major first steps of CNS development (neurulation and differentiation of cerebral vesicles). After 24 WG, pregnancy terminations (43.3%) were mainly performed for corpus callosum agenesis (16/17), vermian agenesis (10/12) and gyral anomalies (13/15). For hindbrain malformations and gyral anomalies, there was a significant relationship between the timing of pregnancy termination and the presence of a severe ventriculomegaly at prenatal diagnosis (p=0.002 and p=0.02, respectively). Conclusion By classifying CNS malformations according to the neuropathological analysis, the authors show that the timing and prevalence of pregnancy termination are distributed in a manner that is consistent with what is currently known on the development of brain. They are also influenced by the French prenatal screening policy and the variable expressivity of the brain malformations and associated lesions.

Nonimmune hydrops fetalis caused by intrauterine human parvovirus B19 infection : A case of spontaneous reversal in utero

We report a case of spontaneous reversal in utero of hydrops fetalis caused by parvovirus B19 maternal-fetal infection. The route leading to fetal hydrops is not fully understood. Severe anemia with hypoxemia and viral fetal myocarditis have been incriminated. Then the main issue is fetal death or spontaneous abortion. Cases of spontaneous reversal of hydrops fetalis are unusual. Fetal regenerative anemia is a good prognostic factor and emphasizes the place of conservative management.

The 2D axial transverse views of the fetal face: A new technique to visualize the fetal hard palate; methodology description and feasibility

The objectives of this study were to describe the methodology and to assess the feasibility of a simple 2D ultrasound technique to visualize the fetal hard palate (FHP) using a strict axial transverse view (ATV).

Epiphyseal punctate calcifications (stippling) in complete trisomy 9

Marie-José Perez1, Anouck Schneider1, Anne-Marie Chaze1, Nicole Bigi1, Geneviève Lefort1, Caroline Rouleau2, Jean-Michel Faure3, Haissam Rahil4, Nami Wadih5, Alain Couture6, Pierre Boulot3, Patricia Blanchet1, Pierre Sarda1 and David Geneviève1* 1Service de Génétique Médicale et Chromosomique, Centre de Référence Maladies Rares Anomalies du Développement et Syndromes Malformatifs Sud-Languedoc Roussillon, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Université Montpellier 1, Faculté de Médecine de Montpellier-Nimes, Montpellier, France 2Service d’Anatomopathologie, Hôpital Lapeyronie, CHRU de Montpellier, France 3Maternité, Hôpital Arnaud de Villeneuve, CHRU de Montpellier, France 4Laboratoire de Cytogénétique, Clinique Clémentville, Montpellier, France 5Gynécologie, Clinique Notre Dame Espérance, Perpignan, France 6Service de Radiologie Pédiatrique, Hôpital Arnaud de Villeneuve, CHRU de Montpellier, France

Prenatal and postnatal evolution of isolated fetal splenic cysts

The aim of this study was to evaluate the prevalence, the prenatal, and postnatal evolution of isolated fetal splenic cysts.