Jerome Dansereau

Androgenetic/biparental mosaicism causes placental mesenchymal dysplasia

Background: Placental mesenchymal dysplasia (PMD) is a distinct syndrome of unknown aetiology that is associated with significant fetal morbidity and mortality. Intrauterine growth restriction is common, yet, paradoxically, many of the associated fetuses/newborns have been diagnosed with Beckwith-Wiedemann syndrome (BWS). Methods: We report two cases of PMD with high levels of androgenetic (complete paternal uniparental isodisomy) cells in the placenta and document, in one case, a likely androgenetic contribution to the fetus as well. Results: The same haploid paternal complement found in the androgenetic cells was present in coexisting biparental cells, suggesting origin from a single fertilisation event. Conclusions: Preferential allocation of the normal cells into the trophoblast explains the absence of trophoblast overgrowth, a key feature of this syndrome. Interestingly, the distribution of androgenetic cells appears to differ from that reported for artificially created androgenetic mouse chimeras. Androgenetic mosaicism for the first time provides an aetiology for PMD, and may be a novel mechanism for BWS and unexplained intrauterine growth restriction.

Double-blind comparison of carbetocin versus oxytocin in prevention of uterine atony after cesarean section☆☆☆★

OBJECTIVE The goal of this study was to compare carbetocin, a long-acting oxytocin analog, with oxytocin in the prevention of uterine atony after cesarean section. STUDY DESIGN We enrolled 694 patients undergoing elective cesarean section in a Canadian multicenter, double-blind, randomized clinical trial. We compared the effect of a single 100 microg dose of carbetocin with that of a standard 8-hour infusion of oxytocin. The primary outcome was the proportion of patients requiring additional oxytocic intervention for uterine atony. A variable sample size, sequential design was used. RESULTS The overall oxytocic intervention rate was 7.4%. The odds of treatment failure requiring oxytocic intervention was 2.03 (95% confidence interval 1.1 to 2.8) times higher in the oxytocin group compared with the carbetocin group, respectively, 32 of 318 (10.1%) versus 15 of 317 (4.7%), P <.05. CONCLUSIONS Carbetocin, a new drug for the prevention of uterine atony, appears to be more effective than a continuous infusion of oxytocin and has a similar safety profile.

The Early Amniocentesis Study: A Randomized Clinical Trial of Early Amniocentesis versus Midtrimester Amniocentesis

OBJECTIVES The primary purpose of this pilot study was to determine whether the safety of early amniocentesis (EA; 11 weeks to 12 weeks and 6 days) is similar to midtrimester amniocentesis (MA; 15 weeks to 16 weeks and 6 days). The secondary objectives were to determine the cytogenetic success and accuracy of EA compared with MA. METHODS This prospective, randomized clinical trial compared continuous ultrasound-guided EA and MA (22-gauge needle) in patients at a late maternal age (> or = 35 years). The procedures were compared for safety, success and accuracy. RESULTS Among the 683 women randomized and followed to pregnancy completion, there was a total of 27/344 (7.8%) and 25/339 (7.4%) fetal losses (spontaneous and induced abortions) in the EA and MA groups, respectively (difference 0.4%; CI -3.6 to 4.4%). The rate of postprocedure spontaneous fetal loss was 2.4% (8/330) in the EA group and 3.3% (10/299) in the MA group (NS). The procedure success rate at the first attempt was 97.6% in the EA group and 99.7% in the MA group. There were no diagnostic errors, and all but 2 EA cultures were successful (both repeated successfully). The perinatal outcome was similar in both groups. CONCLUSIONS EA appears to be as safe and accurate as MA. A large multicentered, randomized trial is currently underway to verify these results.

Double-blind comparison of carbetocin versus oxytocin in preventing uterine atony post cesarean section☆

Objectives : The aim of this study was to compare carbetocin, a long-acting oxytocin analog, to oxytocin in the prevention of post-cesarean uterine atony. Material and methods : We enrolled 694 patients going for elective repeat cesarean in a Canadian multicentre double-blind randomized clinical trial. We compared the effect of a single dose of carbetocin (100 mcg.IV) to a standard 8 h IV infusion of oxytocin. The primary outcome was the proportion of patients requiring additional uterotonic drugs. The design used a sequential analysis using the double triangular test. Results : The overall uterotonic intervention rate was 7.4%. The odds of treatment failure was 2.0 times higher in the oxytocin group compared with the carbetocin group (respectively 10.1% vs. 4.7%, P<0.05). Interim safety analysis shows carbetocin to be well tolerated with a safety profile similar to oxytocin. Conclusion : Carbetocin, a new drug to prevent uterine atony, appears to be more effective than a continuous infusion of oxytocin in preventing uterine atony post-Cesarean.

Acute Pancreatitis in Pregnancy: A Ten-Year Review

Abstract Objective: to review our experience with pancreatitis during pregnancy and to describe maternal and fetal outcomes associated with this rare medical complication. Study Design: we undertook a ten-year retrospective review of the medical records at British Columbia Women’s hospital from 1985 to 1994. Charts containing a diagnosis of pancreatitis during pregnancy were analysed. The presumptive aetiology and the antenatal and postpartum outcomes were extracted and compared to previously published series. Results: twelve cases of pancreatitis during pregnancy were found. The assigned aetiology was gallstone disease in nine cases (75%), hyperlipidaemia in one case (8%), and idiopathic in two cases (17%). The median gestational ages at presentation and delivery were 33 and 36 weeks, respectively. Median birth weight at delivery was 2,760 g. There was no severe maternal or neonatal morbidity. The estimated period prevalence of pancreatitis in pregnancy during this time was 1:5,617. Conclusions: the prevalence of pancreatitis during pregnancy is low. Although the effects of this rare complication on the mother and fetus are still poorly defined, we have identified a high rate of labour induction for maternal reasons and subsequent iatrogenic prematurity is not clearly justified.