L. Boubli

Prenatal diagnosis of fetal corpus callosum agenesis by ultrasonography and magnetic resonance imaging

Corpus callosum agenesis (CCA) was evaluated by ultrasound examination and magnetic resonance imaging (MRI) in 14 cases. Ultrasonography was able to suspect CCA by indirect signs but a definitive diagnosis of CCA was achieved in only four cases. MRI was able to diagnose complete CCA in 13 cases and showed absence of the posterior portion of the corpus callosum in one case. Additional neurological abnormalities including heterotopia, gyration anomaly, asymmetry of the cerebral hemispheres, and Dandy‐Walker variant were documented in five cases, as well as an ocular anomaly which was present in one case, by MRI examination. Prenatal counselling for fetal agenesis of the corpus callosum is difficult as the prognosis is uncertain. The association with other cerebral abnormalities increases the likelihood of a poor outcome and ultrasonographic assessment of the fetal brain is limited. We found MRI to be a safe and useful additional procedure to complement ultrasonographic diagnosis or suspicion of CCA.

Managing Q Fever during Pregnancy: The Benefits of Long-Term Cotrimoxazole Therapy

BACKGROUND Q fever is a zoonosis caused by Coxiella burnetii. During pregnancy, it may result in obstetric complications, such as spontaneous abortion, intrauterine growth retardation, intrauterine fetal death, and premature delivery. Pregnant women are exposed to the risk of chronic Q fever. METHODS We included 53 pregnant women who received a diagnosis of Q fever. We compared the incidence of obstetric and maternal Q fever complications for women who received long-term cotrimoxazole treatment (n=16) with that for women who did not receive long-term cotrimoxazole treatment (n=37); long-term cotrimoxazole treatment was defined as oral administration of trimethoprim-sulfamethoxazole during at least 5 weeks of pregnancy. RESULTS Obstetric complications were observed in 81.1% of pregnant women who did not receive long-term cotrimoxazole therapy: 5 (13.5%) women experienced spontaneous abortions, 10 (27%) experienced intrauterine growth retardation, 10 (27%) experienced intrauterine fetal death, and 10 (27%) experienced premature delivery. Oligoamnios was observed in 4 patients (10.8%). Obstetric complications were found to occur significantly more often in patients infected during their first trimester of pregnancy than in those infected later (P=.032). The outcome of the pregnancy was found to depend on placental infection by C. burnetii (P=.013). Long-term cotrimoxazole treatment protected against maternal chronic Q fever (P=.001), placental infection (P=.038), and obstetric complications (P=.009), especially intrauterine fetal death (P=.018), which was found to be related to placental infection (P=.008). CONCLUSIONS Q fever during pregnancy results in severe obstetric complications, including oligoamnios. Because of its ability to protect against placental infection, intrauterine fetal death, and maternal chronic Q fever, long-term cotrimoxazole treatment should be used to treat pregnant women with Q fever.

Q fever during pregnancy: a cause of poor fetal and maternal outcome.

Q fever is a worldwide zoonosis caused by Coxiella burnetii. Q fever may be present as an acute or a chronic infection and can be reactivated during subsequent pregnancies. Although its exact prevalence remains unknown, it is likely that the number of cases of Q fever in pregnant women is underestimated. During pregnancy, the illness is likely to be asymptomatic, and diagnosis is based on serology. Acute infection results in appearance of IgM and IgG antibodies mainly directed against the avirulent form of C. burnetii (phase II). Chronic Q fever results in particularly high level of IgG and IgA antibodies directed against both virulent (phase I) and avirulent (phase II) forms of the bacterium. Q fever may result in adverse pregnancy outcome, including spontaneous abortion, intrauterine growth retardation, oligoamnios, intrauterine fetal death (IUFD), and premature delivery. Obstetric complications occur significantly more often as C. burnetii infects the patient at an early stage of her pregnancy. Occurrence of IUFD is correlated with the presence of placental infection by C. burnetii and might be the consequence of direct infection of the fetus. The mother is exposed to the risk of chronic Q fever and endocarditis with potential fatal evolution. Long‐term cotrimoxazole therapy prevents from placental infection, IUFD, and maternal chronic Q fever. Such treatment should be used to treat pregnant women with Q fever. Women with previous history of Q fever should have a regular serological follow up. Obstetricians’ knowledge about Q fever must be improved.

High vaginal concentrations of Atopobium vaginae and Gardnerella vaginalis in women undergoing preterm labor.

OBJECTIVE: To estimate the relationship between vaginal quantification of the main microorganisms related with bacterial vaginosis and the risk of preterm delivery among women with preterm labor. METHODS: Molecular methods were used to prospectively quantify Lactobacillus species, Gardnerella vaginalis, Atopobium vaginae, and Mycoplasma hominis in vaginal fluid samples from women admitted for spontaneous preterm labor with intact membranes from July 2007 through July 2008. The primary outcome measure was the relationship between bacterial concentration at admission and preterm delivery, before 37 weeks of gestation. Sensitivity and specificity of molecular cutoff values and 95% confidence intervals (CIs) were calculated using the University of British Columbia Bayesian Calculator type 2. RESULTS: Of the 90 women included, 36 delivered before 37 weeks of gestation (40%). Preterm delivery was not associated with the presence of Lactobacillus species, G vaginalis, A vaginae, or M hominis. In contrast, molecular quantification detected high concentrations of A vaginae (106/mL or more: 25.0% in the preterm group and 9.3% in the term group, P=.04) and G vaginalis (107/mL or more: 16.7% and 3.7%, P=.03) more often in women with preterm deliveries compared with term deliveries. Moreover, high vaginal concentrations of these two microorganisms together were associated with a significantly (P=.03) shorter interval between preterm labor and delivery (46 days, 95% CI 30–61) than were lower concentrations (85 days, 95% CI 75–95). The hazard ratio for a short preterm labor-to-delivery interval was three times higher for high vaginal fluid concentrations of A vaginae and G vaginalis than for lower concentrations (hazard ratio 3.3, 95% CI 1.1–9.5, P=.03). CONCLUSION: The risk of preterm delivery is significantly associated with high vaginal concentrations of A vaginae and G vaginalis in women with preterm labor. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00484653. LEVEL OF EVIDENCE: III

Maternal endothelial soluble cell adhesion molecules with isolated small for gestational age fetuses: comparison with pre‐eclampsia

Objective 1.To evaluate the activation profile of the endothelium in pregnancies complicated by small for gestational age fetuses compared with pre‐eclampsia and normal pregnancy, by measuring the plasma levels of soluble adhesion molecules soluble E‐selectin, intercellular cell adhesion molecule‐1 and vascular cell adhesion molecule‐1. 2. To determine whether soluble adhesion molecules were related to the severity of small for gestational age fetuses and pre‐eclampsia.

Hysteroscopic management of uterine synechiae: A series of 102 observations

This retrospective study concerns 102 cases of intra-uterine adhesions treated by exclusive hysteroscopic approach. Fifty-two patients (51%) presented with reproductive problems, 44 patients (43%) with menstrual problems and 6 were asymptomatic. Seventy-eight patients (76.5%) had an antecedent endometrial trauma on a gravid uterus. One hundred and forty-eight operative hysteroscopies were performed to treat 102 patients; 70 patients were treated in one endoscopic session (68.6%), 23 in two sessions (22.6%), 4 in three sessions (3.9%) and 5 in four sessions (4.9%). We report no infectious, hemorragic or metabolic complication but 6 perforations (5.8%). The mean follow-up is 24.4 months (from 6 to 46 months). Ten patients did not keep contact during follow-up. A good anatomical result was obtained in 88 patients (86.2%) after one or two hysteroscopic sessions. A good result on menstrual problems was obtained in 75% of the cases, especially in amenorrhea (90.5% success rate). The reproductive outcome is more disappointing. We obtained 34 pregnancies in 28 patients (10 abortions, 24 live born children). Twenty-two patients achieved no pregnancy (44%), but 13 of these patients presented with additional infertility factors.

Prenatal diagnosis of fetal cerebral abnormalities by ultrasonography and magnetic resonance imaging

We found magnetic resonance imaging (MRI) of the fetal brain to be effective in confirming or denying diagnosis of fetal cerebral defects when ultrasonography was inconclusive or incomplete. In this paper we describe 31 cases in which ultrasonographic evidence of fetal brain defects was verified by MRI. MRI was performed after curarization of the fetus. In 21 cases, ultrasonographic evidence was confirmed by histological study of the fetus or postnatal radiological examination. In 10 cases, ultrasonographic diagnosis was denied by MRI and healthy infants were born. In one case of cerebral toxoplasmosis, ultrasonography detected periventricular calcifications but MRI was normal. In 20 cases MRI ascertained or further documented the ultrasonographic findings. However in 4 of these 20 cases autopsy of the fetus was required to determine the exact nature of the lesion.

Laparoscopic management of malignant ovarian cysts: a 78-case national survey. Part 1: pre-operative and laparoscopic evaluation

This paper reports a retrospective multi-institutional French survey carried out in 1992 to determine the incidence of laparoscopic management of malignant ovarian cysts. Of 5307 ovarian lesions treated endoscopically, 78 were malignant (1.47%) including 60 borderline tumors and 18 ovarian cancers. In 33% of cases preoperative diagnosis indicated that the tumor was benign. Preoperative findings were suspicious in 59%. Laparoscopic treatment was puncture in 23% of cases, partial exeresis in 51% and total removal in 26%.

Fertility and obstetric outcome after conservative management of placenta accreta

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

Hysteroscopic surgery in postmenopausal women

Objective. To assess the efficacy of hysteroscopic surgery in postmenopausal women presenting with abnormal uterine bleeding.