Olivier Irion

Prediction of pre‐eclampsia, low birthweight for gestation and prematurity by uterine artery blood flow velocity waveforms analysis in low risk nulliparous women

Objective To assess the performance of four previously reported Doppler abnormalities of uterine artery velocity waveforms (presence of a protodiastolic notch, peak systolic over protodiastolic velocities (A:C ratio) > 2.5, peak systolic over end diastolic velocities (A:B ratio) > 90th centile, resistance index (RI) ([A‐B]/A) ≥0.58) in predicting pre‐eclampsia, low birthweight and prematurity.

Nonclosure of the visceral and parietal peritoneum at caesarean section: a randomised controlled trial

Objective To assess the short term morbidity of nonclosure of the peritoneum at caesarean section.

Prediction of preterm delivery by fetal fibronectin: A meta-analysis

Abstract Objective: To assess the cervicovaginal fetal fibronectin test to predict preterm delivery. Data Sources: We searched MEDLINE, Current Contents, Index Medicus , and proceedings of meetings for studies published between 1991 and June 1997. Methods of Study Selection: Inclusion criteria were prospective cohort study; test performed between 20 and 36 weeks’ gestation; fetal fibronectin measured by a previously described assay, with a cutoff level set at 50 ng/mL; test results not disclosed to women or physicians; and fewer than 20% of study participants excluded from the analysis. Tabulation, Integration, and Results: Twenty-nine relevant studies were stratified according to the prevalence of preterm delivery, the number of tests performed, and delivery before 34, 35, or 37 weeks. Sensitivities, specificities, and likelihood ratios were calculated in each study. The summary estimates of the likelihood ratio for tests yielding positive results or tests yielding negative results along with their 95% confidence intervals (CIs) were computed in each stratum according to a random-effects model. All summary likelihood ratios for a test yielding positive results indicated a significant association with preterm delivery. The strongest association was found between a single test with positive results and delivery before 37 weeks in a low-risk population (likelihood ratio 7.5; 95% CI 4.6, 12.3). This association also was found in high-risk women (likelihood ratio 3.5; 95% CI 2.6, 4.6). In high-risk women, a test yielding negative results was associated with a reduction in risk of preterm delivery (likelihood ratio 0.4; 95% CI 0.3, 0.5). Conclusion: Fetal fibronectin in cervicovaginal secretions is associated with preterm delivery in both high-risk and low-risk women.

Preterm Birth Prevention: Effectiveness of Current Strategies

Abstract Objective: to describe the current state of preterm birth in Canada and to ascertain the effectiveness of published preventive strategies. Data sources: a literature review including Statistics Canada 1991 and peer reviewed articles using preterm birth as the primary medical subject heading. The Cochrane Database of Systematic Reviews also was studied. Study selection: randomized controlled trials, quasi-experimental trials, and analytic studies (including retrospective and prospective cohort studies). Data extraction: the following information was recorded about each preventive intervention: population type, sample size, study design, type of intervention, and whether interventions or programmes were carried out in high risk pregnant women or using a population-oriented approach. Data synthesis: high risk strategy tested nine various single interventions and three programmes of multiple interventions in almost 35,000 pregnancies, all in randomized controlled trials. The population-oriented strategy was applied in almost 500,000 pregnancies, although only three interventions in less than 6,000 pregnancies were tested by randomized clinical trials. Conclusion: preterm birth rates have not decreased in Canada for at least thirty years. High risk screening and interventions are not effective in reducing preterm birth rates. There is promising potential for effectiveness with population-oriented strategies but these have to be tested in appropriately designed randomized controlled trials.

Short communication: Can we improve the diagnosis of rupture of membranes? The value of insulin-like growth factor binding protein-1

Our objective was to assess the value of insulin‐like growth factor binding protein‐1 (IGFBP‐1) and other tests for the diagnosis of rupture of the membranes (ROM). We included 49 women with suspected ROM. The gold standard for membranes status was defined based on clinical examination, ultrasonography, tests results (except IGFBP‐1) and labour information. Sensitivity, specificity, positive predictive value and negative predictive value of each test were as follows, respectively: IGFBP‐1 (86, 74, 73 and 87%); bromothymol (64, 100, 100 and 77%); fern test (62, 96, 93 and 75%) and ultrasonography (19, 100, 100 and 61%). The detection of IGFBP‐1 in vaginal secretions has high sensitivity for the diagnosis of ROM.

Peak systolic over protodiastolic ratio as an objective substitute for the uterine artery notch

Objective To measure the inter‐rater agreement for the identification of a uterine artery notch, as well as the association between an observed notch and the peak systolic over protodiastolic (A/C) ratio.

Is intrapartum vibratory acoustic stimulation a valid alternative to fetal scalp pH determination

Objective To determine the association between fetal heart rate accelerations, whether spontaneous or induced by vibratory acoustic stimulation, and subsequent scalp pH values in presence of a suspicious intraparturn fetal heart rate tracing, and thereby assess the ability of accelerations to predict a concurrent normal fetal scalp blood pH.

Neonatal pneumococcal sepsis associated with maternal tubo-ovarian abscess

On the 3rd day of life, his condition deteriorated with convulsions and lethargy, and was intubated for mechanical respiratory support, and given phenobarbital and antibiotic treatment. Blood tests showed sepsis due to coagulase negative staphylococcus, and thrombocytopenia, and he was treated with vancomycin. Th e seizures ceased and the neurological signs improved aft er the 1st week of life. MRI of the brain was performed on the 20th day of life, indicated for investigation of the clinical signs of encephalopathy (Rutherford et al. 2006). Th e MRI revealed multiple bilateral cortical-subcortical parenchymal lesions with haemorrhagic components, compatible with parenchymal venous infarctions (Figure 1a). MRV was additionally performed to study the permeability of the brain venous sinuses and demonstrated thrombosis of the superior sagittal sinus (SSS) (Figure 1b). Th rombophilia screening performed on both the infant and his parents was normal. Th e infant had normal fi ndings on neurological examination on discharge at 52 days of life.

Maternal bilateral adrenal necrosis in the 3rd trimester of pregnancy

Chanoufi MB, Ben Temime R, Masmoudi A et al. 2004. Clinical and anatomic features of acardiac twins. Medical Principles and Practice 13:375–379. Ersch J, Stallmach T. 1998. Cardiac regression sequence: reversal of blood flow diagnostic but not causative in acardiac fetus. Early Human Development 52:81–85. Gillim DL, Hendricks CH. 1953. Holoacardius: review of the literature and a case report. Obstetrics and Gynecology 2:647–653. Lewi L, Valencia C, Gonzalez E et al. 2010. The outcome of twin reversed arterial perfusion sequence diagnosed in the first trimester. American Journal of Obstetrics and Gynecology 203:213.e1–e4. Moore, TR, Gale S, Benirschke K. 1990. Perinatal outcome of 49 pregnancies complicated by acardiac twinning. American Journal of Obstetrics and Gynecology 163:907–912. Roets E, Havenith MG, Klumper FJ et al. 2006. Twin reversed arterial perfusion sequence. European Clinics in Obstetrics and Gynaecology 2:18–23. Tan TY, Sepulveda W. 2003. Acardiac twin: a systematic review of minimally invasive treatment modalities. Ultrasound in Obstetrics and Gynecology 22:409–419.

HIV-1 Infection in Pregnancy: Prevention of Mother-to-child Transmission

Abstract There are over 22 million people worldwide infected by the HIV virus. Most HIV infections are sexually acquired, and women, mainly in the reproductive age, account for a large proportion of cases. The HIV-1 virus can be vertically transmitted during pregnancy, delivery or through breast feeding. Perinatal transmission is the main cause of paediatric HIV infections. The aim of the present review is to discuss the prevention of vertical transmission of the HIV virus from the mother to her child. The strength of evidence supports the administration of antenatal, intrapartum and neonatal zidovudine or other antiretroviral drugs. High maternal HIV load during pregnancy was found to be associated with an increased risk of vertical transmission. Zidovudine was shown to reduce the risk of vertical HIV transmission by 68 percent in a double-blind placebo-controlled randomized trial (P