P.-F. Ceccaldi

Predictive factors for failure of pelvic arterial embolization for postpartum hemorrhage.

To assess the efficacy of pelvic embolization in women with postpartum hemorrhage (PPH) and to determine factors associated with embolization failure.

Pregnancy and delivery in patients with portal vein cavernoma.

Background: Portal vein cavernoma (PVC) is a rare disease resulting from extrahepatic portal vein thrombosis and development of collateral venous circulation. The management of pregnancy and delivery in woman with PVC has rarely been described. Cases: Two primiparous women are presented to illustrate the management of PVC during pregnancy and discuss the delivery route according to the symptoms and the PVC complications. The first patient presented PVC associated with large jejunal varices and high anticardiolipid antibodies. She was treated with β-blocker therapy and low molecular weight heparin during pregnancy, and delivered by cesarean section. The second patient presented protein S deficiency complicated by PVC and thrombocytopenia and delivered vaginally without complications. Conclusion: Many issues should be considered when counseling women with PVC, including the management before and during pregnancy according to symptoms and PVC complications. A multidisciplinary approach seems to be key to the management of delivery. Our advice to caregivers is that elective cesarean section seems necessary in cases with digestive varices. Vaginal delivery, with a passive second stage, seems to be relatively safe and less morbid in women without digestive varices, when maternal and fetal tolerance permits.

Grossesse après transplantation rénale. Suivi obstétrical et retentissement sur le greffon rénal

Introduction La transplantation renale a permis d’ameliorer la qualite et l’esperance de vie des patientes en insuffisance renale chronique terminale ou en dialyse. Depuis plusieurs annees, la frequence des grossesses chez les patientes transplantees renales est en augmentation dans les pays industrialises. Il est donc interessant de connaitre le devenir de ces grossesses ainsi que le retentissement de celle-ci sur le greffon a long terme. Materiel L’etude a porte sur 20 patientes transplantees renales presentant une grossesse suivie conjointement par les services de Gynecologie Obstetrique et de Nephrologie du CHU de Reims. Nous avons etudie les differentes caracteristiques cliniques et biologiques avant la grossesse, le deroulement de celle-ci, l’accouchement et le retentissement sur le greffon renal a distance. Resultats La moyenne d’âge des patientes etait de 30 ans avec un intervalle moyen entre la greffe renale et la grossesse de 5 ans. 80 % des patientes avaient une moyenne de proteinurie inferieure a 300 mg/24 h avant la grossesse. Concernant les parametres biologiques (creatininemie, proteinurie des 24 h) pendant la grossesse, nous n’avons pas constate de difference significative quel que soit le trimestre considere. Aucun rejet aigu n’a ete observe chez ces patientes pendant la grossesse. Les principales complications retrouvees ont ete l’hypertension arterielle et ses complications (pre-eclampsie, HELLP Syndrome) dans 35 % des cas, le retard de croissance in utero avec un taux d’hypotrophie de 39 %, un taux de prematurite eleve de 45 % et un taux de cesariennes important de 55 %. Le retentissement sur le greffon renal a long terme apparait peu important, nous n’avons pas observe de difference significative en post-partum sur une periode de 3 ans. Seules 2 patientes ont presente un retour en dialyse a 3 et 4 ans post-partum avec recidive de leur nephropathie initiale. Conclusion La prise en charge multidisciplinaire des grossesses chez les patientes transplantees renales ainsi que la planification de ces grossesses (delai post-greffe superieur a 2 ans) a permis d’ameliorer le pronostic obstetrical avec, malgre tout, des risques de complications (pre-eclampsie, RCIU) plus frequents mais sans aggravation du retentissement sur le greffon renal a moyen comme a long terme.

Place de la sismothérapie dans la prise en charge des dépressions graves de la grossesse

Electroconvulsive therapy (ECT), also known as electroshock, is a treatment option for patients with severe depression. It involves inducing a comitial crisis under short general anesthesia with curarization. Its use during pregnancy is a rare event and a poorly studied one. A primigravida with a prior bipolar disorder presented a major depressive episode during the second trimester, slightly improved by medical treatment. Electroshocks were performed (10 sessions planned from 26 to 30 weeks of amenorrhea [WA]), with the agreement of the patient. A marked improvement in her condition was recorded in the early sessions. Following a threat of premature birth, the last session was not carried out. She received antidepressant medical treatment in the months preceding childbirth. At 36 WA, the birth was natural and fast to a healthy child (3120 g, Apgar 10-10-10). The mother-child relationship was good. Even if publications are reassuring, the case of a child with multiple cerebral infarctions in a preeclamptic patient was recently reported. The occurrence of any superimposed obstetrical pathology (preeclampsia, premature delivery) should revise this treatment. Given the possible complications, it requires strict supervision of the pregnancy in a hospital setting.

Foetal Thyroid Dysfunction: Treat the Mother First!

A case is presented of foetal compensated hypothyroidism due to persisting low maternal serum FT4 at the beginning of pregnancy. Diagnosis was made by means of foetal ultrasound followed by foetal blood sampling because of atypical findings. Foetal thyroid hypertrophy resolved progressively as exogenous thyroxine was administered to the mother. This case highlights once again the importance of adequate thyroid function during pregnancy.