Sophie Dreux

Contribution of fetal magnetic resonance imaging and amniotic fluid digestive enzyme assays to the evaluation of gastrointestinal tract abnormalities

To analyze the contribution of fetal magnetic resonance imaging (MRI) and amniotic fluid digestive enzyme (AFDE) assays to the evaluation of gastrointestinal tract abnormalities.

Diagnostic accuracy of insulin-like growth factor binding protein-1 for amniotic fluid embolism*.

Objective:To test whether serum insulin-like growth factor binding protein-1 could be used as a biomarker of amniotic fluid passage into the maternal circulation. Design:Case-control study. Setting:Thirteen centers in France. Patients:This case-control study included a group with amniotic fluid embolism (the amniotic fluid embolism group) and a group with symptoms unrelated to amniotic fluid embolism (the non-amniotic fluid embolism group). Serum insulin-like growth factor binding protein-1 level was measured within 6 hrs from onset of symptoms. We also determined serum insulin-like growth factor binding protein-1 in four additional groups of patients with 1) postpartum hemorrhage, 2) uncomplicated labor, 3) normal pregnancy, and 4) non-pregnant patients with acute pulmonary embolism. Interventions:None. Measurements:Serum insulin-like growth factor binding protein-1 levels were determined using an immuno-enzymatic assay. Main results:The amniotic fluid embolism group included 25 patients, the non-amniotic fluid embolism group had 20 patients, the postpartum hemorrhage group had 24 patients, and the uncomplicated labor group had 50 patients. The serum levels of insulin-like growth factor binding protein-1 were higher in the amniotic fluid embolism group (234 134–635 µmol/L) compared with the non-amniotic fluid embolism, postpartum hemorrhage, and uncomplicated labor groups, which had serum levels of 56 36–91 µmol/L, 65 39–91 µmol/L and 49 30–78 µmol/L, respectively (p < .001). Serum insulin-like growth factor binding protein-1 level was not different in women during normal pregnancy (57 37–85 µg/L) compared to the uncomplicated labor group. Patients with acute pulmonary embolism had the lowest insulin-like growth factor binding protein-1 level (5 2–14 µg/L). The area under the receiver-operating-characteristic curve for serum insulin-like growth factor binding protein-1 was 0.98 0.97–1.00 for the amniotic fluid embolism diagnostic. Insulin-like growth factor binding protein-1 rose from 56 43–90 µg/L before symptoms to 458 161–1514 µg/L after the onset of symptoms in ten patients with available measurements of baseline serum insulin-like growth factor binding protein-1. Conclusion:Increased serum levels of insulin-like growth factor binding protein-1 appear to be a valuable biomarker of amniotic fluid passage into the maternal circulation and may be used to diagnose amniotic fluid embolism.

Second-trimester Down syndrome maternal serum marker screening: a prospective study of 11 040 twin pregnancies.

To analyze the value of Down syndrome (DS) second‐trimester maternal serum screening in large series of twin pregnancies.

Outcome and etiologies of fetal megacystis according to the gestational age at diagnosis

To investigate the gestational age‐specific outcomes and the different etiologies of megacystis diagnosed at screening ultrasound.

Nonvisualization of the fetal gallbladder by second‐trimester ultrasound scan: strategy of clinical management based on four examples

When the fetal gallbladder is not seen at ultrasound (US) scan, to propose a diagnostic method of differentiating fetuses who are healthy or have minor anomalies from fetuses with severe anomalies requiring intensive management.

Screening for adverse pregnancy outcome at early gestational age

In the past two decades second-trimester maternal serum screening for Down syndrome has been the most common strategy for prenatal diagnosis of chromosomal aneuploidies. More recently, screening for and diagnosis of chromosomal abnormalities have increasingly been performed in the first trimester. With improvements and technological advances in ultrasound, it is now possible to identify many fetal anomalies at 11-13 weeks of gestation. During the same period biochemical markers in maternal serum (PAPP-A and hCGβ) combined with sonographic measurement of nuchal translucency achieve a Down syndrome detection rate of 85% with a 5% false-positive rate. We describe here the potential of first-trimester markers to screen for Down syndrome as well as other adverse outcomes such as fetal loss, pre-eclampsia, intrauterine growth retardation, and preterm delivery. This early consultation may be the opportunity to help counsel patients and to screen for other adverse complications during pregnancy, such as pre-eclampsia, and to manage potential adverse pregnancy outcomes.

Negative Fetal FSH/LH Regulation in Late Pregnancy Is Associated with Declined Kisspeptin/KISS1R Expression in the Tuberal Hypothalamus

OBJECTIVE Kisspeptins were recently identified as hypothalamic neuropeptides that control GnRH release at pubertal onset and in adults via the activation of KISS-1 receptor (KISS1R). Here, we have tested whether the fetal activation of the gonadotropic axis is related to the hypothalamic expression of kisspeptins and KISS1R. DESIGN AND METHODS LH and FSH levels were measured in fetal blood from the 15th week of gestation (WG) to birth. Immunohistochemistry was performed on the hypothalamus and pituitary at different developmental stages. RESULTS Immunostaining for kisspeptins and KISS1R appeared for both proteins in the hypothalamus as early as 15 WG and subsequently increased until 30-31 WG. In the meantime, serum LH and FSH levels decreased from postmenopausal levels in females or adult levels in males to very low levels. At full term, kisspeptin and KISS1R staining was still observed in the paraventricular, supraoptic, and ventromedial hypothalamic nuclei but not in the arcuate nucleus or median eminence. Hypothalamic GnRH staining was observed at 15 WG and did not vary after the first trimester. In an arhinencephalic fetus of 23 WG, very few GnRH neurons were observed in the hypothalamus, but serum FSH and LH levels were postmenopausal. CONCLUSION Serum LH and FSH levels are independent from GnRH and kisspeptins at midgestation, and then GnRH progressively controls LH and FSH release. A shift from kisspeptin-independent to kisspeptin-dependent GnRH-induced LH and FSH release seems to occur after 30-31 WG. In addition to their function in adults, kisspeptins are also the master regulators of the gonadotropic axis activation in the fetus.

Fetal urine biochemistry at 13–23 weeks of gestation in lower urinary tract obstruction: criteria for in‐utero treatment

To assess the value of fetal urine biochemistry before 23 weeks of gestation in cases of lower urinary tract obstruction (LUTO) to refine prognosis and to select potential candidates for in‐utero intervention.

Second-trimester maternal serum markers and placenta accreta

Biochimie-Hormonologie, Hôpital Robert Debré, AP-HP, Paris, France Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France Biochimie, Université Paris Ile de France Ouest, Versailles, Saint-Quentin, France Gynécologie-Obstétrique, Maternité Port-Royal, Hôpital Cochin, AP-HP, Paris, France French Collaborative Conservative Treatment of Placenta Accreta Study Group Gynécologie-Obstétrique, Hôpital Robert Debré, AP-HP, Paris, France ABA Study Group Gynécologie-Obstétrique, CHU Angers, Angers, France *Correspondence to: Françoise Muller. E-mail: francoise.muller@rdb.aphp.fr

Biochemical amniotic fluid pattern for prenatal diagnosis of esophageal atresia.

Prenatal diagnosis of esophageal atresia (EA) may improve the outcome of affected neonates by allowing optimization of both prenatal and postnatal care. Prenatal sonographic detection is based on polyhydramnios and/or nonvisualization of the fetal stomach bubble, two signs with a large number of etiologies. We evaluated a biochemical approach to improving diagnostic efficiency. We compared amniotic fluid biochemical markers in 44 EA cases with 88 polyhydramnios and 88 nonpolyhydramnios controls. Both matched for GA with cases. Total proteins, alpha-fetoprotein (AFP), and digestive enzyme activities were assayed, including gamma-glutamyl transpeptidase (GGTP). We defined an EA index (AFP multiplied by GGTP). A significant difference (p < 0.0001) was observed for total protein, AFP, GGTP, and EA index between the EA group and each of the two control groups. No statistical difference was observed for any marker between the two most frequent EA subgroups (type I and type III) or between the two control groups. Using a cutoff of 3 for the EA index, 98% sensitivity and 100% specificity were observed for amniotic fluid prenatal diagnosis of EA, whatever the anatomical type. A large prospective series is required to confirm these results.