ABSTRACT Background Berotralstat is a first‐line once‐daily oral prophylactic treatment for hereditary angioedema (HAE). Berolife was designed to evaluate the tolerability and effectiveness of berotralstat in real‐world conditions. Methods Berolife is an open‐label, multicenter, observational study conducted in France from September 2021 to January 2024. The primary objective was to assess tolerability, and secondary objectives included characterization of the treated population and assessment of berotralstat effectiveness. HAE attack rate was assessed before and after initiation of berotralstat using the paired Wilcoxon rank‐sum test. Results Altogether, 80 patients were enrolled in the study (75 with HAE‐C1INH type 1 or 2 and 5 with HAE‐nC1INH) and received at least one dose of berotralstat. At baseline, patients had a mean (standard deviation [SD]) age of 40.0 (17.5) years, and most (67.5%) had received prior long‐term prophylaxis treatment. The mean (SD) duration of berotralstat treatment was 11.5 (8.5) months. Treatment‐related adverse events (AEs) occurred in 45.0% of patients, with gastrointestinal disorders being the most common (diarrhea: 13.8%, abdominal pain: 12.5%, upper abdominal pain: 7.5%). Importantly, no treatment‐related serious AEs were reported. A total of 61 patients were treated with berotralstat for ≥ 6 months and evaluated for effectiveness. At 6 months of treatment, a significant reduction in monthly HAE attack rates was observed (mean [SD]: 0.62 [0.66] vs. mean [SD]: 1.25 [1.10] at baseline; p = 0.001). Conclusions Berotralstat was generally well tolerated with a tolerability profile consistent with prior clinical trials. Significant reductions in monthly HAE attack rates were observed, confirming its effectiveness in real‐world settings.

Background A20 haploinsufficiency (HA20) is an autoinflammatory disease driven by pathogenic variants in TNFAIP3, which plays a crucial role in regulating immune responses. The clinical manifestations of HA20 resemble those of inflammatory bowel disease (IBD), with prominent gastrointestinal (GI) involvement. Given the well-established association between gut microbiota alterations and IBD, this study aimed to describe the GI involvement of HA20 patients and to investigate their fecal microbiota using shotgun sequencing and metabolomics.Methods This study included 16 HA20 patients and 22 healthy age and sex-matched controls. GI clinical phenotype, liver imaging, and liver and GI tissue histology were assessed. Shotgun metagenomic sequencing was performed on fecal DNA. Fecal metabolomic profiling of bile acids, short-chain fatty acids (SCFAs), and tryptophan metabolites was performed.Results Liver imaging revealed chronic liver disease in 3/5 patients, showing as liver dysmorphia and portal hypertension. Histological analysis showed lymphoplasmocytic infiltrate of the GI tract and the liver. The fecal microbiota of HA20 patients was characterized by marked alterations, including a reduction in microbial diversity and an increase in the pro-inflammatory bacterium Ruminococcus gnavus. Microbial bile acid deconjugation and desulfation were impaired. Additionally, tryptophan metabolism was altered, with a shift towards the kynurenine pathway.Conclusion Our results show that HA20 is associated with gut microbiota alterations and significant disruptions in metabolic pathways, particularly involving bile acids. These alterations could contribute to the chronic inflammation observed in HA20. These findings highlight the role of the gut-liver axis and of mucosal barrier dysfunction in HA20.

INTRODUCTION:Patients with von Willebrand disease (VWD) are prone to bleeding, yet they may also experience thrombotic events, whose nature, frequency, and optimal management remain poorly characterised. AIM:To describe the nature and frequency of venous and arterial thrombotic events in VWD patients. METHODS:This multicentre retrospective study analyzed thrombotic events in 1345 patients with constitutional VWD and von Willebrand factor (VWF) activity ≤30 IU/dL from the French BERHLINGO database. Venous events included deep vein thrombosis (DVT) and pulmonary embolism (PE); arterial events included angina, myocardial infarction (MI), ischaemic stroke (ICVA), transient ischaemic attack (TIA), and peripheral artery disease (PAD). Risk factors, therapeutic strategies, efficacy, and bleeding complications were also assessed. RESULTS:We identified 35 thrombotic events: 30 arterial (12 angina, 6 MI, 7 PAD, 4 ICVA, 1 TIA) in 20 patients, and 5 venous (3 PE±DVT, 2 DVT) in 4 patients (1.8% prevalence). The mean patient age was 61.8±14 years. Most arterial events (70%) occurred in men; all venous events were provoked in women. Therapeutic adjustments were made for 10 arterial events (28.6%: 4 withholding, 6 low-dose). Of the 35 events, 11 (31.4%) were recurrences (second or subsequent) in the same patient. Overall, 8/24 patients (33.3%) had multiple events, always at the same site, including twice (18.2%) after therapeutic adjustments. Only trauma-induced bleeding was reported. CONCLUSION:Although rare, thrombosis in VWD patients is associated with age and gender. Given the low bleeding risk, therapeutic approaches similar to those in the general population may be considered. TRIAL REGISTRATION:Cardiovascular and Venous Thromboembolism Disease in Patients with Von Willebrand Disease in the French West (TWIGO); ClinicalTrials.gov ID NCT05773638.

INTRODUCTION:Peripherally inserted central catheters (PICCs) are increasingly used in France for prolonged intravenous therapies such as chemotherapy, parenteral nutrition, or antibiotics. They are easier to place than traditional central venous catheters and carry fewer immediate risks, but remain associated with delayed complications, mainly infections, thromboembolic events, and mechanical issues. METHODS:This literature review aimed to identify risk factors for PICC-related infections and thrombosis. The study used BIBOT, an artificial intelligence program for natural language processing, already validated in prior reviews and the IA language model LLaMA3. PubMed was searched for studies published between 2013 and 2023. RESULTS:Using the AI-based tool BIBOT, 1896 PubMed abstracts on PICCs were automatically screened. After filtering and AI-assisted content analysis, 343 original articles focusing on PICC complications were identified, enabling a targeted selection of 113 articles on infectious and 281 on thrombotic complications. In total, 20 infectious and 59 thrombotic risk factors were manually identified. Among these, the most frequently reported in the reviewed articles for infections were number of lumens, chemotherapy and catheter dwell time. For thrombosis, the most commonly cited factors included cancer or hematologic disease, chemotherapy, PICC diameter and number of lumens (>2). CONCLUSION:The study highlights the value of AI-based tools to accelerate article selection and data extraction in medical literature. However, human validation remains essential to avoid errors and misinterpretations, particularly with acronyms or heterogeneous definitions. Hybrid approaches combining AI with expert review save considerable time and are expected to improve further with multimodal models and multi-agent strategies.

OBJECTIVE:VEXAS syndrome (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) is a recently identified adult-onset autoinflammatory disorder caused by somatic mutations in UBA1. It is characterized by heterogeneous inflammatory and haematological manifestations, making diagnosis challenging. 18F-FDG-PET/CT imaging, which identifies metabolic activity associated with inflammation and malignancy, is often performed during the diagnostic work-up. However, its utility in VEXAS syndrome remains unclear. METHODS:We conducted a multicentre retrospective observational study of patients with genetically-confirmed VEXAS syndrome who underwent 18F-FDG-PET/CT imaging. Clinical, laboratory and imaging data were collected, and 18F-FDG-PET/CT findings were analysed according to disease activity, myelodysplastic syndrome status and mortality. Qualitative 18F-FDG-PET/CT interpretations were based on local nuclear medicine reports. RESULTS:A total of 125 18F-FDG-PET/CT scans were analysed in 66 patients. Bone marrow (83%) and lymph nodes (53%) were the most frequent sites of abnormal FDG uptake, with combinations of bone marrow, lungs, lymph nodes and spleen being the most common patterns. Pulmonary (38%) and vascular involvement (11%) were also observed. The number of organs with abnormal FDG uptake was significantly higher in patients with active disease compared with remission (median 2 vs 1 abnormal sites, P < 0.001). However, 90% of scans performed during presumed clinical remission showed persistent abnormalities, especially in the bone marrow (57%). CONCLUSION:18F-FDG-PET/CT imaging reveals frequent but non-specific abnormalities in VEXAS syndrome, with persistent bone marrow hypermetabolism suggesting subclinical disease activity. While 18F-FDG-PET/CT may have limited diagnostic utility, it holds potential for disease monitoring.

Background The SARS-CoV-2 pandemic, declared in March 2020, has affected over 570 million people worldwide. The impact on pregnant women and fetuses remains unclear, particularly with the Omicron variant, which appears to increase infection rates. This retrospective study describes fetal-maternal complications and placental features in Omicron-variant SARS-CoV-2 infections during pregnancy, and compares them with other variants and non-infected controls from published studies examining the association between SARS-CoV-2 infection and placental pathology Methods We analyzed all consecutive placentas referred to our hospital from May 2021 to March 2023, associated with proven Omicron-variant SARS-CoV-2 maternal infection during pregnancy. Results Among 315 placentas studied, fetal-maternal complication rates were comparable to the general population, including pre-eclampsia (0.6%), intrauterine growth restriction (5%), small for gestational age (9.1%), and preterm birth (3.1%).We observed a significant lower rate of hypotrophic placentas below the 10th percentile (4.1% vs. 15.0%, p < 0.001), chronic deciduitis (3.8% vs 10.5%, p < 0.01), MVM (49.2% vs 58.8%, p < 0.01) and FVM lesions (7.6% vs 14.5%, p < 0.001) in Omicron cohort versus published data from studies of individuals with non-Omicron variant SARS-CoV-2. We did not observe an increased incidence of chronic inflammation nor SARS-cov-2 placentitis histologic triad in comparison to control cases from published data. A high rate of acute histological chorioamnionitis was observed, without increase incidence in preterm deliveries. The interval between infection and delivery did not alter placental features. Conclusion This large Omicron-variant placentas cohort highlighted clinically, an overall good outcome, and histologically significantly less vascular malperfusion and chronic deciduitis than in non-Omicron SARS-Cov-2 variants.

BACKGROUND:Determining venous thromboembolism (VTE) risk among first-degree relatives (FDRs) of VTE patients requires effective risk assessment. We aimed to evaluate VTE risk in FDRs of index cases (ICs) compared to the general population. METHODS:A cross-sectional family study (France, Canada) and a population-based study in the Brest district (France) were conducted. VTEs were adjudicated by an independent clinical event committee. The standardised incidence ratio (SIR), defined as observed-to-expected ratios of VTE in FDR, and 95% confidence interval (CI) were calculated using an indirect standardisation. Expected numbers of VTE were calculated from age-specific incidence rates in the reference population. RESULTS:Among the 2617 FDRs of 507 ICs with VTE, 123 had VTE (annual incidence: 1.2 per 1000 person-years). Of 367,911 Brest district inhabitants, 576 had VTE (annual incidence: 1.6 per 1000 person-years). Compared with the general population, FDRs had a higher VTE risk when the ICs had unprovoked VTE (SIR 1.31, 95%CI 1.11-1.53), had VTE before 47 years (SIR 3.28, 95%CI 2.69-3.85) or when ≥2 FDRs were affected (SIR 1.51, 95%CI 1.14-1.88). The highest VTE risk in FDRs was observed when ICs had unprovoked VTE and ≥2 affected FDRs (SIR 6.36, 95%CI 5.52-7.20) or when ICs had VTE before 47 and ≥2 affected FDRs (SIR 9.93, 95%CI 7.75-12.12). Factor V Leiden and G20210 prothrombin variant status of ICs had a modest influence. CONCLUSION:FDR VTE risk is significantly higher when the IC had unprovoked VTE, before 47 years, and/or when multiple FDRs were affected, compared to the general population.

BACKGROUND:Venous thromboembolism (VTE) prevention in obstetrics remains a major public health concern. Precise data on the timing of VTE events and which women are at risk are necessary to improve thromboprophylaxis strategies. OBJECTIVES:Primary objective was to determine the incidence of VTE during postpartum. Secondary objectives were: (i) to assess VTE incidence during pregnancy; (ii) to describe VTE risk factors; (iii) to evaluate VTE incidence according to risk stratification and thromboprophylaxis. METHODS:From June 2015 to January 2019, the prospective cohort "HEMOTHEPP" study included all pregnant women aged ≥16 years admitted for delivery after 15 weeks of gestation in the Finistère region of France (6 maternity units) and followed for 3 months postpartum. An ethics committee approved the study. The primary outcome was symptomatic, documented VTEs-deep vein thrombosis (DVT), pulmonary embolism (PE), or unusual site VTE-as adjudicated by an independent committee. RESULTS:Among the 20 238 included women, VTE incidence was 4.9 per 1000 person-years (95% CI, 3.3-7.2) during postpartum and 1.3 per 1000 person-years (95% CI, 0.8-2.0) during pregnancy. Postpartum VTEs included 40.0% isolated PEs, 12.0% PE with DVTs, 12.0% isolated DVTs, and 36.0% unusual site VTEs. Of these events, 32.0% occurred during days 0 to 7, 60.0% during days 8 to 42, and 8.0% during days 43 to 90 postpartum. According to the Royal College of Obstetricians and Gynaecologists risk score, 7978 women (39.5%) were classified as intermediate or high risk of postpartum VTE and eligible for thromboprophylaxis; among them, only 3161 (39.6%) received it. Among intermediate-risk women, VTE incidence was similar with or without thromboprophylaxis: 12.0 and 11.8 per 1000 person-years, respectively. CONCLUSION:Postpartum VTE incidence was twice as high as expected. Thromboprophylaxis during postpartum was underprescribed. The high VTE incidence rate after the first week postpartum and in intermediate-risk women, regardless of thromboprophylaxis, highlights the need for randomized trials to evaluate the benefits of thromboprophylaxis.

Introduction Previous studies reported an annual incidence rate of superficial vein thrombosis (SVT) of 0.6/1000 patient-years in obstetrical context. Risk factors of SVT and subsequent risk of venous thromboembolism (VTE) are uncertain. Objective To determine the annual incidence rate of SVT during pregnancy and postpartum, the risk of subsequent VTE and SVT risk factors. Method The “HEMOrrhage and venous THromboEmbolism in PostPartum–HEMOTHEPP” study (NCT02443610) is a French multicenter prospective cohort study of 20,238 unselected pregnant women who delivered at a term >15-week gestation from 1st June 2015 to 31st January 2019 with three-month postpartum follow-up. Study was approved by the Ethics Committee of Brest University Hospital in June 2014. Results Among the 20,238 included women, 56 (annual incidence 2.8/1000 person-years) had isolated and documented SVT: 18 during pregnancy (annual incidence 1.2/1000 person-years) and 38 during postpartum (annual incidence 7.5/1000 person-years). Among the 3722 women who received thromboprophylaxis, 8 had SVT (all in postpartum): none had SVT history, and one had VTE history. Among the 16,516 women without thromboprophylaxis, 48 had SVT (18 during pregnancy and 30 during postpartum): five had SVT history and two had VTE history. One woman with SVT during pregnancy had recurrent SVT during early postpartum despite thromboprophylaxis and none had subsequent VTE. As compared to women with VTE, women with SVT were younger, had healthy weight and had fewer cesarean delivery. Conclusion We found an annual incidence rate of SVT in obstetrical context four-times higher than previously described. The risk of recurrent SVT or VTE during the same pregnancy was low. For women with history of SVT, thromboprophylaxis appeared efficient to prevent recurrent SVT or VTE. SVT risk factors may differ from those for VTE.

Objectifs Le risque de survenue d’une maladie veineuse thromboembolique (MVTE) est augmenté en contexte obstétrical. En raison des nombreux facteurs de risque (FDR) impliqués dans la survenue de cette pathologie et de la nécessité d’une réévaluation fréquente du risque en ante partum et en post-partum, des scores de prédiction du risque de MVTE ont été développés pour faciliter la démarche de prescription d’une thromboprophylaxie. Cet article propose une synthèse critique de ces scores. Méthodes Une revue de la littérature sur PUBMED utilisant les termes ([pregnancy OR postpartum] AND [score OR risk OR model prediction] AND [venous thromboembolism OR pulmonary embolism OR deep vein thrombosis]) – a recensé les articles publiés entre janvier 2000 et mai 2024. Résultats Parmi 2532 articles, quatorze scores ont été retenus. Certains s’appliquent à des sous-populations spécifiques en ante partum et pendant le post-partum : (i) femmes à haut risque de MVTE; (ii) femmes à haut risque de MVTE et de complications vasculo-placentaires ; (iii) femmes atteintes d’obésité ; certains scores ne sont utilisables qu’en post-partum : (i) femmes à haut risque d’un premier épisode ; (ii) femmes ayant accouché par voie basse ou césarienne ; (iii) femmes ayant accouché par césarienne uniquement. D’autres scores s’adressent à une population non sélectionnée. La méthodologie utilisée pour leur construction, le degré de validation, les FDR considérés et les stratégies thérapeutiques proposées selon la classification des femmes enceintes diffèrent également. Conclusion L’utilisation d’un score de prédiction du risque de MVTE est recommandée depuis 2008. Son importance en pratique clinique pour l’évaluation du risque de MVTE et la prescription d’une thromboprophylaxie adéquate est documentée. L’utilisation d’un seul score applicable à toutes les patientes, tant pendant la grossesse que le post-partum, paraît plus adaptée aux praticiens de l’obstétrique. Il sera utilisé par l’ensemble de l’équipe à chacune des consultations et/ou hospitalisations.

BACKGROUND:Eosinophilic granulomatosis with polyangiitis (EGPA) is an eosinophilic antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Rituximab has emerged as the standard of care in other types of ANCA-associated vasculitis, but controlled studies on its use in EGPA are yet lacking. OBJECTIVE:To compare rituximab with conventional strategy for the induction of remission in patients with EGPA. DESIGN:Phase 3, multicenter, randomized, controlled, double-blind, superiority trial. (ClinicalTrials.gov: NCT02807103). SETTING:France. PARTICIPANTS:Patients with a diagnosis of EGPA, newly diagnosed or relapsing disease at the time of screening, with active disease defined as a Birmingham Vasculitis Activity Score (BVAS) of 3 or greater. INTERVENTION:Glucocorticoids plus rituximab (1 g 2 weeks apart) compared with the conventional strategy (glucocorticoids alone or in combination with cyclophosphamide in severe forms) for induction of remission. MEASUREMENTS:The primary end point was remission defined as a BVAS, version 3, of 0 and a prednisone dose of 7.5 mg/d or less at day 180. Secondary end points included duration of remission during the study, average daily glucocorticoid dose, and safety. RESULTS:A total of 105 participants were randomly assigned. Thirty-three (63.5%) patients in the rituximab group achieved the primary end point compared with 32 (60.4%) in the control group (relative risk, 1.05 [95% CI, 0.78 to 1.42]; P = 0.75). Results were similar at day 360. The mean duration of remission was 48.5 ± 6.51 weeks in the rituximab group and 49.1 ± 7.42 weeks in the conventional strategy group (P = 0.41). All relapse and major relapse rates were similar between the 2 groups. There was no statistically significant difference in the average daily glucocorticoid dose and no statistically significant differences in the rates of adverse events between the treatment groups. LIMITATION:Design not appropriate to answer the question of equivalence between rituximab and cyclophosphamide in patients with severe EGPA. CONCLUSIONS:Rituximab was not superior to a conventional remission induction strategy in EGPA. PRIMARY FUNDING SOURCE:French Ministry of Health.

Introduction:The identification of prognostic factors for renal failure in antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) remains a challenge. The benefit of plasma exchange (PLEX) has been questioned, and the target population remains to be defined. We investigated the outcome of patients requiring renal replacement therapy (RRT) at baseline and factors associated with their prognosis at 1 year. Methods:This retrospective multicenter study evaluated the 1-year composite end point of death or end-stage kidney disease (ESKD) in patients with biopsy-proven renal AAV involvement. Results:Of the 394 patients included, 105 (26.6%) were on dialysis at baseline. Of these, 60 (57.1%) reached the composite end point compared with 29 patients (10.0%) who were not on RRT at baseline (P < 0.001). On multivariate analysis, age and sex were not associated with the composite outcome (P = 0.945 and P = 0.154, respectively); however, myeloperoxidase (MPO)-ANCA was (odds ratio [OR]: 3.60; 95% confidence interval [CI]: 1.79-7.60), as was a high baseline histologic renal risk score (OR: 1.29; 95% CI 1.17-1.44). The most strongly associated factor remained the need for dialysis at baseline (OR: 10.91; 95% CI: 5.52-22.70). Of the 91 patients surviving after requiring dialysis at baseline, 45 were weaned from RRT (49.5%) at 1 year, and PLEX was independently associated with a reduced risk of the composite outcome (OR: 0.23, 95% CI: 0.05-0.80). Conclusion:MPO-ANCA, need for dialysis, and high histological renal risk score at baseline were associated with the 1-year composite end point of death or ESKD. Almost half of the patients on dialysis at baseline were off dialysis at 1 year, with a better prognosis in those who had received PLEX.

BACKGROUND:Prospective data on pregnancies in systemic sclerosis are scarce. We aimed to examine the frequency of adverse pregnancy outcomes and maternal disease progression in systemic sclerosis, as well as the factors that predict these events. METHODS:In this analysis, we studied pregnant women with systemic sclerosis (American College of Rheumatology-European League Against Rheumatism 2013 classification) or with Very Early Diagnosis of Systemic Sclerosis (VEDOSS criteria) included in the GR2 French prospective study. Frequency of composite adverse pregnancy outcomes (preterm birth at 34 weeks or less, placental insufficiency complications, small for gestational age, or fetal or neonatal death) and maternal disease course were the primary objectives. The secondary objectives were to assess other complications related to pregnancy (including delivery outcomes and postpartum complications) and compare these results with outcomes for age-matched controls from the French perinatal survey (ENP) 2016 (ie, general population), and to identify predictive factors associated with composite adverse pregnancy outcomes and maternal disease course using univariate analysis. FINDINGS:Between May 1, 2014, and Dec 27, 2020, we included 58 pregnancies (in 52 women), with 53 (91·4%) resulting in livebirths. Of the 53 ongoing pregnancies beyond 22 weeks of gestation, 14 (26·4%) had a composite adverse pregnancy outcome, including two (3·8%) preterm deliveries at 34 weeks of gestation or less, 12 (22·6%) placental insufficiency complications (pre-eclampsia or fetal growth restriction), and six (11·3%) small for gestational age. Among the 53 pregnancies, six (11·3%) severe postpartum haemorrhage events occurred. When compared with the 2016 ENP survey results, pre-eclampsia (seven [13·2%] of 53 vs 16 [3·0%] of 530, p=0·0010, preterm birth before 37 weeks of gestation (seven [13·2%] of 53 vs 31 [5·8%] of 530, p=0·047), birthweight of less than 2500 g (11 [21·1%] of 52 vs 23 [4·3%] of 530, p<0·0001), and severe postpartum haemorrhage (six [11·3%] of 53 vs seven [1·4%] of 516, p=0·0001) were more frequent than in the general population. No factors were significantly associated with the composite adverse pregnancy outcome in univariate analysis. Systemic sclerosis or VEDOSS worsened in 23 (39·7%) of 58 pregnancies, mainly during the postpartum period. In the univariate analysis, diffuse cutaneous systemic sclerosis (odds ratio 3·7 [95% CI 1·1-12·4]) and previous cutaneous vascular involvement (3·7 [1·2-11·5]) were associated with maternal disease progression, whereas the presence of anticentromere antibodies was inversely associated with stable disease (0·2 [0·1-0·8]). INTERPRETATION:Despite 53 (91·4%) of 58 livebirths, systemic sclerosis pregnancies were associated with higher rates of adverse pregnancy outcomes and severe postpartum haemorrhage. Disease worsened in 23 (39·7%) of 58 pregnancies, particularly during the postpartum period, especially in women with diffuse cutaneous systemic sclerosis, previous cutaneous vascular involvement, and antibodies other than anticentromere. FUNDING:Lupus France, Association des Sclérodermiques de France, Association Gougerot Sjögren, Association Francophone Contre la Polychondrite Chronique Atrophiante, AFM-Telethon, Société Nationale Française de Médecine Interne, Société Française de Rhumatologie, Cochin Hospital, French Health Ministry, Fondation for Research in Rheumatology, Association Prix Véronique Roualet, Union Chimique Belge.

The pathophysiology of residual pulmonary vascular obstruction (RPVO) and recurrent venous thromboembolism (VTE) after unprovoked pulmonary embolism (PE) remains poorly understood. The purpose was to evaluate fibrinolytic and tissue remodeling markers as indicators of RPVO and recurrence after a first unprovoked PE. Analyses were conducted in the 18 to 70-year-old patients included in the PADIS-PE trial, with a pulmonary vascular obstruction (PVO) index ≥ 30

Vasculo-placental disorders include pregnancy complications resulting from placental dysfunction of vascular origin, i.e. pre-eclampsia, HELLP syndrome, intrauterine growth retardation (IUGR), placental abruption and stillbirth of vascular origin. Pre-eclampsia should be investigated for antiphospholipid syndrome (APS) in case of severe pre-eclampsia and premature delivery before 34 weeks of gestation. In addition to testing for APS, pathological report of the placenta can identify some anatomical predispositions to placental vascular malperfusion, as well as chronic placental inflammatory lesions and excess fibrin deposits. The latter two are associated with IUGR and recurrent stillbirth, reflecting a dysimmune process of maternal origin. The internal medicine and obstetrics consultation, organized two months after delivery, combines the postnatal visit with an assessment of the causes of vasculo-placental disorders, and enables to inform patients about the management of future pregnancies and their cardiovascular health. (c) 2024 The Author(s). Published by Elsevier Masson SAS on behalf of Societe Nationale Francaise de Medecine Interne (SNFMI). This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).