Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 41 - N° 1 - p. 88-91

Le but de cette étude est de rappeler au clinicien la prévalence et la symptomatologie du syndrome de Treacher-Collins, ainsi que les apports de l’échographie 2D et 3D dans le dépistage et la prise en charge de cette pathologie. Cas clinique. Mme P., 28 ans, G1P0, atteinte d’un syndrome de Treacher-Collins non génotypé, bénéficie à 28 SA d’une échographie fœtale retrouvant un hydramnios avec une dysmorphie faciale en dépit d’échographies T1 et T2 normales. Les diagnostics échographiques 2D et 3D sont confirmés à la naissance de l’enfant qui décédera à un mois de vie d’une inhalation de liquide gastrique sur fausse route. Le syndrome de Treacher-Collins est une maladie génétique grave potentiellement mortelle. Il faut savoir l’évoquer et le rechercher devant la seule présence d’un hydramnios, associée ou non à une fente palatine. Si cette recherche s’avère possible par des clichés conventionnels en mode bidimensionnel, l’échographie 3D apparaît comme un examen désormais incontournable dans la confirmation du diagnostic. The aim of this study is to remind the clinician the prevalence and symptoms of Treacher-Collins syndrome, and the contribution of 2D and 3D ultrasound in the detection and management of this disease. Case report. Ms P., 28 years, G1P0, who suffers from a syndrome of Treacher-Collins not genotyped, has a fetal ultrasound at 28th week of pregnancy finding polyhydramnios with facial dysmorphism despite normal ultrasound scans during first and second trimester. The 2D and 3D ultrasound diagnoses were confirmed at the birth of the child who died at 1 month of life of Mendelson syndrome. Treacher-Collins syndrome is a rare autosomal dominant disorder of facial development that may be lethal. Sonographer should look for craniofacial dysmorphism in front of the only presence of polyhydramnios with or without cleft palate. If research is possible by conventional two-dimensional sonography, 3D ultrasound appears to be essential in confirming the diagnosis.

Abstract Objectives This study compares the prevalence and perinatal mortality of congenital heart defects on La Réunion with European (EUROCAT) standards. Methods and results Data were extracted from a EUROCAT-affiliated congenital malformations registry, covering 88,025 births during the period 2002–2007, on the whole island territory. A total of 512 congenital heart defects were registered, including 424 live births, 18 foetal deaths from 16 weeks of gestation, and 70 terminations of pregnancy. The total prevalence of congenital heart defects was 5.8 per 1000 births and live birth prevalence was 4.8 per 1000. The total prevalence of non-chromosomal congenital heart defects was 5.1 per 1000 births, of which 3% were perinatal deaths, 33.3% prenatally diagnosed, and 11.6% termination of pregnancy. Severe non-chromosomal congenital heart defects – excluding ventricular septal defects, atrial septal defects, and pulmonary valve stenosis – occurred in 2.1 per 1000 births, of which 10.3% were perinatal deaths, 59.1% prenatally diagnosed, and 24.3% termination of pregnancy. Of the severe congenital heart defects, the rates of single ventricle (0.20‰), Ebstein anomaly (0.11‰), common arterial trunk (0.25‰), and atrioventricular septal defect (0.62‰) exceeded averages found in Europe, although coarctation of the aorta was infrequent. Conversely, rates of ventricular septal defects, atrial septal defects, and pulmonary valve stenosis were inferior to European standards. Slightly less than half of the congenital heart defects of chromosomal origin were associated with Down syndrome. Conclusion In La Réunion, the total prevalence of congenital heart defects is far inferior to that found in Europe. The difference can be attributable to lower prevalences of mild congenital heart defects.

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The congenital ichthyosis appears mainly in the form of collodion baby. This one can be suspected in case of polyhydramnios associated with a snowy aspect of the amniotic liquid in the antenatal echography. The reported four cases of collodion baby were premature children having presented a respiratory distress syndrome of variable gravity. The pulmonary disease was of multifactorial origin. The outcome was favorable for four children. (C) 2011 Elsevier Masson SAS. All rights reserved.

Objective. - In France, global rate of caesarian section in twin pregnancies has been 50.2% in 2003. Modes of delivery according to different twin presentations remain controversial in the literature. The purpose of our study is to analyze our practice of twin deliveries in a 5-year period, with neonatal outcomes.Patients and methods. - Among 22,243 women having delivered in our maternity (22 weeks and over) during the study period, the study population consisted of 371 twin pregnancies, of which 305 after 33 weeks gestation.Results. - Different presentations were relatively identical whatever the gestational age of pregnancies: the "cephalic-cephalic" presentation represented 60 to 70% of the total, the "cephalic-breech" presentation approximately 10% while the "breech-cephalic" or "breech-breech" presentations approximately 8% each. Mean terms of pregnancies were 35.2 +/- 2.8 weeks, mean birthweight being 2243 561 g. C-section rate was 53.5%. When the first twin was in cephalic presentation, C-section rate was 40% while it was almost 100% when the first twin was in breech or "other" presentations.Conclusion. - There were no significant differences in neonatal outcomes (mean birthweights, Apgar scores, transfers in neonatology, perinatal deaths) according to different mode of deliveries (vaginal or C-sections). Our policy of planned cesarean section may need to be revised. (C) 2010 Elsevier Masson SAS. All rights reserved.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 33 - N° 7 - p. 615-622

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 35 - N° 8 - p. 804-812

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 35 - N° 7 - p. 732-735

Abdominal pregnancy is a rare localization of ectopic pregnancy, more frequently observed in underdeveloped countries. We report a case of abdominal pregnancy carried to full term delivery, discovered at a time of a cesarean for low site of placenta attachment. Discovery of an abdominal pregnancy at the time of C-section seems exceptional with clinical and ulrasonographic surveillance of pregnancy. The objective of our article is to emphasize the importance of localizing the appendix at the first quarter echography and the utility of the endovaginal ulrasound.

INTRODUCTION:Since the onset of the Chikungunya outbreak in Reunion Island, vertical maternal-fetal transmission of the virus has been observed in newborns, but no such transmission has been demonstrated early during pregnancy. We report here the first three cases of maternal-fetal transmission of the Chikungunya virus (CHIKV) before 16 weeks' gestational age.CASES:Maternal infections occurred at terms of 12 weeks and 4 days, 15 weeks and 5 days, and 15 weeks and were confirmed by positive findings for specific anti-CHIKV IgM. Fetal deaths were subsequently observed, and at that point, CHIKV RT-PCR was negative for all three maternal blood samples. Amniocentesis preceded rupture of membranes in all three cases. RT-PCR showed viral genome in the amniotic fluid of the three fetuses, in the placentas of two, and in the brains of two. Autopsy found no malformations, and all other bacterial and viral test results were negative.DISCUSSION:These findings demonstrate early maternal-fetal transmission of CHIKV, which is suspected to be directly linked to the fetal deaths. This vertical transmission, probably abortifacient, should be considered in the light of human and animal responses to other arboviruses.

Objective Maternal obesity is a well‐known risk factor for caesarean delivery. The aim of this study is to determine whether all the spectrum of pre‐pregnancy maternal corpulence (body mass index [BMI]) is associated with the risk of caesarean delivery.Design Observational study over 4.5 years (2001–05).Setting Groupe Hospitalier Sud‐Réunion’s maternity (island of La Réunion, French overseas department, Indian Ocean).Population All consecutive singleton live births having delivered at the maternity.Methods Data have been analysed according to different risk factors. Maternal corpulence has been defined as the maternal pre‐pregnancy weight. BMIs have been studied by multiples of 5 kg/m2 from 10–14.9 kg/m2 to 40–44.9 kg/m2.Main outcome measure Rate of caesarean section.Results There were 17 462 singleton live births during the period, of which 16 952 (97.1% of the total) pre‐pregnancy BMIs have been determined. There is a linear association (χ2 for linear trend, P < 0.001) between maternal corpulence and risk of caesarean deliveries, the leanest mothers having the best rate of vaginal delivery. This linear association exists in a model controlling for diagnosis of gestational diabetes, term deliveries (≥37 weeks), very short maternal height (<1.50 m), primiparity and maternal age ≥ 35 years (adjusted χ2, P < 0.001).Conclusion There is a significant linear association between pre‐pregnancy maternal corpulence and risk of caesarean deliveries in pregnancies at term. The authors discuss several interpretations including the adaptability of fetal birthweights to maternal corpulence and the concept of soft‐tissue dystocia.

INTRODUCTION:The perinatal mortality rate is 18.5 in the southern part of the Reunion Island (Indian Ocean), of which 2/3 are due to antepartum fetal deaths (APFD).METHODS:During a 4-year period (2001-2004) all APFD from 22 weeks gestation were recorded and analyzed with placental histology, bacteriological samples and autopsies in 27% of cases. The Australasian and New-Zealand classification PSANZ-PDC (2000) was used. Risk factors of fetal death with monofetal pregnancies are determined in comparison with live births.RESULTS:Out of 21.495 total births, 178 APFD were recorded. The main obstetrical risk factors were primiparity (OR 1.6, p = 0.002), maternal age over 34 years (OR 1.6, p = 0.01), hypertensive disorders of pregnancy (OR 3.0, p < .001) and multiple births (OR 2.5, p < 0.001). The great majority of APFD (76%) involved preterm fetuses, of which 61% of very preterm (<33 weeks), and 25% of fetuses were growth retarded (OR 3.9, p < 0.001). Only 8% of cases were considered unexplained. The main etiologies were infectious causes in 26% of cases, vascular fetal growth restriction (18%), specific perinatal conditions (14%) of which one-third were due to cord anomalies, preeclampsia (10%), maternal conditions (8%), congenital anomalies (8%) and ante-partum hemorrhage (7%). We discuss the interests and the limitations of using the Australian and New-Zealand classification PSANZ 2000. Intra-uterine growth retardation is one of the principal risk factors of fetal death.CONCLUSION:Besides well-known obstetrical risk factors such as diabetes, hypertension, multiple pregnancies, all screening of intra-uterine growth retardation in the second trimester of pregnancy should include a special survey in order to minimize the incidence of APFDs.

PURPOSE:Since February 2005, an outbreak of Chikungunya virus (CHIKV) infections occurred in Reunion Island. It is transmitted by the Aedes albopictus mosquito. Neonatal cases observations suggest possible fetal transmission during pregnancy. MATERIAL [corrected] AND METHODS. Observations made in 160 pregnant mothers infected by CHIKV between June 1, 2005 and February 28, 2006, in the south of Reunion island were recorded.RESULTS:Three of nine miscarriages before 22 weeks of gestation could be attributed to the virus. 3,829 births took place during this time. Among the 151 infected women, 118 were viremia negative at delivery, and none of the newborns showed any damage. Among the 33 with positive viremia at delivery, 16 newborns (48.5%) presented neonatal Chikungunya.DISCUSSION:Though fetal contamination risks appear to be rare before 22 weeks of gestation, they are potentially dangerous. After 22 weeks gestation, newborns infection occurs if the mother is viremia positive at delivery. Transplacental transmission is suspected, but the pathogenic mechanism remains unknown.

Décrire les caractéristiques des grossesses gémellaires du sud de la Réunion. Enquête transversale d’observation sur 3 ans recherchant les facteurs de risque et décrivant les événements et les complications associés à toutes les grossesses gémellaires suivies au Groupe Hospitalier Sud-Réunion (GHSR) du 1/1/2001 au 31/12/2003. Deux cent quarante et une grossesses gémellaires ont été recensées parmi 15 837 grossesses, soit une incidence régionale de 1,5 %. Les facteurs prédictifs des grossesses gémellaires suivies au GHSR (n = 234) étaient l’âge supérieur ou égal à 35 ans (63 % des femmes, OR : 8,4 ; IC 95 % 6,3-11,1), les traitements de l’infertilité (15 %) : stimulations ovariennes (OR : 50,2 ; IC 95 % 24,7-102) et fécondation in vitro (OR : 44,3 ; IC 95 % 22,6-86,3). La faible corpulence antéconceptionnelle (IMC < 20) et le célibat étaient inversement associés à ce risque. Globalement, ces grossesses étaient bien suivies. Elles nécessitaient une fois sur deux une hospitalisation dont 30 % pour une menace d’accouchement prématuré. Elles comportaient un risque majoré de pré-éclampsie (OR : 3,0 ; IC 95 % 1,6-5,7) et de diabète gestationnel (OR : 1,9 ; IC 95 % 1,2-2,8). Le taux de césariennes était de 50 % et celui des extractions instrumentales de 12 %. Elles étaient associées à 62 % de prématurité et à 18 % de grande prématurité. Enfin, elles avaient une mortalité périnatale plus importante que les grossesses mono-fœtales (78 ‰ pour les monochoriales, 57 ‰ pour les bichoriales versus 17 ‰, p < 0,0001). À la Réunion, l’incidence des grossesses gémellaires est comparable à celle observée en Europe mais semble moins liée aux techniques de procréation assistée. En revanche, leur morbidité et leur mortalité sont plus importantes. To describe characteristics of multiples pregnancies in southern Reunion Island. A three year cross-sectional observational study aimed at describing risk factors events, complications and associated with twin pregnancies from 22 weeks gestation onward, within a tertiary care hospital centre, the Groupe Hospitalier Sud-Réunion. The study included 241 multiple pregnancies out of 15 837 pregnant women. The regional incidence of multiple pregnancies was 1.5%. Indicators of eligible twin pregnancies (n=234) were mother age up or equal to 35 years (63% of women, OR 8.4; CI95% 6.3-11.1), infertility treatments (15%): ovarian stimulations (OR: 50.2; CI95% 24.7-102) and in vitro-fertilisations (OR: 44.3; CI95% 22.6-86.3). A low maternal corpulence before pregnancy (BMI < 20) and celibacy were negatively associated with twin pregnancies. Prenatal cares for twin pregnancies were globally adequate. The need for hospitalisation was 50% (30% of whom for preterm delivery threats). Twin pregnancies increased risks for pre eclampsia (OR: 3.0; CI95% 1.6-5.7) and gestational diabetes (OR: 1.9; CI95% 1.2-2.8). Caesareans and instrumental delivery rates were 50% and 12% (vs 16% and 7%), respectively. Twin infants were preterm for 62% and very preterm for 18%. Last, they were more likely to die than singletons (perinatal mortality: 78‰ for monochorionic twins, 57‰ for bichorionic twins vs 17‰, p<0.0001, respectively). In Reunion Island, the incidence of multiple pregnancies is similar to that seen in Europe, but seems less due to assisted reproduction techniques. In return, they are associated with higher morbidity and mortality rates.

La mortalité périnatale est de 18,5 dans le sud de l’île de la Réunion. Les morts fœtales in utero (MFIU) comptent pour 2/3 dans cet indice. Étude observationnelle sur 4 ans (2001-2004). Toutes les MFIU à partir de 22 semaines d’aménorrhée (SA) ont été répertoriées et analysées avec histologie placentaire, bilans infectieux et autopsies dans 27 % des cas. D’une part, la classification australasienne PSANZ-PDC (2000) a été utilisée afin de faire une approche des principales causes de décès fœtaux. D’autre part, les facteurs de risque bruts de MFIU des grossesses mono-fœtales, ont été déterminés en comparaison avec les naissances vivantes. Il y a eu 178 MFIU dans notre cohorte sur 21 495 naissances totales. Les principaux facteurs de risque obstétricaux ont été la primiparité (OR : 1,6 ; p = 0,002), l’âge maternel de 35 ans et plus (OR : 1,6 ; p = 0,01), les troubles hypertensifs de la grossesse (OR : 3,0 ; p < 0,001) et les grossesses multiples (OR : 2,5 ; p < 0,001). La grande majorité (76 %) des MFIU ont été de fœtus prématurés, dont 61 % de grands prématurés (< 33 SA) et 25 % présentaient un retard de croissance intra-utérin (OR : 3,9 ; p < 0,001). Seulement 8 % des cas ont été classés comme causes inexpliquées, les étiologies principales ayant été des causes infectieuses dans 26 % des cas, les restrictions vasculaires de la croissance fœtale (18 %), les conditions périnatales spécifiques (14 %), dont 1/3 dû à des pathologies cordonales, la pré-éclampsie (10 %), les conditions maternelles (8 %), les anomalies congénitales (8 %) et l’hémorragie anté-partum (7 %). Nous discutons les intérêts et les limites de la classification PSANZ 2000. Un retard de croissance intra-utérin est un des facteurs de risque principal de mort fœtale in utero. En plus des facteurs de risque de la grossesse bien connus tels que le diabète, l’hypertension, les grossesses multiples, un suivi étroit de toute détection de retard de croissance in utero peut être un facteur de diminution de l’incidence des MFIU. The perinatal mortality rate is 18.5 in the southern part of the Reunion Island (Indian Ocean), of which 2/3 are due to antepartum fetal deaths (APFD). During a 4-year period (2001-2004) all APFD from 22 weeks gestation were recorded and analyzed with placental histology, bacteriological samples and autopsies in 27% of cases. The Australasian and New-Zealand classification PSANZ-PDC (2000) was used. Risk factors of fetal death with monofetal pregnancies are determined in comparison with live births. . Out of 21.495 total births, 178 APFD were recorded. The main obstetrical risk factors were primiparity (OR 1.6, p=0.002), maternal age over 34 years (OR 1.6, p=0.01), hypertensive disorders of pregnancy (OR 3.0, p

OBJECTIVES To describe characteristics of multiples pregnancies in southern Reunion Island. MATERIAL AND METHODS A three-year [corrected] cross-sectional observational study aimed at describing risk factors, events and [corrcected] complications and associated with twin pregnancies from 22 weeks gestation onward, within a tertiary care hospital centre, the Groupe Hospitalier Sud-Réunion. RESULTS The study included 241 multiple pregnancies out of 15 837 pregnant women. The regional incidence of multiple pregnancies was 1.5%. Indicators of eligible twin pregnancies (n=234) were mother age up or equal to 35 years (63% of women, OR 8.4; CI95% 6.3-11.1), infertility treatments (15%): ovarian stimulations (OR: 50.2; CI95% 24.7-102) and in vitro-fertilisations (OR: 44.3; CI95% 22.6-86.3). A low maternal corpulence before pregnancy (BMI<20) and celibacy were negatively associated with twin pregnancies. Prenatal cares for twin pregnancies were globally adequate. The need for hospitalisation was 50% (30% of whom for preterm delivery threats). Twin pregnancies increased risks for pre eclampsia (OR: 3.0; CI95% 1.6-5.7) and gestational diabetes (OR: 1.9; CI95% 1.2-2.8). Caesareans and instrumental delivery rates were 50% and 12% (vs 16% and 7%), respectively. Twin infants were preterm for 62% and very preterm for 18%. Last, they were more likely to die than singletons (perinatal mortality: 78 per thousand for monochorionic twins, 57 per thousand for bichorionic twins vs 17 per thousand, p<0.0001, respectively). CONCLUSION In Reunion Island, the incidence of multiple pregnancies is similar to that seen in Europe, but seems less due to assisted reproduction techniques. In return, they are associated with higher morbidity and mortality rates.

La grossesse abdominale est une localisation extrêmement rare des grossesses extra-utérines. Elle est plus fréquente dans les pays en voie de développement. Nous rapportons le cas d’une grossesse abdominale menée à terme, découverte lors de la césarienne pour placenta recouvrant. II semble exceptionnel qu’avec un suivi clinique et échographique une grossesse abdominale soit découverte lors d’une césarienne.

L’île de la Réunion connaît depuis février 2005 une importante épidémie d’infections à virus Chikungunya (CHIKV), transmises par le moustique Aedes albopictus. En raison de la découverte des formes néonatales, il nous est apparu nécessaire d’évaluer les conséquences de l’infection chez la femme enceinte, et notamment le risque de transmission materno-fœtale, jamais décrit à ce jour. Étude de cohorte rétrospective concernant l’issue de 160 grossesses de patientes infectées, dans le sud de la Réunion, entre le 1er juin 2005 et le 28 février 2006. Parmi 9 cas de mort fœtale de moins de 22 SA, l’imputabilité du virus est évoquée dans 3 cas. 3 829 accouchements ont eu lieu pendant cette période. Parmi 151 patientes infectées pendant la grossesse, 118 femmes ont accouché en dehors de la période virémique ; aucun nouveau-né n’a présenté d’atteinte virale. 33 femmes ont accouché en période virémique, 16 nouveau-nés (48,5 %) ont présenté un Chikungunya néonatal. Le risque de contamination fœtale avant 22 SA semble rare, mais grave. Après 22 SA, les cas d’atteintes néonatales sont observés uniquement chez les nouveau-nés des patientes en période virémique. Un passage transplacentaire du virus semble probable. Sa physiopathologie reste inconnue. Since February 2005, an outbreak of Chikungunya virus (CHIKV) infections occurred in Reunion Island. It is transmitted by the Aedes albopictus mosquito. Neonatal cases observations suggest possible fetal transmission during pregnancy. Observations made in 160 pregnant mothers infected by CHIKV between June 1, 2005 and February 28, 2006, in the south of Reunion island were recorded. Three of nine miscarriages before 22 weeks of gestation could be attributed to the virus. 3 829 births took place during this time. Among the 151 infected women, 118 were viremia negative at delivery, and none of the newborns showed any damage. Among the 33 with positive viremia at delivery, 16 newborns (48.5%) presented neonatal Chikungunya. Though fetal contamination risks appear to be rare before 22 weeks of gestation, they are potentially dangerous. After 22 weeks gestation, newborns infection occurs if the mother is viremia positive at delivery. Transplacental transmission is suspected, but the pathogenic mechanism remains unknown.