Pregnancy is associated with erythrocyte hyperaggregation which acutely returns to baseline during delivery, while a transient hyperviscosity syndrome induced by uterine contractions can be observed. We aimed at analyzing more precisely the modifications of erythrocyte aggregation during labor. 71 uterine contractions in 30 pregnant women (19-45 yr, mean 27.2 +/- 9) were studied, with RBC aggregation (SEFAM erythroaggregometer) measured before, during and after the contraction. Aggregation indices at 10 and 60 sec progressively increased throughout labor (p<0.01). Partial and total dissociation thresholds progressively decrease during labor with a nadir (-10%) at delivery (p<0.01). The aggregation time is transiently shortened (p<0.01) during labor. Although previous measurements with the Myrenne aggregometer showed only during labor a return to nonpregnant values, this analysis by laser backscattering indicates that the stressful events which occur during uterine contractions increase the tendency of RBCs to form aggregates, although they disaggregate more easily.

Fetal diastematomyelia, a malformation due to a longitudinal split of the cord, was diagnosed during the third trimester. Diagnosis was based on the visualization of a sagittal bony spur in the thoracolumbar spinal canal, associated with enlargement of the canal, hemivertebrae and spina bifida without a meningocele.

Objective The effect of selective fetocide on the course of 61 multiple pregnancies.Design An observational study.Setting A tertiary centre.Subjects 61 women whose pregnancies included 37 triplets, 18 quadruplets, 5 quintuplets and 1 heptuplet; 97% followed IVF or the induction of ovulation. The aim of the procedure in most cases was to obtain twins.Interventions Selective reduction was performed before 13 weeks gestation under general anaesthesia, using either a transcervical (n = 26) or transabdominal approach (n = 35). Fifty-four twins, 4 singletons and 3 triplets were obtained after the procedure.Main outcome measure Preterm labour rate.Results The rate of unplanned fetal loss was 13% and was related to the number of suppressed embryos (P<0.05). The preterm labour rate was 56.6%, the mean gestation at delivery was 35.6 weeks. Seven deliveries were before 32 weeks and led to all neonatal deaths. A comparison with published data suggested that fetal reduction reduced the rate of preterm labour in high multiple pregnancies; in 24 twin pregnancies obtained after reduction of triplets there was probably a gain of 2 weeks gestation. Severe growth retardation occurred in 13%. The perinatal mortality rate was 10.8%.Conclusions Selective termination reduces but does not prevent early preterm labour. The procedure is of value in pregnancies with more than 3 fetuses and should be considered carefully for triplet pregnancies.

Objective: To evaluate the effect of selective termination in triplet pregnancies.Design: Comparative, prospective, nonrandomized study.Setting: All 80 pregnancies were managed in a single tertiary center by the same obstetrical team.Patients: Eighty women with triplet pregnancies were divided into two groups: group I consisted of 48 women who wished to continue their pregnancies without reduction; in group II were 32 women who choose reduction generally to obtain twins.Interventions: Selective terminations were performed after an average term of 9.6 weeks of gestation by transcervical or transabdominal approaches.Main Outcome Measurements: The rate of miscarriage and prematurity, fetal growth, perinatal morbidity and mortality, and maternal complications in the two groups.Results: Prematurity was lower in reduced pregnancies (95.5% in triplets versus 53.5%), especially between 24 to 32 weeks' gestation where prematurity was reduced by half. Birth weight was >450 g higher in the reduced group. The perinatal mortality rate was lower for reduced pregnancies, but this difference was not statistically significant. Five life-threatening maternal complications occurred in triplets, with none in the reduced group.Conclusions: Selective terminations are effective in decreasing the rate of prematurity, improving fetal growth, and avoiding maternal complications. The procedure thus could be used in triplet gestations. The ultimate decision should be taken by the couple who must be well informed of the risks of the procedure before deciding.

We present a case of prenatal diagnosis of a fetal cystic hygroma of the arm diagnosed using ultrasound scanning in the 32nd week of gestation. This represents the first reported case of cystic hygroma in this location. Ultrasonography was useful for the assessment of fetal arm mobility and for monitoring the volume of the mass during the pregnancy.

This descriptive study was conducted to evaluate the risk of uterine rupture in cases of late vaginal induced abortions among women with previous cesarean sections. 23 women were referred at a mean gestational age of 23.9 (SD 6.9) weeks of gestation after one or two cesarean sections. Indications for terminating the pregnancy were maternal diseases in 4 cases and fetal anomalies in 19 cases. RU 486 and/or prostaglandins were used for cervical ripening and to induce labor. Vaginal birth was obtained in 20 cases (86.9%) with an average duration of 72 (SD 52) h. Cesarean section was performed in the remaining 3 women because no cervical dilation could be obtained. One uterine rupture occurred and was treated with conservation of the uterus. Late termination of pregnancy in such cases can be achieved without cesarean section with a high success rate.

The combined oral contraceptive pill is an efficient means of contraception. It acts at different levels of the genital tract. Despite its efficiency, it is universally suggested that patients take the pill at regular daily intervals. Little attention has been given to the question of what happens if you miss the pill one day or more. A study was undertaken to evaluate the consequences of pill misses at different times of the cycle. Forty-seven young, healthy, normally menstruating patients voluntarily enrolled. All were given Cilest (ethinyl estradiol 35 micrograms and norgestimate 250 mg, Cilag France) for 21 days without any misses. Then, after a 7-day interval, they were prescribed one (group 1), two (group 2), three (group 3) or four days of pill misses, to occur respectively on day 1 (group a), 6 (group b), 12 (group c) or 18 (group d) of a new 21 day cycle; supplementary contraceptive means were recommended. Four patients had no miss prescribed and served as controls. Ovarian function was evaluated with daily estrogen measurements (E1 + E2 enzymatic dosage, BioMérieux, France) and ultrasound examinations. When required, because of significant increase in estrogen or because of follicular growth detected on ultrasound, LH and progesterone were measured. None of the patients experienced a normal ovulation. Four patients (1 control, 1 from group 2a, and 2 from group 3a) had a significant increase in estrogen levels and had a follicular image on ultrasounds. One of them (group 3a) had a follicular rupture, but none had a LH surge or increase in progesterone.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors describe a case of prenatal diagnosis of hydrometrocolpos performed at 35 weeks of ammenorhea. Diagnosis was based on fetal images of a rounded, solid, pelvic mass increasing rapidly, which evoked vaginal and uterine distension. No associated anomaly was found. This very unusual genital malformation required treatment at birth. This case shows that hydrometrocolpos can be evidenced by prenatal ultra-sonography allowing early treatment and prevention of complications.

Severe foetal thrombocytopenia (24,000 platelets per cubic mm) was diagnosed in a 37-week pregnant woman. The primigravida, primipara mother had been affected with idiopathic thrombocytopenic purpura at the age of 6 years, in remission since the age of 8 years (after splenectomy). The prenatal diagnosis was made by foetal blood sampling performed when the mother's platelet count was normal. The expected haemorrhagic complications of vaginal delivery were avoided by a caesarean section.

En 1983, une equipe Montpellieraine formee de deux gynecologues et d'une psychotherapeute a realise une information ponctuelle a 190 lyceens en classe de troisieme sur la prevention des interruptions volontaires de grossesse et des maladies sexuellement transmissibles. L'evaluation a ete faite 3 ans apres par comparaison a un groupe temoin. Cette etude nous permet donc de penser qu'une information ponctuelle en classe de troisieme peut etre efficace pour prevenir la survenue de grossesses et de maladies sexuellement transmissibles entre 15 et 18 ans

Asthma and respiratory allergies arise from the union of innate (predisposing and hereditary) and acquired factors (e.g. environmental). Without yet being perfectly elucidated there will in the future be a better understanding of the basic concept of the "diathesis" of allergic asthma. It includes the hereditary transmission of sensitising capacity to various major allergens and also of bronchial hyperactivity whose congenital predisposition is shown by studies of groups of twins; but perhaps it is not indispensable to the genesis of asthma, since it apparently may be acquired, as for example in occupational asthma. The understanding of the diathesis enables the prediction of respiratory allergic risk and consequently the early initiation of preventative measures in those new-born at high risk. Together these preventative steps consist of quite a heavy burden, whose efficacy remains imperfect but always timely.