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Cordier AG, Badr DA, Basurto D, Russo F, Deprest J, Orain E, Eixarch E, Otano J, Gratacos E, Moraes De Luna Freire Vargas A, Peralta CFA, Jani JC, Benachi A. Effect of cannula insertion site during fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia on preterm prelabor rupture of membranes. Ultrasound Obstet Gynecol 2024; 63:529-535. [PMID: 38051135 DOI: 10.1002/uog.27548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/02/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE To assess whether the cannula insertion site on the maternal abdomen during fetal endoscopic tracheal occlusion (FETO) for congenital diaphragmatic hernia (CDH) was associated with preterm prelabor rupture of membranes (PPROM) before balloon removal. METHODS This was a multicenter retrospective study of consecutive pregnancies with isolated left- or right-sided CDH that underwent FETO in four centers between January 2009 and January 2021. The site for balloon insertion was categorized as above or below the umbilicus. One propensity score was analyzed in both groups to calculate an average treatment effect (ATE) by inverse probability of treatment weighting. Logistic regression and Cox proportional hazard regression including the ATE weights were performed to examine the effect size of entry point on the frequency and timing of PPROM before balloon removal. RESULTS A total of 294 patients were included. The mean ± SD gestational age at PPROM was 33.45 ± 2.01 weeks and the mean rate of PPROM before balloon removal was 25.9% (76/294). Gestational age at FETO was later in the below-umbilicus group (mean ± SD, 29.47 ± 1.29 weeks vs 29.00 ± 1.25 weeks; P = 0.002) and the duration of FETO was longer in the above-umbilicus group (median, 14.49 min (interquartile range (IQR), 8.00-21.00 min) vs 11.00 min (IQR, 7.00-14.49 min); P = 0.002). After balancing for possible confounding factors, trocar entry point below the umbilicus did not increase the risk of PPROM before balloon removal (adjusted odds ratio, 1.56 (95% CI, 0.89-2.74); P = 0.120) and had no effect on the timing of PPROM before balloon removal (adjusted hazard ratio, 1.56 (95% CI, 0.95-2.55); P = 0.080). CONCLUSION There was no evidence that uterine entry site for FETO was correlated with the risk of PPROM before balloon removal. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A-G Cordier
- Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University, APHP, Clamart, France
- Centre de Référence Maladie Rare, Hernie de Coupole Diaphragmatique, Clamart, France
- Sorbonne Université, APHP, Tenon Hospital, Paris, France
| | - D A Badr
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Vrije Universiteit Brussel, Brussels, Belgium
| | - D Basurto
- Clinical Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Academic Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium
| | - F Russo
- Clinical Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Academic Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium
| | - J Deprest
- Clinical Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Academic Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium
| | - E Orain
- Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University, APHP, Clamart, France
| | - E Eixarch
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - J Otano
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - E Gratacos
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - A Moraes De Luna Freire Vargas
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
- Fetal Medicine Unit, The Heart Hospital, São Paulo, Brazil
- Gestar Fetal Medicine and Surgery Center, São Paulo, Brazil
| | - C F A Peralta
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
- Fetal Medicine Unit, The Heart Hospital, São Paulo, Brazil
- Gestar Fetal Medicine and Surgery Center, São Paulo, Brazil
| | - J C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Vrije Universiteit Brussel, Brussels, Belgium
| | - A Benachi
- Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University, APHP, Clamart, France
- Centre de Référence Maladie Rare, Hernie de Coupole Diaphragmatique, Clamart, France
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Vivanti AJ, Couffignal C, Sibiude J, Cordier AG, Tsatsaris V, Rozenberg F, Launay O, Benachi A, De Luca D, Ancel PY, Marcault E, Ville Y, Carrara J, Luton D, Dommergues M, Borie C, Kayem G, Lecomte L, Leruez-Ville M, Périllaud-Dubois C, Biran V, Manchon P, Picone O, Vauloup-Fellous C. Maternal and neonatal outcomes of French prospective multicenter cohort study COVIPREG during the first two COVID-19 waves. J Gynecol Obstet Hum Reprod 2024; 53:102764. [PMID: 38492667 DOI: 10.1016/j.jogoh.2024.102764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND SARS-CoV-2 infection on pregnant women was the subject of many questions since the COVID-19 pandemic. METHODS We aim to assess maternal and neonatal outcomes of SARS-CoV-2 infection contracted during 2nd and 3rd trimesters of pregnancy during the first two COVID-19 waves across a prospective French multicenter cohort study. Patients were included between April 2020 and January 2021 in 10 maternity hospitals in Paris area with two groups (i) pregnant women with a positive SARS-CoV-2 nasopharyngeal RT-PCR between [14WG; 37WG[(symptomatic infection), (ii) pregnant women with a negative serology (or equivocal) at delivery and without a positive SARS-CoV-2 nasopharyngeal RT-PCR at any time during pregnancy (G2 group) MAIN FINDINGS: 2410 pregnant women were included, of whom 310 had a positive SARS-CoV-2 nasopharyngeal RT-PCR and 217 between [14WG; 37WG[. Most infections occurred between 28 and 37 weeks of gestation (56 %). Most patients could be managed as outpatients, while 23 % had to be hospitalized. Among women with a positive RT-PCR, multiparous women were over-represented (OR = 2.45[1.52;3.87]); were more likely to deliver before 37 weeks of gestation (OR = 2.19[1.44;3.24]) and overall cesarean deliveries were significantly increased (OR = 1.53[1.09;2.13]). CONCLUSIONS This study highlights the maternal, obstetrical, and neonatal burden associated with SARS-CoV-2 infections during the first two pandemic waves before availability of vaccines. TRIAL REGISTRATION NCT04355234 (registration date: 21/04/2020).
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Affiliation(s)
- Alexandre J Vivanti
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, F-92140 Clamart, Université Paris-Saclay, Gif-sur-Yvette France; Groupe de Recherche sur les Infections Pendant la Grossesse (GRIG), Paris, France
| | - Camille Couffignal
- Université de Paris, F-75006 Paris, France; IAME U1137, Inserm, Université Paris Cité, Paris, France
| | - Jeanne Sibiude
- IAME U1137, Inserm, Université Paris Cité, Paris, France; Maternité, AP-HP, Hôpital Louis Mourier, F-75007 Paris, France
| | - Anne-Gael Cordier
- Groupe de Recherche sur les Infections Pendant la Grossesse (GRIG), Paris, France; Université Paris-Saclay, 91190 Gif-sur-Yvette, France; Maternité, AP-HP, Hôpital Bicêtre, F-94270 Le Kremlin-Bicêtre, France
| | - Vassilis Tsatsaris
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Cochin Port Royal, F-75007 Paris, France
| | - Flore Rozenberg
- Laboratoire de Virologie, AP-HP, Hôpital Cochin, F-75014 Paris, France
| | - Odile Launay
- CIC vaccinologie, AP-HP, FHU PREMA, Hôpital Cochin, F-75014 Paris, France
| | - Alexandra Benachi
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, F-92140 Clamart, Université Paris-Saclay, Gif-sur-Yvette France
| | - Daniele De Luca
- Réanimation néonatale, AP-HP, Hôpital Antoine Béclère, F-92140 Clamart, France
| | - Pierre-Yves Ancel
- Unité de recherche clinique, CIC-Mère enfant, AP-HP, FHU PREMA, Hôpital Cochin, F-75014 Paris, France
| | - Estelle Marcault
- Unité de recherche clinique PNVS, AP-HP, Hôpital Bichat, F-75018 Paris, France
| | - Yves Ville
- Maternité, AP-HP, Hôpital Necker, F-75007 Paris, France
| | - Julie Carrara
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, F-92140 Clamart, Université Paris-Saclay, Gif-sur-Yvette France
| | | | - Marc Dommergues
- Sorbonne Université, F-75006 Paris, France; Maternité, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France
| | - Constance Borie
- Maternité, AP-HP, Hôpital Robert Debré, F-75019 Paris, France
| | - Gilles Kayem
- Maternité, AP-HP, Hôpital Trousseau, F-75012 Paris, France
| | - Laurence Lecomte
- Unité de recherche clinique, CIC-Mère enfant, AP-HP, FHU PREMA, Hôpital Cochin, F-75014 Paris, France
| | | | - Claire Périllaud-Dubois
- IAME U1137, Inserm, Université Paris Cité, Paris, France; Université Paris-Saclay, INSERM U1193, 94804 Villejuif, France
| | - Valérie Biran
- Réanimation néonatale, AP-HP, Hôpital Robert Debré, F-75019 Paris, France
| | | | - Olivier Picone
- Groupe de Recherche sur les Infections Pendant la Grossesse (GRIG), Paris, France; IAME U1137, Inserm, Université Paris Cité, Paris, France; Maternité, AP-HP, Hôpital Louis Mourier, F-75007 Paris, France
| | - Christelle Vauloup-Fellous
- Groupe de Recherche sur les Infections Pendant la Grossesse (GRIG), Paris, France; Université Paris-Saclay, INSERM U1193, 94804 Villejuif, France; Laboratoire de Virologie, AP-HP, Hôpital Paul-Brousse, F-94804 Villejuif, France.
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Mégier C, Letourneau A, Bejjani L, Boumerzoug MM, Suffee C, Huynh V, Saada J, Dumery G, Benachi A. [Antenatal care for fetuses with congenital diaphragmatic hernia.]. Gynecol Obstet Fertil Senol 2024:S2468-7189(24)00085-0. [PMID: 38492743 DOI: 10.1016/j.gofs.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 03/18/2024]
Abstract
Congenital diaphragmatic hernia (CDH) can be diagnosed prenatally and its severity assessed by fetal imaging. The prognosis of a fetus with CDH is based on whether or not the hernia is isolated, the measurement of lung volume on ultrasound and MRI, and the position of the liver. The birth of a child with CDH should take place in a center adapted to the care of such children, and in accordance with the recommendations defined by the French National Diagnosis and Care Protocol. It has recently been demonstrated that for moderate and severe forms of CDH, tracheal occlusion using a balloon placed in utero by fetoscopy (FETO) increases survival until discharge from the neonatal unit, but at the cost of an increased risk of prematurity. At the same time, advances in neonatal resuscitation and the standardization of follow-up of these children within the framework of the "Centre de Référence Maladies Rares: Hernie de Coupole Diaphragmatique" have improved the prognosis of these children and young adults.
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Affiliation(s)
- Charles Mégier
- Service de Gynécologie-Obstétrique, CPDPN Paris Saclay, Hôpital Bicêtre - AP-HP. Le Kremlin Bicêtre- Université Paris Saclay, France; Centre de Référence Maladies Rares: Hernie de Coupole Diaphragmatique, France.
| | - Alexandra Letourneau
- Centre de Référence Maladies Rares: Hernie de Coupole Diaphragmatique, France; Service de Gynécologie-Obstétrique, CPDPN Paris Saclay, Hôpital Antoine Béclère - AP-HP. Clamart - Université Paris Saclay, France.
| | - Lina Bejjani
- Centre de Référence Maladies Rares: Hernie de Coupole Diaphragmatique, France; Service de Gynécologie-Obstétrique, CPDPN Paris Saclay, Hôpital Antoine Béclère - AP-HP. Clamart - Université Paris Saclay, France.
| | - Meriem Macha Boumerzoug
- Centre de Référence Maladies Rares: Hernie de Coupole Diaphragmatique, France; Service de Radiologie Pédiatrique Hôpital Bicêtre - Hôpital Bicêtre - AP-HP. Le Kremlin Bicêtre- Université Paris Saclay, France.
| | - Cécile Suffee
- Centre de Référence Maladies Rares: Hernie de Coupole Diaphragmatique, France; Service de Radiologie Hôpital Antoine Béclère - Hôpital Antoine Béclère - AP-HP. Clamart - Université Paris Saclay, France.
| | - Van Huynh
- Centre de Référence Maladies Rares: Hernie de Coupole Diaphragmatique, France; Service de Radiologie Pédiatrique Hôpital Bicêtre - Hôpital Bicêtre - AP-HP. Le Kremlin Bicêtre- Université Paris Saclay, France.
| | - Julien Saada
- Centre de Référence Maladies Rares: Hernie de Coupole Diaphragmatique, France; Service de Gynécologie-Obstétrique, CPDPN Paris Saclay, Hôpital Antoine Béclère - AP-HP. Clamart - Université Paris Saclay, France.
| | - Grégoire Dumery
- Service de Gynécologie-Obstétrique, CPDPN Paris Saclay, Hôpital Bicêtre - AP-HP. Le Kremlin Bicêtre- Université Paris Saclay, France; Centre de Référence Maladies Rares: Hernie de Coupole Diaphragmatique, France.
| | - Alexandra Benachi
- Centre de Référence Maladies Rares: Hernie de Coupole Diaphragmatique, France; Service de Gynécologie-Obstétrique, CPDPN Paris Saclay, Hôpital Antoine Béclère - AP-HP. Clamart - Université Paris Saclay, France.
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Levaillant L, Linglart A, Gajdos V, Benachi A, Souberbielle JC. Reference values for serum calcium in neonates should be established in a population of vitamin D-replete subjects. J Clin Endocrinol Metab 2024:dgae167. [PMID: 38477546 DOI: 10.1210/clinem/dgae167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Serum calcium is frequently measured during the neonatal period, and is known to be influenced by the vitamin D status. We hypothesized that the 25OHD concentration may influence the lower limit of the serum calcium normal range in neonates. METHODS We included in our prospective cohort study 1002 mother-newborn pair recruited from April 2012 to July 2014, in two centers located in the neighborhoods of Paris, France, whose serum calcium was measured at 3 days of life. We established, after exclusion of outliers, a 95% confidence interval (CI) for serum calcium 1) in our whole population of 1002 neonates, 2) in neonates with a cord blood 25OHD concentration ≥ 30 nmol/L, and 3) in those with a 25OHD ≥ 50 nmol/L. RESULTS The mean serum total calcium was 2.46 ± 0.13 nmol/L [95% CI: 2.19-2.72 mmol/L], 2.47 ± 0.25 mmol/L [95% CI: 2.22-2.72 mmol/L], and 2.50 ± 0.25 mmol/L [95% CI: 2.25-2.75 mmol/L] in the whole group, in the 514 neonates with 25OHD ≥ 30 nmol/L, and in the 202 neonates with 25OHD ≥ 50 nmol/L respectively. The lower limit of the 95% range was significantly higher in neonates with 25 OHD ≥ 30 nmol/L (p<0.05) and ≥ 50 nmol/L (p<0.001) than in the entire cohort. CONCLUSION We show that the lower limit of the normal serum calcium range is higher in groups with a higher 25OHD than in unselected subjects. We propose that the reference range for serum calcium in neonates is 2.25 to 2.75 mmol/L.
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Affiliation(s)
- Lucie Levaillant
- AP-HP, Hôpital Bicêtre Paris-Saclay, service d'endocrinologie et diabète de l'enfant, Centre de référence des maladies rares du métabolisme du calcium et du phosphate, filière OSCAR, DMU 3 SEA, Le Kremlin-Bicêtre, France
- Department of Pediatric Endocrinology and Diabetology, University Hospital of Angers, 49933 Angers Cedex 9, France
| | - Agnès Linglart
- AP-HP, Hôpital Bicêtre Paris-Saclay, service d'endocrinologie et diabète de l'enfant, Centre de référence des maladies rares du métabolisme du calcium et du phosphate, filière OSCAR, DMU 3 SEA, Le Kremlin-Bicêtre, France
- Université Paris Saclay, INSERM, physiologie et physiopathologie endocrinienne, Le Kremlin-Bicêtre, France
| | - Vincent Gajdos
- AP-HP, Hôpital Antoine Béclère, service de pédiatrie, DMU3 SEA, Clamart, France
- Université Paris-Saclay, INSERM, CESP Centre for Research in Epidemiology and Population Health, Villejuif, France
| | - Alexandra Benachi
- AP-HP, Hôpital Antoine Béclère, service de gynécologie-obstétrique, DMU2 Santé des Femmes et des nouveau-nés, Clamart, France
- Université Paris-Saclay, Le Kremlin-Bicêtre, France
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Levaillant L, Linglart A, Letamendia E, Boithias C, Ouaras-Lounis S, Thérond P, Lambert AS, Levaillant M, Souberbielle JC, Benachi A, Gajdos V. Serum calcium normal range in 1000 term newborns. Horm Res Paediatr 2024:000534042. [PMID: 38471485 DOI: 10.1159/000534042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/23/2023] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Serum calcium rapidly declines at birth because of the sudden interruption of the maternal-fetal calcium influx. Several factors are known to influence serum calcium in the first days of life, including circulating concentrations of maternal vitamin D. Objective was to establish the normal range variations of neonatal serum calcium according to the French current vitamin D supplementation during pregnancy, i.e. 100,000 IU of cholecalciferol during the third trimester. METHODS We included in our prospective cohort study 1002 mother-newborn dyads from, with recruitments from April 2012 to July 2014 in France, in two recruiting centers located in Paris neighborhoods. RESULTS Total serum calcium at 3 days of life in neonates varied from 2.06 to 2.73 mmol/L [2.5 and 97.5 percentiles], with a mean of 2.45 mmol/L. Serum calcium was similar between babies born from vitamin D supplemented mothers and those born from the non-supplemented ones. Univariate and multivariable analyses demonstrated the importance of maternal and cord blood 25(OH)D concentrations for newborn serum calcium maintenance. CONCLUSION We established that the expected serum calcium in neonates ranges between 2.06 and 2.73 mmol/L which is significantly wider than the adult range. This finding should help physicians in the diagnosis of hypo- or hypercalcemia. In addition, our study supports the importance of vitamin D supplementation and 25(OH)D status for neonatal serum calcium maintenance.
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Zakaria H, Kleinfinger P, Lohmann L, Costa JM, Tsatsaris V, Salomon LJ, Jouannic JM, Rosenblatt J, Demain A, Benachi A, El Khattabi L, Vivanti AJ. Performance of cell-free DNA testing for common fetal trisomies in triplet pregnancies. Prenat Diagn 2024. [PMID: 38448008 DOI: 10.1002/pd.6548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/05/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE In singleton pregnancies, the use of cell-free DNA (cfDNA) analysis as a screening test for common fetal trisomies has spread worldwide though we still lack sufficient data for its use in triplet pregnancies. The objective of this study is to assess the performance of cfDNA testing in detecting fetal aneuploidies in triplet pregnancies as a first-tier test. METHOD We performed a retrospective cohort study including data from pregnant women with a triplet pregnancy who underwent cfDNA testing between May 1, 2017, and January 15, 2020. cfDNA was obtained by massive parallel sequencing (VeriSeq NIPT solution; Illumina®). The objectives of the study were to assess the diagnostic performance of cfDNA testing for trisomy 21 (T21) (primary outcome), trisomy 18 (T18) and 13 (secondary outcomes). RESULTS During the study period, cfDNA testing was performed in 255 women with triplet pregnancy, of which 165 (64.7%) had a neonatal outcome available. Three tests were positive for T21, one of which was confirmed by an antenatal karyotype, and the other was confirmed at birth. The third case did not undergo an invasive procedure and was not confirmed at birth (false positive). In one case, cfDNA testing was positive for T18 and was confirmed by an antenatal karyotype. There were no cases of trisomy 13 in the cohort. The no-call rate was 2.4% at first sampling. Fifty-eight (22.7%) women had embryo reduction, which in 40 (69%) of whom was performed after the cfDNA test result. CONCLUSION cfDNA testing could be offered as primary screening for main fetal aneuploidies in triplet pregnancies after provision of appropriate patient information.
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Affiliation(s)
- Hoda Zakaria
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University, APHP, Clamart, France
| | | | | | | | - Vassilis Tsatsaris
- Division of Obstetrics and Gynecology, "Port Royal" Hospital, Paris Cité University, APHP, Paris, France
| | - Laurent J Salomon
- Division of Obstetrics and Gynecology, "Necker-Enfants Malades" Hospital, Paris Cité University, APHP, Paris, France
| | - Jean-Marie Jouannic
- Division of Fetal Medicine, "Armand Trousseau" Hospital, Sorbonne Paris Nord University, APHP, Paris, France
| | - Jonathan Rosenblatt
- Division of Obstetrics and Gynecology, "Robert Debré" Hospital, Sorbonne Paris Nord University, APHP, Paris, France
| | - Adèle Demain
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University, APHP, Clamart, France
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University, APHP, Clamart, France
| | - Laïla El Khattabi
- Non-Invasive Prenatal Screening laboratory, APHP, Paris Cité University, Hôpital Cochin, Paris, France
- Chromosomal Genomics Unit, Medical Genetics Department, APHP, Sorbonne Paris Nord University, Armand Trousseau and Pitié-Salpêtrière Hospitals, Paris, France
| | - Alexandre J Vivanti
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University, APHP, Clamart, France
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Sharma D, Kozanoğlu I, Ataga KI, Benachi A, Büyükkurt S, Lanzkron S, Ozdogu H, Pancham S, Pecker LH, Robinson SE, Yilmaz Baran S, Howard J. Managing sickle cell disease and related complications in pregnancy: results of an international Delphi panel. Blood Adv 2024; 8:1018-1029. [PMID: 38206762 PMCID: PMC10879679 DOI: 10.1182/bloodadvances.2023011301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024] Open
Abstract
ABSTRACT Data to guide evidence-based management of pregnant people with sickle cell disease (SCD) are limited. This international Delphi panel aimed to identify consensus among multidisciplinary experts for SCD management during pregnancy. The 2-round Delphi process used questionnaires exploring 7 topics (antenatal care, hydroxyurea use, transfusion, prevention of complications, treatment of complications, delivery and follow-up, and bottlenecks and knowledge gaps) developed by a steering committee. Thirteen panelists (hematologists, physiologists, obstetricians, maternal fetal medicine, and transfusion medicine physicians) from the United States, the United Kingdom, Turkey, and France completed the first survey; 12 panelists completed the second round. Anonymized responses were collected and summarized by a contract research organization (Akkodis Belgium). Consensus and strong consensus were predefined as 75% to 90% (9-10 of 12) and >90% (≥11 of 12) of panelists, respectively, agreeing or disagreeing on a response to a predefined clinical scenario or statement. In several areas of SCD management, consensus was achieved: experts recommended performing at least monthly multidisciplinary antenatal follow-up, administering prophylactic aspirin for preeclampsia prevention between gestational weeks 12 and 36, initiating prophylactic transfusion therapy in certain cases, or choosing automated red blood cell exchange over other transfusion methods for patients with iron overload or severe acute chest syndrome. No consensus was reached on several topics including the prophylactic aspirin dose, indications for starting infection prophylaxis, routine use of prophylactic transfusions, or use of prophylactic transfusions for preventing fetal complications. These recommendations could inform clinical care for patients with SCD who are pregnant in the absence of large clinical trials involving this population; the identified knowledge gaps can orient future research.
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Affiliation(s)
- Deva Sharma
- Vanderbilt University Medical Center, Nashville, TN
| | - Ilknur Kozanoğlu
- Department of Physiology, Faculty of Medicine, Başkent University, Ankara, Turkey
- Adana Adult Bone Marrow Transplantation Center (CIC. 589), Apheresis Unit, Başkent University, Yuregir, Adana, Turkey
| | - Kenneth I. Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Assistance Publique Hôpitaux de Paris, Paris Saclay University Hospitals, Clamart, France
| | - Selim Büyükkurt
- Department of Obstetrics and Gynecology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Sophie Lanzkron
- Division of Hematology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Hakan Ozdogu
- Department of Hematology, Faculty of Medicine, Başkent University, Ankara, Turkey
- Adana Adult Bone Marrow Transplantation Center (CIC. 589), Apheresis Unit, Başkent University, Yuregir, Adana, Turkey
| | - Shivan Pancham
- Department of Haematology, Sandwell and West Birmingham Hospitals National Health Service Trust, West Bromwich, United Kingdom
| | - Lydia H. Pecker
- Division of Hematology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Susan E. Robinson
- Department of Women's Health, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Safak Yilmaz Baran
- Department of Obstetrics and Gynecology, Başkent University, Dr. Turgut Noyan Application and Research Center, Adana, Turkey
| | - Jo Howard
- Department of Clinical Haematology, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
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8
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Burgos CM, Irvine W, Vivanti A, Conner P, Machtejeviene E, Peters N, Sabria J, Torres AS, Tognon C, Sgró A, Kouvisalo A, Langeveld-Benders H, Sfeir R, Miserez M, Qvist N, Lokosiute-Urboniene A, Zahn K, Brendel J, Prat J, Eaton S, Benachi A. European reference network for rare inherited congenital anomalies (ERNICA) evidence based guideline on the management of gastroschisis. Orphanet J Rare Dis 2024; 19:60. [PMID: 38347519 PMCID: PMC10860293 DOI: 10.1186/s13023-024-03062-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/03/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The European Reference Network for rare Inherited Congenital Anomalies, ERNICA, guidelines for gastroschisis cover perinatal period to help teams to improve care. METHOD A systematic literature search including 136 publications was conducted. Research findings were assessed following the GRADE methodology. The evidence to decision framework was used to determine the strength and direction of recommendations. RESULTS The mode or timing of delivery do not impact neonatal mortality, risk of NEC or time on parenteral nutrition (PN). Intra or extra abdominal bowel dilatation predict complex gastroschisis and longer length of hospital stay but not increased perinatal mortality. Outcomes after Bianchi procedure and primary fascia closure under anesthesia are similar. Sutureless closure decreases the rate of surgical site infections and duration of ventilation compared to surgical closure. Silo-staged closure with or without intubation results in similar outcomes. Outcomes of complex gastroschisis (CG) undergoing early or delayed surgical repair are similar. Early enteral feeds starting within 14 days is associated with lower risk of surgical site infection. RECOMMENDATIONS The panel suggests vaginal birth between 37 and 39 w in cases of uncomplicated gastroschisis. Bianchi's approach is an option in simple gastroschisis. Sutureless closure is suggested when general anesthesia can be avoided, sutured closure. If anesthesia is required. Silo treatment without ventilation and general anesthesia can be considered. In CG with atresia primary intestinal repair can be attempted if the condition of patient and intestine allows. Enteral feeds for simple gastroschisis should start within 14 days.
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Affiliation(s)
- Carmen Mesas Burgos
- Department of Pediatric Surgery, Karolinska University Hospital, Eugeniavägen 23, C11:33, 17176, Stockholm, Sweden.
| | - Willemijn Irvine
- Department of Evidence Based Medicine and Methodology, Qualicura Healthcare Support Agency, Breda, The Netherlands
| | - Alexandre Vivanti
- Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University, Clamart, France
| | - Peter Conner
- Center for Maternal and Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Egle Machtejeviene
- Department of Gynecology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Nina Peters
- Department of Gynecology and Obstetrics, Erasmus MC, Rotterdam, The Netherlands
| | - Joan Sabria
- Center for Maternal and Fetal Medicine, Hospital St Joan de Dieu, Barcelona, Spain
| | | | - Costanza Tognon
- Department of Neonatology, University of Padua, Padua, Italy
| | - Alberto Sgró
- Department of Pediatric Surgery, University of Padua, Padua, Italy
| | - Antti Kouvisalo
- Department of Pediatric Surgery, Helsinki University Hospital, Helsinki, Finland
| | | | - Rony Sfeir
- Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Marc Miserez
- Department of Surgery, UZ Leuven, Louvain, Belgium
| | - Nils Qvist
- Department of Pediatric Surgery, Odense University Hospital, Odense, Denmark
| | - Ausra Lokosiute-Urboniene
- Department of Pediatric Surgery, Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania
| | - Katrin Zahn
- Department of Pediatric Surgery, Mannheim, Germany
| | - Julia Brendel
- Department of Pediatric Surgery, Hannover Medical University, Hanover, Denmark
| | - Jordi Prat
- Department of Pediatric Surgery, Hospital S Joan de Diu, Barcelona, Spain
| | - Simon Eaton
- Department of Pediatric Surgery, Erasmus MC, Rotterdam, The Netherlands
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University, Clamart, France
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9
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Dütemeyer V, Schaible T, Badr DA, Cordier AG, Weis M, Perez-Ortiz A, Carriere D, Cannie MM, Vuckovic A, Persico N, Cavallaro G, Benachi A, Jani JC. Fetoscopic endoluminal tracheal occlusion vs expectant management for fetuses with severe left-sided congenital diaphragmatic hernia. Am J Obstet Gynecol MFM 2024; 6:101248. [PMID: 38070678 DOI: 10.1016/j.ajogmf.2023.101248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/14/2023] [Accepted: 12/02/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND The treatment of fetuses with a congenital diaphragmatic hernia is challenging, but there is evidence that fetoscopic endoluminal tracheal occlusion has a benefit over expectant care. In addition, standardization and expertism have a great impact on survival and are probably crucial in centers that rely on expectant management with extracorporeal membrane oxygenation after birth. OBJECTIVE This study aimed to examine the survival and morbidity rates of fetuses with a severe isolated left-sided congenital diaphragmatic hernia who underwent fetoscopic endoluminal tracheal occlusion vs expectant management in high-volume centers. STUDY DESIGN This was a multicenter, retrospective study that included all consecutive fetuses with severe isolated left-sided congenital diaphragmatic hernia who were expectantly managed in a German center or who underwent fetoscopic endoluminal tracheal occlusion in 3 other European centers (Belgium, France, and Italy). Severe congenital diaphragmatic hernia was defined as having an observed to expected total fetal lung volume ≤35% with intrathoracic position of the liver diagnosed with magnetic resonance imaging. All magnetic resonance images were centralized, and lung volumes were measured by 2 experienced operators who were blinded to the pre- and postnatal data. Multiple logistic regression analyses were performed to examine the effect of the management strategy in the 2 groups on the short- and long-term outcomes. RESULTS A total of 147 patients who were managed expectantly and 47 patients who underwent fetoscopic endoluminal tracheal occlusion were analyzed. Fetuses who were managed expectantly had lower observed to expected total fetal lung volumes (20.6%±7.5% vs 23.7%±6.8%; P=.013), higher gestational age at delivery (median weeks of gestation, 37.4; interquartile range, 36.6-38.00 vs 35.1; interquartile range, 33.1-37.2; P<.001), and more frequent use of extracorporeal membrane oxygenation (55.8% vs 4.3%; P<.001) than the fetuses who underwent fetoscopic endoluminal tracheal occlusion. The survival rates at discharge and at 2 years of age in the expectant management group were higher than the survival rates of the fetoscopic endoluminal tracheal occlusion group (74.3% vs 44.7%; P=.001 and 72.8% vs 42.5%; P=.001, respectively). After adjustment for maternal age, gestational age at birth, observed to expected total fetal lung volume, and birth weight Z-score, the odds ratios were 4.65 (95% confidence interval, 1.9-11.9; P=.001) and 4.37 (95% confidence interval, 1.8-11.0; P=.001), respectively. CONCLUSION Fetuses with a severe isolated left-sided congenital diaphragmatic hernia had a higher survival rate when treated in an experienced center in Germany with antenatal expectant management and frequent use of extracorporeal membrane oxygenation during the postnatal period than fetuses who were treated with fetoscopic endoluminal tracheal occlusion in 3 centers in Belgium, France, and Italy.
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Affiliation(s)
- Vivien Dütemeyer
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium (Drs Dütemeyer, Badr, and Jani); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (Drs Dütemeyer)
| | - Thomas Schaible
- Department of Neonatology, Universitätsklinikum Mannheim, Mannheim, Germany (Drs Schaible and Perez-Ortiz)
| | - Dominique A Badr
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium (Drs Dütemeyer, Badr, and Jani)
| | - Anne-Gael Cordier
- Department of Obstetrics and Gynecology, Hospital Antoine Béclère, Université Paris Saclay, Clamart, France (Drs Cordier and Benachi)
| | - Meike Weis
- Department of Radiology, Universitätsklinikum Mannheim, Mannheim, Germany (Dr Weis)
| | - Alba Perez-Ortiz
- Department of Neonatology, Universitätsklinikum Mannheim, Mannheim, Germany (Drs Schaible and Perez-Ortiz)
| | - Diane Carriere
- Service de Réanimation Pédiatrique, Hôpital Bicêtre- AP-HP, Université Paris Saclay, Le Kremlin Bicêtre, France (Dr Carriere)
| | - Mieke M Cannie
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium (Dr Cannie)
| | - Aline Vuckovic
- Neonatal Intensive Care Unit, Queen Fabiola Children's Hospital-ULB, Brussels, Belgium (Dr Vuckovic)
| | - Nicola Persico
- Fetal Medicine and Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (Dr Persico); Department of Clinical Science and Community Health, University of Milan, Milan, Italy (Dr Persico)
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (Dr Cavallaro)
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Hospital Antoine Béclère, Université Paris Saclay, Clamart, France (Drs Cordier and Benachi)
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium (Drs Dütemeyer, Badr, and Jani).
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10
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Cornish EF, van der Meeren LE, van der Hoorn MLP, Schoenmakers S, Vivanti AJ, Benachi A, Whitten M, Hignett S, McDonnell T, Williams DJ. Stillbirths due to placental COVID infection associated with chronic histiocytic intervillositis do not recur in subsequent pregnancies. J Infect 2024; 88:215-217. [PMID: 38218418 DOI: 10.1016/j.jinf.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/02/2024] [Accepted: 01/06/2024] [Indexed: 01/15/2024]
Affiliation(s)
- Emily F Cornish
- Elizabeth Garrett Anderson Institute for Women's Health, Department of Maternal and Fetal Medicine, University College London, London, UK.
| | - Lotte E van der Meeren
- Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.
| | | | - Sam Schoenmakers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - Alexandre J Vivanti
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, Assistance Publique-Hôpitaux de Paris, Clamart, France; Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Paris, France.
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, Assistance Publique-Hôpitaux de Paris, Clamart, France; Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Paris, France.
| | - Melissa Whitten
- Elizabeth Garrett Anderson Institute for Women's Health, Department of Maternal and Fetal Medicine, University College London, London, UK.
| | - Stephanie Hignett
- Patient Advocate and Founder, COVID-19 and Pregnancy Baby Loss Support Forum, Liverpool, UK.
| | - Thomas McDonnell
- Department of Inflammation, Division of Medicine, University College London, London, UK.
| | - David J Williams
- Elizabeth Garrett Anderson Institute for Women's Health, Department of Maternal and Fetal Medicine, University College London, London, UK.
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11
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Leyne E, Anselem O, Jordan P, Vivanti AJ, Benachi A, Salomon L, Jacquier M, Jouannic J, Dhombres F, Cambier T, Rosenblatt J, Pannier E, Goffinet F, Tsatsaris V, Athiel Y. Prenatal diagnosis of isolated bilateral clubfoot: Is amniocentesis indicated? Acta Obstet Gynecol Scand 2024; 103:51-58. [PMID: 37942915 PMCID: PMC10755119 DOI: 10.1111/aogs.14716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION The aim of this study is to evaluate the benefit of cytogenetic testing by amniocentesis after an ultrasound diagnosis of isolated bilateral talipes equinovarus. MATERIAL AND METHODS This multicenter observational retrospective study includes all prenatally diagnosed cases of isolated bilateral talipes equinovarus in five fetal medicine centers from 2012 through 2021. Ultrasound data, amniocentesis results, biochemical analyses of amniotic fluid and parental blood samples to test neuromuscular diseases, pregnancy outcomes, and postnatal outcomes were collected for each patient. RESULTS In all, 214 fetuses with isolated bilateral talipes equinovarus were analyzed. A first-degree family history of talipes equinovarus existed in 9.8% (21/214) of our cohort. Amniocentesis was proposed to 86.0% (184/214) and performed in 70.1% (129/184) of cases. Of the 184 karyotypes performed, two (1.6%) were abnormal (one trisomy 21 and one triple X syndrome). Of the 103 microarrays performed, two (1.9%) revealed a pathogenic copy number variation (one with a de novo 18p deletion and one with a de novo 22q11.2 deletion) (DiGeorge syndrome). Neuromuscular diseases (spinal muscular amyotrophy, myasthenia gravis, and Steinert disease) were tested for in 56 fetuses (27.6%); all were negative. Overall, 97.6% (165/169) of fetuses were live-born, and the diagnosis of isolated bilateral talipes equinovarus was confirmed for 98.6% (139/141). Three medical terminations of pregnancy were performed (for the fetuses diagnosed with Down syndrome, DiGeorge syndrome, and the 18p deletion). Telephone calls (at a mean follow-up age of 4.5 years) were made to all parents to collect medium-term and long-term follow-up information, and 70 (33.0%) families were successfully contacted. Two reported a rare genetic disease diagnosed postnatally (one primary microcephaly and one infantile glycine encephalopathy). Parents did not report any noticeably abnormal psychomotor development among the other children during this data collection. CONCLUSIONS Despite the low rate of pathogenic chromosomal abnormalities diagnosed prenatally after this ultrasound diagnosis, the risk of chromosomal aberration exceeds the risks of amniocentesis. These data may be helpful in prenatal counseling situations.
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Affiliation(s)
- Edouard Leyne
- Department of Obstetrics and Gynecology, Assistance Publique‐Hôpitaux de Paris, Port‐Royal MaternityUniversity Hospital Center Cochin Broca Hôtel DieuParisFrance
- Inserm UMR 1195Université Paris SaclayLe Kremlin‐BicêtreFrance
| | - Olivia Anselem
- Department of Obstetrics and Gynecology, Assistance Publique‐Hôpitaux de Paris, Port‐Royal MaternityUniversity Hospital Center Cochin Broca Hôtel DieuParisFrance
| | - Pénélope Jordan
- Department of Genomic Medicine of System and Organs Diseases, Cochin Hospital, APHP CentreUniversité Paris CitéParisFrance
| | - Alexandre J. Vivanti
- Inserm UMR 1195Université Paris SaclayLe Kremlin‐BicêtreFrance
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau‐nés, Antoine Béclère Hospital, AP‐HPUniversité Paris SaclayClamartFrance
| | - Alexandra Benachi
- Department of Genomic Medicine of System and Organs Diseases, Cochin Hospital, APHP CentreUniversité Paris CitéParisFrance
| | - Laurent Salomon
- Maternity and Fetal Medicine Department, Necker Enfant Malades Hospital, APHP, EA 7328Université de ParisParisFrance
| | - Mathilde Jacquier
- Maternity and Fetal Medicine Department, Necker Enfant Malades Hospital, APHP, EA 7328Université de ParisParisFrance
| | - Jean‐Marie Jouannic
- Fetal Medicine Department, Armand Trousseau Hospital, AP‐HPSorbonne UniversityParisFrance
| | - Ferdinand Dhombres
- Fetal Medicine Department, Armand Trousseau Hospital, AP‐HPSorbonne UniversityParisFrance
| | - Tatiana Cambier
- Department of Obstetrics and Gynecology, “Robert Debré” HospitalAssistance Publique ‐ Hôpitaux de ParisParisFrance
| | - Jonathan Rosenblatt
- Department of Obstetrics and Gynecology, “Robert Debré” HospitalAssistance Publique ‐ Hôpitaux de ParisParisFrance
| | - Emmanuelle Pannier
- Department of Obstetrics and Gynecology, Assistance Publique‐Hôpitaux de Paris, Port‐Royal MaternityUniversity Hospital Center Cochin Broca Hôtel DieuParisFrance
| | - François Goffinet
- Department of Obstetrics and Gynecology, Assistance Publique‐Hôpitaux de Paris, Port‐Royal MaternityUniversity Hospital Center Cochin Broca Hôtel DieuParisFrance
| | - Vassilis Tsatsaris
- Department of Obstetrics and Gynecology, Assistance Publique‐Hôpitaux de Paris, Port‐Royal MaternityUniversity Hospital Center Cochin Broca Hôtel DieuParisFrance
| | - Yoann Athiel
- Department of Obstetrics and Gynecology, Assistance Publique‐Hôpitaux de Paris, Port‐Royal MaternityUniversity Hospital Center Cochin Broca Hôtel DieuParisFrance
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12
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Carrara J, Habibi A, Benachi A, Cheminet G. Sickle cell disease and pregnancy. Presse Med 2023; 52:104203. [PMID: 37939877 DOI: 10.1016/j.lpm.2023.104203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/10/2023] Open
Abstract
Pregnancy is a particularly risky period in the life of patients with sickle cell disease (SCD). Physiological changes during pregnancy increase the risk of vaso-occlusive crises (VOC), acute chest syndrome, venous thromboembolic events, and infections. This concerns haemoglobin (Hb) S/C and S/β+-thalassaemia patients as much than S/S or S/β0-thalassaemia patients. SCD also increases the risk of obstetrical complications, such as preeclampsia, in utero foetal death, preterm delivery mostly induced, and intrauterine growth restriction. Thus, pregnancy should be planned and closely monitored by a multidisciplinary team involving obstetricians and sickle cell disease specialists. Before pregnancy, the parents should also be informed about the risk of transmission of this autosomal recessive disease, and the father should therefore be prescribed haemoglobin electrophoresis. Treatments have to be revised when planning pregnancy: hydroxyurea (HU) should be stopped as soon as pregnancy is suspected or confirmed. Preventive blood transfusion is not systematic, but is recommended in the case of a pre-existing transfusion program prior to pregnancy, severe pre-existing organ damage, severe obstetric history, and severe or repeated crises during follow-up, especially in patients taking HU before. Despite the risks of prematurity, systematic administration of corticosteroids for foetal lung maturation is not recommended due to the risk of maternal vaso-occlusive event. Although more frequent, due to obstetrical and maternal complications, caesarean section is not systematic, in the absence of maternal contraindications. It is advisable not to exceed the term of 39 weeks of amenorrhoea. Post-partum follow-up is recommended, particularly because of the risk of thromboembolism.
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Affiliation(s)
- Julie Carrara
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, 92140 Clamart, France.
| | - Anoosha Habibi
- Sickle Cell Referral Center, Internal Medicine Unit, Henri Mondor Hospital, AP-HP, 94000 Créteil, France; INSERM-U955, Institut Mondor, Université Paris-Est Créteil, Team 2 Transfusion et Maladies du Globule rouge, Laboratoire d'Excellence GR-Ex, 94000 Créteil, France
| | - Alexandra Benachi
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, 92140 Clamart, France
| | - Geoffrey Cheminet
- Service de médecine interne, Centre National de Référence des syndromes drépanocytaires majeurs et autres maladies rares du globule rouge et de l'érythropoïèse, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, 75015 Paris, France
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13
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Monier I, Lelong N, Benachi A, Jouannic JM, Khoshnood B, Zeitlin J. Postnatal diagnosis of congenital anomalies despite active systematic prenatal screening policies: a population-based registry study. Am J Obstet Gynecol MFM 2023; 5:101170. [PMID: 37783275 DOI: 10.1016/j.ajogmf.2023.101170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Prenatal screening for congenital anomalies is an important component of maternity care, with continual advances in screening technology. However, few recent studies have investigated the overall effectiveness of a systematic policy of prenatal screening for congenital anomalies, such as in France where an ultrasound per trimester is recommended for all pregnant individuals. OBJECTIVE This study aimed to assess the proportion and the type of congenital anomalies that are not detected during pregnancy. STUDY DESIGN The study population included all singleton fetuses and newborns with congenital anomalies from the Paris Registry of Congenital Malformations (remaPAR) from 2001 to 2021. The registry includes all live births and stillbirths at ≥22 weeks of gestation and terminations of pregnancy for fetal anomaly at any gestational age with congenital anomalies diagnosed from the prenatal period until discharge home from hospital after birth. The prevalence of postnatally detected congenital anomalies was estimated overall and for 5-year intervals within the study period. We also reported the proportion of postnatal detection by subgroups of congenital anomalies according to the EUROCAT classification. RESULTS Of the 16,602 malformed singleton fetuses and newborns, 32.7% were detected postnatally. Of those with severe anomalies, 11.9% were detected postnatally. The postnatal detection rate decreased from 34.3% from 2001 to 2005, to 27.8% from 2016 to 2021 (P<.001). Anomalies most frequently detected postnatally were genital anomalies (n=969; 87.0%), followed by ear, neck, and face anomalies (n=71; 78.0%), eye anomalies (n=154; 74.0%), and limb anomalies (n=1802; 68.4%). Anomalies of the kidneys and the urinary tract (n=219; 7.1%) and the abdominal wall (n=37; 8.7%) were least likely to be detected after birth. Among the anomalies classified as severe, postnatal detection rates were highest for limb reduction defects (n=142; 40.6%), complete transposition of the great arteries (n=31; 17.6%), and diaphragmatic hernia (n=26; 17.2%). CONCLUSION Despite improvement of prenatal screening over a 20-year period, our results show that there is still a margin for improvement in prenatal diagnosis of congenital anomalies.
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Affiliation(s)
- Isabelle Monier
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Institut national de la santé et de la recherche médicale (Inserm), Institut national de recherche pour l'agriculture, l'alimentation et l'environnement (INRAE), Paris, France (Dr Monier, Ms Lelong, and Drs Khoshnood and Zeitlin).
| | - Nathalie Lelong
- Department of Obstetrics and Gynaecology, Antoine-Béclère Hospital, Assistance publique - Hôpitaux de Paris (AP-HP), Paris-Saclay University, Paris, France (Dr Benachi)
| | - Alexandra Benachi
- Department of Obstetrics and Gynaecology, Antoine-Béclère Hospital, Assistance publique - Hôpitaux de Paris (AP-HP), Paris-Saclay University, Paris, France (Dr Benachi)
| | - Jean-Marie Jouannic
- Fetal Medicine Department, Armand-Trousseau Hospital, AP-HP, Sorbonne University, Paris, France (Dr Jouannic)
| | - Babak Khoshnood
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Institut national de la santé et de la recherche médicale (Inserm), Institut national de recherche pour l'agriculture, l'alimentation et l'environnement (INRAE), Paris, France (Dr Monier, Ms Lelong, and Drs Khoshnood and Zeitlin)
| | - Jennifer Zeitlin
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Institut national de la santé et de la recherche médicale (Inserm), Institut national de recherche pour l'agriculture, l'alimentation et l'environnement (INRAE), Paris, France (Dr Monier, Ms Lelong, and Drs Khoshnood and Zeitlin)
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14
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Horn-Oudshoorn EJJ, Russo FM, Deprest JA, Kipfmueller F, Geipel A, Schaible T, Rafat N, Cordier AG, Benachi A, Abbasi N, Chiu PPL, de Boode WP, Sikkel E, Peters NCJ, Hansen BE, Reiss IKM, DeKoninck PLJ. Survival in very preterm infants with congenital diaphragmatic hernia and association with prenatal imaging markers: A retrospective cohort study. BJOG 2023; 130:1403-1411. [PMID: 37069727 DOI: 10.1111/1471-0528.17497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES To describe the outcomes of preterm born infants with congenital diaphragmatic hernia (CDH; ≤32.0 weeks of gestation) and the associations between prenatal imaging markers and survival. DESIGN Retrospective cohort study. SETTING Multicentre study in large referral centres. POPULATION Infants with an isolated unilateral CDH, live born at 32.0 weeks or less of gestation, between January 2009 and January 2020. METHODS Neonatal outcomes were evaluated for infants that were expectantly managed during pregnancy and infants that underwent fetoscopic endoluminal tracheal occlusion (FETO) therapy, separately. We evaluated the association between prenatal imaging markers and survival to discharge. Prenatal imaging markers included observed to expected lung-to-head ratio (o/e LHR), side of the defect, liver position, stomach position grade, and observed to expected total fetal lung volume (o/e TFLV). MAIN OUTCOME MEASURE Survival to discharge. RESULTS We included 53 infants born at 30+4 (interquartile range 29+1 -31+2 ) weeks. Survival in fetuses expectantly managed during pregnancy was 48% (13/27) in left-sided CDH and 33% (2/6) in right-sided CDH. Survival in fetuses that underwent FETO therapy was 50% (6/12) in left-sided CDH and 25% (2/8) in right-sided CDH. The o/e LHR at baseline was positively associated with survival in cases expectantly managed during pregnancy (odds ratio [OR] 1.20, 95% CI 1.07-1.42, p < 0.01), but not in cases that received FETO therapy (OR 1.01, 95% CI 0.88-1.15, p = 0.87). Stomach position grade (p = 0.03) and o/e TFLV were associated with survival (p = 0.02); liver position was not (p = 0.13). CONCLUSIONS In infants with CDH born at or before 32 weeks of gestation, prenatal imaging markers of disease severity were associated with postnatal survival.
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Affiliation(s)
- Emily J J Horn-Oudshoorn
- Division of Neonatology, Department of Paediatrics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Francesca M Russo
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Academic Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium
| | - Jan A Deprest
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Academic Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium
| | - Florian Kipfmueller
- Department of Neonatology and Paediatric Critical Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Thomas Schaible
- Department of Neonatology, University Hospital Mannheim, Mannheim, Germany
| | - Neysan Rafat
- Department of Neonatology, University Hospital Mannheim, Mannheim, Germany
| | - Anne-Gael Cordier
- Centre Reference Maladie Rare, Hernie de Coupole Diaphragmatique, Clamart, France
- Department of Obstetrics and Gynaecology, Hospital Antoine Béclère, University Paris-Saclay, Clamart, France
| | - Alexandra Benachi
- Centre Reference Maladie Rare, Hernie de Coupole Diaphragmatique, Clamart, France
- Department of Obstetrics and Gynaecology, Hospital Antoine Béclère, University Paris-Saclay, Clamart, France
| | - Nimrah Abbasi
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Priscilla P L Chiu
- Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Willem P de Boode
- Department of Neonatology, Radboud University Medical Centre, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Esther Sikkel
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Nina C J Peters
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Bettina E Hansen
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Irwin K M Reiss
- Division of Neonatology, Department of Paediatrics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Philip L J DeKoninck
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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15
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Bretelle F, Loubière S, Desbriere R, Loundou A, Blanc J, Heckenroth H, Schmitz T, Benachi A, Haddad B, Mauviel F, Danoy X, Mares P, Chenni N, Ménard JP, Cocallemen JF, Slim N, Sénat MV, Chauleur C, Bohec C, Kayem G, Trastour C, Bongain A, Rozenberg P, Serazin V, Fenollar F. Effectiveness and Costs of Molecular Screening and Treatment for Bacterial Vaginosis to Prevent Preterm Birth: The AuTop Randomized Clinical Trial. JAMA Pediatr 2023; 177:894-902. [PMID: 37459059 PMCID: PMC10352927 DOI: 10.1001/jamapediatrics.2023.2250] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/04/2023] [Indexed: 07/20/2023]
Abstract
Importance Bacterial vaginosis (BV) is a well-known risk factor for preterm birth. Molecular diagnosis of BV is now available. Its impact in the screening and treatment of BV during pregnancy on preterm births has not been evaluated to date. Objective To evaluate the clinical and economic effects of point-of-care quantitative real-time polymerase chain reaction screen and treat for BV in low-risk pregnant women on preterm birth. Design, Setting, and Participants The AuTop trial was a prospective, multicenter, parallel, individually randomized, open-label, superiority trial conducted in 19 French perinatal centers between March 9, 2015, and December 18, 2017. Low-risk pregnant women before 20 weeks' gestation without previous preterm births or late miscarriages were enrolled. Data were analyzed from October 2021 to November 2022. Interventions Participants were randomized 1:1 to BV screen and treat using self-collected vaginal swabs (n = 3333) or usual care (n = 3338). BV was defined as Atopobium vaginae (Fannyhessea vaginae) load of 108 copies/mL or greater and/or Gardnerella vaginalis load of 109 copies/mL or greater, using point-of-care quantitative real-time polymerase chain reaction assays. The control group received usual care with no screening of BV. Main Outcomes and Measures Overall rate of preterm birth before 37 weeks' gestation and total costs were calculated in both groups. Secondary outcomes were related to treatment success as well as maternal and neonate health. Post hoc subgroup analyses were conducted. Results Among 6671 randomized women (mean [SD] age, 30.6 [5.0] years; mean [SD] gestational age, 15.5 [2.8] weeks), the intention-to-treat analysis of the primary clinical and economic outcomes showed no evidence of a reduction in the rate of preterm birth and total costs with the screen and treat strategy compared with usual care. The rate of preterm birth was 3.8% (127 of 3333) in the screen and treat group and 4.6% (153 of 3338) in the control group (risk ratio [RR], 0.83; 95% CI, 0.66-1.05; P = .12). On average, the cost of the intervention was €203.6 (US $218.0) per participant, and the total average cost was €3344.3 (US $3580.5) in the screen and treat group vs €3272.9 (US $3504.1) in the control group, with no significant differences being observed. In the subgroup of nulliparous women (n = 3438), screen and treat was significantly more effective than usual care (RR, 0.62; 95% CI, 0.45-0.84; P for interaction = .003), whereas no statistical difference was found in multiparous (RR, 1.30; 95% CI, 0.90-1.87). Conclusion and Relevance In this clinical trial of pregnant women at low risk of preterm birth, molecular screening and treatment for BV based on A vaginae (F vaginae) and/or G vaginalis quantification did not significantly reduce preterm birth rates. Post hoc analysis suggests a benefit of screen and treat in low-risk nulliparous women, warranting further evaluation in this group. Trial Registration ClinicalTrials.gov Identifier: NCT02288832.
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Affiliation(s)
- Florence Bretelle
- Department of Obstetrics and Gynecology, La Conception Hospital, Assistance Publique–Hopitaux de Marseille, Marseille, France
- Aix-Marseille Univ, IRD, Assistance Publique–Hopitaux de Marseille, UMRD-258 Microbes, Evolution, Phylogenie and Infection (MEPHI), Marseille, France
| | - Sandrine Loubière
- Research Unit EA 3279, CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Raoul Desbriere
- Department of Obstetrics and Gynecology, Fondation Hopital Saint Joseph, Marseille, France
| | - Anderson Loundou
- Research Unit EA 3279, CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Julie Blanc
- Research Unit EA 3279, CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
- Department of Obstetrics and Gynecology, Hopital Nord, Assistance Publique–Hopitaux de Marseille, Marseille, France
| | - Hélène Heckenroth
- Department of Obstetrics and Gynecology, La Conception Hospital, Assistance Publique–Hopitaux de Marseille, Marseille, France
| | - Thomas Schmitz
- Service de Gynécologie Obstétrique, Assistance Publique–Hôpitaux de Paris Hôpital Robert Debré, Université Paris Cité, Paris, France
| | - Alexandra Benachi
- Service de Gynécologie-Obstétrique, DMU Santé des Femmes et des nouveau-nés Hôpital Antoine Béclère, Assistance Publique–Hôpitaux de Paris, Clamart, France
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, Assistance Publique–Hôpitaux de Paris, Université Paris Saclay, Clamart, France
| | - Bassam Haddad
- Centre Hospitalier de Créteil, Créteil, France
- Department of Obstetrics and Gynecology, Institut Mondor de Recherche Biomedicale, Université Paris Est Creteil, Centre Hospitalier Creteil, Creteil, France
| | - Franck Mauviel
- Department of Obstetrics and Gynecology, Centre hospitalier de Toulon sainte Musse, Toulon, France
| | - Xavier Danoy
- Departement of Obstetrics and Gynecology, Centre hospitalier d’Aix en Provence, Centre hospitalier de Pertuis, Aix en Provence, France
| | - Pierre Mares
- Departement of Obstetrics and Gynecology, Centre hospitalier universitaire de Nimes, Nimes, France
| | - Nawal Chenni
- Departement of Obstetrics and Gynecology, Centre hospitalier d’Aubagne, Aubagne, France
| | - Jean-Pierre Ménard
- Direction de la Protection Maternelle et Infantile et de la Promotion de la Santé, Conseil départemental du Val-de-Marne, Créteil, France
| | - Jean-François Cocallemen
- Departement de recherche clinique, Hopital Nord, Assistance hôpitaux de Marseille, Assistance Publique–Hopitaux de Marseille, Marseille, France
| | | | - Marie Victoire Sénat
- Departement Gynécologie Obstétrique, Centre hospitalier Universitaire du Kremlin Bicetre, Kremlin Bicetre, France
- Clinical Epidemiology, Centre de Recherche en épidémiologie et Santé des populations, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Inserm, Team U1018, Villejuif, France
| | - Céline Chauleur
- Service de Gynécologie-obstétrique, CHU de Saint Etienne, INSERM, SAINBIOSE, U1059, Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne, France
| | | | - Gilles Kayem
- Service de Gynécologie Obstétrique de l’hôpital Trousseau, Université Pierre et Marie Curie, INSERM U1153, Paris, France
| | - Cynthia Trastour
- Departement d’Obstétrique-Reproduction-Gynécologie, Hôpital Archet, CHU de Nice, Nice, France
| | - André Bongain
- Departement d’Obstétrique-Reproduction-Gynécologie, Hôpital Archet, CHU de Nice, Nice, France
| | - Patrick Rozenberg
- Clinical Epidemiology, Centre de Recherche en épidémiologie et Santé des populations, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Inserm, Team U1018, Villejuif, France
- American Hospital of Paris, Neuilly-sur-Seine, France
| | - Valerie Serazin
- Service de Biologie Médicale, CHI de Poissy-Saint-Germain-en-Laye, Poissy, France
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Institut national de la recherche agronomique, Biologie de la Reproduction, Environnement, Epigénétique et Développement, Paris, France
| | - Florence Fenollar
- Department of Infectious Diseases, Hopital de la Timone, Assistance Publique–Hopitaux de Marseille, IHU-Méditerranée Infection, Marseille, France
- Aix-Marseille Univ, Institut recherche et développement, Assistance Publique–Hopitaux de Marseille, SSA, Vecteurs – Infections Tropicales et Méditeranéennes, Marseille, France
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16
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Vergote S, De Bie FR, Duffy JMN, Bosteels J, Benachi A, Power B, Meijer F, Hedrick HL, Fernandes CJ, Reiss IKM, De Coppi P, Lally KP, Deprest JA. Core outcome set for perinatal interventions for congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2023; 62:374-382. [PMID: 37099763 DOI: 10.1002/uog.26235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To develop a core set of prenatal and neonatal outcomes for clinical studies evaluating perinatal interventions for congenital diaphragmatic hernia, using a validated consensus-building method. METHODS An international steering group comprising 13 leading maternal-fetal medicine specialists, neonatologists, pediatric surgeons, patient representatives, researchers and methodologists guided the development of this core outcome set. Potential outcomes were collected through a systematic review of the literature and entered into a two-round online Delphi survey. A call was made for stakeholders with experience of congenital diaphragmatic hernia to review the list and score outcomes based on their perceived relevance. Outcomes that fulfilled the consensus criteria defined a priori were discussed subsequently in online breakout meetings. Results were reviewed in a consensus meeting, during which the core outcome set was defined. Finally, the definitions, measurement methods and aspirational outcomes were defined in online and in-person definition meetings by a selection of 45 stakeholders. RESULTS Overall, 221 stakeholders participated in the Delphi survey and 198 completed both rounds. Fifty outcomes met the consensus criteria and were discussed and rescored by 78 stakeholders in the breakout meetings. During the consensus meeting, 93 stakeholders agreed eventually on eight outcomes, which constituted the core outcome set. Maternal and obstetric outcomes included maternal morbidity related to the intervention and gestational age at delivery. Fetal outcomes included intrauterine demise, interval between intervention and delivery and change in lung size in utero around the time of the intervention. Neonatal outcomes included neonatal mortality, pulmonary hypertension and use of extracorporeal membrane oxygenation. Definitions and measurement methods were formulated by 45 stakeholders, who also added three aspirational outcomes: duration of invasive ventilation, duration of oxygen supplementation and use of pulmonary vasodilators at discharge. CONCLUSIONS We developed with relevant stakeholders a core outcome set for studies evaluating perinatal interventions in congenital diaphragmatic hernia. Its implementation should facilitate the comparison and combination of trial results, enabling future research to better guide clinical practice. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Vergote
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - F R De Bie
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - J M N Duffy
- Department of Women and Children's Health, King's College London, London, UK
| | - J Bosteels
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - A Benachi
- Service de Gynécologie-Obstétrique, Hôpital Antoine-Béclère, AP-HP, Clamart, France
- Centre de Référence Maladies Rares Hernie de Coupole Diaphragmatique, Hôpital Antoine-Béclère, AP-HP, Clamart, France
| | - B Power
- The Congenital Diaphragmatic Hernia Charity (CDH UK), King's Lynn, UK
| | - F Meijer
- PlatformCHD, Arnhem, The Netherlands
| | - H L Hedrick
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - C J Fernandes
- Division of Neonatology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - I K M Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - P De Coppi
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital for Children, London, UK
- Stem Cells and Regenerative Medicine Section, Institute of Child Health, University College London, London, UK
| | - K P Lally
- Department of Pediatric Surgery, McGovern Medical School at UTHealth Houston, Children's Memorial Hermann Hospital, Houston, TX, USA
| | - J A Deprest
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Department of Women and Children's Health, King's College London, London, UK
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17
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Nguyen T, Heide S, Guilbaud L, Valence S, Perre SV, Blondiaux E, Keren B, Quenum-Miraillet G, Jouannic JM, Mandelbrot L, Picone O, Guet A, Tsatsaris V, Milh M, Girard N, Vincent M, Nizon M, Poirsier C, Vivanti A, Benachi A, Portes VD, Guibaud L, Patat O, Spentchian M, Frugère L, Héron D, Garel C. Abnormalities of the corpus callosum. Can prenatal imaging predict the genetic status? Correlations between imaging phenotype and genotype. Prenat Diagn 2023; 43:746-755. [PMID: 37173814 DOI: 10.1002/pd.6382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Recent studies have evaluated prenatal exome sequencing (pES) for abnormalities of the corpus callosum (CC). The objective of this study was to compare imaging phenotype and genotype findings. METHOD This multicenter retrospective study included fetuses with abnormalities of the CC between 2018 and 2020 by ultrasound and/or MRI and for which pES was performed. Abnormalities of the CC were classified as complete (cACC) or partial (pACC) agenesis of the CC, short CC (sCC), callosal dysgenesis (CD), interhemispheric cyst (IHC), or pericallosal lipoma (PL), isolated or not. Only pathogenic (class 5) or likely pathogenic (class 4) (P/LP) variants were considered. RESULTS 113 fetuses were included. pES identified P/LP variants for 3/29 isolated cACC, 3/19 isolated pACC, 0/10 isolated sCC, 5/10 isolated CD, 5/13 non-isolated cACC, 3/6 non-isolated pACC, 8/11 non-isolated CD and 0/12 isolated IHC and PL. Associated cerebellar abnormalities were significantly associated with P/LP variants (OR = 7.312, p = 0.027). No correlation was found between phenotype and genotype, except for fetuses with a tubulinopathy and an MTOR pathogenic variant. CONCLUSIONS P/LP variants were more frequent in CD and in non-isolated abnormalities of the CC. No such variants were detected for fetuses with isolated sCC, IHC and PL.
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Affiliation(s)
- Toan Nguyen
- Service de radiologie pédiatrique, Hôpital Armand-Trousseau, Médecine Sorbonne Université, APHP, DMU DIAMENT, GRC Images, Paris, France
| | - Solveig Heide
- Service de génétique médicale, Hôpital Pitié-Salpêtrière, Paris, France
| | - Lucie Guilbaud
- Service de médecine fœtale, Hôpital Armand-Trousseau, Sorbonne Université, APHP, DMU ORIGYNE, Paris, France
| | | | - Saskia Vande Perre
- Service de radiologie pédiatrique, Hôpital Armand-Trousseau, Médecine Sorbonne Université, APHP, DMU DIAMENT, GRC Images, Paris, France
| | - Eléonore Blondiaux
- Service de radiologie pédiatrique, Hôpital Armand-Trousseau, Médecine Sorbonne Université, APHP, DMU DIAMENT, GRC Images, Paris, France
| | - Boris Keren
- Service de génétique médicale, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Jean-Marie Jouannic
- Service de médecine fœtale, Hôpital Armand-Trousseau, Sorbonne Université, APHP, DMU ORIGYNE, Paris, France
| | - Laurent Mandelbrot
- Service de gynécologie obstétrique, Hôpital Louis-Mourier, Colombes, France
| | - Olivier Picone
- Service de gynécologie obstétrique, Hôpital Louis-Mourier, Colombes, France
| | - Agnès Guet
- Service de neuropédiatrie, Hôpital Louis-Mourier, Colombes, France
| | - Vassilis Tsatsaris
- Service de gynécologie obstétrique, Hôpital Cochin-Port Royal, Paris, France
| | - Mathieu Milh
- Service de neuropédiatrie, CHU de Marseille, AP-HM, Marseille, France
| | - Nadine Girard
- Service de neuroradiologie, CHU de Marseille, AP-HM, Marseille, France
| | | | | | | | - Alexandre Vivanti
- Service de gynécologie obstétrique, CHU Antoine Béclère, Clamart, France
| | - Alexandra Benachi
- Service de gynécologie obstétrique, CHU Antoine Béclère, Clamart, France
| | | | - Laurent Guibaud
- Service d'imagerie pédiatrique et fœtale, Hôpital Femme Mère Enfant, Lyon, France
| | - Olivier Patat
- Service de génétique médicale, Hôpital Purpan, Toulouse, France
| | | | - Lisa Frugère
- Service de génétique médicale, Hôpital Pitié-Salpêtrière, Paris, France
| | - Delphine Héron
- Service de génétique médicale, Hôpital Pitié-Salpêtrière, Paris, France
| | - Catherine Garel
- Service de radiologie pédiatrique, Hôpital Armand-Trousseau, Médecine Sorbonne Université, APHP, DMU DIAMENT, GRC Images, Paris, France
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18
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Fradin D, Tost J, Busato F, Mille C, Lachaux F, Deleuze JF, Apter G, Benachi A. DNA methylation dynamics during pregnancy. Front Cell Dev Biol 2023; 11:1185311. [PMID: 37287456 PMCID: PMC10242503 DOI: 10.3389/fcell.2023.1185311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
Pregnancy is a state of multiple physiological adaptations. Since methylation of DNA is an epigenetic mechanism that regulates gene expression and contributes to adaptive phenotypic variations, we investigated methylation changes in maternal blood of a longitudinal cohort of pregnant women from the first trimester of gestation to the third. Interestingly, during pregnancy, we found a gain of methylation in genes involved in morphogenesis, such as ezrin, while we identified a loss of methylation in genes promoting maternal-infant bonding (AVP and PPP1R1B). Together, our results provide insights into the biological mechanisms underlying physiological adaptations during pregnancy.
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Affiliation(s)
- Delphine Fradin
- INSERM U1169, Bicêtre Hospital, Paris Sud University, Le Kremlin-Bicêtre, Paris, France
| | - Jorg Tost
- The Laboratory for Epigenetics and Environment, Centre National de Recherche en Genomique Humaine, CEA-Institut de Biologie Francois Jacob, Université Paris-Saclay, Evry, France
| | - Florence Busato
- The Laboratory for Epigenetics and Environment, Centre National de Recherche en Genomique Humaine, CEA-Institut de Biologie Francois Jacob, Université Paris-Saclay, Evry, France
| | - Clémence Mille
- INSERM U1169, Bicêtre Hospital, Paris Sud University, Le Kremlin-Bicêtre, Paris, France
| | - Fanny Lachaux
- INSERM U1169, Bicêtre Hospital, Paris Sud University, Le Kremlin-Bicêtre, Paris, France
| | - Jean-François Deleuze
- Centre National de Recherche en Génomique Humaine, Institut de Biologie François Jacob, CEA, Université Paris-Saclay, Evry, France
| | - Gisèle Apter
- Child and Perinatal Psychiatric Department, Le Havre University Hospital, University Rouen Normandie, Le Havre, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-nés, Assistance Publique Hôpitaux de Paris, Antoine Beclere Hospital, Université Paris-Saclay, Paris, France
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Dervin T, Ranisavjevic N, Laot L, Mayeur A, Duperier C, Steffann J, Borghese R, Stoppa-Lyonnet D, Frydman N, Benachi A, Sonigo C, Grynberg M. Knowledge, acceptability and personal attitude toward pre-implantation 1 genetic testing (PGT) and pre-natal diagnosis (PND) for females carrying BRCA pathogenic variant according to fertility preservation experience. J Assist Reprod Genet 2023:10.1007/s10815-023-02798-9. [PMID: 37154838 DOI: 10.1007/s10815-023-02798-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/04/2023] [Indexed: 05/10/2023] Open
Abstract
PURPOSE Preimplantation genetic testing (PGT-M) and prenatal diagnosis (PND) followed by medical termination of pregnancy when the fetus is affected are two procedures developed to avoid the transmission of a severe hereditary disease which can be proposed to females that carried BRCA pathogenic variants. These females can also be offered fertility preservation (FP) when diagnosed with cancer or even before a malignancy occurs. The aim of the study was to evaluate the acceptability and personal attitude of women carrying a BRCA mutation toward techniques that can prevent BRCA transmission to their progeny. METHODS Female mutated for BRCA1 or BRCA2 were invited to complete an online survey of 49 queries anonymously between June and August 2022. RESULTS A total of 87 participants responded to the online survey. Overall, 86.2% of women considered that PGT-M should be proposed to all BRCA mutation carriers regardless of the severity of the family history, and 47.1% considered or would consider PGT-M for themselves. For PND, these percentages were lower reaching 66.7% and 29.9%, respectively. Females with personal history of breast cancer or FP achievement were more prone to undergo PND for themselves despite the overall acceptability of this procedure. Among the subgroup who had undergone FP (n = 58), there was no significant difference in acceptance of principle and personal attitude toward PGT-M and PND compared to the group without FP. CONCLUSION BRCA pathogenic variants female carriers do need information about reproductive issues, even if they are not prone to undergo PGT-M nor PND for themselves. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Traicie Dervin
- Department of Reproductive Medicine and Fertility Preservation, Université Paris-Saclay, Assistance Publique, Hôpitaux de Paris, Antoine Beclere Hospital, F-92140, Clamart, France
| | - Noémie Ranisavjevic
- Department of Reproductive Medicine, CHU and University of Montpellier, 371 Avenue du Doyen Gaston, Giraud, 34090, Montpellier, France
| | - Lucie Laot
- Department of Reproductive Medicine and Fertility Preservation, Université Paris-Saclay, Assistance Publique, Hôpitaux de Paris, Antoine Beclere Hospital, F-92140, Clamart, France
| | - Anne Mayeur
- Service de Biologie de La Reproduction - CECOS, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris, Antoine Beclere Hospital, F-92140, Clamart, France
| | - Constance Duperier
- Department of Reproductive Medicine and Fertility Preservation, Université Paris-Saclay, Assistance Publique, Hôpitaux de Paris, Antoine Beclere Hospital, F-92140, Clamart, France
| | - Julie Steffann
- Université Paris Cité, Imagine INSERM UMR1163, Service de Médecine Génomique Des Maladies Rares, Groupe Hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - Roxana Borghese
- Université Paris Cité, Imagine INSERM UMR1163, Service de Médecine Génomique Des Maladies Rares, Groupe Hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | | | - Nelly Frydman
- Service de Biologie de La Reproduction - CECOS, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris, Antoine Beclere Hospital, F-92140, Clamart, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, DMU Santé Des Femmes Et Des Nouveau-Nés, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris, Antoine Beclere Hospital, F-92140, Clamart, France
| | - Charlotte Sonigo
- Department of Reproductive Medicine and Fertility Preservation, Université Paris-Saclay, Assistance Publique, Hôpitaux de Paris, Antoine Beclere Hospital, F-92140, Clamart, France
- Université Paris Saclay, Inserm, Physiologie Et Physiopathologie Endocrinienne, F-94276, Le Kremlin-Bicêtre, France
| | - Michael Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Université Paris-Saclay, Assistance Publique, Hôpitaux de Paris, Antoine Beclere Hospital, F-92140, Clamart, France.
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20
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Claudet A, De Luca D, Mosnino E, Mattern J, Picone O, Sibiude J, Wafo E, Tsatsaris V, Giral E, Grefenstette I, Carrara J, Badr DA, Saint-Frison MH, Prevot S, Benachi A, Vivanti AJ. Impact of SARS-CoV-2 Infection on Unvaccinated Pregnant Women: Non-Reassuring Fetal Heart Rate Tracing Because of Placentitis. Viruses 2023; 15:v15051069. [PMID: 37243156 DOI: 10.3390/v15051069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/14/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
In 2020, a new coronavirus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in China. SARS-CoV-2 infection has been shown to be highly morbid in pregnant women, being a risk factor for several obstetric conditions leading to increased maternal and neonatal mortality. A few studies since 2020 have shown SARS-CoV-2 maternal-fetal transmission and noted placental abnormalities grouped under the term placentitis. We hypothesized that these placental lesions could be responsible for abnormalities in placental exchange and therefore abnormalities in cardiotocographic monitoring, leading to premature fetal extraction. The objective is to identify the clinical, biochemical, and histological determinants associated with the occurrence of non-reassuring fetal heart rate (NRFHR) outside labor in fetuses of SARS-CoV-2-infected mothers. We conducted a retrospective multicenter case series of the natural history of maternal SARS-CoV-2 infections resulting in fetal delivery outside labor due to NRFHR. Collaboration was sought with the maternity hospitals in the CEGORIF, the APHP and Brussels hospitals. The investigators were contacted by e-mail on three successive occasions over a period of one year. Data from 17 mothers and 17 fetuses were analyzed. Most women had a mild SARS-CoV-2 infection; only two women presented severe infection. No woman was vaccinated. We found a substantial proportion of maternal coagulopathy at birth: elevation of APTT ratio (62%), thrombocytopenia (41%) and liver cytolysis (58.3%). Iatrogenic prematurity was noted in 15 of 17 fetuses, and 100% were born by cesarean delivery due to emergency criteria. One male neonate died on the day of birth due to peripartum asphyxia. Three cases of maternal-fetal transmission were recorded following WHO criteria. Placental analysis in 15 cases revealed eight cases of SARS-CoV-2 placentitis, causing placental insufficiency. In total, 100% of the placentas analyzed showed at least one lesion suggestive of placentitis. SARS-CoV-2 maternal infection during pregnancy is likely to generate neonatal morbidity in relation to placental damage resulting in placental insufficiency. This morbidity may be the consequence of induced prematurity as well as acidosis in the most severe situations. Placental damage occurred in unvaccinated women and in women with no identified risk factor, in contrast to severe maternal clinical forms.
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Affiliation(s)
- Alexandra Claudet
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
| | - Elie Mosnino
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
| | - Jérémie Mattern
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
| | - Olivier Picone
- Division of Obstetrics and Gynecology, "Louis Mourier" Hospital, Paris Nord Val de Seine University, APHP, 75000 Paris, France
- Inserm IAME 1137, 75000 Paris, France
- GRIG: Groupe de Recherche sur les Infections en cours de Grossesse, 75000 Paris, France
| | - Jeanne Sibiude
- Division of Obstetrics and Gynecology, "Louis Mourier" Hospital, Paris Nord Val de Seine University, APHP, 75000 Paris, France
- Inserm IAME 1137, 75000 Paris, France
| | - Estelle Wafo
- Division of Obstetrics and Gynecology, "Marne La Vallée" Hospital, 77600 Jossigny, France
| | - Vassilis Tsatsaris
- Division of Obstetrics and Gynecology, "Port Royal" Hospital, Paris Centre University Hospitals, APHP, 75000 Paris, France
| | - Emilie Giral
- Division of Obstetrics and Gynecology, "André Grégoire" Hospital, 93100 Montreuil, France
| | - Irène Grefenstette
- Division of Obstetrics and Gynecology, "Centre Hospitalier des Quatre Villes", 92064 Saint Cloud, France
| | - Julie Carrara
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
| | - Dominique A Badr
- Division of Obstetrics and Gynecology, "University Hospital Brugmann", Université Libre de Bruxelles, 1070 Brussels, Belgium
| | | | - Sophie Prevot
- Division of Pathology, "Bicetre" Hospital, Paris Saclay University Hospitals, APHP, 94270 Le Kremlin-Bicêtre, France
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
| | - Alexandre J Vivanti
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
- GRIG: Groupe de Recherche sur les Infections en cours de Grossesse, 75000 Paris, France
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21
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Rovani S, Rahshenas M, Salomon LJ, Benachi A, Choupeaux L, Goua V, Jouannic JM, Bouar GL, Massardier J, Rosenblatt J, Sartor A, Thong-Vanh C, Vaast P, Lelong N, Khoshnood B, Delacourt C. Impact of prenatal estimation of the risk of respiratory distress in neonates with congenital pulmonary malformations on the choice of delivery site. Arch Pediatr 2023; 30:195-200. [PMID: 37061356 DOI: 10.1016/j.arcped.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/07/2022] [Accepted: 03/04/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND The vast majority of prenatally diagnosed congenital pulmonary malformations (CPM) remain asymptomatic at birth. The maximal value of the CPM volume ratio (CVRmax) predicts the risk of neonatal respiratory distress (NRD), and should allow for better assessment of the level of expertise needed at the delivery site. AIM This study evaluated the level of maternity units currently chosen for the delivery of CPMs, and determined the impact of the choice of delivery site based on the CVRmax, with a threshold of 0.4 cm2. METHODS Data were extracted from the French prospective MALFPULM cohort, with inclusion between March 2015 and June 2018. RESULTS The final study population consisted of 383 women. Deliveries in level 1 or 2 maternity units (n = 98, 25%) involved CPMs with lower CVRmax (p<0.001), causing fewer signs of prenatal compression (p = 0.025). Among the 62 children (16%) who presented with NRD, only seven (11%) were born in level 1 or 2 units (p = 0.0078). Choosing the maternity level according to the CVRmax would have increased the number of births in level 1 or 2 maternity hospitals by 70%. In these maternity units, the percentage of children with NRD would have increased from 8% in the actual distribution to 10% in the new strategy. CONCLUSION Our results showed an overuse of level 3 maternity hospitals for the delivery of newborns with a prenatal diagnosis of CPM. The use of CVRmax should enable a reduction in the use of expertise centers without an adverse impact on newborns.
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Affiliation(s)
- S Rovani
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et Allergologie Pédiatriques, Paris, France
| | - M Rahshenas
- Inserm UMR 1153, Maternité Port-Royal, Paris, France
| | - L J Salomon
- Université de Paris Cité, Paris, France; AP-HP, Hôpital Necker-Enfants Malades, Service d'Obstétrique, Paris, France
| | - A Benachi
- AP-HP, Hôpital Antoine Béclère, Service de Gynécologie-Obstétrique, Université Paris Sud, Clamart, France
| | - L Choupeaux
- AP-HP, Unité de recherche clinique Cochin-Necker, Paris, France
| | - V Goua
- Service d'Obstétrique, CHU Poitiers, France
| | - J-M Jouannic
- AP-HP, Hôpital Armand-Trousseau, Service de Gynécologie-Obstétrique, Université Paris Sorbonne, France
| | - G Le Bouar
- Service d'Obstétrique, CHU Rennes, France
| | - J Massardier
- Hospices Civils de Lyon, HFME, Service d'Obstétrique, France
| | - J Rosenblatt
- AP-HP, Hôpital Robert Debré, Service d'Obstétrique, Paris, France
| | - A Sartor
- Service d'Obstétrique, CHU Toulouse, France
| | | | - P Vaast
- Service d'Obstétrique, CRHU Lille, France
| | - N Lelong
- Inserm UMR 1153, Maternité Port-Royal, Paris, France
| | - B Khoshnood
- Inserm UMR 1153, Maternité Port-Royal, Paris, France
| | - C Delacourt
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et Allergologie Pédiatriques, Paris, France; Université de Paris Cité, Paris, France.
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22
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Bouzaglou A, Dumery G, Letourneau A, Benachi A, Vivanti AJ, Cordier AG. Management and survival of foetuses with trisomy 18 in a French retrospective cohort. J Gynecol Obstet Hum Reprod 2023; 52:102565. [PMID: 36863687 DOI: 10.1016/j.jogoh.2023.102565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/15/2023] [Accepted: 02/27/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVES The main objective of this study was to evaluate parents' current demands following the announcement of trisomy 18 and maternal risks. MATERIAL AND METHODS A single-centre retrospective study was performed in the Paris Saclay Foetal Medicine Department from 2018 to 2021. All patients followed up in the department who had cytogenetic confirmation of trisomy 18 were included. RESULTS 89 patients were recruited. The most common malformations at ultrasound examination were cardiac or brain abnormalities, distal arthrogryposis as well as severe intrauterine growth retardation. 29% of foetuses with trisomy 18 had more than three malformations. 77.5% of patients requested medical termination of pregnancy. Among the 19 patients who chose to continue their pregnancy, 10 (52.6%) presented with obstetrical complications, of which 7 (41.2%) experienced stillbirth; five babies were born alive with no survival at 6 months. CONCLUSION In France, in the case of foetal trisomy 18, most women request termination of pregnancy. In the post-natal period, the management of a newborn with trisomy 18 is oriented towards palliative care. The mother's risk of obstetrical complications should be part of counselling. Follow-up, support and safety should be the goal of management of these patients, regardless of the patient's choice.
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Affiliation(s)
- Ana Bouzaglou
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-nés, Hôpital Bicêtre, AP-HP, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Gregoire Dumery
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-nés, Hôpital Bicêtre, AP-HP, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Alexandra Letourneau
- Department of Obstetrics and Gynecology DMU Santé des Femmes et des Nouveau-nés, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, Clamart, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology DMU Santé des Femmes et des Nouveau-nés, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, Clamart, France
| | - Alexandre J Vivanti
- Department of Obstetrics and Gynecology DMU Santé des Femmes et des Nouveau-nés, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, Clamart, France
| | - Anne-Gael Cordier
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-nés, Hôpital Bicêtre, AP-HP, Université Paris Saclay, Le Kremlin Bicêtre, France; Department of Obstetrics and Gynecology, DMU ORIGYNE, Hôpital Tenon, Sorbonne Université, Paris, France.
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23
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Poisson M, Sibiude J, Mosnino E, Koual M, Landraud L, Fidouh N, Mandelbrot L, Vauloup-Fellous C, Luton D, Benachi A, Vivanti AJ, Picone O. Impact of variants of SARS-CoV-2 on obstetrical and neonatal outcomes. J Gynecol Obstet Hum Reprod 2023; 52:102566. [PMID: 36870417 PMCID: PMC9979701 DOI: 10.1016/j.jogoh.2023.102566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/07/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND SARS-CoV-2 can lead to several types of complications during pregnancy. Variant surges are associated with different severities of disease. Few studies have compared the clinical consequences of specific variants on obstetrical and neonatal outcomes. Our goal was to evaluate and compare disease severity in pregnant women and obstetrical or neonatal complications between variants of SARS-CoV-2 that have circulated in France over a two-year period (2020-2022). METHOD This retrospective cohort study included all pregnant women with a confirmed SARS-CoV-2 infection (positive naso-pharyngeal RT-PCR test) from March 12, 2020 to January 31, 2022, in three tertiary maternal referral obstetric units in the Paris metropolitan area, France. We collected clinical and laboratory data for mothers and newborns from patients' medical records. Variant identification was either available following sequencing or extrapolated from epidemiological data. RESULTS There were 234/501 (47%) Wild Type (WT), 127/501 (25%) Alpha, 98/501 (20%) Delta, and 42/501 (8%) Omicron. No significative difference was found regarding two composite adverse outcomes. There were significantly more hospitalizations for severe pneumopathy in Delta variant than WT, Alpha and Omicron respectively (63% vs 26%, 35% and 6%, p<0.001), more frequent oxygen administration (23% vs 12%, 10% and 5%, p = 0,001) and more symptomatic patients at the time of testing with Delta and WT (75% and 71%) versus Alpha and Omicron variants (55% and 66% respectively, p<0.01). Stillbirth tended to be associated with variants (p = 0.06): WT 1/231 (<1%) vs 4/126 (3%), 3/94 (3%), and 1/35 (3%) in Alpha, Delta and Omicron cases respectively. No other difference was found. CONCLUSION Although the Delta variant was associated with more severe disease in pregnant women, we found no difference regarding neonatal and obstetrical outcomes. Neonatal and obstetrical specific severity may be due to mechanisms other than maternal ventilatory and general infection.
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Affiliation(s)
- M Poisson
- AP-HP, Hôpital Louis Mourier, Department of Gynecology and Obstetrics, Colombes, France
| | - J Sibiude
- AP-HP, Hôpital Louis Mourier, Department of Gynecology and Obstetrics, Colombes, France; Université Paris Cité, IAME, INSERM, Paris, France; Groupe de Recherche sur les Infections pendant la Grossesse, Colombes, France; Fédération Hospitalo-Universitaire PREMA (FHU), Paris, France
| | - E Mosnino
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, APHP 157 rue de la Porte de Trivaux, 92140, Clamart, France
| | - M Koual
- Fédération Hospitalo-Universitaire PREMA (FHU), Paris, France; AP-HP, Hôpital Bichat, Department of Gynecology and Obstetrics, Paris, France
| | - L Landraud
- Université Paris Cité, IAME, INSERM, Paris, France; Fédération Hospitalo-Universitaire PREMA (FHU), Paris, France; AP-HP, Hôpital Louis Mourier, Department of Hygiene and Microbiology, Colombes, France
| | - N Fidouh
- AP-HP, Hôpital Bichat, Department of Virology, Paris, France
| | - L Mandelbrot
- AP-HP, Hôpital Louis Mourier, Department of Gynecology and Obstetrics, Colombes, France; Université Paris Cité, IAME, INSERM, Paris, France; Groupe de Recherche sur les Infections pendant la Grossesse, Colombes, France; Fédération Hospitalo-Universitaire PREMA (FHU), Paris, France
| | - C Vauloup-Fellous
- Saclay University, Gif-sur-Yvette, France; AP-HP, Division of Virology, Paul Brousse Hospital, Paris Saclay University Hospitals, INSERM U1193, Villejuif, France
| | - D Luton
- AP-HP, Division of Virology, Paul Brousse Hospital, Paris Saclay University Hospitals, INSERM U1193, Villejuif, France; APHP, Hôpital Bicêtre, Department of Gynecology and Obstetrics, Le Kremlin-Bicêtre, France
| | - A Benachi
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, APHP 157 rue de la Porte de Trivaux, 92140, Clamart, France; AP-HP, Division of Virology, Paul Brousse Hospital, Paris Saclay University Hospitals, INSERM U1193, Villejuif, France
| | - A J Vivanti
- Fédération Hospitalo-Universitaire PREMA (FHU), Paris, France; AP-HP, Division of Virology, Paul Brousse Hospital, Paris Saclay University Hospitals, INSERM U1193, Villejuif, France
| | - O Picone
- AP-HP, Hôpital Louis Mourier, Department of Gynecology and Obstetrics, Colombes, France; Université Paris Cité, IAME, INSERM, Paris, France; Groupe de Recherche sur les Infections pendant la Grossesse, Colombes, France; Fédération Hospitalo-Universitaire PREMA (FHU), Paris, France.
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24
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De Luca D, Vauloup-Fellous C, Benachi A, Vivanti A. Transmission of SARS-CoV-2 from mother to fetus or neonate: What to know and what to do? Semin Fetal Neonatal Med 2023; 28:101429. [PMID: 36935314 PMCID: PMC10010052 DOI: 10.1016/j.siny.2023.101429] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
SARS-CoV-2 can be vertically transmitted from the mother to the fetus and the neonate. This transmission route is rare compared to the environmental or horizontal spread and therefore, the risk can be deemed inconsequential by some medical providers. However, severe, although just as rare, feto-neonatal consequences are possible: fetal demise, severe/critical neonatal COVID-19 and multi-inflammatory syndrome (MIS-N) have been described. Therefore, it is important for the clinicians to know the mechanism of vertical transmission, how to recognize this, and how to deal with neonatal COVID-19 and MIS-N. Our knowledge about this field has significantly increased in the last three years. This is a summary of the pathophysiology, diagnostics, and therapeutics of vertical SARS-CoV-2 transmission that clinicians apply in their clinical practice.
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Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Clamart, France.
| | - Christelle Vauloup-Fellous
- Division of Virology, "Paul Brousse" Hospital, Paris Saclay University Hospitals, APHP, Villejuif, France
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
| | - Alexandre Vivanti
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
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25
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Lejamtel F, Oheix C, Morales E, Martinovic J, Labrune P, Petit FM, Receveur A, Achour-Frydman N, Benachi A, Puisney-Dakhli C, Vivanti AJ. Management of copy number variants associated with incomplete penetrance and variable expressivity-Results of a French survey. Clin Genet 2023; 103:335-340. [PMID: 36273389 DOI: 10.1111/cge.14252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/19/2022] [Accepted: 10/18/2022] [Indexed: 02/04/2023]
Abstract
Increasing interest regarding neurodevelopmental disorders and democratization of chromosomal microarray analysis have led to growing identification of neuro-susceptibility copy number variations (CNVs). These CNVs have incomplete penetrance and variable expressivity (PIEV), which makes phenotypic features hard to predict. The French Consortium "AchroPuce" has provided a list of 17 CNVs that should be considered as PIEV CNVs. This list led to consensual French practices of healthcare professionals in postnatal diagnosis. However, no consensus was established in prenatal diagnosis and fetal pathology. 121 French health professionals were surveyed their opinions and practices regarding reporting of PIEV CNVs to patients, in order to identify key points so as to establish French recommendations. The survey showed that professionals in favor of reporting PIEV CNVs to patients in prenatal diagnosis and fetal pathology (respectively, 76% and 84% of respondents) considered highlighted that multidisciplinary consultation is the main point-of-care management before family survey. This statement is close to recommendations published worldwide. As a consequence, multidisciplinary expertise should be the basis of French recommendations concerning the reporting of PIEV CNVs and genetic counseling in prenatal diagnosis and fetal pathology.
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Affiliation(s)
- Floriane Lejamtel
- Histology, Embryology and Cytogenetics Department, Antoine Béclère Hospital, GHU Paris Saclay, AP-HP, Clamart, France
- Obstetrics and Gynecology Department, Antoine Béclère Hospital, GHU Paris Saclay, AP-HP, Clamart, France
- Fetal pathology Unit, Antoine Béclère Hospital, GHU Paris Saclay, AP-HP, Clamart, France
- Pediatric Department, Antoine Béclère Hospital, GHU Paris Saclay, AP-HP, Clamart, France
| | - Cécile Oheix
- Histology, Embryology and Cytogenetics Department, Antoine Béclère Hospital, GHU Paris Saclay, AP-HP, Clamart, France
- Obstetrics and Gynecology Department, Antoine Béclère Hospital, GHU Paris Saclay, AP-HP, Clamart, France
- Fetal pathology Unit, Antoine Béclère Hospital, GHU Paris Saclay, AP-HP, Clamart, France
- Pediatric Department, Antoine Béclère Hospital, GHU Paris Saclay, AP-HP, Clamart, France
| | - Elisa Morales
- Histology, Embryology and Cytogenetics Department, Antoine Béclère Hospital, GHU Paris Saclay, AP-HP, Clamart, France
- Obstetrics and Gynecology Department, Antoine Béclère Hospital, GHU Paris Saclay, AP-HP, Clamart, France
- Fetal pathology Unit, Antoine Béclère Hospital, GHU Paris Saclay, AP-HP, Clamart, France
- Pediatric Department, Antoine Béclère Hospital, GHU Paris Saclay, AP-HP, Clamart, France
| | - Jelena Martinovic
- Fetal pathology Unit, Antoine Béclère Hospital, GHU Paris Saclay, AP-HP, Clamart, France
| | - Philippe Labrune
- Pediatric Department, Antoine Béclère Hospital, GHU Paris Saclay, AP-HP, Clamart, France
| | - François Mickaël Petit
- Molecular Genetics Unit, Antoine Béclère Hospital, GHU Paris Saclay, AP-HP, Clamart, France
| | - Aline Receveur
- Histology, Embryology and Cytogenetics Department, Antoine Béclère Hospital, GHU Paris Saclay, AP-HP, Clamart, France
| | - Nelly Achour-Frydman
- Reproductive Biology Unit CECOS, Paris-Saclay University, Antoine Béclère Hospital, AP-HP, Clamart, France
| | - Alexandra Benachi
- Obstetrics and Gynecology Department, Antoine Béclère Hospital, GHU Paris Saclay, AP-HP, Clamart, France
| | - Chloé Puisney-Dakhli
- Histology, Embryology and Cytogenetics Department, Antoine Béclère Hospital, GHU Paris Saclay, AP-HP, Clamart, France
| | - Alexandre Joseph Vivanti
- Obstetrics and Gynecology Department, Antoine Béclère Hospital, GHU Paris Saclay, AP-HP, Clamart, France
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Alcover N, Regiroli G, Benachi A, Vauloup-fellous C, Vivanti AJ, De luca D. Systematic review and synthesis of stillbirths and late miscarriages following SARS-CoV-2 infections. Am J Obstet Gynecol 2023:S0002-9378(23)00026-1. [PMID: 36706855 PMCID: PMC9872559 DOI: 10.1016/j.ajog.2023.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/07/2023] [Accepted: 01/17/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To describe the characteristics of fetal demises following SARS-CoV-2 infections and clarify if they are associated with clinical severity, placental lesions or malformations or due to actual fetal infections. DATA SOURCES PubMed and Web of Science databases (searched between December 1, 2019 and April 30, 2022). STUDY ELIGIBILITY CRITERIA Cohort, cross-sectional and case-control studies, as well as case series or case reports describing stillbirths or late miscarriages (i.e. pregnancy loss occurring between 14 and 22 weeks, before and after the onset of labor, respectively) from mothers infected by SARS-CoV-2 during pregnancy (demonstrated by at least one positive real-time reverse transcription polymerase chain reaction on nasopharyngeal swabs, and/or placental infection with SARS-CoV-2). No language restrictions were applied; cases with other causes possibly explaining the fetal demise were excluded. STUDY APPRAISAL AND SYNTHESIS METHODS PRISMA and MOOSE guidelines were followed. Quality of case series/reports was evaluated with the specific Mayo Clinic Evidence-Based Practice Center tool. Maternal and clinical fetal data were collected as well as placental and fetal virology and histology findings. Data were summarized with descriptive statistics using World Health Organization criteria to classify disease severity and fetal-neonatal infections. RESULTS Data from 184 mothers and 190 fetuses were analyzed. No clear link with maternal clinical severity or fetal malformation was evident. Approximately 78% of fetal demises occurred during the second and third trimester, ≈6 and 13 days after diagnosis of SARS-CoV-2 infection or the beginning of symptoms, respectively. Most (88%) placentas were positive for SARS-CoV-2 or presented the histological features of placentitis (massive fibrin deposition and chronic intervillositis) previously observed in transplacentally transmitted infections (≈85-91%). Eleven (5.8%) and 114 (60%) fetuses had a confirmed or possible in utero transmitted SARS-CoV-2 infection, respectively. CONCLUSIONS The synthesis of available data shows that fetal demises generally occur a few days after the infection with histological placental inflammatory lesions associated with transplacental SARS-CoV-2 transmission and eventually causing placental insufficiency.
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Affiliation(s)
- Noemi Alcover
- Division of Obstetrics and Gynecology, “Antoine Béclère” Hospital, Paris Saclay University Hospitals, APHP (Clamart – France)
| | - Giulia Regiroli
- Division of Pediatrics and Neonatal Critical Care, “Antoine Béclère” Hospital, Paris Saclay University Hospitals, APHP (Clamart – France)
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, “Antoine Béclère” Hospital, Paris Saclay University Hospitals, APHP (Clamart – France)
| | - Christelle Vauloup-fellous
- Division of Virology, “Paul Brousse” Hospital, Paris Saclay University Hospitals, APHP (Villejuif, France)
| | - Alexandre J. Vivanti
- Division of Obstetrics and Gynecology, “Antoine Béclère” Hospital, Paris Saclay University Hospitals, APHP (Clamart – France)
| | - Daniele De luca
- Division of Pediatrics and Neonatal Critical Care, “Antoine Béclère” Hospital, Paris Saclay University Hospitals, APHP (Clamart – France),Corresponding author: Prof. Daniele De Luca, Division of Pediatrics and Neonatal Critical Care Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140 Clamart, +33145474444
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Guillet S, Loustau V, Boutin E, Zarour A, Comont T, Souchaud-Debouverie O, Costedoat Chalumeau N, Pan-Petesch B, Gobert D, Cheze S, Viallard JF, Morin AS, Sauvetre G, Cliquennois M, Royer B, Masseau A, Terriou L, Fieschi C, Lambotte O, Girault S, Lioger B, Audia S, Sacre K, Lega JC, Langlois V, Benachi A, Orvain C, Devidas A, Humbert S, Gambier N, Ruivard M, Zarrouk V, Ebbo M, Willems L, Segaux L, Mahevas M, Haddad B, Michel M, Canoui-Poitrine F, Godeau B. Immune thrombocytopenia and pregnancy: an exposed/nonexposed cohort study. Blood 2023; 141:11-21. [PMID: 36054922 PMCID: PMC10644036 DOI: 10.1182/blood.2022017277] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/18/2022] [Accepted: 08/03/2022] [Indexed: 01/10/2023] Open
Abstract
The risk of immune thrombocytopenia (ITP) worsening during pregnancy and neonatal ITP (NITP) have never been prospectively studied. We included 180 pregnant and 168 nonpregnant women with ITP in a prospective, multicenter, observational cohort study. A total of 131 pregnant women with ITP were matched to 131 nonpregnant women with ITP by history of splenectomy, ITP status (no response, response, complete response), and duration. Groups were followed for 15 months. The primary outcome was the first occurrence of ITP worsening defined by a composite end point including bleeding events and/or severe thrombocytopenia (<30 × 109/L) and/or ITP treatment modification. We also studied the recurrence of ITP worsening and the incidence of NITP and risk factors. The first occurrence of ITP worsening did not differ between pregnant and nonpregnant women with ITP (53.4 per 100 person-years [95% confidence interval {CI}, 40.8-69.9] vs 37.1 [95% CI, 27.5-50.0]; hazard ratio {HR}, 1.35 [95% CI, 0.89-2.03], P = .16). Pregnant women with ITP were more likely to have recurrence of severe thrombocytopenia and treatment modification (HR, 2.71 [95% CI, 1.41-5.23], P = .003; HR, 2.01 [95% CI, 1.14-3.57], P = .017, respectively). However, recurrence of severe bleeding events was not different between groups (P = .4). Nineteen (14%) neonates showed NITP <50 × 109/L. By multivariable analysis, NITP was associated with a previous offspring with NITP and maternal platelet count <50 × 109/L within 3 months before delivery (adjusted odds ratio, 5.55 [95% CI, 1.72-17.89], P = .004 and 4.07 [95% CI, 1.41-11.73], P = .009). To conclude, women with ITP do not increase their risk of severe bleeding during pregnancy. NITP is associated with NITP history and the severity of maternal ITP during pregnancy. These results will be useful for counseling women with ITP.
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MESH Headings
- Infant, Newborn
- Female
- Humans
- Pregnancy
- Purpura, Thrombocytopenic, Idiopathic/epidemiology
- Purpura, Thrombocytopenic, Idiopathic/therapy
- Purpura, Thrombocytopenic, Idiopathic/complications
- Cohort Studies
- Prospective Studies
- Pregnancy Complications, Hematologic/epidemiology
- Pregnancy Complications, Hematologic/therapy
- Thrombocytopenia, Neonatal Alloimmune/therapy
- Retrospective Studies
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Affiliation(s)
- Stéphanie Guillet
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Valentine Loustau
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
- Service de Médecine Interne, Centre Hospitalier Alpes Léman, Contamine sur Arve, France
| | - Emmanuelle Boutin
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France
| | - Anissa Zarour
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Thibault Comont
- Service de Médecine Interne et d’Immunopathologie–IUCT-Oncopole, CHU de Toulouse, Toulouse, France
| | | | - Nathalie Costedoat Chalumeau
- Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
- Centre for Clinical Epidemiology, Hôpital Hôtel-Dieu, AP-HP, Université de Paris, Centre of Research in Epidemiology and Statistics, Paris, France
| | | | - Delphine Gobert
- Service de Médecine Interne, Hôpital Saint Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Stéphane Cheze
- Institut d’Hématologie de Basse-Normandie, Centre Hospitalier de Caen Normandie, Caen, France
| | | | - Anne-Sophie Morin
- Service de Médecine Interne, Hôpital Jean Verdier, AP-HP, Bondy, France
| | - Gaetan Sauvetre
- Service de Médecine Interne, Hôpital Charles Nicolle, Université de Rouen, Rouen, France
| | - Manuel Cliquennois
- Service d'Onco-hématologie Adulte, Hôpital Saint-Vincent de Paul, GH de l'institut Catholique de Lille, Lille, France
| | - Bruno Royer
- Service d’Immuno-hématologie, Hôpital Saint Louis, Paris, France
- Service d’Hématologie clinique, CHU d’Amiens, Amiens, France
| | - Agathe Masseau
- Service de Médecine Interne, CHU de Nantes, Nantes, France
| | - Louis Terriou
- Service de Médecine Interne et d’Immunologie Clinique, CHU Lille, Université de Lille, Lille, France
| | - Claire Fieschi
- Service d’Immunologie Clinique, Hôpital Saint Louis, AP-HP, Paris, France
| | - Olivier Lambotte
- Service de Médecine Interne et d’Immunologie Clinique, Hôpital Bicêtre, Université Paris Sacly, Le Kremlin-Bicêtre, France
| | - Stéphane Girault
- Service d’Hématologie Clinique et de Thérapie Cellulaire, CHU Dupuytren, Limoges, France
| | | | - Sylvain Audia
- Service de Médecine Interne et d’Immunologie Clinique, Centre de Référence Constitutif des Cytopénies Auto-Immunes, Hôpital François Mitterrand, CHU Dijon-Bourgogne, Dijon, France
| | - Karim Sacre
- Service de Médecine Interne, Hôpital Bichat, AP-HP, Paris, France et Université de Paris, Centre de Recherche sur l’Inflammation, INSERM UMR1149, CNRS ERL8252, Laboratoire d’Excellence Inflamex, Paris, France
| | - Jean Christophe Lega
- Service de Médecine Interne et Médecine Vasculaire, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Université de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS-UMR 5588, Université Lyon 1, Lyon, France
| | - Vincent Langlois
- Service de Médecine Interne, Hôpital Jacques Monod, Le Havre, France
| | - Alexandra Benachi
- Service d’Obstétrique et Gynécologie, Hôpital Antoine-Béclère, AP-HP, Université Paris-Saclay, Clamart, France
| | - Corentin Orvain
- Service d’Hématologie, Hôpital d’Anger, INSERM, CRCINA, Université d’Angers, Angers, France
| | - Alain Devidas
- Service d’Hématologie Clinique, CH Sud Francilien, Corbeil Essonnes, France
| | | | - Nicolas Gambier
- Service de Médecine Interne, CH Général Delafontaine, St Denis, France
| | - Marc Ruivard
- Service de Médecine Interne, CHU Estaing, Clermont-Ferrand, France
| | - Virginie Zarrouk
- Service de Médecine Interne, Hôpital Beaujon, AP-HP, Clichy, France
| | - Mikael Ebbo
- Service de Médecine Interne, Hôpital de la Conception, AP-HP, Université Aix-Marseille, Marseille, France
| | - Lise Willems
- Service d’Hématologie Clinique, Hôpital Cochin, Paris, France
| | - Lauriane Segaux
- Service de Santé Publique, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Matthieu Mahevas
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Bassam Haddad
- Centre Hospitalier Inter-Communal de Créteil, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Equipe Immunorégulation et Biothérapie (I-BIOT), Université Paris Est Créteil, Univ Paris Est Créteil, INSERM U955, Institut Mondor De Recherche Biomédicale (IMRB), Créteil, France
| | - Marc Michel
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Florence Canoui-Poitrine
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Service de Santé Publique, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
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Sananès N, Basurto D, Cordier AG, Elie C, Russo FM, Benachi A, Deprest J. Fetoscopic endoluminal tracheal occlusion with Smart-TO balloon: Study protocol to evaluate effectiveness and safety of non-invasive removal. PLoS One 2023; 18:e0273878. [PMID: 36913364 PMCID: PMC10010565 DOI: 10.1371/journal.pone.0273878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/24/2023] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION One of the drawbacks of fetoscopic endoluminal tracheal occlusion (FETO) for congenital diaphragmatic hernia is the need for a second invasive intervention to reestablish airway patency. The "Smart-TO" (Strasbourg University-BSMTI, France) is a new balloon for FETO, which spontaneously deflates when positioned near a strong magnetic field, e.g., generated by a magnetic resonance image (MRI) scanner. Translational experiments have demonstrated its efficacy and safety. We will now use the Smart-TO balloon for the first time in humans. Our main objective is to evaluate the effectiveness of prenatal deflation of the balloon by the magnetic field generated by an MRI scanner. MATERIAL AND METHODS These studies were first in human (patients) trials conducted in the fetal medicine units of Antoine-Béclère Hospital, France, and UZ Leuven, Belgium. Conceived in parallel, protocols were amended by the local Ethics Committees, resulting in some minor differences. These trials were single-arm interventional feasibility studies. Twenty (France) and 25 (Belgium) participants will have FETO with the Smart-TO balloon. Balloon deflation will be scheduled at 34 weeks or earlier if clinically required. The primary endpoint is the successful deflation of the Smart-TO balloon after exposure to the magnetic field of an MRI. The secondary objective is to report on the safety of the balloon. The percentage of fetuses in whom the balloon is deflated after exposure will be calculated with its 95% confidence interval. Safety will be evaluated by reporting the nature, number, and percentage of serious unexpected or adverse reactions. CONCLUSION These first in human (patients) trials may provide the first evidence of the potential to reverse the occlusion by Smart-TO and free the airways non-invasively, as well a safety data.
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Affiliation(s)
- Nicolas Sananès
- Department of Maternal Fetal Medicine, Strasbourg University Hospital, Strasbourg, France
- INSERM 1121 ’Biomaterials and Bioengineering’, Strasbourg University, Strasbourg, France
- * E-mail:
| | - David Basurto
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Anne-Gaël Cordier
- Department of Maternal fetal Medicine, Antoine–Béclère Hospital - Paris–Saclay University, Clamart, France
| | - Caroline Elie
- Clinical Research Unit/Clinical Investigation Center, Necker-Enfants Malades Hospital, Paris, France
| | - Francesca Maria Russo
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Alexandra Benachi
- Department of Maternal fetal Medicine, Antoine–Béclère Hospital - Paris–Saclay University, Clamart, France
| | - Jan Deprest
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Institute for Women’s Health, University College London, London, United Kingdom
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Doncarli A, Araujo-Chaveron L, Crenn-Hebert C, Vacheron MN, Léon C, Khireddine I, Chin F, Benachi A, Tebeka S, Regnault N. Mental health of pregnant women during the SARS-CoV-2 pandemic in France: Evolution of self-perceived psychological state during the first lockdown, and anxiety frequency two months after the lockdown ended. PLoS One 2023; 18:e0272108. [PMID: 37079562 PMCID: PMC10118145 DOI: 10.1371/journal.pone.0272108] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/22/2023] [Indexed: 04/21/2023] Open
Abstract
Previous pandemics and related lockdowns have had a deleterious impact on pregnant women's mental health. We studied the impact of the SARS-CoV-2/Covid-19 pandemic and France's first lockdown on pregnant women's mental health. A cross-sectional study was conducted in July 2020 using a web-questionnaire completed by 500 adult women who were pregnant during the first lockdown in France (March-May 2020). Questions focused on their self-perceived psychological state and affects they felt before and during the lockdown and anxiety symptomatology (HAD) two months after it ended. A robust variance Poisson regression model was used to estimate adjusted prevalence ratios (aPR) for anxiety and self-perceived psychological state evolution. One in five respondents (21.1%) reported psychological deterioration during lockdown. Associated determinants were: i) little or no social support (self-perceived) (aRP = 1.77, 95%CI[1.18-2.66]), ii) increased workload (1.65, [1.02-2.66]), and iii) poor/moderate knowledge about SARS-CoV-2 transmission (1.60, [1.09-2.35]). Seven percent of women reporting psychological deterioration had access to professional psychological support during lockdown, while 19% did not despite wanting it. Women reported heightened powerlessness (60.3%), frustration (64%) and fear (59.2%) during lockdown. One in seven respondents (14.2%, 95%CI[10.9-18.2]) had anxiety symptoms. Determinants associated: i) at least one pregnancy-related pathology (aPR = 1.82, 95%CI[1.15-2.88]), ii) overweightness or obesity (1.61, [1.07-2.43]), iii) one child under the age of six years in the household during the lockdown (3.26, [1.24-8.53]), iv) little or no social support (self-perceived) during the lockdown (1.66, [1.07-2.58]), v) friend or relatives diagnosed with Covid-19 or with symptoms of the disease (1.66; [1.06-2.60]), vi) no access to medication for psychological distress (2.86, [1.74-4.71]), and vii) unsuccessfully seeking exchanges with healthcare professionals about their pregnancy during the pandemic (1.66, [1.08-2.55]). Our results can guide prevention and support policies for pregnant women during pandemics, current or future, with or without lockdowns. Preventing perinatal mental health problems is essential to ensure a supportive environment for the child's development.
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Affiliation(s)
| | | | - Catherine Crenn-Hebert
- Department of Gynecology and Obstetrics, Louis Mourier University Hospital, AP-HP, Colombes, France
- Regional Health Agency of Ile de France (ARS-IDF), Saint-Denis, France
| | - Marie-Noëlle Vacheron
- Consultation d'Information, Conseils et Orientation Pour les Femmes Enceintes ou Avec Désir D'Enfant Atteintes de Trouble Psychique (CICO), GHU Paris Psychiatrie et Neurosciences, Hôpital Saint-Anne, Paris, France
| | | | | | | | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Antoine Beclere Hospital, AP-HP, Clamart, France
- Université Paris Saclay, Clamart, France
| | - Sarah Tebeka
- Santé Publique France, Saint-Maurice, France
- Université Paris Cité, INSERM U1266, F-75014, Paris, France
- Department of Psychiatry, AP-HP, Louis Mourier Hospital, F-92700, Colombes, France
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Egloff C, Sibiude J, Vauloup-Fellous C, Benachi A, Bouthry E, Biquard F, Hawkins-Villarreal A, Houhou-Fidouh N, Mandelbrot L, Vivanti AJ, Picone O. New data on efficacy of valacyclovir in secondary prevention of maternal-fetal transmission of cytomegalovirus. Ultrasound Obstet Gynecol 2023; 61:59-66. [PMID: 35900718 DOI: 10.1002/uog.26039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/21/2022] [Accepted: 07/18/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Congenital cytomegalovirus (CMV) infection is the leading cause of non-genetic hearing and neurological deficits. The aim of our study was to evaluate the efficacy and safety of valacyclovir (VCV) treatment in preventing CMV transmission to the fetus after maternal primary infection. METHODS This was a retrospective, multicenter study evaluating the rate of maternal-fetal CMV transmission in pregnancies with maternal primary CMV infection treated with VCV at a dosage of 8 g per day (VCV group) compared with a control group of untreated women. Each case underwent virological testing to confirm maternal primary infection and to provide accurate dating of onset of infection. The primary outcome was the presence of congenital CMV infection at birth diagnosed based on polymerase chain reaction analysis of saliva, urine and/or blood samples. The efficacy of VCV treatment was assessed using logistic regression analysis adjusted for a propensity score. RESULTS In total, 143 patients were included in the final analysis, of whom 59 were in the VCV group and 84 were in the untreated control group. On propensity-score-adjusted analysis, VCV treatment was significantly associated with an overall reduction in the rate of maternal-fetal CMV transmission (odds ratio, 0.40 (95% CI, 0.18-0.90); P = 0.029). The rate of maternal-fetal CMV transmission, determined at birth, in the VCV vs control group was 7% (1/14) vs 10% (1/10) after periconceptional maternal primary infection (P = 1.00), 22% (8/36) vs 41% (19/46) after first-trimester maternal primary infection (P = 0.068) and 25% (2/8) vs 52% (14/27) after second-trimester maternal primary infection (P = 0.244). When analyzing the efficacy of VCV treatment according to maternal viremia at treatment initiation, there was a trend towards greater efficacy when patients were viremia-positive (21% vs 43%; P = 0.072) compared with when they were viremia-negative (22% vs 17%; P = 0.659). Maternal side effects associated with VCV were mild and non-specific in most cases. CONCLUSION Our findings indicate that VCV treatment of pregnant women with primary CMV infection reduces the risk of maternal-fetal transmission of CMV and may be effective in cases with primary infection in the first and second trimesters. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C Egloff
- Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier, AP-HP, Colombes, France
- University of Paris, Paris, France
- IAME, INSERM, Paris, France
| | - J Sibiude
- Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier, AP-HP, Colombes, France
- University of Paris, Paris, France
- IAME, INSERM, Paris, France
- FHU PREMA, Paris, France
- Research Group on Infections during Pregnancy (GRIG), Velizy, France
| | - C Vauloup-Fellous
- Research Group on Infections during Pregnancy (GRIG), Velizy, France
- Virology Department, Hôpital Paul-Brousse, INSERM U1993, Université Paris Saclay, AP-HP, Villejuif, France
| | - A Benachi
- Research Group on Infections during Pregnancy (GRIG), Velizy, France
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-nés, Hôpital Antoine Béclère, Paris Saclay University, AP-HP, Clamart, France
| | - E Bouthry
- Research Group on Infections during Pregnancy (GRIG), Velizy, France
- Department of Biology of Infectious Agents, Angers University Hospital, Angers, France
| | - F Biquard
- Department of Obstetrics and Gynaecology, Angers University Hospital, Angers, France
| | - A Hawkins-Villarreal
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Fetal Medicine Service, Obstetrics Department, Santo Tomás Hospital, University of Panama, Panama City, Panama (on behalf of the Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine)
| | - N Houhou-Fidouh
- Virology Department, Hôpital Bichat Claude-Bernard, Université de Paris, AP-HP, Paris, France
| | - L Mandelbrot
- Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier, AP-HP, Colombes, France
- University of Paris, Paris, France
- IAME, INSERM, Paris, France
- FHU PREMA, Paris, France
- Research Group on Infections during Pregnancy (GRIG), Velizy, France
| | - A J Vivanti
- Research Group on Infections during Pregnancy (GRIG), Velizy, France
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-nés, Hôpital Antoine Béclère, Paris Saclay University, AP-HP, Clamart, France
| | - O Picone
- Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier, AP-HP, Colombes, France
- University of Paris, Paris, France
- IAME, INSERM, Paris, France
- FHU PREMA, Paris, France
- Research Group on Infections during Pregnancy (GRIG), Velizy, France
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De Luca D, Vauloup-Fellous C, Benachi A, Masturzo B, Manzoni P, Vivanti A. The Essentials about Neonatal Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Coronavirus Disease: A Narrative Review. Am J Perinatol 2022; 39:S18-S22. [PMID: 36356589 DOI: 10.1055/s-0042-1758487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can occur in neonates as the virus can be transmitted both horizontally (from the environment) and vertically (during the pregnancy or at the delivery). Compared to the adult outbreak, neonatal infections do not represent a public health problem. Nonetheless, severe and life-threatening cases may rarely occur and both obstetricians and neonatologists should have a good knowledge of perinatal SARS-CoV-2 infection and related consequences. A high suspicion index must be applied and ruling out neonatal SARS-CoV-2 infection must become a part of the routine clinical workout. Moreover, neonates may be affected by the multisystem inflammatory syndrome, due to a dysregulated host response in the absence of any SARS-CoV-2 infection. We performed a narrative review to summarize here the available literature describing the essentials that should be known by every neonatologist and obstetrician, starting from what has been discovered in 2020 and adding what has been learned in the following years. The paper describes the mechanisms of transmission, clinical features, diagnostic tools, and criteria, as well as possible treatment and prevention strategies. The goal is to provide the practical points to be remembered at the bedside while caring for a pregnant woman or a neonate with suspected or proven coronavirus disease 2019 or multisystem inflammatory syndrome. KEY POINTS: · SARS-CoV-2 neonatal infections occur both vertically (30%) and horizontally (70%).. · Approximately, half of patients do not have clinical manifestations; clinical and laboratory signs are similar to those of adults but usually milder.. · Remdesivir and steroids can be used as a treatment..
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Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Clamart, France.,Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Le Plessis Robinson, France
| | - Christelle Vauloup-Fellous
- Division of Virology, "Paul Brousse" Hospital, Paris Saclay University Hospitals, APHP, Villejuif, France
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
| | - Bianca Masturzo
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, Italy
| | - Paolo Manzoni
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, Italy
| | - Alexandre Vivanti
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
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Montalva L, Carricaburu E, Sfeir R, Fouquet V, Khen-Dunlop N, Hameury F, Panait N, Arnaud A, Lardy H, Schmitt F, Piolat C, Lavrand F, Ballouhey Q, Scalabre A, Hervieux E, Michel JL, Germouty I, Buisson P, Elbaz F, Lecompte JF, Petit T, Guinot A, Abbo O, Sapin E, Becmeur F, Forgues D, Pons M, Kamdem AF, Berte N, Auger-Hunault M, Benachi A, Bonnard A. Anti-reflux surgery in children with congenital diaphragmatic hernia: A prospective cohort study on a controversial practice. J Pediatr Surg 2022; 57:826-833. [PMID: 35618494 DOI: 10.1016/j.jpedsurg.2022.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 04/04/2022] [Accepted: 04/19/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Gastro-esophageal reflux disease (GERD) is the most frequent long-term morbidity of congenital diaphragmatic hernia (CDH) survivors. Performing a preventive fundoplication during CDH repair remains controversial. This study aimed to: (1) Analyze the variability in practices regarding preventive fundoplication; (2) Identify predictive factors for fundoplication. (3) Evaluate the impact of preventive fundoplication on gastro-intestinal outcomes in children with a CDH patch repair; METHODS: This prospective multi-institutional cohort study (French CDH Registry) included CDH neonates born in France between January 1st, 2010-December 31st, 2018. Patch CDH was defined as need for synthetic patch or muscle flap repair. Main outcome measures included need for curative fundoplication, tube feed supplementation, failure to thrive, and oral aversion. RESULTS Of 762 CDH neonates included, 81 underwent fundoplication (10.6%), either preventive or curative. Median follow-up was 3.0 years (IQR: 1.0-5.0). (1) Preventive fundoplication is considered in only 31% of centers. The rates of both curative fundoplication (9% vs 3%, p = 0.01) and overall fundoplication (20% vs 3%, p < 0.0001) are higher in centers that perform preventive fundoplication compared to those that do not. (2) Predictive factors for preventive fundoplication were: prenatal diagnosis (p = 0.006), intra-thoracic liver (p = 0.005), fetal tracheal occlusion (p = 0.002), CDH-grade C-D (p < 0.0001), patch repair (p < 0.0001). After CDH repair, 8% (n = 51) required curative fundoplication (median age: 101 days), for which a patch repair was the only independent predictive factors identified upon multivariate analysis. (3) In neonates with patch CDH, preventive fundoplication did not decrease the need for curative fundoplication (15% vs 11%, p = 0.53), and was associated with higher rates of failure to thrive (discharge: 81% vs 51%, p = 0.03; 6-months: 81% vs 45%, p = 0.008), tube feeds (6-months: 50% vs 21%, p = 0.02; 2-years: 65% vs 26%, p = 0.004), and oral aversion (6-months: 67% vs 37%, p = 0.02; 1-year: 71% vs 40%, p = 0.03). CONCLUSIONS Children undergoing a CDH patch repair are at high risk of requiring a curative fundoplication. However, preventive fundoplication during a patch repair does not decrease the need for curative fundoplication and is associated with worse gastro-intestinal outcomes in children. LEVEL OF EVIDENCE II - Prospective Study.
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Affiliation(s)
- Louise Montalva
- Department of Pediatric General Surgery and Urology, Robert-Debré University Hospital, AP-HP, Paris, France; Sorbonne University, Paris, France.
| | - Elisabeth Carricaburu
- Department of Pediatric General Surgery and Urology, Robert-Debré University Hospital, AP-HP, Paris, France
| | - Rony Sfeir
- Lille University and University Hospital, Lille, France
| | - Virginie Fouquet
- Department of Pediatric Surgery, Paris South University Hospitals, AP-HP, Le Kremlin-Bicêtre, France
| | - Naziha Khen-Dunlop
- Department of Pediatric Surgery, Necker-Enfants Malades, AP-HP, Paris, France
| | - Frederic Hameury
- Department of Pediatric Surgery, Hôpital Femme Mère Enfant University Hospital, Hospices Civils de Lyon, Bron, France
| | - Nicoleta Panait
- Department of Pediatric Surgery, La Timone Children Hospital, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Alexis Arnaud
- Department of Pediatric Surgery, Rennes University Hospital, Rennes, France
| | - Hubert Lardy
- Department of Pediatric Surgery, Tours University Hospital, Tours, France
| | - Françoise Schmitt
- Department of Pediatric Surgery, Angers University Hospital, Angers, France
| | - Christian Piolat
- Department of Pediatric Surgery, Couple-Enfant Hospital, Grenoble, France
| | - Frederic Lavrand
- Department of Pediatric Surgery, University of Bordeaux, Pellegrin University Hospital, Bordeaux, France
| | - Quentin Ballouhey
- Department of Pediatric Surgery, Limoges University Hospital, Limoges, France
| | - Aurélien Scalabre
- Department of Pediatric Surgery, Hôpital Nord, Saint-Etienne, France
| | - Erik Hervieux
- Department of Pediatric Surgery, Armand Trousseau University Hospital, Paris, France
| | - Jean-Luc Michel
- Department of Pediatric Surgery, Felix Guyon Hospital, La Réunion, France
| | - Isabelle Germouty
- Department of Pediatric Surgery, Brest University Hospital, Brest, France
| | - Philippe Buisson
- Department of Pediatric Surgery, Amiens University Hospital, Amiens, France
| | - Frederic Elbaz
- Department of Pediatric Surgery, University Hospital, Rouen, France
| | - Jean-Francois Lecompte
- Department of Pediatric Surgery, Nice Pediatric Hospital, University of Nice-Sophia Antipolis, Nice, France
| | - Thierry Petit
- Department of Pediatric Surgery, Caen University Hospital, Caen, France
| | - Audrey Guinot
- Department of Pediatric Surgery, Hôtel-Dieu University Hospital, Nantes, France
| | - Olivier Abbo
- Department of Pediatric Surgery, Hôpital des Enfants, Toulouse, France
| | - Emmanuel Sapin
- Department of Pediatric Surgery, Dijon University Hospital, Dijon, France
| | - François Becmeur
- Department of Pediatric Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Dominique Forgues
- Department of Pediatric Surgery, Montpellier University Hospital, Montpellier, France
| | - Maguelonne Pons
- Department of Pediatric Surgery, Clermont Ferrand University Hospital, Clermont Ferrand, France
| | - Arnaud Fotso Kamdem
- Department of Pediatric Surgery, Besançon University Hospital, Besançon, France
| | - Nicolas Berte
- Department of Pediatric Surgery, University Hospital, Nancy, France
| | - Marie Auger-Hunault
- Department of Pediatric Surgery, Poitiers University Hospital, Poitiers, France
| | - Alexandra Benachi
- Université Paris-Sud, Le Kremlin-Bicêtre, France; Centre de Référence des Maladies Rares, Hernie de Coupole Diaphragmatique, France; Service de Gynécologie-Obstétrique, Assistance Publique-Hôpitaux de Paris, Hôpital Antoine Béclère, Clamart, France
| | - Arnaud Bonnard
- Department of Pediatric General Surgery and Urology, Robert-Debré University Hospital, AP-HP, Paris, France
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Boisson M, Cordier AG, Martinovic J, Receveur A, Mouka A, Diot R, Egoroff C, Esnault G, Drévillon L, Benachi A, Tachdjian G, Tosca L. Copy number variations analysis in a cohort of 47 fetuses and newborns with congenital diaphragmatic hernia. Prenat Diagn 2022; 42:1627-1635. [PMID: 36403094 PMCID: PMC10100393 DOI: 10.1002/pd.6268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/31/2022] [Accepted: 11/13/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The congenital diaphragmatic hernia (CDH), characterized by malformation of the diaphragm and lung hypoplasia, is a common and severe birth defect that affects around 1 in 4000 live births. However, the etiology of most cases of CDH remains unclear. The aim of this study was to perform a retrospective analysis of copy number variations (CNVs) using a high-resolution array comparative genomic hybridization (array-CGH) in a cohort of fetuses and newborns with CDH. METHODS Forty seven fetuses and newborns with either isolated or syndromic CDH were analyzed by oligonucleotide-based array-CGH Agilent 180K technique. RESULTS A mean of 10.2 CNVs was detected by proband with a total number of 480 CNVs identified based on five categories: benign, likely benign, of uncertain signification, likely pathogenic, and pathogenic. Diagnostic performance was estimated at 19.15% (i.e., likely pathogenic and pathogenic CNVs) for both CDH types. We identified 11 potential candidate genes: COL25A1, DSEL, EYA1, FLNA, MECOM, NRXN1, RARB, SPATA13, TJP2, XIRP2, and ZFPM2. CONCLUSION We suggest that COL25A1, DSEL, EYA1, FLNA, MECOM, NRXN1, RARB, SPATA13, TJP2, XIRP2, and ZFPM2 genes may be related to CDH occurrence. Thus, this study provides a possibility for new methods of a positive diagnosis.
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Affiliation(s)
- Marie Boisson
- Service d'Histologie, Embryologie et Cytogénomique, AP-HP. Université Paris Saclay, Hôpital Antoine Béclère, Clamart, France
| | - Anne-Gael Cordier
- Service de Gynécologie Obstétrique, AP-HP. Université Paris Saclay, Hôpital Antoine Béclère, Clamart, France.,Centre de Référence Maladie Rare Hernie de Coupole Diaphragmatique, AP-HP. Université Paris Saclay, Hôpital Antoine Béclère, Clamart, France
| | - Jelena Martinovic
- Unité de Fœtopathologie, AP-HP. Université Paris Saclay, Hôpital Antoine Béclère, Clamart, France
| | - Aline Receveur
- Service d'Histologie, Embryologie et Cytogénomique, AP-HP. Université Paris Saclay, Hôpital Antoine Béclère, Clamart, France
| | - Aurélie Mouka
- Service d'Histologie, Embryologie et Cytogénomique, AP-HP. Université Paris Saclay, Hôpital Antoine Béclère, Clamart, France.,Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Laboratoire de Développement des Gonades, UMRE008 Stabilité Génétique Cellules Souches et Radiations, Commissariat à l'Energie Atomique et aux Énergies Alternatives, Fontenay-aux-Roses, France
| | - Romain Diot
- Service d'Histologie, Embryologie et Cytogénomique, AP-HP. Université Paris Saclay, Hôpital Antoine Béclère, Clamart, France
| | - Catherine Egoroff
- Unité de Fœtopathologie, AP-HP. Université Paris Saclay, Hôpital Antoine Béclère, Clamart, France
| | - Geoffroy Esnault
- Service d'Histologie, Embryologie et Cytogénomique, AP-HP. Université Paris Saclay, Hôpital Antoine Béclère, Clamart, France
| | - Loïc Drévillon
- Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Alexandra Benachi
- Service de Gynécologie Obstétrique, AP-HP. Université Paris Saclay, Hôpital Antoine Béclère, Clamart, France.,Centre de Référence Maladie Rare Hernie de Coupole Diaphragmatique, AP-HP. Université Paris Saclay, Hôpital Antoine Béclère, Clamart, France.,Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Gérard Tachdjian
- Service d'Histologie, Embryologie et Cytogénomique, AP-HP. Université Paris Saclay, Hôpital Antoine Béclère, Clamart, France.,Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Laboratoire de Développement des Gonades, UMRE008 Stabilité Génétique Cellules Souches et Radiations, Commissariat à l'Energie Atomique et aux Énergies Alternatives, Fontenay-aux-Roses, France
| | - Lucie Tosca
- Service d'Histologie, Embryologie et Cytogénomique, AP-HP. Université Paris Saclay, Hôpital Antoine Béclère, Clamart, France.,Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Laboratoire de Développement des Gonades, UMRE008 Stabilité Génétique Cellules Souches et Radiations, Commissariat à l'Energie Atomique et aux Énergies Alternatives, Fontenay-aux-Roses, France
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Huré M, Peyronnet V, Sibiude J, Cazenave MG, Anselem O, Luton D, Vauloup-Fellous C, Deruelle P, Cordier AG, Benachi A, Mandelbrot L, Couffignal C, Pauphilet V, Vivanti AJ, Picone O. [SARS-Cov-2 vaccine's acceptance among pregnant women-A cross-sectional survey]. Gynecol Obstet Fertil Senol 2022; 50:712-720. [PMID: 35914734 PMCID: PMC9335352 DOI: 10.1016/j.gofs.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE SARS-CoV-2 is more likely to cause severe cases in pregnant women. They were part of the priority groups since April 2021 to benefit from SARS-CoV-2 vaccination before its extent to general population. This contribution aims to evaluate, in the postpartum period, the achievement of COVID-19 vaccination and factors associated in women during their pregnancy. MATERIAL AND METHOD Multicenter cross-sectional survey study conducted from September to December 2021 with online self-questionnaire. All postpartum patients hospitalized in one of the 6 participating maternity hospitals were invited to answer. The questionnaire asked patients about their demographic characteristics, vaccination modalities, vaccine tolerance, and their general perception of vaccination. RESULTS Of the 371 women who responded, the vaccination rate was 65.7% (IC95% [60.8-70.4]), whom 98.8% entirely during pregnancy. Associated factors with vaccination during pregnancy were older age, higher socio-professional category, and prior information provided by health professionals. Factors that appear to motivate vaccination were personal protection and protection of the newborn. Finally, main factors negatively influencing the vaccination process were the fear of vaccine side effects and the negative perception of vaccines in general. DISCUSSION Acceptability and information about the vaccine by health professionals is in constant improvement. Information campaigns should be continued to improve the acceptability of vaccination, in light of the accumulating data.
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Affiliation(s)
- M Huré
- Assistance publique-Hôpitaux de Paris, AP-HP Nord, hôpital Louis-Mourier, service de gynécologie obstétrique, Colombes, France; Université Paris Cité, France
| | - V Peyronnet
- Assistance publique-Hôpitaux de Paris, AP-HP Nord, hôpital Louis-Mourier, service de gynécologie obstétrique, Colombes, France
| | - J Sibiude
- Assistance publique-Hôpitaux de Paris, AP-HP Nord, hôpital Louis-Mourier, service de gynécologie obstétrique, Colombes, France; Université Paris Cité, France; Inserm, IAME, 75018 Paris, France; FHU PREMA, Paris, France
| | - M G Cazenave
- Assistance publique-Hôpitaux de Paris, AP-HP Nord, hôpital Louis-Mourier, service de gynécologie obstétrique, Colombes, France
| | - O Anselem
- Assistance publique-Hôpitaux de Paris, AP-HP Nord, hôpital Bichat, département de recherche clinique, biostatistiques et épidémiologie, 75018 Paris, France; Maternité Port-Royal, hôpital Cochin, AP-HP, centre-université de Paris, Paris, France
| | - D Luton
- Université Paris Cité, France; FHU PREMA, Paris, France; Service de gynécologie-obstétrique, université Paris Cité, FHU prématurité, hôpital Bichat, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, Paris, France
| | - C Vauloup-Fellous
- Groupe de recherche sur les infections pendant la grossesse (GRIG), Vélizy, France; Hôpital universitaire, AP-HP, département de virologie, département de biologie génétique et PUI, université Paris Saclay, Villejuif, France; Inserm U1193, université Paris Saclay, Villejuif, France
| | - P Deruelle
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - A G Cordier
- Université Paris Cité, France; Département de gynécologie et obstétrique, DMU santé des femmes et des nouveau-nés, hôpital Antoine-Béclère, université Paris Saclay, AP-HP, France
| | - A Benachi
- Département de gynécologie et obstétrique, DMU santé des femmes et des nouveau-nés, hôpital Antoine-Béclère, université Paris Saclay, AP-HP, France
| | - L Mandelbrot
- Assistance publique-Hôpitaux de Paris, AP-HP Nord, hôpital Louis-Mourier, service de gynécologie obstétrique, Colombes, France; Université Paris Cité, France; Inserm, IAME, 75018 Paris, France; FHU PREMA, Paris, France
| | - C Couffignal
- Université Paris Cité, France; Inserm, IAME, 75018 Paris, France; Assistance publique-Hôpitaux de Paris, AP-HP Nord, hôpital Bichat, département de recherche clinique, biostatistiques et épidémiologie, 75018 Paris, France
| | - V Pauphilet
- Université Paris Cité, France; Maternité hôpital Robert-Debré, AP-HP, France
| | - A J Vivanti
- Département de gynécologie et obstétrique, DMU santé des femmes et des nouveau-nés, hôpital Antoine-Béclère, université Paris Saclay, AP-HP, France; Groupe de recherche sur les infections pendant la grossesse (GRIG), Vélizy, France
| | - O Picone
- Assistance publique-Hôpitaux de Paris, AP-HP Nord, hôpital Louis-Mourier, service de gynécologie obstétrique, Colombes, France; Université Paris Cité, France; Inserm, IAME, 75018 Paris, France; FHU PREMA, Paris, France; Groupe de recherche sur les infections pendant la grossesse (GRIG), Vélizy, France.
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Vivanti AJ, Fesquet S, Gabriel D, Letourneau A, Crenn-Hebert C, De Luca D, Bouyer J, Novelli S, Benachi A, Veil R. Impact of the 1st Wave of the COVID-19 Pandemic and Lockdown on In Utero Transfer Activity in the Paris Area, France. J Clin Med 2022; 11:jcm11164850. [PMID: 36013088 PMCID: PMC9410163 DOI: 10.3390/jcm11164850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: To assess changes in the number and profile of in utero transfer requests during the first lockdown. Methods: An observational, retrospective, cohort study. All pregnant women, from the Paris area (France), for whom a request for in utero transfer to the transfer unit was made during the first lockdown in France (from 17 March to 10 May 2020) or during a mirror period (years 2016 to 2019) were included. We compared the numbers and proportions of various indications for in utero transfer, the rates of in utero transfer acceptance and the proportion of outborn deliveries. Results: 206 transfer requests were made during the lockdown versus 227, 236, 204 and 228 in 2016, 2017, 2018 and 2019, respectively. The relative proportion of requests for threatened preterm births and for fetal growth restriction decreased from 45% in the mirror period to 37% and from 8 to 3%, respectively. The transfer acceptance rates and outborn deliveries did not differ between time periods. Conclusions: Although a reduction in in utero transfer requests was observed for certain indications, the first lockdown was not associated with a decrease in acceptance rates nor in an increase in outborn births of pregnancies with a high risk of prematurity in the Paris area.
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Affiliation(s)
- Alexandre J. Vivanti
- Division of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-Nés, Antoine Béclère Hospital, Paris Saclay University, AP-HP, 92140 Clamart, France
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), 75000 Paris, France
- Correspondence: ; Tel.: +33-145-374-441
| | - Stanislas Fesquet
- Division of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-Nés, Antoine Béclère Hospital, Paris Saclay University, AP-HP, 92140 Clamart, France
| | - Diane Gabriel
- Epidemiology and Public Health Department, Bicêtre Hospital, Paris Saclay University, AP-HP, 94270 Le Kremlin Bicêtre, France
| | - Alexandra Letourneau
- Division of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-Nés, Antoine Béclère Hospital, Paris Saclay University, AP-HP, 92140 Clamart, France
| | - Catherine Crenn-Hebert
- Perinat-ARS-IDF, Regional Health Agency of Ile-de-France (ARS-IDF), 93200 Saint-Denis, France
- Division of Obstetrics and Gynecology, Louis Mourier Hospital, AP-HP, 92025 Colombes, France
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, DMU Santé des Femmes et des Nouveau-Nés, Antoine Béclère Hospital, Paris Saclay University, AP-HP, 92140 Clamart, France
| | - Jean Bouyer
- CESP, Inserm, UVSQ, Université Paris-Saclay, 94807 Villejuif, France
| | - Sophie Novelli
- CESP, Inserm, UVSQ, Université Paris-Saclay, 94807 Villejuif, France
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-Nés, Antoine Béclère Hospital, Paris Saclay University, AP-HP, 92140 Clamart, France
| | - Raphaël Veil
- Epidemiology and Public Health Department, Bicêtre Hospital, Paris Saclay University, AP-HP, 94270 Le Kremlin Bicêtre, France
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36
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Gillet de Thorey A, Ozanne A, Melki J, Dumery G, Benachi A, Vivanti AJ. State of the art of antenatal diagnosis and management of vein of Galen aneurysmal malformations. Prenat Diagn 2022; 42:1073-1080. [PMID: 35793434 DOI: 10.1002/pd.6203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/09/2022] [Accepted: 06/26/2022] [Indexed: 11/09/2022]
Abstract
Vein of Galen aneurysmal malformation (VGAM) is a severe rare vascular anomaly whose prognosis depends on cerebral and cardiac consequences that can be hard to diagnose, let alone predict in utero. We performed an updated review to summarize current research on the genetics, ultrasound and MRI of VGAM that could help in the diagnosis and management of VGAM. Prenatal diagnosis of VGAM has greatly improved in recent years. Ultrasound allows in utero detection of VGAM in most cases now and is the best exam for prenatal cardiac evaluation. Tricuspid insufficiency is the only cardiac feature associated with poor prognosis. Cardiomegaly may indicate a risk of cardiac failure at birth and should prompt discussion of birth in a specialized facility. Ultrasound can identify constituted cerebral lesions, but MRI diagnoses early signs of cerebral hemodynamic changes, notably through the detection of pseudo-feeders. Genetic exploration should be proposed after VGAM diagnosis. Ultrasound and MRI are essential complementary tools for the diagnosis of VGAM, but also for prognostic evaluation, and provide information for the counseling of parents and optimal management of the pregnancy.
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Affiliation(s)
- Axelle Gillet de Thorey
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
| | - Augustin Ozanne
- Department of Interventional Neuroradiology, National Reference Center for Paediatric Neurovascular Malformation, APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Judith Melki
- Institut National de la Santé et de la Recherche Médicale (Inserm) UMR-1195, Paris Saclay University, Le Kremlin Bicêtre, France
| | - Grégoire Dumery
- Division of Obstetrics and Gynecology, Bicêtre Hospital, Paris Saclay University Hospitals, APHP, Le Kremlin Bicêtre, France
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, APHP, Clamart, France.,Institut National de la Santé et de la Recherche Médicale (Inserm) UMR-1195, Paris Saclay University, Le Kremlin Bicêtre, France
| | - Alexandre J Vivanti
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, APHP, Clamart, France.,Institut National de la Santé et de la Recherche Médicale (Inserm) UMR-1195, Paris Saclay University, Le Kremlin Bicêtre, France
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Gubana F, Christov C, Coste T, Tournier-Lasserve E, Benachi A, Fallet-Bianco C, Encha-Razavi F, Martinovic J. Prenatal Diagnosis of COL4A1 Mutations in Eight Cases: Further Delineation of the Neurohistopathological Phenotype. Pediatr Dev Pathol 2022; 25:435-446. [PMID: 35382634 DOI: 10.1177/10935266221080134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Increasing number of mutations responsible for vascular lesions, leading to ischemic or hemorrhagic stroke in young adults, has been identified in the recent years. It has been demonstrated in both mice and humans, that mutations in COL4A1 gene promote cerebral hemorrhages. In humans, both adults and children may be affected, and the spectrum has been broadened recently to neonates and fetuses. METHODS We present a cohort of eight COL4A1 mutated fetuses in which cerebral hemorrhages were detected by ultrasound leading to elective terminations of pregnancy. RESULTS Our neuropathological studies demonstrated a strikingly similar pathological pattern, dominated by supra- and infratentorial multifocal hemorrhagic lesions of various abundance and age in the vicinity of enlarged small vessels having a discontinuous wall. This was constantly associated with a spectrum of supratentorial post-ischemic damages of the grey and white matters. Morphometric studies of brain vessels confirmed vascular dilation and hypervascularization in both grey and white matters and severe attenuation of the smooth-muscle actin staining in the white matter. CONCLUSION These observations add to the rare human neuropathological phenotype of COL4A1 mutations. Its recognition is mandatory to enhance the number of tested patients in the future, as well as the genetic counseling of parents.
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Affiliation(s)
- Francesca Gubana
- Unit of Embryo-Fetal Pathology, AP-HP, 36895Antoine Béclère Hospital, Clamart, France.,Department of Obstetrics and Gynecology, AP-HP, 36895Antoine Béclère Hospital, Paris Saclay University, Clamart, France
| | - Christo Christov
- Department of Histology, CHRU, 571075INSERM U1256, NGERE, Nancy, France
| | - Thibault Coste
- Department of Neurovascular Genetics, AP-HP, 571075St Louis Hospital, Paris, France
| | | | - Alexandra Benachi
- Department of Obstetrics and Gynecology, AP-HP, 36895Antoine Béclère Hospital, Paris Saclay University, Clamart, France
| | | | - Ferechte Encha-Razavi
- Unit of Embryo-Fetal Pathology, AP-HP, 36895Antoine Béclère Hospital, Clamart, France
| | - Jelena Martinovic
- Unit of Embryo-Fetal Pathology, AP-HP, 36895Antoine Béclère Hospital, Clamart, France
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Winters P, Curnow KJ, Benachi A, Gil MM, Santacruz B, Nishiyama M, Hasegawa F, Sago H. Multisite assessment of the impact of a prenatal testing educational App on patient knowledge and preparedness for prenatal testing decision making. J Community Genet 2022; 13:435-444. [PMID: 35680723 PMCID: PMC9314500 DOI: 10.1007/s12687-022-00596-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/25/2022] [Indexed: 10/25/2022] Open
Abstract
In this study, we wanted to assess the impact of the use of a patient educational app on patient knowledge about noninvasive prenatal testing (NIPT) and preparedness for prenatal screening decision-making. A randomized control study was carried out at three international sites between January 2019 and October 2020. Study participants completed a pre-consultation survey and post-consultation survey to assess knowledge, satisfaction, and preparedness for prenatal screening consultation. Providers completed a post-consultation survey. In the control arm, the pre-consultation survey was completed prior to consultation with their prenatal care provider. In the intervention arm, the pre-consultation survey was completed after using the app but prior to consultation with their prenatal care provider. Mean knowledge scores in the 203 participants using the app were significantly higher pre-consultation (p < 0.001) and post-consultation (p < 0.005) than those not using the app. Higher pre-consultation knowledge scores in the intervention group were observed at all sites. Most (86%) app users stated they were "Satisfied" or "Very Satisfied" with it as a tool. Providers rated the intervention group as more prepared than controls (p = 0.027); provider assessment of knowledge was not significantly different (p = 0.073). This study shows that clinical implementation of a patient educational app in a real-world setting was feasible, acceptable to pregnant people, and positively impacted patient knowledge.
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Affiliation(s)
| | | | - Alexandra Benachi
- Obstetrics and Gynecology Department, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, Clamart, France
| | - Maria Mar Gil
- Obstetrics and Gynecology Department, Hospital Universitario de Torrejón and School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Belen Santacruz
- Obstetrics and Gynecology Department, Hospital Universitario de Torrejón and School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Miyuki Nishiyama
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Fuyuki Hasegawa
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
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Mosnino E, Bernardes LS, Mattern J, Hipólito Micheletti B, Aparecida de Castro Maldonado A, Vauloup-Fellous C, Doucet-Populaire F, De Luca D, Benachi A, Vivanti AJ. Impact of SARS-CoV-2 Alpha and Gamma Variants among Symptomatic Pregnant Women: A Two-Center Retrospective Cohort Study between France and Brazil. J Clin Med 2022; 11:jcm11092663. [PMID: 35566787 PMCID: PMC9101133 DOI: 10.3390/jcm11092663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 01/12/2023] Open
Abstract
New variants of SARS-CoV-2 are a major source of concern, especially for pregnant women and in the perinatal context. The primary aim of this study was to compare the severity of COVID-19 infection in pregnant women depending on strain predominance between wild-type Alpha and Gamma variants. The secondary aim was to study the impact of these strains on obstetrical and neonatal outcomes. We conducted a two-center international retrospective cohort study, which included two type III maternity hospitals, one in France and one in Brazil, comparing the first period corresponding to the wild-type strain and the second period corresponding to the predominance of the Alpha variant in France and the Gamma variant in Brazil. We included 151 pregnant women with symptomatic SARS-CoV-2 infection confirmed by RT-PCR. The rate of severe-to-critical infection, according to the WHO definition, was seven-fold higher in patients infected during the “variant period” than in patients infected during the “wild-type period” (aOR = 7.07, 95CI [2.50−21.6], p < 0.001). There were no statistical differences concerning composite obstetrical and neonatal outcomes between the different periods. While analyzing each variant separately, it was found that, in France, the risk of developing a severe-to-critical infection was three times greater during the Alpha period than during the wild-type period (OR = 3.25, 95CI [0.70−15.6], p = 0.13) and, in Brazil, the risk was twelve times greater during the Gamma period than during the wild-type period (OR = 11.8, 95CI [2.46−72.3], p = 0.003). The Alpha and Gamma variants of SARS-CoV-2 seem to be more dangerous in the obstetrical context. With the rapid emergence of new variants, it is necessary to accelerate vaccination to protect women and newborn children.
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Affiliation(s)
- Elie Mosnino
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University, Assistance-Publique des Hôpitaux de Paris, 92140 Clamart, France; (E.M.); (J.M.); (A.B.)
| | - Lisandra S. Bernardes
- Division of Obstetrics and Gynecology, Hospital e Maternidade Sepaco, São Paulo 04005-002, Brazil; (L.S.B.); (B.H.M.); (A.A.d.C.M.)
- School of Medicine, Faculdade Israelita de Ciências da Saude Albert Einstein, São Paulo 05521-200, Brazil
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo 05508-070, Brazil
| | - Jeremie Mattern
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University, Assistance-Publique des Hôpitaux de Paris, 92140 Clamart, France; (E.M.); (J.M.); (A.B.)
| | - Bruna Hipólito Micheletti
- Division of Obstetrics and Gynecology, Hospital e Maternidade Sepaco, São Paulo 04005-002, Brazil; (L.S.B.); (B.H.M.); (A.A.d.C.M.)
- School of Medicine, Faculdade Israelita de Ciências da Saude Albert Einstein, São Paulo 05521-200, Brazil
| | | | - Christelle Vauloup-Fellous
- Division of Virology, Paul Brousse Hospital, Paris Saclay University, Assistance-Publique des Hôpitaux de Paris, 94800 Villejuif, France;
- Research Group on Infections in Pregnancy (GRIG), 75000 Paris, France
- Inserm U-1193, Paris Saclay University, Villejuif, 94800 Paris, France
| | - Florence Doucet-Populaire
- Division of Microbiology, Antoine Béclère Hospital, Paris Saclay University, Assistance-Publique des Hôpitaux de Paris, 92140 Clamart, France;
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Antoine Béclère Hospital, Paris Saclay University, Assistance-Publique des Hôpitaux de Paris, 92140 Clamart, France;
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University, Assistance-Publique des Hôpitaux de Paris, 92140 Clamart, France; (E.M.); (J.M.); (A.B.)
- Research Group on Infections in Pregnancy (GRIG), 75000 Paris, France
| | - Alexandre J. Vivanti
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University, Assistance-Publique des Hôpitaux de Paris, 92140 Clamart, France; (E.M.); (J.M.); (A.B.)
- Research Group on Infections in Pregnancy (GRIG), 75000 Paris, France
- Correspondence: ; Tel.: +33-145374441
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Poisson M, Sibiude J, Mosnino E, Landraud L, Mandelbrot L, Vauloup-Fellous C, Benachi A, Vivanti A, Picone O. Impact des variants du SARS-CORONAVIRUS-2 sur les issues obstétricales et néonatales. Gynécologie Obstétrique Fertilité & Sénologie 2022. [PMCID: PMC9153299 DOI: 10.1016/j.gofs.2022.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction Le SARS-CORONAVIRUS-2 est un virus à ARN en évolution génétique constante. L’accumulation de mutations génétiques est à l’origine de l’émergence de variants dont la prolifération et la diffusion ont entraîné les différentes vagues de la pandémie. Ces mutations confèrent au virus des facteurs de virulence, qui peuvent avoir des impacts cliniques significatifs. Les conséquences spécifiques de l’infection au cours de la grossesse ont déjà été mises en évidence, avec pour principale complication, la prématurité. Des données très récentes évoquent une plus grande sévérité de l’infection au variant DELTA. Cette étude a pour but de comparer les issues obstétricales lors des infections à CORONAVIRUS-19 en cours de grossesse, en fonction du variant concerné. Méthodes Il s’agit d’une étude observationnelle, rétrospective, bicentrique, basée sur l’analyse des dossiers médicaux des patientes ayant contracté la COVID au cours de leur grossesse avec un diagnostic par PCR, depuis février 2020. Les critères de jugement concernaient la sévérité de l’infection maternelle, les issues obstétricales (prématurité, survenue d’un retard de croissance intra-utérin ou d’une prééclampsie, hospitalisation, modalités d’accouchement) et les issues néonatales (poids de naissance, adaptation à la vie extra-utérine, complications néonatales). Le recueil des données est toujours en cours. Résultats Il s’agit de résultats préliminaires concernant les patientes symptomatiques ou dépistées au cours d’une mise en travail spontanée prématurée ou au diagnostic d’une mort fœtale in utero. Des variants ont été identifiés dans 30 % des cas et sont ainsi répartis : Delta (5 %), UK (20 %), South African et Belgian (3 %). Les souches virales restantes sont soit de type sauvage (wild type), soit indéterminé avec une identification parfois toujours en cours. Le terme de naissance est de 35 SA dans le groupe Delta vs 37 SA dans le groupe UK. Le groupe Delta comporte 58 % de patientes sévères contre 24 % dans le groupe UK. Conclusion L’infection à SARS-CORONAVIRUS-2 semble être de gravité différente en fonction du variant concerné avec une sévérité de la maladie et un taux de prématurité plus importants en cas de variant Delta, malgré le faible nombre de patientes porteuses analysées à ce jour.
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Araujo-Chaveron L, Doncarli A, Crenn-Hebert C, Demiguel V, Boudet-Berquier J, Barry Y, Gomes Do Espirito Santo ME, Guajardo-Villar A, Menguy C, Tabaï A, Wyndels K, Benachi A, Regnault N. Pregnant women’s unmet need to communicate with a health professional during the SARS-CoV-2 pandemic lockdown in France: The Covimater cross-sectional study. PLoS One 2022; 17:e0266996. [PMID: 35482777 PMCID: PMC9049552 DOI: 10.1371/journal.pone.0266996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/29/2022] [Indexed: 11/24/2022] Open
Abstract
During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic lockdown, communication between pregnant women and health professionals may have become complicated due to restrictions on movement and saturated health services. This could have impacts on pregnancy monitoring and women’s wellbeing. We aimed to i) describe the unmet need of pregnant women living in France to communicate with health professionals about the pandemic and their pregnancy during the lockdown, ii) assess the socio-demographic, medical and contextual factors associated with this unmet need. The Covimater cross-sectional study, conducted in July 2020, includes data on 500 adult women’s experiences of pregnancy during the first lockdown period in France (i.e., from March to May 2020). The women, all residents in metropolitan France, answered a web-based questionnaire about their conversations with health professionals during the lockdown, as well as their social and medical characteristics. A robust variance Poisson regression model was used to estimate crude or adjusted prevalence ratios (aPRs) for their unmet need to communicate with health professionals about the pandemic and their pregnancy. Forty-one percent of participants reported an unmet need to communicate with a health professional during the lockdown, mainly about the risk of transmitting SARS-CoV-2 to their baby and the consequences for the latter. Factors associated were: i) being professionally inactive (aPR = 1.58,CI95%[(1.14–2.21]), ii) having an educational level below secondary school diploma (1.38,[1.05,-1.81]), iii) having experienced serious arguments/violence (2.12,[1.28–3.52]), iv) being very worried about the pandemic (1.41,[1.11–1.78]), v) being primiparous (1.36,[1.06–1.74]) and vi) having had pregnancy consultations postponed/cancelled by health professionals during the lockdown (1.35,[1.06–1.73]). These results can be used to develop targeted strategies that ensure pregnant women are able to i) communicate with health professionals about the potential impact of the SARS-CoV-2 pandemic on their pregnancy, and ii) access up-to-date and reliable information on the consequences of SARS-CoV-2 for themselves and their child.
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Affiliation(s)
- Lucia Araujo-Chaveron
- Non-Communicable Diseases and Trauma Division, Santé Publique France, Saint-Maurice, France
| | - Alexandra Doncarli
- Non-Communicable Diseases and Trauma Division, Santé Publique France, Saint-Maurice, France
- * E-mail:
| | - Catherine Crenn-Hebert
- Department of Gynecology and Obstetrics, Louis Mourier University Hospital, AP-HP, Colombes, France
| | - Virginie Demiguel
- Non-Communicable Diseases and Trauma Division, Santé Publique France, Saint-Maurice, France
| | - Julie Boudet-Berquier
- Non-Communicable Diseases and Trauma Division, Santé Publique France, Saint-Maurice, France
| | - Yaya Barry
- Non-Communicable Diseases and Trauma Division, Santé Publique France, Saint-Maurice, France
| | | | - Andréa Guajardo-Villar
- Data Processing, Support and Analysis Department, Santé Publique France, Saint-Maurice, France
| | - Claudie Menguy
- Non-Communicable Diseases and Trauma Division, Santé Publique France, Saint-Maurice, France
| | - Anouk Tabaï
- Alert and Crisis Department, Santé Publique France, Saint-Maurice, France
| | - Karine Wyndels
- Santé Publique France, Hauts-de-France Regional Office, Saint-Maurice, France
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, AP-HP, Clamart, France
- Paris Saclay University, Clamart, France
| | - Nolwenn Regnault
- Non-Communicable Diseases and Trauma Division, Santé Publique France, Saint-Maurice, France
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Vivanti AJ, Nhung NTH, Ha CTT, Cong NH, Bac DV, de Thorey AG, Benachi A, Deffieux X, Le DTH. Successful conservative management of a spontaneous hemorrhagic uterine rupture at 18 weeks of gestation. J Gynecol Obstet Hum Reprod 2022; 51:102396. [PMID: 35489714 DOI: 10.1016/j.jogoh.2022.102396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/19/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
Prelabor uterine rupture is a very rare complication of pregnancy that in most cases occurs when there is a history of uterine surgery. Maternal and neonatal morbidity is significant. Most often, the pregnancy must be terminated to rescue both the mother and the newborn, if possible. We report the case of a patient who had a pre-labor uterine rupture at 18 weeks of gestation (WG) complicated by massive hemoperitoneum. Emergency surgery with conservative management allowed the pregnancy to continue until 32+3 WG. In very rare situations of uterine rupture at a very early term, conservative management appears to be an acceptable solution to allow the pregnancy to continue until a sufficient gestational age to limit complications related to prematurity.
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Affiliation(s)
- Alexandre J Vivanti
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-nés Antoine Béclère Hospital, Université Paris Saclay, AP-HP, Clamart, France.
| | | | - Cao Thi Thuy Ha
- Department of Obstetrics and Gynecology, Tam Anh Hospital, Hanoi City, Viet Nam
| | - Nguyen Huu Cong
- Department of Obstetrics and Gynecology, Tam Anh Hospital, Hanoi City, Viet Nam
| | - Duong Viet Bac
- Department of Obstetrics and Gynecology, Tam Anh Hospital, Hanoi City, Viet Nam
| | - Axelle Gillet de Thorey
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-nés Antoine Béclère Hospital, Université Paris Saclay, AP-HP, Clamart, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-nés Antoine Béclère Hospital, Université Paris Saclay, AP-HP, Clamart, France
| | - Xavier Deffieux
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-nés Antoine Béclère Hospital, Université Paris Saclay, AP-HP, Clamart, France
| | - Dinh Thi Hien Le
- Department of Obstetrics and Gynecology, Tam Anh Hospital, Hanoi City, Viet Nam
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Van Calster B, Benachi A, Nicolaides KH, Gratacos E, Berg C, Persico N, Gardener GJ, Belfort M, Ville Y, Ryan G, Johnson A, Sago H, Kosiński P, Bagolan P, Van Mieghem T, DeKoninck PLJ, Russo FM, Hooper SB, Deprest JA. The randomized Tracheal Occlusion To Accelerate Lung growth (TOTAL)-trials on fetal surgery for congenital diaphragmatic hernia: reanalysis using pooled data. Am J Obstet Gynecol 2022; 226:560.e1-560.e24. [PMID: 34808130 DOI: 10.1016/j.ajog.2021.11.1351] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Two randomized controlled trials compared the neonatal and infant outcomes after fetoscopic endoluminal tracheal occlusion with expectant prenatal management in fetuses with severe and moderate isolated congenital diaphragmatic hernia, respectively. Fetoscopic endoluminal tracheal occlusion was carried out at 27+0 to 29+6 weeks' gestation (referred to as "early") for severe and at 30+0 to 31+6 weeks ("late") for moderate hypoplasia. The reported absolute increase in the survival to discharge was 13% (95% confidence interval, -1 to 28; P=.059) and 25% (95% confidence interval, 6-46; P=.0091) for moderate and severe hypoplasia. OBJECTIVE Data from the 2 trials were pooled to study the heterogeneity of the treatment effect by observed over expected lung-to-head ratio and explore the effect of gestational age at balloon insertion. STUDY DESIGN Individual participant data from the 2 trials were reanalyzed. Women were assessed between 2008 and 2020 at 14 experienced fetoscopic endoluminal tracheal occlusion centers and were randomized in a 1:1 ratio to either expectant management or fetoscopic endoluminal tracheal occlusion. All received standardized postnatal management. The combined data involved 287 patients (196 with moderate hypoplasia and 91 with severe hypoplasia). The primary endpoint was survival to discharge from the neonatal intensive care unit. The secondary endpoints were survival to 6 months of age, survival to 6 months without oxygen supplementation, and gestational age at live birth. Penalized regression was used with the following covariates: intervention (fetoscopic endoluminal tracheal occlusion vs expectant), early balloon insertion (yes vs no), observed over expected lung-to-head ratio, liver herniation (yes vs no), and trial (severe vs moderate). The interaction between intervention and the observed over expected lung-to-head ratio was evaluated to study treatment effect heterogeneity. RESULTS For survival to discharge, the adjusted odds ratio of fetoscopic endoluminal tracheal occlusion was 1.78 (95% confidence interval, 1.05-3.01; P=.031). The additional effect of early balloon insertion was highly uncertain (adjusted odds ratio, 1.53; 95% confidence interval, 0.60-3.91; P=.370). When combining these 2 effects, the adjusted odds ratio of fetoscopic endoluminal tracheal occlusion with early balloon insertion was 2.73 (95% confidence interval, 1.15-6.49). The results for survival to 6 months and survival to 6 months without oxygen dependence were comparable. The gestational age at delivery was on average 1.7 weeks earlier (95% confidence interval, 1.1-2.3) following fetoscopic endoluminal tracheal occlusion with late insertion and 3.2 weeks earlier (95% confidence interval, 2.3-4.1) following fetoscopic endoluminal tracheal occlusion with early insertion compared with expectant management. There was no evidence that the effect of fetoscopic endoluminal tracheal occlusion depended on the observed over expected lung-to-head ratio for any of the endpoints. CONCLUSION This analysis suggests that fetoscopic endoluminal tracheal occlusion increases survival for both moderate and severe lung hypoplasia. The difference between the results for the Tracheal Occlusion To Accelerate Lung growth trials, when considered apart, may be because of the difference in the time point of balloon insertion. However, the effect of the time point of balloon insertion could not be robustly assessed because of a small sample size and the confounding effect of disease severity. Fetoscopic endoluminal tracheal occlusion with early balloon insertion in particular strongly increases the risk for preterm delivery.
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Affiliation(s)
- Ben Van Calster
- Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands; EPI-center, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Alexandra Benachi
- Department of Obstetrics and Gynaecology of the Hospital Antoine Béclère, Université Paris Saclay, Clamart, France
| | | | | | | | - Nicola Persico
- Hospital Maggiore Policlinico IRCCS, University of Milan, Milan, Italy
| | | | - Michael Belfort
- Texas Children's Hospital, Baylor College of Medicine Houston, TX
| | | | - Greg Ryan
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Haruhiko Sago
- National Center for Child Health and Development, Tokyo, Japan
| | - Przemysław Kosiński
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Pietro Bagolan
- Medical and Surgical Department of the Fetus-Newborn-Infant, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Tim Van Mieghem
- Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium; Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Philip L J DeKoninck
- Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium; Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Francesca M Russo
- Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium; Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute for Medical Research, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Jan A Deprest
- Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium; Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium; Institute for Women's Health, University College London Hospital, London, United Kingdom.
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Robledo KP, Tarnow-Mordi WO, Rieger I, Suresh P, Martin A, Yeung C, Ghadge A, Liley HG, Osborn D, Morris J, Hague W, Kluckow M, Lui K, Soll R, Cruz M, Keech A, Kirby A, Simes J, Popat H, Reid S, Gordon A, De Waal K, Wright IM, Wright A, Buchan J, Stubbs M, Newnham J, Simmer K, Young C, Loh D, Kok Y, Gill A, Strunk T, Jeffery M, Chen Y, Morris S, Sinhal S, Cornthwaite K, Walker SP, Watkins AM, Collins CL, Holberton JR, Noble EJ, Sehgal A, Yeomans E, Elsayed K, Mohamed AL, Broom M, Koh G, Lawrence A, Gardener G, Fox J, Cartwright DW, Koorts P, Pritchard MA, McKeown L, Lainchbury A, Shand AW, Michalowski J, Smyth JP, Bolisetty S, Adno A, Lee G, Seidler AL, Askie LM, Groom KM, Eaglen DA, Baker EC, Patel H, Wilkes N, Gullam JE, Austin N, Leishman DE, Weston P, White N, Cooper NA, Broadbent R, Stitely M, Dawson P, El-Naggar W, Furlong M, Hatfield T, de Luca D, Benachi A, Letamendia-Richard E, Escourrou G, Dell'Orto V, Sweet D, Millar M, Shah S, Sheikh L, Ariff S, Morris EA, Young L, Evans SK, Belfort M, Aagaard K, Pammi M, Mandy G, Gandhi M, Davey J, Shenton E, Middleton J, Black R, Cheng A, Murdoch J, Jacobs C, Meyer L, Medlin K, Woods H, O'Connor KA, Bice C, Scott K, Hayes M, Cruickshank D, Sam M, Ireland S, Dickinson C, Poulsen L, Fucek A, Hegarty J, Rogers J, Sanchez D, Zupan Simunek V, Hanif B, Pahl A, Metayer J, Duley L, Marlow N, Schofield D, Bowen J. Effects of delayed versus immediate umbilical cord clamping in reducing death or major disability at 2 years corrected age among very preterm infants (APTS): a multicentre, randomised clinical trial. The Lancet Child & Adolescent Health 2022; 6:150-157. [DOI: 10.1016/s2352-4642(21)00373-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/04/2021] [Accepted: 11/17/2021] [Indexed: 01/07/2023]
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Russo F, Benachi A, Gratacos E, Zani A, Keijzer R, Partridge E, Sananes N, De Coppi P, Aertsen M, Nicolaides KH, Deprest J. Antenatal Management of Congenital Diaphragmatic Hernia: what's next ? Prenat Diagn 2022; 42:291-300. [PMID: 35199368 DOI: 10.1002/pd.6120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/19/2022] [Accepted: 02/20/2022] [Indexed: 11/07/2022]
Abstract
Congenital diaphragmatic hernia (CDH) can be diagnosed in the prenatal period and its severity can be measured by fetal imaging. There is now level I evidence that, in selected cases, Fetoscopic Endoluminal Tracheal Occlusion (FETO) increases survival to discharge from the neonatal unit as well as the risk for prematurity. Both effects are dependent on the time point of tracheal occlusion. FETO may also lead to iatrogenic death when done in unexperienced centres. The implementation of the findings from our clinical studies, may also vary based on local conditions. These may be different in terms of available skill set, access to fetal therapy, as well as outcome based on local neonatal management. We encourage prior benchmarking of local outcomes with optimal postnatal management, based on large enough numbers and using identical criteria as in the recent trials. We propose to work further on prenatal prediction methods, and the improvement of fetal intervention. In this manuscript, we describe a research agenda from a fetal medicine perspective. This research should be in parallel with innovation in neonatal and pediatric (surgical) management of this condition. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Francesca Russo
- Department of Development and Regeneration, Cluster Woman and Child, KU Leuven and Clinical Department of Obstetrics and Gynaecology, UZ Leuven, Leuven, Belgium
| | - Alexandra Benachi
- Department of Obstetrics and Gynaecology, Hospital Antoine Béclère, Université Paris Saclay, Clamart, France
| | | | - Augusto Zani
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Richard Keijzer
- Department of Pediatric Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Emily Partridge
- Department of Pediatric Surgery, Children's Hospital of Philadelphia, PA, USA
| | - Nicolas Sananes
- Department Obstetrics and Gynaecology, University Hospitals Strasbourg, Strasbourg, France
| | | | - Michael Aertsen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Jan Deprest
- Department of Development and Regeneration, Cluster Woman and Child, KU Leuven and Clinical Department of Obstetrics and Gynaecology, UZ Leuven, Leuven, Belgium.,Institute of Women's Health, University College London, London, United Kingdom
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Egloff C, Couffignal C, Cordier AG, Deruelle P, Sibiude J, Anselem O, Benachi A, Luton D, Mandelbrot L, Vauloup-Fellous C, Vivanti AJ, Picone O. Pregnant women's perceptions of the COVID-19 vaccine: A French survey. PLoS One 2022; 17:e0263512. [PMID: 35130318 PMCID: PMC8820613 DOI: 10.1371/journal.pone.0263512] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 01/20/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Pregnant women are at increased risk for COVID-19, and COVID-19 vaccine is the most promising solution to overcome the current pandemic. This study was conducted to evaluate pregnant women’s perceptions and acceptance of COVID-19 vaccination. Materials & methods A cross-sectional study was conducted from February 18 to April 5 2021. An anonymous survey was distributed in 7 French obstetrics departments to all pregnant women before a prenatal visit. All pregnant women attending a follow-up consultation were asked to participate in the study. An anonymous web survey was available through a QR code and participants were asked whether or not they would agree to be vaccinated against SARS-CoV-2, and why. The questionnaire included questions on the patients’ demographics and their knowledge of COVID-19 vaccines. Results Of the 664 pregnant women who completed the questionnaire, 29.5% (95% CI 27.7; 31.3) indicated they would agree to be vaccinated against COVID-19. The main reason for not agreeing was being more afraid of potential side effects of the SARS-CoV-2 vaccine on the fetus than of COVID-19. Factors influencing acceptance of vaccination were: being slightly older, multiparity, having discussed it with a caregiver and acceptance of the influenza vaccine. Discussion Nearly one-third of pregnant women in this population would be willing to be vaccinated. In addition to studies establishing fetal safety, public health agencies and healthcare professionals should provide accurate information about the safety of COVID-19 vaccines.
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Affiliation(s)
- Charles Egloff
- Assistance Publique-Hôpitaux de Paris APHP, Nord, Service de Gynécologie Obstétrique, Hôpital Louis Mourier, Colombes, France
- Université de Paris, Paris, France
- INSERM, IAME, Paris, France
| | - Camille Couffignal
- FHU PREMA, Paris, France
- AP-HP, Hôpital Bichat, Clinical Research, Biostatistics and Epidemiology Department, Paris, France
| | - Anne Gael Cordier
- Université Paris-Saclay, INSERM U1193, Villejuif, France
- Department of Obstetrics and Gynecology, Antoine Beclere Hospital, Paris Saclay University, AP-HP, Clamart, France
| | - Philippe Deruelle
- Pôle de gynécologie Obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jeanne Sibiude
- Assistance Publique-Hôpitaux de Paris APHP, Nord, Service de Gynécologie Obstétrique, Hôpital Louis Mourier, Colombes, France
- Université de Paris, Paris, France
- INSERM, IAME, Paris, France
- FHU PREMA, Paris, France
| | - Olivia Anselem
- Maternité Port-Royal, Hôpital Cochin, AP-HP, Centre-Université de Paris, Paris, France
| | - Alexandra Benachi
- Université Paris-Saclay, INSERM U1193, Villejuif, France
- Department of Obstetrics and Gynecology, Antoine Beclere Hospital, Paris Saclay University, AP-HP, Clamart, France
| | - Dominique Luton
- Université de Paris, Paris, France
- FHU PREMA, Paris, France
- Service de gynécologie-obstétrique, FHU Prematurity, Bichat Hospital Assistance publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris APHP, Nord, Service de Gynécologie Obstétrique, Hôpital Louis Mourier, Colombes, France
- Université de Paris, Paris, France
- INSERM, IAME, Paris, France
- FHU PREMA, Paris, France
| | - Christelle Vauloup-Fellous
- Université Paris-Saclay, INSERM U1193, Villejuif, France
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
- Laboratoire de Virologie, Hôpital Paul Brousse, AP-HP, Université Paris-Saclay, Villejuif, France
| | - Alexandre J. Vivanti
- Université Paris-Saclay, INSERM U1193, Villejuif, France
- Department of Obstetrics and Gynecology, Antoine Beclere Hospital, Paris Saclay University, AP-HP, Clamart, France
| | - Olivier Picone
- Assistance Publique-Hôpitaux de Paris APHP, Nord, Service de Gynécologie Obstétrique, Hôpital Louis Mourier, Colombes, France
- Université de Paris, Paris, France
- INSERM, IAME, Paris, France
- FHU PREMA, Paris, France
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
- * E-mail:
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Koumakis E, Cormier-Daire V, Dellal A, Debernardi M, Cortet B, Debiais F, Javier RM, Thomas T, Mehsen-Cetre N, Cohen-Solal M, Fontanges E, Laroche M, Porquet-Bordes V, Marcelli C, Benachi A, Briot K, Roux C, Cormier C. Osteogenesis Imperfecta: characterization of fractures during pregnancy and post-partum. Orphanet J Rare Dis 2022; 17:22. [PMID: 35090500 PMCID: PMC8796450 DOI: 10.1186/s13023-021-02148-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 12/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background Pregnancy and breastfeeding are associated with bone density loss. Fracture occurrence during pregnancy and post-partum, and its determinants, remain poorly known in Osteogenesis Imperfecta (OI). The aim of this study was to characterize fractures that occurred during pregnancy and post-partum in OI patients. Results We conducted a retrospective multicentric study including a total of 50 previously pregnant OI women from 10 Bone Centers in France. Among these patients, 12 (24%) patients experienced fractures during pregnancy or in the 6 months following delivery, and 38 (76%) did not experience any fracture. The most frequent localizations were: proximal femur (25%), spine (25%), distal femur (12.5%), and pelvis (12.5%). Fractures during pregnancy occurred during the third trimester and post-partum fractures occurred with a mean delay of 2 months following delivery. No fractures occurred during childbirth. We next compared the 12 patients with pregnancy or post-partum fractures with the 38 patients without fractures. Mean age at pregnancy was 32.7 ± 3.1 years-old in the fractured group, vs 29.3 ± 5.0 years-old in the non-fractured group (p = 0.002). Breastfeeding was reported in 85.7% of patients in the fractured group, vs 47.1% in the non-fractured group (p = 0.03). All patients with post-partum fractures were breastfeeding. Bone mineral density was significantly lower in patients with pregnancy-related fractures compared with other patients: spine Z-score − 2.9 ± 1.6DS vs − 1.5 ± 1.7DS (p = 0.03), and total hip Z-score − 2.0 ± 0.7DS vs − 0.5 ± 1.4DS (p = 0.04). At least one osteoporosis-inducing risk factor or disease other than OI was identified in 81.8% vs 58.6% of fractured vs non-fractured patients (not significant). Fracture during pregnancy or post-partum was not associated with the severity of OI. Bisphosphonates before pregnancy were reported in 16.7% and 21.1% of patients with pregnancy-related fractures and non-fractured patients, respectively (not significant). Conclusions OI management during pregnancy and post-partum should aim for optimal control of modifiable osteoporosis risk factors, particularly in patients with low BMD. Breastfeeding should be avoided.
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Affiliation(s)
- Eugénie Koumakis
- Rheumatology Department, Cochin Hospital, Paris, AP-HP Centre-Paris University, Reference Center for Rare Genetic Bone Disorders-Cochin-constitutive site, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France. .,Clinical Genetics, Reference Center for bone disorders, INSERM UMR 1163, Imagine Institute, Necker Enfants-Malades Hospital, AP-HP, Paris University, Paris, France.
| | - Valérie Cormier-Daire
- Clinical Genetics, Reference Center for bone disorders, INSERM UMR 1163, Imagine Institute, Necker Enfants-Malades Hospital, AP-HP, Paris University, Paris, France
| | - Azeddine Dellal
- Rheumatology Department, Cochin Hospital, Paris, AP-HP Centre-Paris University, Reference Center for Rare Genetic Bone Disorders-Cochin-constitutive site, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Marc Debernardi
- Rheumatology Department, Cochin Hospital, Paris, AP-HP Centre-Paris University, Reference Center for Rare Genetic Bone Disorders-Cochin-constitutive site, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Bernard Cortet
- Department of Rheumatology and ULR 4490 (MABLAB), Competence Center for Rare Genetic Bone Disorders, University-Hospital of Lille, 59000, Lille, France
| | - Françoise Debiais
- Department of Rheumatology, CHU Poitiers; CNRS ERL7003, University of Poitiers, Poitiers, France
| | - Rose-Marie Javier
- Rheumatology Department, Competence Center for Rare Genetic Bone Disorders, University-Hospital of Strasbourg, 67098, Strasbourg, France
| | - Thierry Thomas
- Department of Rheumatology, CHU Saint-Etienne, INSERM U1059, Université de Lyon, Saint-Etienne, France
| | - Nadia Mehsen-Cetre
- Service de Rhumatologie, Centre de Compétence MOC et Dysplasie Fibreuse, CHU Bordeaux-Tripode, Bordeaux, France
| | - Martine Cohen-Solal
- Biocar Inserm U1132 and Université de Paris, Hôpital Lariboisière, 75010, Paris, France
| | - Elisabeth Fontanges
- Department of Rheumatology, Hôpital Edouard Herriot, CHU de Lyon, Lyon, France
| | - Michel Laroche
- Centre de Rhumatologie, CHU Purpan, 1 place du Dr Baylac, 31059, Toulouse Cedex, France
| | - Valérie Porquet-Bordes
- Endocrine, Bone Diseases, and Genetics Unit, Reference Centre for Rare Diseases of the Calcium and Phosphate Metabolism, ERN BOND, OSCAR Network, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | | | - Alexandra Benachi
- Departement of Obstetrics, Gynecology and Reproductive Medicine, Hôpital Antoine-Béclère - Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France
| | - Karine Briot
- Rheumatology Department, Cochin Hospital, Paris, AP-HP Centre-Paris University, Reference Center for Rare Genetic Bone Disorders-Cochin-constitutive site, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.,INSERM UMR 1153, INSERM, PRESS Sorbonne Paris-Cité, Paris, France
| | - Christian Roux
- Rheumatology Department, Cochin Hospital, Paris, AP-HP Centre-Paris University, Reference Center for Rare Genetic Bone Disorders-Cochin-constitutive site, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.,INSERM UMR 1153, INSERM, PRESS Sorbonne Paris-Cité, Paris, France
| | - Catherine Cormier
- Rheumatology Department, Cochin Hospital, Paris, AP-HP Centre-Paris University, Reference Center for Rare Genetic Bone Disorders-Cochin-constitutive site, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
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Monier I, Receveur A, Houfflin-Debarge V, Goua V, Castaigne V, Jouannic JM, Mousty E, Saliou AH, Bouchghoul H, Rousseau T, Valat AS, Groussolles M, Fuchs F, Benoist G, Degre S, Massardier J, Tsatsaris V, Kleinfinger P, Zeitlin J, Benachi A. Should prenatal chromosomal microarray analysis be offered for isolated fetal growth restriction? A French multicenter study. Am J Obstet Gynecol 2021; 225:676.e1-676.e15. [PMID: 34058167 DOI: 10.1016/j.ajog.2021.05.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/07/2021] [Accepted: 05/15/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Compared with standard karyotype, chromosomal microarray analysis improves the detection of genetic anomalies and is thus recommended in many prenatal indications. However, evidence is still lacking on the clinical utility of chromosomal microarray analysis in cases of isolated fetal growth restriction. OBJECTIVE This study aimed to estimate the proportion of copy number variants detected by chromosomal microarray analysis and the incremental yield of chromosomal microarray analysis compared with karyotype in the detection of genetic abnormalities in fetuses with isolated fetal growth restriction. STUDY DESIGN This retrospective study included all singleton fetuses diagnosed with fetal growth restriction and no structural ultrasound anomalies and referred to 13 French fetal medicine centers over 1 year in 2016. Fetal growth restriction was defined as an estimated fetal weight of <tenth percentile for gestational age identified in ultrasound reports. For this analysis, we selected fetuses who underwent invasive genetic testing with karyotype and chromosomal microarray analysis results. Data were obtained from medical records and ultrasound databases and postmortem and placental examination reports in case of spontaneous stillbirths and terminations of pregnancy. Following the American College of Medical Genetics and Genomics guidelines, copy number variants were classified into 5 groups as following: pathogenic, likely pathogenic, variant of unknown significance, likely benign, and benign. RESULTS Of 682 referred fetuses diagnosed with isolated fetal growth restriction, both karyotype and chromosomal microarray analysis were performed in 146 fetuses. Overall, the detection rate of genetic anomalies found by chromosomal microarray analysis was estimated to be 7.5% (11 of 146 [95% confidence interval, 3.3-11.8]), including 10 copy number variants classified as pathogenic and 1 copy number variant classified as likely pathogenic. Among the 139 fetuses with normal karyotype, 5 were detected with pathogenic and likely pathogenic copy number variants, resulting in an incremental yield of 3.6% (95% confidence interval, 0.5-6.6) in chromosomal microarray analysis compared with karyotype. All fetuses detected with pathogenic or likely pathogenic copy number variants resulted in terminations of pregnancy. In addition, 3 fetuses with normal karyotype were detected with a variant of unknown significance (2.1%). Among the 7 fetuses with abnormal karyotype, chromosomal microarray analysis did not detect trisomy 18 mosaicism in all fetuses. CONCLUSION Our study found that compared with karyotype, chromosomal microarray analysis improves the detection of genetic anomalies in fetuses diagnosed with isolated fetal growth restriction. These results support the use of chromosomal microarray analysis in addition to karyotype for isolated fetal growth restriction.
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Affiliation(s)
- Isabelle Monier
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Epidemiology and Statistics Research Center, Université de Paris, Institut national de la santé et de la recherche médicale, Institut national de la recherche agronomique, Paris, France; Department of Obstetrics and Gynaecology, Antoine Béclère Hospital, AP-HP, Paris Saclay University, Clamart, France.
| | - Aline Receveur
- Department of Cytogenetics and Reproductive Biology, Antoine Béclère Hospital, AP-HP, Paris Saclay University, Clamart, France
| | | | - Valérie Goua
- Department of Obstetrics and Gynaecology, Poitiers University Hospital, Poitiers, France
| | - Vanina Castaigne
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Jean-Marie Jouannic
- Fetal Medicine Department, Armand-Trousseau Hospital, AP-HP, Sorbonne University, Paris, France
| | - Eve Mousty
- Department of Gynaecology and Obstetrics, Nîmes University Hospital, Nîmes, France
| | - Anne-Hélène Saliou
- Department of Obstetrics and Gynaecology, Brest University Hospital, Brest, France
| | - Hanane Bouchghoul
- Department of Obstetrics and Gynaecology, Bicêtre Hospital, AP-HP, Paris Saclay University, Le Kremlin Bicêtre, France
| | - Thierry Rousseau
- Department of Obstetrics and Gynaecology, Dijon University Hospital, Dijon, France
| | - Anne-Sylvie Valat
- Department of Obstetrics and Gynaecology, Lens Hospital, Lens, France
| | - Marion Groussolles
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, Toulouse University Hospital, Toulouse, France
| | - Florent Fuchs
- Department of Obstetrics and Gynecology, Montpellier University Hospital Center, Montpellier, France
| | - Guillaume Benoist
- Department of Obstetrics and Gynecology, Caen University Hospital Center, Caen, France
| | - Sophie Degre
- Department of Obstetrics and Gynecology, Le Havre University Hospital Center, Le Havre, France
| | - Jérôme Massardier
- Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Bron, France
| | - Vassilis Tsatsaris
- Department of Obstetrics and Gynecology, Cochin Hospital, AP-HP, Paris-Descartes University, Paris, France
| | | | - Jennifer Zeitlin
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Epidemiology and Statistics Research Center, Université de Paris, Institut national de la santé et de la recherche médicale, Institut national de la recherche agronomique, Paris, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynaecology, Antoine Béclère Hospital, AP-HP, Paris Saclay University, Clamart, France
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Benachi A, Rabant M, Martinovic J, Bouchghoul H, Vivanti AJ, Leon J, Grunenwald A, Roumenina L, Celton JL, Bessieres B, Taupin JL, Zuber J. Chronic histiocytic intervillositis: manifestation of placental alloantibody-mediated rejection. Am J Obstet Gynecol 2021; 225:662.e1-662.e11. [PMID: 34126086 DOI: 10.1016/j.ajog.2021.06.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chronic histiocytic intervillositis (chronic intervillositis) is defined by a diffuse infiltration of monocytes into the intervillous space, which often leads to poor obstetrical outcomes, including recurrent intrauterine growth restriction, miscarriage, and fetal death. The pathogenesis of chronic intervillositis is still poorly defined, and there is an unmet medical need for improved management. OBJECTIVE This study aimed to demonstrate the role of anti-human leukocyte antigen alloantibodies in the pathogenesis of chronic intervillositis through the application of criteria used in solid-organ transplantation for the diagnosis of antibody-mediated rejection. STUDY DESIGN A multidisciplinary research study based on thorough immunologic and pathologic investigations was carried out for 2 separate couples who experienced recurrent secondary fetal losses following a first normal pregnancy associated with histologic evidence of chronic intervillositis. RESULTS Very high levels of complement-fixing, fetus-specific antibodies targeting mismatched human leukocyte antigen alleles, harbored by the 2 paternal haplotypes, were identified in both cases. Polymorphic human leukocyte antigens were expressed on the surface of trophoblastic villi of the inflamed placenta but not in healthy placental tissue. The binding of alloantibodies to paternal human leukocyte antigens induced dramatic activation of the complement classical pathway in trophoblastic villi, leading to C4d deposition and formation of the terminal complex C5b-9. All requirements for the diagnosis of antibody-mediated placental rejection were fulfilled according to the criteria used in the Banff classification of allograft pathology. In silico analysis was performed using a human leukocyte antigen epitope viewer to reconstitute the human leukocyte antigen sensitization history. Reactivity against a single mismatched epitope present in the first-born healthy child accounted for a broad sensitization to human leukocyte antigens, including those harbored by the 2 paternal haplotypes. This finding explained the high rates of chronic intervillositis recurrence during subsequent pregnancies. CONCLUSION This study provides novel mechanistic insights into the pathogenesis of chronic intervillositis and provides new avenues for individualized counseling and therapeutic options.
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Affiliation(s)
- Alexandra Benachi
- Department of Obstetrics and Gynecology, Hôpital Antoine-Béclère, Assistance Publique-Hôpitaux de Paris, Clamart, France; Université Paris-Saclay, Gif-sur-Yvette, France.
| | - Marion Rabant
- Département d'Anatomopathologie, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR) 1151, Paris, France
| | - Jelena Martinovic
- Département de Foetopathologie, Hôpital Antoine-Béclère, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Hanane Bouchghoul
- Université Paris-Saclay, Gif-sur-Yvette, France; Département d'Obstétrique et Gynécologie, Hôpital Kremlin-Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Alexandre J Vivanti
- Department of Obstetrics and Gynecology, Hôpital Antoine-Béclère, Assistance Publique-Hôpitaux de Paris, Clamart, France; Université Paris-Saclay, Gif-sur-Yvette, France
| | - Juliette Leon
- Département d'Anatomopathologie, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM UMR 1163, Paris, France
| | - Anne Grunenwald
- Centre de Recherche des Cordeliers, INSERM, Sorbonne University, Université de Paris, Paris, France
| | - Lubka Roumenina
- Centre de Recherche des Cordeliers, INSERM, Sorbonne University, Université de Paris, Paris, France
| | - Jean-Louis Celton
- Laboratoire d'Histocompatibilité, Hôpital de Nouméa, Nouméa, New Caledonia
| | - Bettina Bessieres
- Département d'Anatomopathologie, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Luc Taupin
- Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, INSERM UMR 976, Institut de Recherche Saint Louis, Paris, France
| | - Julien Zuber
- University of Paris, INSERM UMR 1163, Paris, France; Département de Néphrologie et Transplantation Rénale, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Doncarli A, Araujo-Chaveron L, Crenn-Hebert C, Demiguel V, Boudet-Berquier J, Barry Y, Gomes Do Espirito Santo ME, Guajardo-Villar A, Menguy C, Tabaï A, Wyndels K, Benachi A, Regnault N. Impact of the SARS-CoV-2 pandemic and first lockdown on pregnancy monitoring in France: the COVIMATER cross-sectional study. BMC Pregnancy Childbirth 2021; 21:799. [PMID: 34847872 PMCID: PMC8630988 DOI: 10.1186/s12884-021-04256-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/09/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, consultations and pregnancy monitoring examinations had to be reorganised urgently. In addition, women themselves may have postponed or cancelled their medical monitoring for organisational reasons, for fear of contracting the disease caused by SARS-CoV-2 (COVID-19) or for other reasons of their own. Delayed care can have deleterious consequences for both the mother and the child. Our objective was therefore to study the impact of the SARS-CoV-2 pandemic and the first lockdown in France on voluntary changes by pregnant women in the medical monitoring of their pregnancy and the associated factors. METHODS A cross-sectional study was conducted in July 2020 using a web-questionnaire completed by 500 adult (> 18 years old) pregnant women during the first French lockdown (March-May 2020). A robust variance Poisson regression model was used to estimate adjusted prevalence ratios (aPRs). RESULTS Almost one women of five (23.4%) reported having voluntarily postponed or foregone at least one consultation or pregnancy check-up during the lockdown. Women who were professionally inactive (aPR = 1.98, CI95%[1.24-3.16]), who had experienced serious disputes or violence during the lockdown (1.47, [1.00-2.16]), who felt they received little or no support (1.71, [1.07-2.71]), and those who changed health professionals during the lockdown (1.57, [1.04-2.36]) were all more likely to have voluntarily changed their pregnancy monitoring. Higher level of worry about the pandemic was associated with a lower probability of voluntarily changing pregnancy monitoring (0.66, [0.46-0.96]). CONCLUSIONS Our results can guide prevention and support policies for pregnant women in the current and future pandemics.
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Affiliation(s)
- Alexandra Doncarli
- Santé publique France, French national public health agency, Non-Communicable Diseases and Trauma Division, Perinatology, Early childhood and Mental Health Unit, 14, rue du Val d'Osne, F-94415, Saint-Maurice, France.
| | - Lucia Araujo-Chaveron
- Santé publique France, French national public health agency, Non-Communicable Diseases and Trauma Division, Perinatology, Early childhood and Mental Health Unit, 14, rue du Val d'Osne, F-94415, Saint-Maurice, France
| | - Catherine Crenn-Hebert
- Department of Gynecology and Obstetrics, Louis Mourier University Hospital, AP-HP, Colombes, France
| | - Virginie Demiguel
- Santé publique France, French national public health agency, Non-Communicable Diseases and Trauma Division, Perinatology, Early childhood and Mental Health Unit, 14, rue du Val d'Osne, F-94415, Saint-Maurice, France
| | - Julie Boudet-Berquier
- Santé publique France, French national public health agency, Non-Communicable Diseases and Trauma Division, Perinatology, Early childhood and Mental Health Unit, 14, rue du Val d'Osne, F-94415, Saint-Maurice, France
| | - Yaya Barry
- Santé publique France, French national public health agency, Non-Communicable Diseases and Trauma Division, Perinatology, Early childhood and Mental Health Unit, 14, rue du Val d'Osne, F-94415, Saint-Maurice, France
| | - Maria-Eugênia Gomes Do Espirito Santo
- Santé publique France, French national public health agency, Non-Communicable Diseases and Trauma Division, Perinatology, Early childhood and Mental Health Unit, 14, rue du Val d'Osne, F-94415, Saint-Maurice, France
| | - Andrea Guajardo-Villar
- Santé publique France, French national public health agency, Data processing, support and analysis department, Saint-Maurice, France
| | - Claudie Menguy
- Santé publique France, French national public health agency, Non-Communicable Diseases and Trauma Division, Perinatology, Early childhood and Mental Health Unit, 14, rue du Val d'Osne, F-94415, Saint-Maurice, France
| | - Anouk Tabaï
- Santé publique France, French national public health agency, Alert and crisis department, Saint-Maurice, France
| | - Karine Wyndels
- Santé Publique France, French national public health agency, Hauts-de-France regional office, Saint-Maurice, France
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, AP-HP, Clamart, France
- Paris Saclay University, Clamart, France
| | - Nolwenn Regnault
- Santé publique France, French national public health agency, Non-Communicable Diseases and Trauma Division, Perinatology, Early childhood and Mental Health Unit, 14, rue du Val d'Osne, F-94415, Saint-Maurice, France
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