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Chitrit Y, Korb D, Morin C, Schmitz T, Oury JF, Sibony O. Perinatal mortality and morbidity, timing and route of delivery in monoamniotic twin pregnancies: a retrospective cohort study. Arch Gynecol Obstet 2020; 303:685-693. [PMID: 32902675 DOI: 10.1007/s00404-020-05782-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/20/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Monoamniotic twin pregnancies are at high risk of perinatal complications and fetal loss. The objective of this study is to describe the management and outcomes of monoamniotic twin pregnancies in a French university obstetrics department. METHODS Retrospective review of all consecutive monoamniotic twin pregnancies managed between 1992 and 2018 in a level-3 university hospital maternity unit. Antenatal variables, gestational age and other neonatal characteristics at delivery, mode of delivery, and its reason were recorded, together with outcomes, including a composite adverse neonatal outcome. RESULTS Overall, 46 monoamniotic twin pregnancies (92 fetuses) were identified during the study period. Among them, 27 fetal losses and 2 early neonatal deaths were reported. Congenital abnormalities accounted for 33.3% of the 27 fetal losses, and unexpected fetal deaths for 29.6%. Among the 37 women who gave birth to 65 live infants at 23 or more weeks of gestation, 17 had cesarean and 19 vaginal deliveries. Overall and composite adverse neonatal outcomes did not differ significantly for the 33 children born vaginally and the 31 by cesarean deliveries. The prospective risk of intrauterine death in all 92 fetuses reached its nadir of 1.8% at 336/7 weeks. CONCLUSION This series confirms the still high risk of fetal and neonatal death of these twins and shows that congenital abnormalities but also unexpected fetal deaths account for the majority of pre- and postnatal mortality. Our data suggest that vaginal delivery of monoamniotic twins is safe and that delivery for uncomplicated monoamniotic twins should be considered around 33 weeks of gestation, but not later than 35 weeks.
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Affiliation(s)
- Yvon Chitrit
- Department of Gynecology-Obstetrics, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, 48, Bd Sérurier, 75935, Paris Cedex 19, France.
| | - Diane Korb
- Department of Gynecology-Obstetrics, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, 48, Bd Sérurier, 75935, Paris Cedex 19, France.,Epidemiology and Statistics Research Center/CRESS, University of Paris, INSERM, INRA, 75004, Paris, France
| | - Cecile Morin
- Department of Gynecology-Obstetrics, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, 48, Bd Sérurier, 75935, Paris Cedex 19, France.,Université de Paris, INSERM U1141, 75019, Paris, France
| | - Thomas Schmitz
- Department of Gynecology-Obstetrics, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, 48, Bd Sérurier, 75935, Paris Cedex 19, France.,Epidemiology and Statistics Research Center/CRESS, University of Paris, INSERM, INRA, 75004, Paris, France
| | - Jean-François Oury
- Department of Gynecology-Obstetrics, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, 48, Bd Sérurier, 75935, Paris Cedex 19, France.,University of Paris, Paris, France
| | - Olivier Sibony
- Department of Gynecology-Obstetrics, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, 48, Bd Sérurier, 75935, Paris Cedex 19, France.,University of Paris, Paris, France
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2
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Klein J, Buffin-Meyer B, Boizard F, Moussaoui N, Lescat O, Breuil B, Fedou C, Feuillet G, Casemayou A, Neau E, Hindryckx A, Decatte L, Levtchenko E, Raaijmakers A, Vayssière C, Goua V, Lucas C, Perrotin F, Cloarec S, Benachi A, Manca-Pellissier MC, Delmas HL, Bessenay L, Le Vaillant C, Allain-Launay E, Gondry J, Boudailliez B, Simon E, Prieur F, Lavocat MP, Saliou AH, De Parscau L, Bidat L, Noel C, Floch C, Bourdat-Michel G, Favre R, Weingertner AS, Oury JF, Baudouin V, Bory JP, Pietrement C, Fiorenza M, Massardier J, Kessler S, Lounis N, Auriol FC, Marcorelles P, Collardeau-Frachon S, Zürbig P, Mischak H, Magalhães P, Batut J, Blader P, Saulnier Blache JS, Bascands JL, Schaefer F, Decramer S, Schanstra JP. Amniotic fluid peptides predict postnatal kidney survival in developmental kidney disease. Kidney Int 2020; 99:737-749. [PMID: 32750455 DOI: 10.1016/j.kint.2020.06.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 04/22/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 12/16/2022]
Abstract
Although a rare disease, bilateral congenital anomalies of the kidney and urinary tract (CAKUT) are the leading cause of end stage kidney disease in children. Ultrasound-based prenatal prediction of postnatal kidney survival in CAKUT pregnancies is far from accurate. To improve prediction, we conducted a prospective multicenter peptidome analysis of amniotic fluid spanning 140 evaluable fetuses with CAKUT. We identified a signature of 98 endogenous amniotic fluid peptides, mainly composed of fragments from extracellular matrix proteins and from the actin binding protein thymosin-β4. The peptide signature predicted postnatal kidney outcome with an area under the curve of 0.96 in the holdout validation set of patients with CAKUT with definite endpoint data. Additionally, this peptide signature was validated in a geographically independent sub-cohort of 12 patients (area under the curve 1.00) and displayed high specificity in non-CAKUT pregnancies (82 and 94% in 22 healthy fetuses and in 47 fetuses with congenital cytomegalovirus infection respectively). Change in amniotic fluid thymosin-β4 abundance was confirmed with ELISA. Knockout of thymosin-β4 in zebrafish altered proximal and distal tubule pronephros growth suggesting a possible role of thymosin β4 in fetal kidney development. Thus, recognition of the 98-peptide signature in amniotic fluid during diagnostic workup of prenatally detected fetuses with CAKUT can provide a long-sought evidence base for accurate management of the CAKUT disorder that is currently unavailable.
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Affiliation(s)
- Julie Klein
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Bénédicte Buffin-Meyer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Franck Boizard
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Nabila Moussaoui
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Ophélie Lescat
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Benjamin Breuil
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Camille Fedou
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Guylène Feuillet
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Audrey Casemayou
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Eric Neau
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - An Hindryckx
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Luc Decatte
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Elena Levtchenko
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Anke Raaijmakers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Christophe Vayssière
- Université Toulouse III Paul-Sabatier, Toulouse, France; Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France; INSERM, UMR1027, Toulouse, France
| | - Valérie Goua
- Prenatal Diagnosis Unit, Poitiers University Hospital, Poitiers, France
| | | | - Franck Perrotin
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Tours, Tours, France; INSERM, U1253, "Imaging and Brain," François-Rabelais University of Tours, Tours, France
| | - Sylvie Cloarec
- Reference Center for Rare Kidney Diseases, Pediatric Nephrology Service, CHRU Clocheville, Tours, France
| | - Alexandra Benachi
- Gynecology-Obstetric Service, AP-HP, Hôpital Antoine Béclère, Université Paris-Sud, Clamart, France
| | - Marie-Christine Manca-Pellissier
- Center for Prenatal Diagnosis, Timone Children's Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, Marseille, France
| | | | - Lucie Bessenay
- Pediatric Service, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Emma Allain-Launay
- Pediatric Nephrology Service, Hôpital Mère-Enfants, CHU Nantes, Nantes, France
| | - Jean Gondry
- Department of Obstetrics and Gynecology, University Hospital of Amiens, Amiens, France; INSERM, U1105, Picardie Jules Verne University, CHU Amiens, Amiens, France
| | | | - Elisabeth Simon
- Prenatal Diagnosis, Fondation Lenval, CHU de Nice, Nice, France
| | - Fabienne Prieur
- Clinical Genetics Service, CHU de Saint-Etienne, Saint-Etienne, France
| | - Marie-Pierre Lavocat
- Department of Pediatrics, Hôpital Nord, CHU de Saint Etienne, Saint Etienne, France
| | - Anne-Hélène Saliou
- Multidisciplinary Center for Prenatal Diagnosis, CHRU de Brest, Brest, France
| | - Loic De Parscau
- Department of Pediatrics and Medical Genetics, CHRU Morvan, Brest, France
| | - Laurent Bidat
- Gynecology-Obstetrics Service, Centre Hospitalier René Dubos, Pontoise, France
| | - Catherine Noel
- Gynecology-Obstetrics Service, Centre Hospitalier René Dubos, Pontoise, France
| | - Corinne Floch
- Pediatric Service, Hôpital Louis Mourier, Colombes, France
| | | | - Romain Favre
- Ultrasound and Foetal Medicine Service of the Department of Gynecology and Obstetrics, Hôpitaux Universitaires de Strasbourg, CMCO, Schiltigheim, France
| | - Anne-Sophie Weingertner
- Ultrasound and Foetal Medicine Service of the Department of Gynecology and Obstetrics, Hôpitaux Universitaires de Strasbourg, CMCO, Schiltigheim, France
| | - Jean-François Oury
- Gynecology-Obstetrics Service, Hôpital Universitaire Robert Debré, APHP, Paris, France
| | - Véronique Baudouin
- Pediatric Nephrology Service, Hôpital Universitaire Robert-Debré, APHP, Paris, France
| | - Jean-Paul Bory
- Service de Gynécologie-Obstétrique, Maternité Alix-de-Champagne, CHU de Reims, Reims, France
| | | | - Maryse Fiorenza
- Gynecology-Obstetrics Service, l'Hôpital Mère Enfant de Limoges, Limoges, France
| | - Jérôme Massardier
- Gynecology-Obstetrics Service, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | | | - Nadia Lounis
- Pediatric Clinical Research Unit, Clinical Research Center Toulouse, Hôpital des Enfants, Toulouse, France
| | - Françoise Conte Auriol
- Pediatric Clinical Research Unit, Clinical Research Center Toulouse, Hôpital des Enfants, Toulouse, France
| | - Pascale Marcorelles
- Department of Pathology, EA 4685, Neuronal Epithelium Interaction Laboratory, Université de Bretagne Occidentale Brest, France
| | - Sophie Collardeau-Frachon
- Department of Pathology, Children and Mother's Hospital, Groupement Hospitalier Est, CHU de Lyon-Bron, France
| | - Petra Zürbig
- Mosaiques Diagnostics and Therapeutics, Hannover, Germany
| | - Harald Mischak
- Mosaiques Diagnostics and Therapeutics, Hannover, Germany; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Pedro Magalhães
- Mosaiques Diagnostics and Therapeutics, Hannover, Germany; Department of Pediatric Nephrology, Hannover Medical School, Hannover, Germany
| | - Julie Batut
- Center for Developmental Biology (UMR5547) and Center for Integrative Biology (FR 3743), Université de Toulouse, CNRS, UPS, 31062, Toulouse, France
| | - Patrick Blader
- Center for Developmental Biology (UMR5547) and Center for Integrative Biology (FR 3743), Université de Toulouse, CNRS, UPS, 31062, Toulouse, France
| | - Jean-Sebastien Saulnier Blache
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | | | - Franz Schaefer
- Division of Pediatric Nephrology, Heidelberg University Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Stéphane Decramer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France; Pediatric Nephrology Service, Hôpital des Enfants, CHU Toulouse, Toulouse, France; Reference Center for Rare Renal Diseases of the Southwest (SORARE), Toulouse, France.
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France.
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3
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Journiac N, Gilabert-Juan J, Cipriani S, Benit P, Liu X, Jacquier S, Faivre V, Delahaye-Duriez A, Csaba Z, Hourcade T, Melinte E, Lebon S, Violle-Poirsier C, Oury JF, Adle-Biassette H, Wang ZQ, Mani S, Rustin P, Gressens P, Nardelli J. Cell Metabolic Alterations due to Mcph1 Mutation in Microcephaly. Cell Rep 2020; 31:107506. [DOI: 10.1016/j.celrep.2020.03.070] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 12/21/2019] [Accepted: 03/21/2020] [Indexed: 12/13/2022] Open
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4
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Sibony O, Oury JF. Homage. J Gynecol Obstet Hum Reprod 2019. [DOI: 10.1016/j.jogoh.2019.101640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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5
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Dreux S, Rosenblatt J, Moussy-Durandy A, Patin F, Favre R, Lortat-Jacob S, El Ghoneimi A, Oury JF, Deschenes G, Ville Y, Heidet L, Muller F. Urine biochemistry to predict long-term outcomes in fetuses with posterior urethral valves. Prenat Diagn 2018; 38:964-970. [PMID: 30207389 DOI: 10.1002/pd.5359] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 09/06/2018] [Accepted: 09/09/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Because the literature on the predictive value of fetal urinalysis is controversial in fetuses with lower urinary tract obstruction, we determined the best model of fetal urine biochemical markers correlated with long-term postnatal renal function based on glomerular filtration rate (GFR). METHOD This retrospective study concerned 89 fetuses with lower urinary tract obstruction and their renal function after 10 years of age. We correlated fetal urine biochemical markers (total protein, β2-microglobulin, sodium, chloride, glucose, calcium, and phosphorus) with GFR at 10 to 30 years of age in 89 patients with posterior urethral valves. We defined five stages of chronic kidney disease (CKD). RESULTS Of the 89 patients, 18 (20%) are 20 years old or over. Postnatal renal function was good in 67.4% (GFR > 60 mL/min/1.73 m2 ) and poor in 17% (GFR < 30 mL/min/1.73 m2 ). All fetal urine markers differed between CKD stage 1 + 2 and CKD stage 4 + 5 (P < 0.001). β2-microblobulin showed an 87% sensitivity for a 72% specificity. A combination of β2-microglobulin and chloride gave the best results (93% sensitivity and 71% specificity) versus amniotic fluid volume (80% sensitivity and 73% specificity). CONCLUSION Fetal urine biochemistry predicts long-term (10-30 years) postnatal renal function.
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Affiliation(s)
- Sophie Dreux
- Biochemistry-Hormonology, Robert Debré Hospital, AP-HP, Paris, France
| | | | - Amélie Moussy-Durandy
- Pediatric Nephrology, and Reference Center for Hereditary Renal Diseases (MARHEA), Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Franck Patin
- Biochemistry-Hormonology, Robert Debré Hospital, AP-HP, Paris, France
| | - Romain Favre
- Obstetrics and Gynecology, Hautepierre and CMCO Hospital, Strasbourg, France
| | | | - Alaa El Ghoneimi
- Pediatric Surgery, Robert Debré Hospital, AP-HP, Paris, France.,University Paris Diderot, Paris, France
| | - Jean-François Oury
- Obstetrics and Gynecology, Robert Debré Hospital, AP-HP, Paris, France.,University Paris Diderot, Paris, France
| | - Georges Deschenes
- Pediatric Nephrology, Robert Debré Hospital, AP-HP, Paris, France.,University Paris Diderot, Paris, France
| | - Yves Ville
- Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,University Paris Descartes, Paris, France
| | - Laurence Heidet
- Pediatric Nephrology, and Reference Center for Hereditary Renal Diseases (MARHEA), Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Francoise Muller
- Biochemistry-Hormonology, Robert Debré Hospital, AP-HP, Paris, France
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6
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Rosenblatt J, Dreux S, Spaggiari E, Morin C, Allaf B, Valat AS, Halim D, Oury JF, Muller F. Prenatal diagnosis of megacystis microcolon intestinal hypoperistalsis syndrome by biochemical analysis of fetal urine. Prenat Diagn 2018; 38:585-590. [PMID: 29752823 DOI: 10.1002/pd.5283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/18/2018] [Accepted: 05/01/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objective of the study is to determine a model of fetal urine biochemical markers to differentiate megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) from other megacystis. METHOD This is a retrospective study of biochemical analysis of fetal urine in patients who presented prenatally with megacystis. We studied β2-microglobulin, sodium, calcium, and phosphorus. Twenty-six patients subsequently diagnosed with MMIHS were compared with 2 control groups: one of end-stage renal failure (64 fetuses) and the second of "good" postnatal renal function (control group, 64 fetuses). RESULTS Mean fetal urine β2-microglobulin was significantly higher (P < .001) in end-stage renal failure (15.7 mg/L) than in MMIHS (2.2 mg/L) and the control group (3.2 mg/L). Fetal urine profiles differed significantly (P < .001) between MMIHS and the control group: median sodium 46.5 and 51 mmol/L, median calcium 1.12 and 0.73 mmol/L, and median phosphorus 0.03 and 0.15 mmol/L respectively. Fetal urinary ionic index [ratio: calcium / (phosphorus × sodium)] gave an area under the ROC curve of 0.86, at 54% sensitivity and 97% specificity, with correct classification in 84% of cases. We defined a nomogram to obtain a probability for MMIHS. CONCLUSION Fetal urinalysis can be helpful in prenatal differentiation of MMIHS from posterior urethral valves with good postnatal renal function.
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Affiliation(s)
- Jonathan Rosenblatt
- Gynecologie-Obstétrique, Hôpital Universitaire Robert Debré, APHP, Paris, France
| | - Sophie Dreux
- Biochimie-Hormonologie, Hôpital Universitaire Robert Debré, APHP, Paris, France
| | | | - Cécile Morin
- Gynecologie-Obstétrique, Hôpital Universitaire Robert Debré, APHP, Paris, France
| | - Bichr Allaf
- Biochimie-Hormonologie, Hôpital Universitaire Robert Debré, APHP, Paris, France
| | - Anne Sylvie Valat
- Gynécologie-Obstétrique, Centre Hospitalier Lens, CPDPN, Lille, France
| | - Danny Halim
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jean-François Oury
- Gynecologie-Obstétrique, Hôpital Universitaire Robert Debré, APHP, Paris, France
| | - Françoise Muller
- Biochimie-Hormonologie, Hôpital Universitaire Robert Debré, APHP, Paris, France
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7
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Kantor E, Guglielminotti J, Azria E, Luton D, Laurent M, Oury JF, Mahieu-Caputo D, Ravaud P, Estellat C. Socioeconomic Deprivation and Utilization of Anesthetic Care During Pregnancy and Delivery. Anesth Analg 2017; 125:925-933. [DOI: 10.1213/ane.0000000000002275] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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8
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Linard M, Blondel B, Estellat C, Deneux-Tharaux C, Luton D, Oury JF, Schmitz T, Mandelbrot L, Azria E. Association between inadequate antenatal care utilisation and severe perinatal and maternal morbidity: an analysis in the PreCARE cohort. BJOG 2017. [DOI: 10.1111/1471-0528.14794] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M Linard
- UMR1153 - Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé research team); DHU Risks in Pregnancy; Paris Descartes University - INSERM; Paris France
| | - B Blondel
- UMR1153 - Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé research team); DHU Risks in Pregnancy; Paris Descartes University - INSERM; Paris France
| | - C Estellat
- Epidemiology and Clinical Research Department; URC Paris-Nord; APHP; Paris France
- CIC 1425-EC; UMR 1123; INSERM; Paris France
| | - C Deneux-Tharaux
- UMR1153 - Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé research team); DHU Risks in Pregnancy; Paris Descartes University - INSERM; Paris France
| | - D Luton
- Department of Obstetrics and Gynaecology; Beaujon-Bichat Hospital; DHU Risks in Pregnancy; APHP; Paris Diderot University; Paris France
| | - JF Oury
- Department of Obstetrics and Gynaecology; Robert Debré Hospital; AP-HP; Paris Diderot University; Paris France
| | - T Schmitz
- Department of Obstetrics and Gynaecology; Robert Debré Hospital; AP-HP; Paris Diderot University; Paris France
| | - L Mandelbrot
- Department of Obstetrics and Gynaecology; Louis Mourier Hospital; DHU Risks in Pregnancy; AP-HP; Paris Diderot University; Colombes France
| | - E Azria
- UMR1153 - Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé research team); DHU Risks in Pregnancy; Paris Descartes University - INSERM; Paris France
- Maternity Unit; Paris Saint Joseph Hospital; DHU Risks in Pregnancy; Paris Descartes University; Paris France
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9
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Halim D, Brosens E, Muller F, Wangler MF, Beaudet AL, Lupski JR, Akdemir ZHC, Doukas M, Stoop HJ, de Graaf BM, Brouwer RWW, van Ijcken WFJ, Oury JF, Rosenblatt J, Burns AJ, Tibboel D, Hofstra RMW, Alves MM. Loss-of-Function Variants in MYLK Cause Recessive Megacystis Microcolon Intestinal Hypoperistalsis Syndrome. Am J Hum Genet 2017; 101:123-129. [PMID: 28602422 PMCID: PMC5501771 DOI: 10.1016/j.ajhg.2017.05.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [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: 04/10/2017] [Accepted: 05/11/2017] [Indexed: 12/11/2022] Open
Abstract
Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is a congenital disorder characterized by loss of smooth muscle contraction in the bladder and intestine. To date, three genes are known to be involved in MMIHS pathogenesis: ACTG2, MYH11, and LMOD1. However, for approximately 10% of affected individuals, the genetic cause of the disease is unknown, suggesting that other loci are most likely involved. Here, we report on three MMIHS-affected subjects from two consanguineous families with no variants in the known MMIHS-associated genes. By performing homozygosity mapping and whole-exome sequencing, we found homozygous variants in myosin light chain kinase (MYLK) in both families. We identified a 7 bp duplication (c.3838_3844dupGAAAGCG [p.Glu1282_Glyfs∗51]) in one family and a putative splice-site variant (c.3985+5C>A) in the other. Expression studies and splicing assays indicated that both variants affect normal MYLK expression. Because MYLK encodes an important kinase required for myosin activation and subsequent interaction with actin filaments, it is likely that in its absence, contraction of smooth muscle cells is impaired. The existence of a conditional-Mylk-knockout mouse model with severe gut dysmotility and abnormal function of the bladder supports the involvement of this gene in MMIHS pathogenesis. In aggregate, our findings implicate MYLK as a gene involved in the recessive form of MMIHS, confirming that this disease of the visceral organs is heterogeneous with a myopathic origin.
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Affiliation(s)
- Danny Halim
- Department of Clinical Genetics, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands
| | - Erwin Brosens
- Department of Clinical Genetics, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands
| | - Françoise Muller
- Biochimie Prenatale, Hôpital Universitaire Robert Debré, 75019 Paris, France
| | - Michael F Wangler
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; Texas Childen's Hospital, Houston, TX 77030, USA
| | - Arthur L Beaudet
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; Texas Childen's Hospital, Houston, TX 77030, USA
| | - James R Lupski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; Texas Childen's Hospital, Houston, TX 77030, USA; Baylor-Hopkins Center for Mendelian Genomics, Baylor College of Medicine, Houston, TX 77030, USA; Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Zeynep H Coban Akdemir
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Baylor-Hopkins Center for Mendelian Genomics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Michael Doukas
- Department of Pathology, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands
| | - Hans J Stoop
- Department of Pathology, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands
| | - Bianca M de Graaf
- Department of Clinical Genetics, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands
| | - Rutger W W Brouwer
- Erasmus Center for Biomics, Erasmus Medical Center, 3000 CA Rotterdam, the Netherlands
| | | | - Jean-François Oury
- Department of Obstetrics and Gynecology, Hôpital Universitaire Robert Debré, 75019 Paris, France
| | - Jonathan Rosenblatt
- Department of Obstetrics and Gynecology, Hôpital Universitaire Robert Debré, 75019 Paris, France
| | - Alan J Burns
- Department of Clinical Genetics, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands; Stem Cells and Regenerative Medicine, Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, WC1N 1EH London, UK
| | - Dick Tibboel
- Department of Pediatric Surgery, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands
| | - Robert M W Hofstra
- Department of Clinical Genetics, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands; Stem Cells and Regenerative Medicine, Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, WC1N 1EH London, UK.
| | - Maria M Alves
- Department of Clinical Genetics, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands.
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10
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Gonthier C, Estellat C, Deneux-Tharaux C, Blondel B, Alfaiate T, Schmitz T, Oury JF, Mandelbrot L, Luton D, Ravaud P, Azria E. Association between maternal social deprivation and prenatal care utilization: the PreCARE cohort study. BMC Pregnancy Childbirth 2017; 17:126. [PMID: 28506217 PMCID: PMC5433136 DOI: 10.1186/s12884-017-1310-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 12/14/2016] [Accepted: 04/17/2017] [Indexed: 11/25/2022] Open
Abstract
Background Maternal social deprivation is associated with an increased risk of adverse maternal and perinatal outcomes. Inadequate prenatal care utilization (PCU) is likely to be an important intermediate factor. The health care system in France provides essential health services to all pregnant women irrespective of their socioeconomic status. Our aim was to assess the association between maternal social deprivation and PCU. Methods The analysis was performed in the database of the multicenter prospective PreCARE cohort study. The population source consisted in all parturient women registered for delivery in 4 university hospital maternity units, Paris, France, from October 2010 to November 2011 (N = 10,419). This analysis selected women with singleton pregnancies that ended after 22 weeks of gestation (N = 9770). The associations between maternal deprivation (four variables first considered separately and then combined as a social deprivation index: social isolation, poor or insecure housing conditions, no work-related household income, and absence of standard health insurance) and inadequate PCU were tested through multivariate logistic regressions also adjusted for immigration characteristics and education level. Results Attendance at prenatal care was poor for 23.3% of the study population. Crude relative risks and confidence intervals for inadequate PCU were 1.6 [1.5–1.8], 2.3 [2.1–2.6], and 3.1 [2.8–3.4], for women with a deprivation index of 1, 2, and 3, respectively, compared to women with deprivation index of 0. Each of the four deprivation variables was significantly associated with an increased risk of inadequate PCU. Because of the interaction observed between inadequate PCU and mother’s country of birth, we stratified for the latter before the multivariate analysis. After adjustment for the potential confounders, this social gradient remained for women born in France and North Africa. The prevalence of inadequate PCU among women born in sub-Saharan Africa was 34.7%; the social gradient in this group was attenuated and no longer significant. Other factors independently associated with inadequate PCU were maternal age, recent immigration, and unplanned or unwanted pregnancy. Conclusion Social deprivation is independently associated with an increased risk of inadequate PCU. Recognition of risk factors is an important step in identifying barriers to PCU and developing measures to overcome them. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1310-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Clémentine Gonthier
- UMR1153 - Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University - INSERM, 53 Avenue de l'Observatoire, 75014, Paris, France.,Department of Obstetrics and Gynecology, Beaujon-Bichat Hospital, DHU Risks in Pregnancy, APHP, Paris Diderot University, 46 Rue Henri Huchard, 75018, Paris, France
| | - Candice Estellat
- Epidemiology and clinical research Department, URC Paris-Nord, APHP, 46 Rue Henri Huchard, 75018, Paris, France.,CIC 1425-EC, UMR 1123, INSERM, Paris, France
| | - Catherine Deneux-Tharaux
- UMR1153 - Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University - INSERM, 53 Avenue de l'Observatoire, 75014, Paris, France
| | - Béatrice Blondel
- UMR1153 - Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University - INSERM, 53 Avenue de l'Observatoire, 75014, Paris, France
| | - Toni Alfaiate
- Epidemiology and clinical research Department, URC Paris-Nord, APHP, 46 Rue Henri Huchard, 75018, Paris, France
| | - Thomas Schmitz
- Department of Obstetrics and Gynecology, Robert Debré Hospital, AP-HP, Paris Diderot University, 48, boulevard Sérurier, 75019, Paris, France
| | - Jean-François Oury
- Department of Obstetrics and Gynecology, Robert Debré Hospital, AP-HP, Paris Diderot University, 48, boulevard Sérurier, 75019, Paris, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynecology, Louis Mourier Hospital, DHU Risks in Pregnancy, AP-HP, Paris Diderot University, 178 Rue des Renouillers, 92700, Colombes, France
| | - Dominique Luton
- Department of Obstetrics and Gynecology, Beaujon-Bichat Hospital, DHU Risks in Pregnancy, APHP, Paris Diderot University, 46 Rue Henri Huchard, 75018, Paris, France.,UMR676, Paris Diderot University - INSERM, Paris, France
| | - Philippe Ravaud
- UMR1153 - Méthodes de l'évaluation thérapeutique des maladies chroniques (METHOS research team), INSERM, 1 Place du Parvis de Notre-Dame, 75004, Paris, France
| | - Elie Azria
- UMR1153 - Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University - INSERM, 53 Avenue de l'Observatoire, 75014, Paris, France. .,Department of Obstetrics and Gynecology, Groupe Hospitalier Paris Saint Joseph, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
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11
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Spaggiari E, Faure G, Dreux S, Czerkiewicz I, Stirnemann JJ, Guimiot F, Heidet L, Favre R, Salomon LJ, Oury JF, Ville Y, Muller F. Sequential fetal serum β2-microglobulin to predict postnatal renal function in bilateral or low urinary tract obstruction. Ultrasound Obstet Gynecol 2017; 49:617-622. [PMID: 27197901 DOI: 10.1002/uog.15968] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 01/21/2016] [Revised: 05/03/2016] [Accepted: 05/13/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Fetal serum β2-microglobulin has been shown to predict postnatal renal outcome in cases of fetal obstructive uropathy. We assessed the value of serial measurements of fetal serum β2-microglobulin in the prediction of postnatal renal outcome. METHODS We retrospectively studied renal outcome in 42 fetuses with bilateral or low urinary tract obstruction that had fetal blood sampling on at least two occasions to assay serum levels of β2-microglobulin. Amniotic fluid volume at the time of each sampling was recorded. We classified renal outcome as either favorable (when postnatal renal function was normal) or adverse (when postnatal chronic renal failure occurred or when renal dysplasia at autopsy was noted). A β2-microglobulin cut-off of 5 mg/L and amniotic fluid index of 5 cm were used to predict postnatal renal outcome. RESULTS Renal outcome was adverse in 28 cases and favorable in 14. In 12 (28.6%) cases, fetal serum β2-microglobulin concentration differed between the first and last measurement. Prediction of postnatal renal outcome was correct in 11 of these cases based on the last β2-microglobulin measurement. The sensitivity of β2-microglobulin in predicting renal outcome was significantly higher (P = 0.005) when using the last rather than the first measurement (96.4% vs 64.3%), with similar specificity for both measurements (85.7% vs 78.6%, non-significant). The sensitivity of amniotic fluid volume was also significantly higher (P = 0.005) when using the last rather than the first measurement (75.0% vs 35.7%), with similar specificity for both measurements (64.3% vs 71.4%, non-significant). CONCLUSION Sequential measurement of serum β2-microglobulin, performed for adverse ultrasound findings, such as renal parenchymal abnormality or decreasing amniotic fluid volume, predicts postnatal renal outcome more accurately than does a single assay. This may be due to possible worsening of renal injury with increasing duration of urinary tract obstruction. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E Spaggiari
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - G Faure
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - S Dreux
- Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France
| | - I Czerkiewicz
- Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France
| | - J J Stirnemann
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - F Guimiot
- Department of Developmental Biology, Robert Debré Hospital, AP-HP, Paris, France
- University Paris Diderot and Sorbonne Paris-Cité, Paris, France
| | - L Heidet
- Department of Pediatric Nephrology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - R Favre
- Department of Obstetrics and Gynecology, Hautepierre and CMCO Hospital, Strasbourg, France
| | - L J Salomon
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - J F Oury
- University Paris Diderot and Sorbonne Paris-Cité, Paris, France
- Department of Obstetrics and Gynecology, Robert Debré Hospital, AP-HP, Paris, France
| | - Y Ville
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - F Muller
- Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France
- University Versailles Saint-Quentin, Versailles, France
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12
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Azria E, Blondel B, Estellat C, Luton D, Oury JF, Schmitz T, Mandelbrot L, Deneux C, Linard M. 632: Association between prenatal care utilization and severe perinatal and maternal morbidities: an analysis within the precare cohort. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Chitrit Y, Bourdon M, Korb D, Grapin-Dagorno C, Joinau-Zoulovits F, Vuillard E, Paye-Jaouen A, Peycelon M, Belarbi N, Delezoide AL, Schmitz T, El Ghoneimi A, Sibony O, Oury JF. Posterior urethral valves and vesicoureteral reflux: can prenatal ultrasonography distinguish between these two conditions in male fetuses? Prenat Diagn 2016; 36:831-7. [DOI: 10.1002/pd.4868] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 06/20/2016] [Accepted: 06/26/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Yvon Chitrit
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Mathilde Bourdon
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Diane Korb
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | | | | | - Edith Vuillard
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Annabel Paye-Jaouen
- Department of Pediatric Urology and Surgery; Hôpital Robert Debré AP-HP; Paris France
| | - Matthieu Peycelon
- Department of Pediatric Urology and Surgery; Hôpital Robert Debré AP-HP; Paris France
| | - Nadia Belarbi
- Department of Pediatric Imaging; Hôpital Robert Debré AP-HP; Paris France
| | - Anne-Lyse Delezoide
- Department of Developmental Biology; Hôpital Robert Debré AP-HP; Paris France
| | - Thomas Schmitz
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Alaa El Ghoneimi
- Department of Pediatric Urology and Surgery; Hôpital Robert Debré AP-HP; Paris France
| | - Olivier Sibony
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Jean-François Oury
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
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14
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Alberti A, Salomon LJ, Le Lorc'h M, Couloux A, Bussières L, Goupil S, Malan V, Pelletier E, Hyon C, Vialard F, Rozenberg P, Bouhanna P, Oury JF, Schmitz T, Romana S, Weissenbach J, Vekemans M, Ville Y. Non-invasive prenatal testing for trisomy 21 based on analysis of cell-free fetal DNA circulating in the maternal plasma. Prenat Diagn 2016; 35:471-6. [PMID: 25643828 DOI: 10.1002/pd.4561] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 01/04/2015] [Accepted: 01/14/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE By-the-book implementation of non-invasive prenatal test and clinical validation for trisomy 21. STUDY DESIGN Publicly funded prospective study of 225 cases. Women at risk for trisomy 21 > 1/250 based on combined ultrasound and serum markers during first or second trimester were eligible following an informed consent. The technique was established from the available literature and performed on 10 mL of venous blood collected prior to chorionic villus sampling or amniocentesis. Investigators were blinded to the fetal karyotype. Results were expressed in Z-scores of the percentage of each chromosome. RESULTS Among 976 eligible cases, 225 were processed: 8 were used for pretesting phase and 23 to build a reference set. One hundred thirty six euploid cases and 47 with trisomy 21 were then run randomly. Eleven cases yielded no result (4.8%). Z-scores were above 3 (7.58+/-2.41) for chromosome 21 in all 47 trisomies and in none of the euploid cases (0.11+/-1.0). Z-scores were within normal range for the other chromosomes in both groups. Using a cut-off of 3, sensitivity and specificity were of 100% 95% CI [94.1, 100] and 100% 95% CI [98, 100], respectively. CONCLUSION Non-invasive prenatal test for trisomy 21 is a robust strategy that can be translated from seminal publications. Publicly funded studies should refine its indications and cost-effectiveness in prenatal screening and diagnosis. © 2015 John Wiley & Sons, Ltd.
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15
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Azria E, Estellat C, Alfaiate T, Schmitz T, Oury JF, Mandelbrot L, Luton D, Ravaud P. 152: Impact of maternal social deprivation on maternal and perinatal severe adverse outcomes: the PreCARE cohort study. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Gonthier C, Estellat C, Alfaiate T, Schmitz T, Oury JF, Mandelbrot L, Luton D, AZRIA E. 547: Impact of maternal deprivation on prenatal care utilization: the PreCARE cohort study. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Rachid ML, Dreux S, Pean de Ponfilly G, Vargas-Poussou R, Czerkiewicz I, Chevenne D, Oury JF, Deschênes G, Muller F. Prenatal diagnosis of Bartter syndrome: amniotic fluid aldosterone. Prenat Diagn 2015; 36:88-91. [PMID: 26528764 DOI: 10.1002/pd.4717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 10/27/2015] [Accepted: 10/27/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Bartter syndrome is a severe inherited tubulopathy characterized by postnatal salt wasting, severe polyuria, dehydration, failure to thrive and secondary hyperaldosteronism. Prenatally, the disease is usually discovered following the onset of severe polyhydramnios in the second trimester. We studied amniotic fluid aldosterone concentration in Bartter syndrome and in controls. METHODS Amniotic fluid aldosterone was assayed by radioimmunoassay. We undertook a retrospective case-control study based on 36 cases of prenatally suspected and postnatally confirmed Bartter syndrome (22 with identified mutations): and 72 gestational age matched controls presenting with polyhydramnios and 72 without polyhydramnios. Amniotic fluid aldosterone was compared between the three groups. RESULTS The median amniotic fluid aldosterone concentration in the Bartter syndrome group (90 pg/mL) was not different from that in the controls with polyhydramnios (90 pg/mL, P = 0.33) or without polyhydramnios (87 pg/mL, P = 0.41). CONCLUSION Amniotic fluid aldosterone assay cannot be used for prenatal diagnosis of Bartter syndrome. © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Myriam L Rachid
- Biochimie-Hormonologie, Hôpital Robert Debré, APHP, Paris, France
| | - Sophie Dreux
- Biochimie-Hormonologie, Hôpital Robert Debré, APHP, Paris, France
| | | | - Rosa Vargas-Poussou
- Département de Génétique, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | | | - Didier Chevenne
- Biochimie-Hormonologie, Hôpital Robert Debré, APHP, Paris, France
| | | | | | - Françoise Muller
- Biochimie-Hormonologie, Hôpital Robert Debré, APHP, Paris, France.,Université Versailles Saint Quentin en Yvelines, Paris, France
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18
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Allaf B, Dreux S, Schmitz T, Czerkiewicz I, Le Vaillant C, Benachi A, Houfflin-Debarge V, Maréchaud M, Oury JF, Muller F. Amniotic fluid biochemistry in isolated polyhydramnios: a series of 464 cases. Prenat Diagn 2015; 35:1331-5. [DOI: 10.1002/pd.4700] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/22/2015] [Accepted: 09/24/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Bichr Allaf
- Biochimie-Hormonologie; Hôpital Robert Debré, APHP; Paris France
| | - Sophie Dreux
- Biochimie-Hormonologie; Hôpital Robert Debré, APHP; Paris France
| | - Thomas Schmitz
- Gynécologie-Obstétrique; Hôpital Robert Debré, APHP; Paris France
| | | | | | - Alexandra Benachi
- Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Antoine Béclère, AP-HP; Université Paris Sud; Clamart France
| | | | | | | | - Françoise Muller
- Biochimie-Hormonologie; Hôpital Robert Debré, APHP; Paris France
- Université Versailles Saint Quentin en Yvelines; Versailles France
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19
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Abdennadher W, Chalouhi G, Dreux S, Rosenblatt J, Favre R, Guimiot F, Salomon LJ, Oury JF, Ville Y, Muller F. Fetal urine biochemistry at 13-23 weeks of gestation in lower urinary tract obstruction: criteria for in-utero treatment. Ultrasound Obstet Gynecol 2015; 46:306-311. [PMID: 25412852 DOI: 10.1002/uog.14734] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 08/13/2014] [Revised: 11/12/2014] [Accepted: 11/12/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To assess the value of fetal urine biochemistry before 23 weeks of gestation in cases of lower urinary tract obstruction (LUTO) to refine prognosis and to select potential candidates for in-utero intervention. METHODS This was a retrospective study including 72 cases of LUTO with fetal urine sampled before 23 weeks and assayed for total protein, β-2-microglobulin, sodium, chloride, calcium, phosphorus, glucose and gamma-glutamyl transpeptidase (GGTP). Two groups were defined according to renal outcome: 1) bilateral renal dysplasia on histological examination or renal failure at birth; 2) normal postnatal renal function or histologically normal appearance of the kidneys. Correlations between fetal urinary biochemical markers and postnatal renal function were studied. RESULTS LUTO was isolated in 56/72 (77.8%) cases and was associated with other malformations in 16/72 (22.2%) cases. High GGTP levels (236 IU/L vs 5 IU/L; P < 0.0001) were observed in fetal urine in the five cases of urodigestive fistula. A significant difference between outcome groups was observed for β-2-microglobulin (P = 0.0017), sodium (P = 0.0008), chloride (P = 0.0028) and calcium (P = 0.0092) but not for protein, glucose or phosphorus. Sensitivity and specificity in defining a poor renal prognosis were 80.6% and 89% for β-2-microglobulin, 61.3% and 100% for sodium and 64.5% and 100% for calcium, respectively. CONCLUSIONS Fetal urinalysis before 23 weeks of gestation allowed distinction between three groups: 1) fetuses with normal urine biochemistry for which fetal therapy should be discussed; 2) fetuses with abnormal urine biochemistry for which prognosis for renal outcome is poor and for which the benefit of fetal therapy is likely to be compromised; 3) fetuses with urodigestive fistula.
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Affiliation(s)
- W Abdennadher
- Department of Obstetrics and Gynaecology, Hôpital Necker Enfants Malades, APHP, Paris, France
| | - G Chalouhi
- Department of Obstetrics and Gynaecology, Hôpital Necker Enfants Malades, APHP, Paris, France
| | - S Dreux
- Department of Biochemistry, Hôpital Robert Debré, APHP, Paris, France
| | - J Rosenblatt
- Department of Obstetrics and Gynaecology, Hôpital Robert Debré, APHP, Paris, France
| | - R Favre
- Department of Obstetrics and Gynaecology, CMCO, Schiltigheim, France
| | - F Guimiot
- Department of Developmental Biology, Hôpital Robert Debré, APHP, Paris, France
| | - L J Salomon
- Department of Obstetrics and Gynaecology, Hôpital Necker Enfants Malades, APHP, Paris, France
| | - J F Oury
- Department of Obstetrics and Gynaecology, Hôpital Robert Debré, APHP, Paris, France
| | - Y Ville
- Department of Obstetrics and Gynaecology, Hôpital Necker Enfants Malades, APHP, Paris, France
| | - F Muller
- Department of Biochemistry, Hôpital Robert Debré, APHP, Paris, France
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20
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Barthod G, Teissier N, Bellarbi N, Viala P, Oury JF, Dray G, Vuillard E, Michel J, Van Den Abbeele T. Fetal airway management on placental support: limitations and ethical considerations in seven cases. J OBSTET GYNAECOL 2014; 33:787-94. [PMID: 24219714 DOI: 10.3109/01443615.2013.823924] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to evaluate the paediatric and maternal outcome after ex utero intrapartum treatment (EXIT). A retrospective review was carried out of the medical charts (gestational age, circumstances of diagnosis, multidisciplinary prenatal decision, date of surgery, paediatric and maternal outcome) of all the fetuses eligible for/delivered via the EXIT procedure in our paediatrics and obstetrics tertiary care and teaching centre, between October 2004 and May 2011. Seven fetuses with cervical teratoma, epignathus tumour or congenital high airway obstruction syndrome (CHAOS) were included in our study. Two pregnancies were terminated and five fetuses were delivered alive. The airway was secured in all five cases (two endotracheal intubations and three tracheostomies). No maternal complications were observed. On average, babies were delivered at 32 gestational weeks, and spent 31 days in the intensive care unit. All but one baby were ventilated for 18 days. Long-term paediatric outcome was favourable. It is concluded that airway management by the EXIT procedure has become an efficient technique. A multidisciplinary prenatal assessment is essential in order to select appropriate cases.
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Affiliation(s)
- G Barthod
- Department of Paediatric ENT, Robert Debré Hospital, AP-HP, Paris VII University Denis Diderot , Sorbonne Paris Cité
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Blachier A, Alberti C, Korb D, Schmitz T, Patrick V, Christine B, Oury JF, Sibony O. Diet or medically treated gestational diabetes: is there any difference for obstetrical and neonatal complications? A French cohort study. J Perinat Med 2014; 42:315-9. [PMID: 24246283 DOI: 10.1515/jpm-2013-0079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 10/09/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of the present study was to determine specific obstetrical and neonatal complications associated with diet-treated gestational diabetes (DTGD) and medically treated gestational diabetes (MTGD). METHODS This is a prospective cohort study of women followed in the Robert Debré Hospital (France, Paris) and who have given birth between 1 January, 2004, and 19 November, 2010. Clinical, biological, maternal and neonatal data were reported in the maternity database. Associations between obstetrical and neonatal complications and gestational diabetes were evaluated by estimating odd ratios (ORs) and their 95% CIs, using a logistic regression model. RESULTS 16,244 pregnancies were included in the study. 1515 (9.3%) women had gestational diabetes: 1108 (7.3%) had DTGD, 243 (1.7%) had MTGD. After full adjustment, MTGD was associated with an increased risk of nonscheduled cesarean (ORnonscheduled=2.3; 95% CI: 1.6-3.3; P<0.001) while DTGD was not (ORnonscheduled=1.0; 95% CI: 0.8-1.3; P<0.96). Clinical macrosomia was positively associated with DTGD (OR=2; 95% CI: 1.7-2.4; P<0.0001) or MTGD (OR=2.9; 95% CI: 2.1-3.9; P<0.0001). CONCLUSION This study confirms that macrosomia is the main complication of DTGD. By contrast, DTGD was not associated with neonatal hypoglycemia and cesarean, while these complications were associated with MTGD.
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Capito C, Belarbi N, Paye Jaouen A, Leger J, Carel JC, Oury JF, Sebag G, El-Ghoneimi A. Prenatal pelvic MRI: additional clues for assessment of urogenital obstructive anomalies. J Pediatr Urol 2014; 10:162-6. [PMID: 24054781 DOI: 10.1016/j.jpurol.2013.07.020] [Citation(s) in RCA: 15] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 07/23/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Ultrasound prenatal evaluation of pelvic cystic mass can be challenging. After having ruled out a cloaca anterior to a large hydrocolpos, it is important to differentiate between combined urogenital anomalies such as urogenital sinus and isolated genital anomalies. PATIENTS AND METHODS We reviewed the charts of 13 women referred for a third trimester pelvic MRI for cystic pelvic mass discovered in second trimester ultrasound. We evaluated MRI compared with postnatal surgical findings in order to determine clues for improving prenatal diagnoses. RESULTS MRI excluded the diagnosis of cloacal malformation in nine cases with no false negative. Once a cloaca is ruled out, a different signal between the bladder and the hydrocolpos on T2 sequences is in favor of an isolated genital obstruction. In contrast, in case of urogenital sinus, the vagina is filled with a mixture of genital secretions and urine, which gives it an MRI signal similar to the bladder on T2 sequences. CONCLUSION Third trimester fetal MRI is an essential exam for characterization of pelvic cystic mass diagnosed by ultrasound. This exam appears valuable for invalidating the diagnosis of cloacal malformation and for differentiating between isolated genital obstruction and urogenital sinus.
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Affiliation(s)
- Carmen Capito
- AP-HP, Hôpital Robert Debré, Service de Chirurgie Viscérale et d'Urologie Pédiatriques, centre de référence de maladies endocriniennes Rares de la Croissance, F-75019 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, F-75019 Paris, France.
| | - Nadia Belarbi
- AP-HP, Hôpital Robert Debré, Service de Radiologie Pédiatrique, Paris, France.
| | - Annabel Paye Jaouen
- AP-HP, Hôpital Robert Debré, Service de Chirurgie Viscérale et d'Urologie Pédiatriques, centre de référence de maladies endocriniennes Rares de la Croissance, F-75019 Paris, France.
| | - Juliane Leger
- Université Paris Diderot, Sorbonne Paris Cité, F-75019 Paris, France; AP-HP, Hôpital Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, F-75019 Paris, France; Institut National de la Santé et de la Recherche Médicale Unité UMR 676, F-75019 Paris, France.
| | - Jean-Claude Carel
- Université Paris Diderot, Sorbonne Paris Cité, F-75019 Paris, France; AP-HP, Hôpital Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, F-75019 Paris, France; Institut National de la Santé et de la Recherche Médicale Unité UMR 676, F-75019 Paris, France.
| | - Jean-François Oury
- Université Paris Diderot, Sorbonne Paris Cité, F-75019 Paris, France; AP-HP, Hôpital Robert Debré, Service de Gynécologie, Obstétrique et Diagnostic Prénatal, F-75019 Paris, France.
| | - Guy Sebag
- AP-HP, Hôpital Robert Debré, Service de Radiologie Pédiatrique, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, F-75019 Paris, France.
| | - Alaa El-Ghoneimi
- AP-HP, Hôpital Robert Debré, Service de Chirurgie Viscérale et d'Urologie Pédiatriques, centre de référence de maladies endocriniennes Rares de la Croissance, F-75019 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, F-75019 Paris, France.
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Schmitz T, Pourcelot AG, Moutafoff C, Biran V, Sibony O, Oury JF. Cervical ripening with low-dose prostaglandins in planned vaginal birth after cesarean. PLoS One 2013; 8:e80903. [PMID: 24260505 PMCID: PMC3834249 DOI: 10.1371/journal.pone.0080903] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 04/30/2013] [Accepted: 10/17/2013] [Indexed: 12/04/2022] Open
Abstract
Objectives To compare uterine rupture, maternal and perinatal morbidity rates in women with one single previous cesarean after spontaneous onset of labor or low-dose prostaglandin-induced cervical ripening for unfavourable cervix. Study Design This was a retrospective cohort study of 4,137 women with one single previous cesarean over a 22-year period. Inpatient prostaglandin administration consisted in single daily local applications. Results Vaginal delivery was planned for 3,544 (85.7%) patients, 2,704 (76.3%) of whom delivered vaginally (vaginal birth after Cesarean (VBAC) rate = 65.4%). Among women receiving prostaglandins (n=515), 323 (62.7%) delivered vaginally. Uterine rupture (0.7% compared with 0.8%, OR 1.1, 95% CI 0.4-3.4, p=0.88), maternal (0.9% compared with 1.2%, OR 1.3, 95% CI 0.5-3.2, p=0.63) and perinatal (0.3% compared with 0.8%, OR 2.4, 95% CI 0.7-8.5, p=0.18) morbidity rates did not differ significantly between patients with spontaneous onset of labor and those receiving prostaglandins, nor did these rates differ according to the planned mode of delivery. Conclusion In comparison with patients with spontaneous labor, inducing cervical ripening with low-dose prostaglandins in case of unfavourable cervix is not associated with appreciable increase in uterine rupture, maternal or perinatal morbidity.
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Affiliation(s)
- Thomas Schmitz
- Service de Gynécologie Obstétrique, Hôpital Robert Debré, AP-HP, Paris, France
- Université Paris Diderot, Paris, France
- * E-mail:
| | - Anne-Gaelle Pourcelot
- Service de Gynécologie Obstétrique, Hôpital Robert Debré, AP-HP, Paris, France
- Université Paris Diderot, Paris, France
| | - Constance Moutafoff
- Service de Gynécologie Obstétrique, Hôpital Robert Debré, AP-HP, Paris, France
- Université Paris Diderot, Paris, France
| | - Valérie Biran
- Université Paris Diderot, Paris, France
- Service de Néonatalogie, Hôpital Robert Debré, AP-HP, Paris, France
| | - Olivier Sibony
- Service de Gynécologie Obstétrique, Hôpital Robert Debré, AP-HP, Paris, France
- Université Paris Diderot, Paris, France
| | - Jean-François Oury
- Service de Gynécologie Obstétrique, Hôpital Robert Debré, AP-HP, Paris, France
- Université Paris Diderot, Paris, France
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Bornes M, Spaggiari E, Schmitz T, Dreux S, Czerkiewicz I, Delezoide AL, El-Ghoneimi A, Oury JF, Muller F. Outcome and etiologies of fetal megacystis according to the gestational age at diagnosis. Prenat Diagn 2013; 33:1162-6. [PMID: 23939878 DOI: 10.1002/pd.4215] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 07/28/2013] [Accepted: 08/09/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the gestational age-specific outcomes and the different etiologies of megacystis diagnosed at screening ultrasound. METHODS A retrospective single-center study was conducted between 1989 and 2009. We identified all consecutive cases of megacystis prenatally diagnosed during routine ultrasound screening. Outcome, final diagnosis, and renal function were recorded. RESULTS Eighty-four patients were included. An isolated lower urinary tract obstruction was observed in 38/84 (45.2%), ureterovesical reflux in 9/84 (10.7%), an associated congenital abnormality in 32/84 (38.1%) and a normal bladder in 5/84 (6%). Increased gestational age at diagnosis was correlated with an increased rate of live born children (P < 0.01). No cases of megacystis diagnosed in the first trimester were born alive. When diagnosis of posterior urethral valves (PUV) was made in the third trimester, the ultimate survival rate was 11/13 (84.6%) compared with 3/12 (25%) for a diagnosis made in the second trimester (P = 0.02). CONCLUSION Lower urinary tract obstruction is the main etiology of megacystis. Megacystis can also be part of more complex malformations. Outcome of megacystis detected in the first trimester is poor. PUV detected in the third trimester had a better overall survival rate than PUV detected in the second trimester.
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Affiliation(s)
- Marie Bornes
- Gynecology and Obstetrics, AP-HP, Robert Debré Hospital, Paris, France; Gynecology and Obstetrics, AP-HP, Tenon Hospital, Paris, France
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Spaggiari E, Baumann C, Alison M, Oury JF, Belarbi N, Dupont C, Guimiot F, Delezoide AL. Mowat-Wilson syndrome in a fetus with antenatal diagnosis of short corpus callosum: advocacy for standard autopsy. Eur J Med Genet 2013; 56:297-300. [PMID: 23523603 DOI: 10.1016/j.ejmg.2013.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 12/19/2012] [Accepted: 03/05/2013] [Indexed: 02/05/2023]
Abstract
Mowat-Wilson syndrome (MWS) is a genetic disease caused by heterozygous mutations or deletions of the ZEB2 gene rarely diagnosed prenatally and with little fetal description reported. It is mainly characterized by moderate-to-severe intellectual disability, epilepsy, facial dysmorphism and various malformations including Hirschsprung disease and corpus callosum anomalies. Here we report a fetal case of MWS well described, suspected at standard autopsy. The association of a corpus callosum hypoplasia with a histological Hirschsprung disease and a typical facial gestalt allowed the guiding of genetic testing. Classical fetopathological examination still keeps indications in cases of syndromic association in the era of virtual autopsy.
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Affiliation(s)
- Emmanuel Spaggiari
- Department of Developmental Biology, Robert Debré Hospital, AP-HP, 48 Boulevard Sérurier, Paris, France.
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Dreux S, Salomon LJ, Muller F, Goffinet F, Oury JF, Sentilhes L. Second-trimester maternal serum markers and placenta accreta. Prenat Diagn 2012; 32:1010-2. [PMID: 22729439 DOI: 10.1002/pd.3932] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Lecarpentier E, Dreux S, Blanc T, Schaub B, Ville Y, Mandelbrot L, Ghoneimi AE, Oury JF, Muller F. Biochemical analysis of cystic fluid in the diagnosis of fetal intra-abdominal masses. Prenat Diagn 2012; 32:627-31. [DOI: 10.1002/pd.3871] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Edouard Lecarpentier
- Gynécologie Obstétrique; Hôpital Robert Debré, AP-HP, Université Paris-Diderot; Paris France
| | - Sophie Dreux
- Biochimie-Hormonologie; Hôpital Robert Debré, AP-HP; Paris France
| | - Thomas Blanc
- Chirurgie Viscérale et Urologie Pédiatrique; Hôpital Robert Debré, AP-HP, Université Paris-Diderot; Paris France
| | - Bruno Schaub
- Gynécologie Obstétrique; Centre Hospitalier Universitaire; Fort-de-France France
| | - Yves Ville
- Gynécologie Obstétrique; Hôpital Necker Enfants Malades, AP-HP; Paris France
| | | | - Alaa El Ghoneimi
- Chirurgie Viscérale et Urologie Pédiatrique; Hôpital Robert Debré, AP-HP, Université Paris-Diderot; Paris France
| | - Jean-François Oury
- Gynécologie Obstétrique; Hôpital Robert Debré, AP-HP, Université Paris-Diderot; Paris France
| | - Françoise Muller
- Biochimie-Hormonologie; Hôpital Robert Debré, AP-HP; Paris France
- Université Versailles Saint Quentin; Versailles France
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Al-Hazmi H, Dreux S, Delezoide AL, Dommergues M, Lortat-Jacob S, Oury JF, El-Ghoneimi A, Muller F. Outcome of prenatally detected bilateral higher urinary tract obstruction or megacystis: sex-related study on a series of 709 cases. Prenat Diagn 2012; 32:649-54. [PMID: 22544566 DOI: 10.1002/pd.3877] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 02/17/2012] [Accepted: 02/26/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the sex specific outcome of fetuses with prenatally detected urinary tract dilatation, with the exclusion of pyelectasia. METHOD Included in the study were 709 cases of major dilatation of the fetal urinary tract, diagnosed at routine ultrasound scan. For each sex group, cases were divided into two subgroups depending on the level of dilatation. Final diagnosis was based on postnatal evaluation or on fetal autopsy. Postnatal renal function was evaluated using serum creatinine at two years of age. RESULTS Bilateral higher urinary tract dilatation was prenatally observed in 148 (20.8%) and lower urinary tract obstruction or bladder dilatation in 561 (79.1%) of the 709 cases (121 female and 588 male fetuses) (P <0.001). Bladder dilatation was less frequent in female fetuses (62%) than in males (82.6%) (P <0.001). At final diagnosis, associated malformations were observed in 53.7% of female fetuses versus 11% in males (P <0.001). The survival rate was 42.7%. Postnatal renal function, evaluated in 289/303 live infants, was impaired in 29.7% of cases and depended on the level of obstruction, but not on the sex. CONCLUSION Prenatally detected urinary tract dilatation has a poor prognosis both in male and female fetuses. Associated malformations are observed more frequently in female than in male fetuses.
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Affiliation(s)
- Hamdan Al-Hazmi
- Department of Pediatric Surgery and Urology, Hôpital Robert Debré, AP-HP, University of Paris VII, Paris, France
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Guilherme R, Drunat S, Delezoide AL, Ray CL, Oury JF, Luton D. Zygosity and Chorionicity in the Prognosis of Triplet Pregnancies: Contribution of Microsatellites. Twin Res Hum Genet 2012; 11:648-55. [DOI: 10.1375/twin.11.6.648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractWe assess the prognostic values of zygosity and chorionicity in triplet pregnancies (TP) with the assistance of microsatellites analysis. 53 consecutive TP whose prenatal care and delivery occurred in our maternity hospital were included in this prospective study. Zygosity of all sets of triplets (alive or stillbirth, after 22 weeks of gestation) was determined by PCR-amplified microsatellites markers analysis. Chorionicity was determined by placental analysis in our fetopathology referral department and validated by molecular analysis of zygosity. Placental conformations, obstetrical and neonatal outcomes of TP were studied according to their zygosity and chorionicity. Monozygotic and to a greater extent, dizygotic TP were associated with an increase in placental ischemic injuries, velamentous cord insertions, twin-twin transfusion syndromes, fetal anomalies, and perinatal mortality when compared with the trizygotic TP (p<0.05). Monochorionic and more significantly, dichorionic TP presented with the same increases as trichorionic TP (p<0.05). Thus chorionicity easily determined by ultrasound evaluation during the first trimester of the pregnancy must remain the main prognosis criterion in TP. Taking into account the rare indications of prenatal diagnosis of zygosity, it became apparent that chorionicity has a greater impact than zygosity when distinguishing high-risk groups of TP.
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Vuillard E, Chitrit Y, Dreux S, Elghoneimi A, Oury JF, Muller F. Sonographic measurement of corpus spongiosum in male fetuses. Prenat Diagn 2011; 31:1160-3. [PMID: 21953058 DOI: 10.1002/pd.2854] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 08/03/2011] [Accepted: 08/03/2011] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To establish a nomogram of the corpus spongiosum dimensions in male fetuses and to evaluate its correlation with penile length. These references can be useful when fetal genital anomalies are suspected, particularly to distinguish micropenis from concealed penis cases. METHOD A cross-sectional prospective study was conducted on 486 fetuses of normal singleton pregnancies between 18 and 40 weeks. Corpus spongiosum length, penile length, penile diameter and scrotal diameter were measured by one operator. All measurements were analyzed according to gestational age. RESULTS The four measurements were studied as a function of gestational age. Median values, 3(rd) and 97(th) percentiles were determined using regression curves. A correlation between penile length and corpus spongiosum length (r(2) = 0.845) was observed. CONCLUSION We established measurements of the length of fetal corpus spongiosum and a correlation between the former and the penile length. These references can be useful when fetal genital anomalies are suspected.
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Affiliation(s)
- Edith Vuillard
- Gynécologie-Obstétrique, Hôpital Robert Debré, AP-HP, Paris, France
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Spiesser-Robelet L, Rouault A, Prot-Labarthe S, Bourdon O, Oury JF, Brion F, Gagnayre R. Analyse des besoins éducatifs des femmes allaitantes vis-à-vis de la prise de médicaments. ACTA ACUST UNITED AC 2010. [DOI: 10.1051/tpe/2010005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Boulkedid R, Sibony O, Bossu-Salvador C, Oury JF, Alberti C. Monitoring healthcare quality in an obstetrics and gynaecology department using a CUSUM chart. BJOG 2010; 117:1225-35. [PMID: 20560945 DOI: 10.1111/j.1471-0528.2010.02632.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To use cumulative sum (CUSUM) charts for the early detection of variations in quality of care in a maternity department. DESIGN Retrospective analysis of prospectively collected data. SETTING Maternity department of a teaching hospital in Paris (France). POPULATION Data from 20 519 women and 21 448 infants were collected between January 2000 and December 2007. METHODS CUSUM charts were used to monitor the rate of 19 pre-selected quality indicators over 3 years (2005-2007), against standards developed by department obstetrician gynaecologists. Periods with adverse event rates that did not meet the standards were identified. MAIN OUTCOME MEASURES Quality indicator rates. RESULTS Indicators fell into three groups based on the number of periods with unacceptable rates: less than one per year [e.g. the rate of intensive care unit (ICU) admission of mothers and rate of third- or fourth-degree perineal tears]; one every 2-12 months on average (e.g. blood transfusion and sulprostone use in the overall population of women); and at least one per month (insufficient availability of epidural analgesia). CONCLUSION CUSUM charts for a broad range of quality indicators can be used to monitor the quality of care in an obstetrics department. A prospective study investigating the ability of CUSUM-based monitoring to improve maternal and neonatal outcomes would be of interest.
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Affiliation(s)
- R Boulkedid
- AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, France.
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Saada J, Oudrhiri N, Bonnard A, de Lagausie P, Aissaoui A, Hauchecorne M, Oury JF, Aigrain Y, Peuchmaur M, Lehn JM, Lehn P, Luton D. Combining keratinocyte growth factor transfection into the airways and tracheal occlusion in a fetal sheep model of congenital diaphragmatic hernia. J Gene Med 2010; 12:413-22. [DOI: 10.1002/jgm.1451] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Garnier A, Dreux S, Vargas-Poussou R, Oury JF, Benachi A, Deschênes G, Muller F. Bartter syndrome prenatal diagnosis based on amniotic fluid biochemical analysis. Pediatr Res 2010; 67:300-3. [PMID: 19915517 DOI: 10.1203/pdr.0b013e3181ca038d] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [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: 11/06/2022]
Abstract
Bartter syndrome is an autosomic recessive disease characterized by severe polyuria and sodium renal loss. The responsible genes encode proteins involved in electrolyte tubular reabsorption. Prenatal manifestations, mainly recurrent polyhydramnios because of fetal polyuria, lead to premature delivery. After birth, polyuria leads to life-threatening dehydration. Prenatal genetic diagnosis needs an index case. The aim of this study was to analyze amniotic fluid biochemistry for the prediction of Bartter syndrome. We retrospectively studied 16 amniotic fluids of Bartter syndrome-affected fetuses diagnosed after birth, only six of them being genetically proven. We assayed total proteins, alpha-fetoprotein, and electrolytes and defined a Bartter index corresponding to the multiplication of total protein and of alpha-fetoprotein. Results were compared with two control groups matched for gestational age-non-Bartter polyhydramnios (n = 30) and nonpolyhydramnios (n = 60). In Bartter syndrome, we observed significant differences (p < 0.0001) for protein amniotic fluid levels when compared with the two control groups (1.55 g/L, 3.9 g/L, and 5.2 g/L, respectively) and low Bartter index (0.16, 0.82, and 1.0, respectively). No statistical difference was observed for electrolytes. In conclusion, Bartter syndrome can be prenatally suspected on amniotic fluid biochemistry (sensitivity 93% and specificity 100%), allowing appropriate management before and after birth.
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Affiliation(s)
- Arnaud Garnier
- Nephrologie Pediatrique, Hôpital Robert Debré AP-HP, Paris, France
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Guilherme R, Guimiot F, Tabet AC, Khung-Savatovsky S, Gauthier E, Nouchy M, Benzacken B, Verloes A, Oury JF, Delezoide AL, Aboura A. Abnormal muscle development of the diaphragm in a fetus with 2p14-p16 duplication. Am J Med Genet A 2010; 149A:2892-7. [PMID: 19938079 DOI: 10.1002/ajmg.a.33135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Romain Guilherme
- Department of Developmental Biology, AP-HP Robert Debré University Hospital, Paris Diderot University, Paris, France.
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Ceccaldi PF, Cohen S, Vuillard E, Guimiot F, Delezoide AL, Poujade O, Ducarme G, Oury JF, Luton D. Correlation between Colored Doppler Echography of Fetal Thyroid Goiters and Histologic Study. Fetal Diagn Ther 2010; 27:233-5. [DOI: 10.1159/000304269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 03/19/2010] [Indexed: 11/19/2022]
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Sermondade N, Dreux S, Oury JF, Muller F. Second-trimester maternal serum screening for Down syndrome in twin-to-twin transfusion syndrome. Prenat Diagn 2009; 29:814-5. [PMID: 19418465 DOI: 10.1002/pd.2285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Levaillant JM, Moeglin D, Zouiten K, Bucourt M, Burglen L, Soupre V, Baumann C, Jaquemont ML, Touraine R, Picard A, Vuillard E, Belarbi N, Oury JF, Verloes A, Vazquez MP, Labrune P, Delezoide AL, Gérard-Blanluet M. Binder phenotype: clinical and etiological heterogeneity of the so-called Binder maxillonasal dysplasia in prenatally diagnosed cases, and review of the literature. Prenat Diagn 2009; 29:140-50. [PMID: 19156647 DOI: 10.1002/pd.2167] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Prenatal Binder profile is a well known clinical phenotype, defined by a flat profile without nasal eminence, contrasting with nasal bones of normal length. Binder profile results of a hypoplasia of the nasal pyramid (sometimes referred to as maxillonasal dysplasia). We report 8 fetuses prenatally diagnosed as Binder phenotype, and discuss their postnatal diagnoses. METHODS Ultrasonographic detailed measurements in 2D and 3D were done on the 8 fetuses with Binder profile, and were compared with postnatal phenotype. RESULTS All fetuses have an association of verticalized nasal bones, abnormal convexity of the maxilla, and some degree of chondrodysplasia punctata. The final diagnoses included fetal warfarin syndrome (one patient), infantile sialic acid storage (one patient), probable Keutel syndrome (one patient), and five unclassifiable types of chondrodysplasia punctata. CONCLUSION This series demonstrates the heterogeneity of prenatally diagnosed Binder phenotype, and the presence of chondrodysplasia punctata in all cases. An anomaly of vitamin K metabolism, possibly due to environmental factors, is suspected in these mild chondrodysplasia punctata. We recommend considering early prophylactic vitamin K supplementation in every suspected acquired vitamin K deficiency including incoercible vomiting of the pregnancy.
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Affiliation(s)
- J M Levaillant
- Prenatal Diagnosis Unit, APHP Antoine Béclère University Hospital, Clamart, France
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Huel C, Guibourdenche J, Vuillard E, Ouahba J, Piketty M, Oury JF, Luton D. Use of ultrasound to distinguish between fetal hyperthyroidism and hypothyroidism on discovery of a goiter. Ultrasound Obstet Gynecol 2009; 33:412-420. [PMID: 19306478 DOI: 10.1002/uog.6315] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To determine whether sonography can be used to distinguish hyperthyroidism from hypothyroidism in pregnancies with fetal goiter. METHODS This was a retrospective study of 39 cases of fetal goiter. The majority of the mothers had Graves' disease. Fetuses were scanned for the existence of a hypertrophic thyroid gland (goiter) beginning at 22 gestational weeks. Once a goiter was diagnosed, different echographic features were analyzed and the effect of chosen treatment on fetal thyroid development was monitored. RESULTS On color Doppler, 68.8% of hypothyroid goiters had a peripheral vascular pattern vs. 20% in cases of fetal hyperthyroidism (P = 0.0574). No hypothyroid goiter presented central vascularization whereas half the hyperthyroid goiters did (P = 0.0013). Fetal tachycardia was a good indicator of hyperthyroidism (57.1% v.s 6.3%; P = 0.0055). Delayed bone maturation was seen in hypothyroid goiters (46.9% vs. 0%; P = 0.0307), while advanced bone maturity was specific to hyperthyroid goiters (85.7% vs. 0%; P < 0.0001). Lastly, an increase in fetal movement was observed in cases of fetal hypothyroidism (43.8% vs. 0%; P = 0.0364). CONCLUSION Based on the color Doppler pattern of goiter, fetal heart rate, bone maturation and fetal mobility, we established an ultrasound score to predict fetal thyroid function in cases of fetal goiter.
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Affiliation(s)
- C Huel
- Department of Perinatology, Robert Debré Hospital, Paris, France
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Tilea B, Alberti C, Adamsbaum C, Armoogum P, Oury JF, Cabrol D, Sebag G, Kalifa G, Garel C. Cerebral biometry in fetal magnetic resonance imaging: new reference data. Ultrasound Obstet Gynecol 2009; 33:173-181. [PMID: 19172662 DOI: 10.1002/uog.6276] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To provide normal magnetic resonance imaging (MRI) reference biometric data of the fetal brain, to evaluate reproducibility and gender effect, to compare the two cerebral hemispheres and to compare MRI with ultrasonographic biometry, in a large cohort. METHODS Normal cerebral fetal MRI examinations were collected prospectively and several parameters were measured: the supratentorial space (bone and cerebral fronto-occipital and biparietal (BPD) diameters), the length of the corpus callosum (LCC), the surface area, height and anteroposterior diameter of the vermis, the transverse cerebellar diameter (TCD) and the anteroposterior diameter of the pons. We evaluated the interobserver reproducibility of measurements and the possible gender effect on measurements of bone BPD, TCD and LCC. We compared right and left hemispheres, right and left atria and ultrasound and MRI measurements. RESULTS The study included 589 fetuses, ranging from 26 to 40 weeks. Normal values (from 3(rd) to 97(th) percentile) are provided for each parameter. Interobserver agreement was excellent, with an intraclass correlation coefficient (ICC) > 0.75 for many parameters. The gender effect was evaluated in 372 cases and did not reveal any clinically meaningful difference. Comparison between the right and left cerebral hemispheres and between the right and left atria did not reveal any meaningful differences. Ultrasound and MRI measurements of BPD and TCD were compared in 94 cases and 48 cases, respectively, and the agreement was excellent (ICC = 0.85). CONCLUSIONS We present new reproducible reference charts for cerebral MRI biometry at 26-40 weeks' gestation, from a large cohort of fetuses.
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Affiliation(s)
- B Tilea
- AP-HP, Hôpital Robert Debré, Service d'Imagerie Pédiatrique, Paris, France
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Guilherme R, Le Ray C, Vuillard E, Garel C, Delezoide AL, Oury JF, Luton D. Ultrasound assessment of the prognosis in triplet pregnancies. Acta Obstet Gynecol Scand 2009; 88:386-90. [DOI: 10.1080/00016340902792433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Garchet-Beaudron A, Dreux S, Leporrier N, Oury JF, Muller F. Second-trimester Down syndrome maternal serum marker screening: a prospective study of 11 040 twin pregnancies. Prenat Diagn 2008; 28:1105-9. [DOI: 10.1002/pd.2145] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Dreux S, Olivier C, Dupont JM, Leporrier N, Oury JF, Muller F. Maternal serum screening in cases of mosaic and translocation Down syndrome. Prenat Diagn 2008; 28:699-703. [DOI: 10.1002/pd.2051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Candito M, Rivet R, Herbeth B, Boisson C, Rudigoz RC, Luton D, Journel H, Oury JF, Roux F, Saura R, Vernhet I, Gaucherand P, Muller F, Guidicelli B, Heckenroth H, Poulain P, Blayau M, Francannet C, Roszyk L, Brustié C, Staccini P, Gérard P, Fillion-Emery N, Guéant-Rodriguez RM, Van Obberghen E, Guéant JL. Nutritional and genetic determinants of vitamin B and homocysteine metabolisms in neural tube defects: a multicenter case-control study. Am J Med Genet A 2008; 146A:1128-33. [PMID: 18386810 DOI: 10.1002/ajmg.a.32199] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Neural tube defects (NTDs) are severe congenital malformations due to failure of neural tube formation in early pregnancy. The proof that folic acid prevents NTDs raises the question of whether other parts of homocysteine (Hcy) metabolism may affect rates of NTDs. This French case-control study covered: 77 women aged 17-42 years sampled prior to elective abortion for a severe NTDs (cases) and 61 women aged 20-43 years with a normal pregnancy. Plasma and erythrocyte folate, plasma B6, B12 and Hcy were tested as five polymorphisms MTHFR 677 C --> T, MTHFR 1298 A --> C, MTR 2756 A --> G, MTTR 66 A --> G and TCN2 776 C --> G. Cases had significantly lower erythrocyte folate, plasma folate, B12 and B6 concentrations than the controls, and higher Hcy concentration. The odds ratio was 2.15 (95% CI: 1.00-4.59) for women with the MTRR 66 A --> G allele and it was decreased for mothers carrying the MTHFR 1298 A --> C allele. In multivariate analysis, only the erythrocyte folate concentration (P = 0.005) and plasma B6 concentration (P = 0.020) were predictors. Red cell folate is the main determinant of NTDs in France. Folic acid supplement or flour fortification would prevent most cases. Increased consumption of vitamins B12 and B6 could contribute to the prevention of NTDs. Genetic polymorphisms played only a small role. Until folic acid fortification becomes mandatory, all women of reproductive age should consume folic acid in a multivitamin that also contains B12 and B6.
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Affiliation(s)
- Mirande Candito
- Inserm U-145, Department of Biochemistry, CHU Nice Hôpital Pasteur, Nice, France.
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Huel G, Sahuquillo J, Debotte G, Oury JF, Takser L. Hair mercury negatively correlates with calcium pump activity in human term newborns and their mothers at delivery. Environ Health Perspect 2008; 116:263-7. [PMID: 18288328 PMCID: PMC2235233 DOI: 10.1289/ehp.10381] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [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: 04/19/2007] [Accepted: 11/15/2007] [Indexed: 05/04/2023]
Abstract
BACKGROUND Calcium homeostasis is a known target of several environmental toxicants including lead and mercury. OBJECTIVE Our goal was to determine the relationship between Hg exposure and erythrocyte Ca pump activity in women at delivery and in their newborns. METHODS We determined total Hg as well as Pb concentrations in 81 hair and blood samples obtained at delivery. Basal and calmodulin-stimulated Ca pump activity was measured in red blood cells from cord blood and maternal erythrocyte plasma membranes. RESULTS Maternal hair Hg negatively correlates with Ca pump activity in maternal and cord blood erythrocytes. Pb and Hg both independently correlate negatively with Ca pump activity without any statistically significant interaction. After adjustment for potential confounders, Pb and Hg explain about 30% and 7% of total variance of Ca pump activity in newborns and mothers, respectively. CONCLUSION Our findings confirm results reported in previous experimental studies and support the use of biomarkers in newborns from general population.
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Affiliation(s)
- Guy Huel
- Institut National de la Santé et de la Recherche Médicale (INSERM-IFR69-U780), Recherche en Épidemiologie et en Biostatistique, Villejuif, France
| | - Josiane Sahuquillo
- Institut National de la Santé et de la Recherche Médicale (INSERM-IFR69-U780), Recherche en Épidemiologie et en Biostatistique, Villejuif, France
| | - Ginette Debotte
- Institut National de la Santé et de la Recherche Médicale (INSERM-IFR69-U780), Recherche en Épidemiologie et en Biostatistique, Villejuif, France
| | - Jean-François Oury
- Département d’Obstétrique et Gynécologie, Hôpital Robert Debré, Paris, France
| | - Larissa Takser
- Département d’Obstétrique et Gynécologie, Faculté de Médecine, Université de Sherbrooke, Québec, Canada
- Address correspondence to L. Takser, Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e avenue Nord, Sherbrooke, Québec, Canada J1H 5N4. Telephone: 1-819-346-1110 ext 15809. Fax: 1-819-820-6434. E-mail:
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Tilea B, Delezoide AL, Khung-Savatovski S, Guimiot F, Vuillard E, Oury JF, Garel C. Comparison between magnetic resonance imaging and fetopathology in the evaluation of fetal posterior fossa non-cystic abnormalities. Ultrasound Obstet Gynecol 2007; 29:651-9. [PMID: 17476704 DOI: 10.1002/uog.4012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To compare magnetic resonance imaging (MRI) and fetopathological findings in the evaluation of non-cystic fetal posterior fossa anomalies and to describe associated abnormalities. METHODS This was a prospective study from 2000 to 2005 of fetuses identified on ultrasound as having sonographic suspicion of posterior fossa malformation. All underwent a thorough MRI examination of the fetal brain, after which we classified each fetus as presenting one of the following pathologies: vermian hypoplasia or agenesis, cerebellar and/or brain stem hypoplasia, destructive or dysplastic lesions. All of the pregnancies were then terminated, after which the whole fetus underwent fetopathological examination. We compared the findings from MRI and fetopathological examinations and recorded the associated cerebral and extracerebral abnormalities. RESULTS Twenty-five fetuses were included. MRI was performed at a mean gestational age of 31 weeks, and fetopathological examination at 33 weeks. In 12 cases we observed vermian hypoplasia, six had partial vermian agenesis, 11 had cerebellar hemisphere hypoplasia, seven had brain stem hypoplasia, four had destructive lesions and six had dysplastic lesions. The two techniques were similar in their performance with respect to the detection of vermian agenesis, brain stem hypoplasia and destructive lesions. There were four false-positive results of MRI for vermian hypoplasia and a poor agreement regarding cerebellar hemisphere hypoplasia. No dysplastic lesions were diagnosed by MRI. None of the posterior fossa malformations was isolated and many cerebral and extracerebral abnormalities were found. CONCLUSION A systematic analysis of the posterior fossa in fetal MRI makes it possible to diagnose accurately most posterior fossa malformations. These malformations never occurred in isolation in our study.
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Affiliation(s)
- B Tilea
- Service d'Imagerie Pédiatrique, Hôpital Robert Debré, AP-HP, Paris VII Denis Diderot University, Paris, France
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Abstract
OBJECTIVE To assess the efficacy of a new uterine compression suturing technique in reducing postpartum haemorrhage secondary to severe uterine atony. DESIGN Retrospective study. SETTING University hospital between December 2000 and March 2006. POPULATION Twenty women with uterine atony and postpartum bleeding that did not react to usual medical management. METHODS All these women underwent compression suturing of the uterus, in which the anterior and posterior walls of the uterus were attached so as to compress the uterus. MAIN OUTCOME MEASURES Arrest of the bleeding, complications and fertility. RESULTS Uterine compression suturing was sufficient to stop the bleeding immediately in 95% of the women. None of the women developed complications related to the procedure. All the women recovered normal menstrual cycles. Since uterine compression suturing, eight women have tried to conceive and six (75%) have had a term delivery. CONCLUSION Uterine compression suturing is a simple conservative procedure to stop postpartum haemorrhage in the case of failure of the usual management. This surgical technique can be performed quickly and does not seem to decrease fertility.
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Affiliation(s)
- J Ouahba
- Department of Obstetrics and Gynaecology, Robert Debré Hospital, Paris, France.
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Abstract
Neonates with gastroschisis have perivisceritis resulting from contact between the bowel and amniotic fluid. Here, we characterized the mediators involved in this inflammatory process in humans and ewes, to find a reliable marker of this process. We have diagnosed 41 cases of gastroschisis since 1995. Amniotic fluid sampled for karyotyping between 15 and 32 wk of gestation was also used to assay cytokines and inflammatory proteins. The findings were compared with those in 93 age-matched controls. Amniotic fluid cells were analyzed by means of cytology. Histologic examination of the bowel was performed when neonatal appendectomy was performed. The findings were compared with those obtained in a ewe model of gastroschisis. In gastroschisis, amniotic total protein, IL-6, IL-8, and ferritin levels were significantly higher than in controls. Gastroschisis was associated with significantly higher cell counts (mainly mononuclear cells) in amniotic fluid. At birth, macrophages were abundant in the fibrous peel covering the bowel. Similar results were obtained in the ewe model. Gastroschisis may be associated with a subchronic inflammatory process of variable intensity. This inflammation is restricted to the bowel wall and involves inflammatory cells such as macrophages, which may secrete ferritin, neopterin, and calprotectin.
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Abstract
OBJECTIVE To examine whether X-ray pelvimetry data to evaluate the likelihood of vaginal birth after previous cesarean section. DESIGN Retrospective study. SETTING University hospital. POPULATION Patients with a previous cesarean delivery who underwent X-ray pelvimetry and gave birth at gestational age 37 weeks during a seven-year period. METHODS 1190 patients with a scarred uterus were compared with 15,189 patients without a scarred uterus. In the scarred uterus group, 760 patients with a transverse pelvic diameter > or =12 cm were compared with 430 patients with a transverse pelvic diameter <12 cm. MAIN OUTCOME MEASURES The obstetrical outcomes were spontaneous or induced labor, and mode of delivery. The maternal morbidity outcomes were hemorrhage requiring transfusion of packed red cells, uterine rupture, bladder injury, and hysterectomy due to hemorrhage. The neonatal morbidity outcomes were the 5-min Apgar score, transfer to intensive care, and intubation. RESULTS Patients with a scarred uterus had a significantly higher rate of cesarean section (35.5%) than those with no prior cesarean section (9%). Among patients with a scarred uterus who were selected for vaginal delivery, 81% delivered vaginally when the transverse diameter (TD) of the pelvic inlet was greater than 12 cm, 68% when the TD was between 11.5 and 12 cm, and 58% when the TD was less than 11.5 cm. Maternal morbidity was significantly higher in the patients with a scarred uterus. The neonatal results were comparable in the different groups. CONCLUSION X-ray pelvimetry tailors the information given to each patient about the likelihood of having a vaginal delivery. It can also be used to optimize the selection of patients allowed to enter labor.
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Affiliation(s)
- Olivier Sibony
- Department of Obstetrics and Gynecology, Hospital Robert Debré, Paris, France.
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Abstract
OBJECTIVE To define the contribution of prenatal investigation and evaluate the prognosis of isolated mild ventriculomegaly (IMV). DESIGN Retrospective study. SETTING University hospital between January 1992 and December 2002. POPULATION One hundred and sixty-seven cases of prenatal unilateral or bilateral IMV without any associated anomaly at the time of initial diagnosis. METHODS Complementary investigations were performed: amniocentesis with karyotyping, screening for viruses and acetylcholinesterase electrophoresis, magnetic resonance imaging (MRI), and ultrasonography every 3-4 weeks. MAIN OUTCOME MEASURES Results of prenatal investigations, pregnancy outcome, and postnatal psychomotor development. RESULTS IMV was diagnosed around 26.5 weeks. Amniocentesis revealed four chromosomal anomalies and two cytomegalovirus infections. MRI diagnosed brain-associated anomalies in 15 cases and ultrasonographic monitoring highlighted malformations not initially diagnosed in 28 cases. Termination of pregnancy (TOP) was considered in 21 pregnancies (12.6%). Indications were aneuploidy, fetal infectious disease or associated malformations. In women for whom a TOP was considered, consanguinity, fetus of female sex and frontal horn enlargement were statistically more frequent, ventriculomegaly was more often bilateral and asymmetrical, atrial width, and the rate of progressive ventricular enlargement were significantly higher. One hundred and one children with prenatal IMV were assessed between 19 and 127 months (mean age 54.68 +/- 2.87 months). Twelve children had neurological disease or psychomotor delay and 89 children had a normal psychomotor development. Poor neurological outcome was more often associated with atrial width greater than or equal to 12 mm, asymmetrical bilateral enlargement, and progression of the ventriculomegaly. CONCLUSION The detection of IMV raises the question of the child's psychomotor development and justifies meticulous prenatal investigation. In addition to associated anomalies, three criteria are often associated with an unfavourable outcome: atrial width greater than 12 mm, progression of the enlargement, and asymmetrical and bilateral ventriculomegaly.
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Affiliation(s)
- J Ouahba
- Department of Prenatal Diagnosis, Robert Debré Hospital, Paris, France.
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