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Modified Delphi study of ultrasound signs associated with placenta accreta spectrum. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:518-525. [PMID: 36609827 DOI: 10.1002/uog.26155] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To determine, by expert consensus through a modified Delphi process, the role of standardized and new ultrasound signs in the prenatal evaluation of patients at high risk of placenta accreta spectrum (PAS). METHODS A systematic review of articles providing information on ultrasound imaging signs or markers associated with PAS was performed before the development of questionnaires for the first round of the Delphi process. Only peer-reviewed original research studies in the English language describing one or more new ultrasound sign(s) for the prenatal evaluation of PAS were included. A three-round consensus-building Delphi method was then conducted under the guidance of a steering group, which included nine experts who invited an international panel of experts in obstetric ultrasound imaging in the evaluation of patients at high risk for PAS. Consensus was defined as agreement of ≥ 70% between participants. RESULTS The systematic review identified 15 articles describing eight new ultrasound signs for the prenatal evaluation of PAS. A total of 35 external experts were approached, of whom 31 agreed and participated in the first round. Thirty external experts (97%) and seven experts from the steering group completed all three Delphi rounds. A consensus was reached that a prior history of at least one Cesarean delivery, myomectomy or PAS should be an indication for detailed PAS ultrasound assessment. The panelists also reached a consensus that seven of the 11 conventional signs of PAS should be included in the examination of high-risk patients and the routine mid-gestation scan report: (1) loss of the 'clear zone', (2) myometrial thinning, (3) bladder-wall interruption, (4) placental bulge, (5) uterovesical hypervascularity, (6) placental lacunae and (7) bridging vessels. A consensus was not reached for any of the eight new signs identified by the systematic review. With respect to other ultrasound features that are not specific to PAS but increase the probability of PAS at birth, the panelists reached a consensus for the finding of anterior placenta previa or placenta previa with cervical involvement. The experts were also asked to determine which PAS signs should be quantified and consensus was reached only for the quantification of placental lacunae using an existing score. For predicting surgical outcome in patients with a high probability of PAS at delivery, a consensus was obtained for loss of the clear zone, bladder-wall interruption, presence of placental lacunae and presence of placenta previa involving the cervix. CONCLUSIONS We have confirmed the continued importance of seven established standardized ultrasound signs of PAS, highlighted the role of transvaginal ultrasound in evaluating the placental position and anatomy of the cervix, and identified new ultrasound signs that may become useful in the future prenatal evaluation and management of patients at high risk for PAS at birth. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Abstract
Importance Approximately 60% of women develop a uterine niche after a cesarean delivery (CD). A niche is associated with various gynecological symptoms including abnormal uterine bleeding, pain, and infertility, but there is little consensus in the literature on the distinction between the sonographic finding of a niche and the constellation of associated symptoms. Objective To achieve consensus on defining the clinical condition that constitutes a symptomatic uterine niche and agree upon diagnostic criteria and uniform nomenclature for this condition. Design, Setting, and Participants A consensus based modified electronic Delphi (eDelphi) study, with a predefined Rate of Agreement (RoA) of 70% or higher. Experts were selected according to their expertise with niche-related consultations, publications, and participation in expert groups and received online questionnaires between November 2021 and May 2022. Main Outcomes and Measures Definition, nomenclature, symptoms, conditions to exclude, and diagnostic criteria of an illness caused by a symptomatic uterine niche. Results In total, 31 of the 60 invited experts (51.7%) participated, of whom the majority worked in university-affiliated hospitals (28 of 31 [90.3%]), specialized in benign gynecology (20 of 31 [64.5%]), and worked in Europe (24 of 31 [77.4%]). Three rounds were required to achieve consensus on all items. All participants underlined the relevance of a new term for a condition caused by a symptomatic niche and its differentiation from a sonographic finding only. Experts agreed to name this condition cesarean scar disorder, defined as a uterine niche in combination with at least 1 primary or 2 secondary symptoms (RoA, 77.8%). Defined primary symptoms were postmenstrual spotting, pain during uterine bleeding, technical issues with catheter insertion during embryo transfer, and secondary unexplained infertility combined with intrauterine fluid. Secondary symptoms were dyspareunia, abnormal vaginal discharge, chronic pelvic pain, avoiding sexual intercourse, odor associated with abnormal blood loss, secondary unexplained infertility, secondary infertility despite assisted reproductive technology, negative self-image, and discomfort during participation in leisure activities. Consensus was also achieved on certain criteria that should be met and conditions that should be excluded before making the diagnosis. Conclusions and Relevance In this modified Delphi study, a panel of 31 international niche experts reached consensus for the constellation of symptoms secondary to a uterine niche and named it cesarean scar disorder.
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[Uterine rupture in a patient with a cesarean scar pregnancy]. REVUE MEDICALE DE LIEGE 2022; 77:202-205. [PMID: 35389002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Caesarean scar pregnancy is a rare form of ectopic pregnancy, but it is increasingly common due to the increasing number of caesarean sections and advances in medical imaging. There are two types of cesarean scar pregnancy depending on the depth of the implantation : endogenous type I and exogenous type II. In the case of a pregnancy resulting from a type II caesarean scar, the main complication is uterine rupture, which could be life-threatening for the patient. Early diagnosis and treatment are therefore essential for the woman. We report the case of a patient in early pregnancy with a history of cesarean section who presented with severe pelvic pain due to uterine rupture.
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[Twin pregnancy and polymalformative syndrome by Enterovirus]. REVUE MEDICALE DE LIEGE 2020; 75:489-493. [PMID: 32779895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Prenatal diagnosed congenital infection by Enterovirus is rarely described in the literature. A few casereports describe severe abnormalities observed by ultrasound that have led to spontaneous intrauterine demise or early death of the newborn. We report the case of a dichorionic diamniotic twin pregnancy. At 24 weeks of gestation, the second trimester ultrasound examination shows cardiac, brain and abdominal abnormalities in one of the fetuses. The other fetus has a normal appearance. "Standard" serological tests conducted on the mother are negative and amniocentesis reveals no genetic abnormality. After birth, Reverse Transcription Polymerase Chain Reaction (PCR) on samples of blood, ascites and stool reveals to be positive for Enterovirus in both newborns. Both are viable and exhibit severe brain abnormalities with severe neurological sequelae such as cerebral palsy, visual and hearing impairment. This case report illustrates the difficulty of prenatal diagnosis of congenital Enterovirus infection and informs about its possible neurological sequelae.
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From first-trimester screening to risk stratification of evolving pre-eclampsia in second and third trimesters of pregnancy: comprehensive approach. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:5-12. [PMID: 31503374 DOI: 10.1002/uog.21869] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/30/2019] [Indexed: 06/10/2023]
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A proposal for standardized magnetic resonance imaging (MRI) descriptors of abnormally invasive placenta (AIP) - From the International Society for AIP. Diagn Interv Imaging 2019; 100:319-325. [PMID: 30853416 DOI: 10.1016/j.diii.2019.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 11/29/2022]
Abstract
Abnormally invasive placenta (AIP) is used to describe a placenta that does not separate naturally after delivery and cannot be extirpated without causing abnormally high blood loss. Recently, the use of a standardized terminology for descriptors of AIP signs seen on ultrasound has been prosed but to date no such unified descriptors have been developed for magnetic resonance imaging (MRI). The purpose of this paper is to propose a unified terminology based on a consensus opinion from the members of the International Society for AIP (IS-AIP) that include obstetricians, gynecologists, radiologists, pathologists, anesthesiologists and basic science researchers. We assume that using these standardized MRI descriptors for AIP will be useful for clinical use, education, teaching and future research projects, thus assumably improving care of patients with this condition. In addition, using a uniform terminology for AIP should become the first step of a standardized MRI report.
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Abnormally adherent and invasive placenta: a spectrum disorder in need of a name. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:165-166. [PMID: 29231264 PMCID: PMC6402048 DOI: 10.1002/uog.18982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 06/07/2023]
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[Use of sFlt-1/PlGF ratio in preeclampsia : a monocentric retrospective analysis]. REVUE MEDICALE DE LIEGE 2017; 72:393-398. [PMID: 28892314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Soluble Fms-like tyrosine kinase 1 (sFlt-1) is an anti-angiogenic factor released in higher amounts in preeclampsia and implicated in endothelial dysfunction. sFlt-1/PlGF ratio is used in the prediction of preeclampsia. An sFlt-1/PlGF ratio inferior to 38 predicts the short-term absence of preeclampsia. A ratio ? 85 (early-onset PE) or ? 110 (late-onset of PE) could diagnose preeclampsia. In this study, sFlt-1/PlGF ratio has been measured in 183 patients. Sixty-seven preeclampsia have been diagnosed preeclamptic at delivery. The median sFlt-1/PlGF ratio was 100.3. The median ratio among women with preeclampsia (N=67) versus no preeclampsia (N=116) was 212.7 versus 35.4. In accordance with this analysis, an sFlt-1/PlGF ratio ? 38 has a sensibility of 95,5 % and a specificity of 73.3 %. The positive predictive value and the negative predictive value were 67.4 % and 96.6 %, respectively. These results suggest that sFlt-1/PlGF ratio is helpful in the diagnosis of preeclampsia.
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Re: Prediction of delivery time in second stage of labor using transperineal ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:663-664. [PMID: 28471029 DOI: 10.1002/uog.17424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/20/2016] [Indexed: 06/07/2023]
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Computed tomography and ultrasound to determine fetal head station. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:279-280. [PMID: 28169500 DOI: 10.1002/uog.17291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 04/15/2016] [Indexed: 06/06/2023]
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11
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Angiogenic factors and prediction of adverse pregnancy outcomes in suspected preeclampsia: the PROGNOSIS study. Pregnancy Hypertens 2017. [DOI: 10.1016/j.preghy.2016.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Re: Angle of fetal head progression measured using transperineal ultrasound as a predictive factor of vacuum extraction failure. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:668-669. [PMID: 27854391 DOI: 10.1002/uog.17313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/03/2016] [Indexed: 06/06/2023]
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13
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Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:271-275. [PMID: 26205041 DOI: 10.1002/uog.14952] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 06/30/2015] [Accepted: 07/12/2015] [Indexed: 05/26/2023]
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14
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Pilotstudie – sFLT1 and PLGF als Serummarker zur Detektion der abnorm invasiven Plazenta (AIP). Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Prädiktion der Präeklampsie mit dem sFlt-1/PlGF-Quotienten – die PROGNOSIS-Studie. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1548681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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16
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Implementation of the sFlt-1/PlGF ratio for prediction and diagnosis of pre-eclampsia in singleton pregnancy: implications for clinical practice. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:241-6. [PMID: 25736847 PMCID: PMC4369131 DOI: 10.1002/uog.14799] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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17
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Biomechanics analysis of the ilio-psoas transfer related to the lumbosacral myelomeningocele. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Implanted functional electrical stimulation of the fibularis communis nerve: Impacts on gait quality and consequences on cerebral cortex activity. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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[Mirror syndrome: a case report in fetal medicine]. REVUE MEDICALE DE LIEGE 2013; 68:440-443. [PMID: 24180198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Mirror syndrome is a rare entity describing the association of foetal hydrops and maternal symptoms as general oedema and excessive weight gain mimicking preeclampsia. We report the case of a patient who developed symptoms of oedema, weight gain, headache and biological hemodilution associated with foetal hydrops due to a complex congenital heart defect. This symptomatology spontaneously resolved after foetal expulsion. Mirror or Ballantyne's syndrome needs to be identified on time and well differentiated from preeclampsia. Its consequences may involve the maternal and foetal prognosis.
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Investigation on Detergent Tablet Stability: from Raw Materials to Tablet Properties. TENSIDE SURFACT DET 2013. [DOI: 10.3139/113.100288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
The aim of this study is to investigate the functional characteristics (mechanical strength, disintegration and dissolution) of effervescent detergent tablets with chlorine provider under various storage conditions. The contribution of surfactant to the tablet stability was studied by comparing tablets without and with surfactant. After one year of storage in polypropylene tubes, the properties were modified for both formulas but the way to reach the end-point was different. In order to precise the influence of relative humidity, the tablets were exposed to controlled humidity levels, after a preliminary drying stage: with the surfactant, stability was better at lower humidity but for higher relative humidity, tablet properties were affected to a larger extent, compared to the formula without surfactant. Raman spectroscopy pointed out modifications of effervescent couple with humidity indicating i) a beginning of effervescence in the tablets and ii) the limiting effect of the surfactant on this phenomenon.
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[Addictions and pregnancy : how to ruin a pregnancy]. REVUE MEDICALE DE LIEGE 2013; 68:239-244. [PMID: 23888571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Pregnant women are well aware that any addiction during pregnancy can be harmful to the child. In spite of this knowledge, many continue to smoke, to drink alcohol, to consume illicit drugs or to absorb medicines because these dependences are particularly strong. Tobacco, alcohol, cocaine and ecstasy represent the most dangerous substances as regards foetal damage. The period of pregnancy is the optimal moment to stop these addictions. It is therefore essential to raise awareness among the general public, policy makers, and physicians of the fact that addictions during pregnancy cause a disparity in terms of future health and life expectancy of the unborn child.
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[Adenomyosis]. REVUE MEDICALE DE LIEGE 2013; 68:160-162. [PMID: 23755704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Adenomyosis is a medical benign condition of the endometrium-myometrium interface that is histopathologically characterized by the presence of ectopic tissue (endometrial glands and stroma) in myometrium. The diagnosis is complicated by the low specificity of its symptoms and the frequent associations with others gynaecologic pathologies. Consequently, paraclinic investigations are essential to make the diagnosis.
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Quantification of fetal head direction and descent. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:99-100. [PMID: 23280737 DOI: 10.1002/uog.12351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Teaching and learning normal gynecological ultrasonography using simple virtual reality objects: a proposal for a standardized approach. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:595-596. [PMID: 22492592 DOI: 10.1002/uog.11090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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25
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[Pseudoxanthoma elasticum and obstetric epidural analgesia: report of a case]. ACTA ACUST UNITED AC 2011; 30:685-7. [PMID: 21705175 DOI: 10.1016/j.annfar.2011.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 05/18/2011] [Indexed: 11/16/2022]
Abstract
Pseudoxanthoma elasticum is a rare inherited disorder of the elastic tissue characterised by multisystem manifestations. Skin, eyes, gastro-intestinal system and cardiovascular system are the major affected systems. We describe the anaesthetic management of a parturient affected by this disease.
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[X-linked hydrocephaly. A case report in fetal medicine]. REVUE MEDICALE DE LIEGE 2011; 66:126-129. [PMID: 21560427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
X-linked hydrocephaly (Li Syndrome) is a rare cause of hydrocephaly. It is, however, the most common genetic form of congenital hydrocephaly and consists of the association of hydrocephaly, mental retardation, leg spasticity and adducted thumbs. The phenotype is variable. A mutation of the LICAM gene is known to be the aetiology of the syndrome. We present an antenatal case managed in our department.
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A study of progress of labour using intrapartum translabial ultrasound, assessing head station, direction, and angle of descent. BJOG 2010; 118:62-9. [DOI: 10.1111/j.1471-0528.2010.02775.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Maternal plasma soluble endoglin at 11-13 weeks' gestation in pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:680-687. [PMID: 20205159 DOI: 10.1002/uog.7621] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To examine the performance of screening for pre-eclampsia (PE) by a combination of maternal factors, soluble endoglin (sEng), pregnancy associated plasma protein-A (PAPP-A), placental growth factor (PlGF) and uterine artery lowest pulsatility index (L-PI) at 11-13 weeks' gestation. METHODS Uterine artery L-PI, sEng, PAPP-A and PlGF were measured at 11-13 weeks in 90 singleton pregnancies that subsequently developed PE, including 30 that required delivery before 34 weeks (early PE) and 60 with late PE, and 180 unaffected controls. Screening performance for PE by maternal factors, sEng, PAPP-A, PlGF and uterine artery L-PI and their combinations was determined. RESULTS In early PE, compared to controls, plasma sEng and uterine L-PI were significantly increased and serum PAPP-A and PlGF were decreased. In late PE, compared to controls, serum PlGF was decreased and uterine L-PI was increased but plasma sEng and serum PAPP-A were not significantly different. In screening for early PE, the detection rate for a 10% false-positive rate was 46.7% for sEng alone and 96.3% for a combination of maternal factors, sEng, PlGF and uterine artery L-PI. CONCLUSIONS Effective screening for early PE can be provided by a combination of maternal factors, sEng, PlGF and uterine artery L-PI at 11-13 weeks' gestation.
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[Treatment of severe preeclampsia: until when and for what risks/benefits?]. REVUE MEDICALE DE LIEGE 2009; 64:620-625. [PMID: 20143745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The four major hypertensive disorders related to pregnancy are preeclampsia, chronic hypertension, preeclampsia superimposed upon chronic hypertension, and gestational hypertension. The development of hypertension and proteinuria in pregnancy is usually due to preeclampsia, particularly in a primigravida. These findings typically become apparent in the latter part of the third trimester and progress until delivery, but some women develop symptoms in the latter half of the second trimester, or intrapartum, or the early postpartum period. Preeclampsia is characterized as mild or severe. Severe hypertension, coagulopathy, thrombocytopenia, liver function abnormalities, and fetal growth restriction are features of severe disease. Laboratory evaluation should assess haemoglobin/hematocrit and platelet count, renal and hepatic function, as well as assessment of fetal well-being and growth. Timing of delivery is based upon gestational age, maternal and fetal condition, and the severity of preeclampsia. Maternal end organ dysfunction and nonreassuring tests of fetal well-being are indications for delivery at any gestational age. Antihypertensive treatment aims at protecting the mother from severe hypertensive encephalopathy, but may jeopardize the fetus. We recommend antenatal corticosteroids (betamethasone) be given to women with preeclampsia at 26 to 34 weeks of gestation. Magnesium sulfate is more effective than phenytoin for prevention of eclamptic seizures.
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Association rare d’un choriangiome et d’une hémangiomatose néonatale diffuse. ACTA ACUST UNITED AC 2009; 38:246-9. [DOI: 10.1016/j.jgyn.2008.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Revised: 08/27/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022]
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[How I explore...the benefit of 3D/4D ultrasound in obstetrics]. REVUE MEDICALE DE LIEGE 2008; 63:153-157. [PMID: 18561772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
During recent years, 3D has become an important tool in ultrasound. In obstetrics, the classic 2D examination with Doppler is now often completed by 3D. In this article the strengths and weaknesses of this technique are discussed.
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Utilisation de fortes doses de toxine botulique de type A chez l'enfant: intérêt et sécurité en pratique clinique. ACTA ACUST UNITED AC 2007; 50 Suppl 1:S7-S11. [PMID: 17550812 DOI: 10.1016/s0168-6054(07)80003-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The purpose of this article is to examine the current state of administering high doses botulinum toxin type A for the treatment of childhood spasticity, particularly Cerebral Palsy. The inter-relationship between the Cerebral Palsy neurological maturation and the early management is discussed, including identification of common gait patterns and the choice of target muscles for focal or multi focal spasticity management. High doses of botulinum toxin type A, when multilevel and integrated management approach is indicated, appear to be a safe, efficacious treatment for multi focal Cerebral Palsy spasticity. A review of literature guides the clinician about necessary adaptation of botulinum toxin doses and found no evidence that higher doses result in a increase of complications. Further studies would be interesting in order to evaluate long term safety and efficacy of this therapy in Cerebral Palsy.
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Quantitative Volumenflussmessung in der fetalen Vena umbilicalis zwischen 11 und 14 SSW: eine Pilot-Studie. Z Geburtshilfe Neonatol 2005. [DOI: 10.1055/s-2005-923189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Volumenflussmessung in der fetalen intraabdominalen Nabelschnurvene: Vergleich zweier Methoden. Z Geburtshilfe Neonatol 2004. [DOI: 10.1055/s-2003-818104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Placenta percreta: Diagnostik und Therapie, Fallserie (n=7). Z Geburtshilfe Neonatol 2004. [DOI: 10.1055/s-2003-818127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Placenta percreta: Diagnostische und therapeutische Überlegungen – Fallserie aus zwei Universitätsfrauenkliniken. Geburtshilfe Frauenheilkd 2003. [DOI: 10.1055/s-2003-815186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Quantitative Messung des fetalen Nabelvenenflusses: Vergleich zweier Methoden, Normalwerte im Schwangerschaftsverlauf und mögliche klinische Anwendung. Geburtshilfe Frauenheilkd 2003. [DOI: 10.1055/s-2003-815139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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[Measurement of volume flow by "colour velocity imaging (CVI)": technique of measurement in the intrahepatic fetal umbilical vein]. ZENTRALBLATT FUR GYNAKOLOGIE 2003; 125:179-82. [PMID: 14556095 DOI: 10.1055/s-2003-42909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
"Colour Velocity Imaging (CVI)" permits acquisition of ultrasound Doppler data for quantitative analysis. CVI can be used to study the fetal circulation. In a pilot study we attempted measuring umbilical venous flow. Data acquisition is simple and fast. In the current implementation, data is sent to a work-station and analysed off-line. There is significant "intra-observer-variability" that could be attributable to true physiological variation or measurement inaccuracies. Measurement of fetal umbilical volume flow by CVI is a new and simple technique. Before its clinical use assumptions about the vessel, flow, variability and normal values must be verified in the fetus.
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Abstract
The energy cost of walking (C) in nine chronic hemiparetic patients was calculated by measuring the total mechanical work (Wtot) done by the muscles and the efficiency of this work production (eta). The energy cost was twice normal in slow walkers and 1.3 times greater in fast walkers. The increase in C was proportional to the increase in Wtot and eta was normal at around 20%, despite an increase in muscle tone and muscle co-contractions. This type of approach gives a greater understanding into how segmental impairments increase Wtot and C and contribute to a patient's disability.
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