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Hermann M, Khoshnood B, Anselem O, Bouvattier C, Coussement A, Brisset S, Benachi A, Tsatsaris V. Lack of consensus in the choice of termination of pregnancy for Turner syndrome in France. BMC Health Serv Res 2019; 19:994. [PMID: 31870363 PMCID: PMC6929477 DOI: 10.1186/s12913-019-4833-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The observed rate of termination of pregnancy (TOP) for Turner syndrome varies worldwide and even within countries. In this vignette study we quantified agreement among ten multidisciplinary prenatal diagnosis centers in Paris. METHODS We submitted online three cases of Turner syndrome (increased nuchal translucency, normal ultrasound, aortic coarctation) to fetal medicine experts: one obstetrician, one pediatrician and one geneticist in each of the ten Parisian centers. Each case was presented in the form of a progressive clinical history with conditional links dependent upon responses. The background to each case was provided, along with the medical history of the parents and the counseling they got from medical staff. The experts indicated online whether or not they would accept the parents' request for TOP. We assessed the percentage of agreement for acceptance or refusal of TOP. We also used a multilevel logistic regression model to evaluate differences among obstetrician-gynecologists, pediatricians and cytogeneticists. RESULTS Overall agreement among the experts to accept or refuse TOP was, respectively, 25 and 28%. The percentage of disagreement was 47%. The percentage of agreement to accept TOP was 33, 8 and 33% for obstetrician-gynecologists, pediatricians and cytogeneticists, respectively. The respective percentages of agreement to refuse TOP were 19, 47 and 26%. CONCLUSION Our results show the lack of consensus with regard to decisions related to termination of pregnancy for Turner Syndrome. This lack of consensus in turn underscores the importance of multidisciplinary management of these pregnancies in specialized fetal medicine centers.
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Affiliation(s)
- Monika Hermann
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris-Sud, Assistance-Publique Hôpitaux de Paris, Clamart, France. .,Université Paris Sud, Le Kremlin-Bicêtre, France.
| | - Babak Khoshnood
- INSERM U1153 - Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé) centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité (CRESS), Paris, France
| | - Olivia Anselem
- Maternité de Port Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Claire Bouvattier
- Service d'endocrinologie pédiatrique, Hopital Bicêtre, Hôpitaux Universitaires Paris-Sud, Assistance-Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Aurélie Coussement
- Service de cytogénétique, Hôpital Cochin, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Sophie Brisset
- Université Paris Sud, Le Kremlin-Bicêtre, France.,Service de d'histologie, embryologie et cytogénétique, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris-Sud, Assistance-Publique Hôpitaux de Paris, Clamart, France
| | - Alexandra Benachi
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris-Sud, Assistance-Publique Hôpitaux de Paris, Clamart, France.,Université Paris Sud, Le Kremlin-Bicêtre, France
| | - Vassilis Tsatsaris
- Maternité de Port Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance-Publique Hôpitaux de Paris, Paris, France.,Université René Descartes, Paris, France
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Pregnancies and obstetrical prognosis after oocyte donation in Turner Syndrome: A multicentric study. Eur J Obstet Gynecol Reprod Biol 2019; 238:73-77. [PMID: 31121341 DOI: 10.1016/j.ejogrb.2019.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/19/2019] [Accepted: 05/10/2019] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Turner syndrome is one of the most frequent chromosomal abnormalities in women, with a prevalence estimated to be 1 of 2500 live birth. Pregnancy in women with Turner syndrome is known to be at high risk, whether it is spontaneous or after oocyte donation, because of miscarriages and potential cardio-vascular complications which can be life-threatening. All of these patients should therefore be screened with a comprehensive cardio-vascular assessment before pregnancy, and have a close follow-up during and after pregnancy. PATIENTS AND METHODS It is a retrospective study, conducted in 10 of the 27 French oocyte donation centers between 2012 and 2016, on all the patients presenting with Turner syndrome included in an oocyte donation program. RESULTS 151 embryo transfers were realized in 73 patients, resulting in 39 pregnancies. Among these pregnancies, 24 children were born healthy, 11 spontaneous miscarriages, 3 voluntary abortions, 1 extra-uterine pregnancy and 1 maternal death from non-cardio-vascular origin occurred. Pregnancies were complicated by gravid arterial hypertension in 28.2% of cases, preeclampsia in 10.3% of cases, and gestational diabetes in 7.7% of cases. CONCLUSION This study bring out obstetrical complications of the same magnitude than the ones described in the literature. Lead over a period of 4 years, in 10 French oocyte donation centers, it doesn't reveal any cardio-vascular complications, conversely to other studies published before French and American recommendations. This study reinforces the usefulness of specific recommendations for the care of these particular patients.
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Bucerzan S, Miclea D, Popp R, Alkhzouz C, Lazea C, Pop IV, Grigorescu-Sido P. Clinical and genetic characteristics in a group of 45 patients with Turner syndrome (monocentric study). Ther Clin Risk Manag 2017; 13:613-622. [PMID: 28496331 PMCID: PMC5422538 DOI: 10.2147/tcrm.s126301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Introduction Recent years have seen a shift in perspective on Turner syndrome, as it is no longer considered a significant disability due to therapeutic advances. The delay of diagnosis and the underdiagnosis are common in Turner syndrome, especially because of the great phenotypic variability and lack of firm diagnostic criteria. Aim Our first aim was to assess the clinical and the cytogenetic characteristics and growth rate in growth hormone (GH)-treated patients as compared to those with spontaneous growth. The second aim was to analyze the Y chromosomal sequences. Materials and methods We analyzed 45 patients diagnosed with Turner syndrome in Genetic Pathology Centre of Cluj Emergency Children’s Hospital. We carried out a study of the clinical features, the correlations between the karyotype and the phenotype, and we also made a research of Y chromosome sequences. Results The average age at diagnosis was 8.9±5.4 years. A significant association was observed between the number of external phenotypical abnormalities and internal malformations (r=0.45), particularly the cardiovascular ones (r=0.44). Patients treated with GH showed improvement in growth rate, with final stature significantly better than in untreated patients; benefits following treatment were greater if diagnosis was made before the age of 5 years. Thirteen percent of patients experienced spontaneous and complete puberty, whereas 30% experienced incomplete puberty. Patients with the 45,X genotype had a greater stature deficit and a higher incidence of cardiac malformations, compared with patients with 45,X/46,XX mosaic karyotype. Y chromosome sequences were found in only one patient, who subsequently underwent gonadectomy. Conclusion The importance of this study resides, to the best of our knowledge, in the fact that the largest group of patients in Romania was analyzed and assessed. To draw firm conclusions on the most valuable clinical indicators for Turner syndrome diagnosis in clinical practice, studies on large groups of patients should be conducted.
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Affiliation(s)
- Simona Bucerzan
- Emergency Hospital for Children, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Diana Miclea
- Emergency Hospital for Children, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Molecular Sciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Popp
- Department of Molecular Sciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Camelia Alkhzouz
- Emergency Hospital for Children, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cecilia Lazea
- Emergency Hospital for Children, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan Victor Pop
- Department of Molecular Sciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Paula Grigorescu-Sido
- Emergency Hospital for Children, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Chaker F, Chihaoui M, Yazidi M, Bouyahia M, Slimane H. Pheochromocytoma in a 45 X, iso (Xq) Turner syndrome. ANNALES D'ENDOCRINOLOGIE 2016; 77:57-9. [PMID: 26874993 DOI: 10.1016/j.ando.2016.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 01/08/2016] [Accepted: 01/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Fatma Chaker
- University of Tunis El Manar, Rabta University Hospital, Faculty of Medicine, Department of Endocrinology and Diabetes, Tunis, Tunisia.
| | - Melika Chihaoui
- University of Tunis El Manar, Rabta University Hospital, Faculty of Medicine, Department of Endocrinology and Diabetes, Tunis, Tunisia.
| | - Meriem Yazidi
- University of Tunis El Manar, Rabta University Hospital, Faculty of Medicine, Department of Endocrinology and Diabetes, Tunis, Tunisia.
| | - Maha Bouyahia
- University of Tunis El Manar, Aziza othmana University Hospital, Faculty of Medicine, Department of gynocology, Tunis, Tunisia.
| | - Hedia Slimane
- University of Tunis El Manar, Rabta University Hospital, Faculty of Medicine, Department of Endocrinology and Diabetes, Tunis, Tunisia.
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[Pemphigoid gestationis and Turner syndrome; an uncommon association]. ACTA ACUST UNITED AC 2015; 44:675-8. [PMID: 25613827 DOI: 10.1016/j.jgyn.2014.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/31/2014] [Accepted: 12/01/2014] [Indexed: 11/23/2022]
Abstract
The authors report an uncommon case of a pregnant woman with Turner syndrome (TS) whose pregnancy (with favorable outcome) was complicated by a pemphigoid gestationis in third trimester. This case points out that monitoring of these pregnancies is not limited to cardiac monitoring. Prevalence of auto-immune diseases is increased in the TS. Auto-immune dermatoses, such as pemphigoid gestationis, are one of the potential complications during pregnancy and should be known to practitioners.
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[Oocyte donation in patients with Turner syndrome: A high-risk pregnancy]. ANNALES D'ENDOCRINOLOGIE 2009; 70:246-51. [PMID: 19200942 DOI: 10.1016/j.ando.2008.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 12/04/2008] [Accepted: 12/09/2008] [Indexed: 01/15/2023]
Abstract
Turner's syndrome is characterized by an ovarian failure, which occurs in most cases before puberty and leads to infertility. In vitro fertilization with oocyte donation has dramatically transformed the prognosis of infertility of these women. However, in the same time, it has become obvious that pregnancies in Turner's syndrome are at very high risk of possible sudden death because of a specific risk for cardiovascular complications involving aortic root dissection. We report the case of a serious cardiac failure occurred during a twin pregnancy obtained by oocyte donation in a 39-year-old patient with Turner's syndrome. Pregnancy outcome was hopefully favourable thanks to a foetal extraction at 27 weeks of amenorrhoea. If the most reported cases of maternal deaths in patients with Turner's syndrome are associated with an aortic root dissection, our observation is characterized by a full normal cardiologic assessment before the pregnancy and by the absence of aortic root dilatation during pregnancy. This case also illustrates the very high risk of pregnancy in women with Turner's syndrome and the importance of a multidisciplinary care by professionals informed and been used to this obstetric practice.
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Fénichel P, Letur H. [Procreation in Turner's syndrome: which recommendations before, during and after pregnancy?]. ACTA ACUST UNITED AC 2008; 36:891-7. [PMID: 18706846 DOI: 10.1016/j.gyobfe.2008.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Accepted: 06/23/2008] [Indexed: 01/15/2023]
Abstract
Turner's Syndrome (TS) is characterized by an ovarian failure which occurs in most cases before puberty and leads to infertility. In less than 10% of women with TS, puberty may occur and spontaneous pregnancies are possible with a high risk of fetal loss, chromosomal and congenital abnormalities. Fertile women with TS should therefore be counselled with regard to these increased risks and be offered prenatal diagnosis testing. For all the other women with TS, in vitro fertilization with oocyte donation (OD) has dramatically transformed the prognosis of infertility. However, in the same time, it has become obvious that pregnancies in TS either spontaneous or obtained after oocyte donation are at very high risk of possible sudden death. Miscarriages are very frequent probably linked to uterine abnormalities. The most specific risks lie in cardiovascular complications involving aortic root dissection, severe hypertension (HTA) or ventricular insufficiency. In fact pregnancies in TS women cumulate the risk of congenital heart defects and HTA associated to TS, the risk of preeclampsia associated to oocyte donation and the increased cardiac work necessary for pregnancy. It is therefore absolutely necessary for all women with TS to undergo a full cardiological assessment before seeking to become pregnant including echocardiography, thoracic magnetic resonance imaging (MRI) to verify aortic root, cardiac valves and left ventricular function, hypertension monitoring and treatment. Single embryo transfer must definitively be considered. Cardiovascular surveillance during pregnancy has to be enhanced especially at the third trimester and during the peripartum period, most women requiring caesarean section for delivery because of cephalopelvic disproportion and/or aortic root dilatation risk.
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Affiliation(s)
- P Fénichel
- Service d'endocrinologie et médecine de la reproduction, CECOS, hôpital de l'Archet, CHU de Nice, BP 3079, 06202 Nice cedex 03, France.
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