Impact of individual social deprivation on environmental risk perception by French pregnant women

Background

Individual social deprivation (ISD) can have significant impact on the life conditions. However, few studies explored the impact of ISD on the preventive behaviors adopted by pregnant women (PW) in relation to exposure of chemicals.

AIM

This study aims to describe the link between ISD and the perception of chemical and environmental risks.

Methods

A cross-sectional survey was performed among PW present in maternity hospitals in Auvergne (France). Face-to-face interviews with a standardized questionnaire were used to collect anonymously the data (socio-demographic characteristics, smoking behaviors, perception of environmental risks (PER Score based on Likert scale ranking from 0 to 10), individual social deprivation (by EPICES score)). Statistical analysis (univariate analysis - logistic regression) was performed with Modalisa® 8.0 (Kynos, Paris).

Results

300 PW (29±5 years old) were included. The majority of PW reported being aware of the risks associated with chemicals. The PER Score is estimated at 6.3±1.8. It was significantly associated with parity and trimester of pregnancy, and inversely linked to age of PW. The EPICES Score was 19.9 ±17.8 (rank: 0-85). With a precariousness threshold of 30, only a quarter of the PW were in a precarious situation. The EPICES Score was inversely related to age, smoking behaviors, and environmental risks perception. The criterion of choice of everyday products was linked to the EPICES score. 'Organic products' were mainly used by PW with EPICES Score < 30 (not precarious).

Conclusions

The weight of social determinisms on environmental sensitivity highlights the need for targeted prevention. The role of health professionals in prevention and environmental health promotion is essential, especially to detect women of low socioeconomic status who may not be sensitive to media messages and prevention campaigns disseminated by health authorities.

Key messages

Perinatal health professionals must have a major role in environmental health promotion, especially for pregnant women with individual social deprivation. Perception of chemicals and environmental risks was inversely linked to the individual social deprivation (EPICES score) in this French PW population.

Cosmetics and pregnancy: perception of health risk by health professionals and pregnant women

Contex

During pregnancy, the International Federation of Gyneco-Obstetrics (FIGO) advocates limiting exposure to chemicals present in everyday products, including cosmetics. However, both pregnant women (PW) and perinatal health professionals (PHP) know still poorly this source of exposure. AIMS: The PERICOS-Quali Study aims to identify the perception of the risk associated with the use of cosmetics during pregnancy by PHP and PW.

Methodology

A qualitative survey was conducted among PHP and PW in Auvergne (France). The data were collected by semi-structured interviews with the PHP and by focus group with the PW, until saturation of the speeches, by an experienced investigator, with an interview guide. The interviews were recorded, the verbatim was transcribed and subjected to a thematic analysis with the N-VIVO v11 software.

Results

12 PHP (5 midwives, 2 general practitioners and 5 obstetricians) and 24 PW were interviewed. PHP and PW considered cosmetics as wellness and body-care products. Furthermore PHP noted that during pregnancy women used more often organic products, moisturizers or anti-stretch marks, and reduced the use of perfumes, deodorants. In the absence of recommandations based on Evidence-Based Medecine, PHP and PW considered the risk related to cosmetics as not major. The PHP (especially midwives) reported giving advice to comfort the pregnant women; their positioning was not to prohibit the use of cosmetics during pregnancy. PW did not identify PHP as reliable sources of information about cosmetics.

Conclusions

PHP are seeking for tools to help them to better advice PW. And PW would like also to have pertinent advices about cosmetics to make a reasoned choice.

Key messages

Health education about use of cosmetics during pregnancy is necessary. Pregnant women and health professionals don’t perceive health risk linked to cosmetics.

Perception of health risk linked to environmental factors by pregnant women

Bacground

Recently, the International Federation of Gyneco-Obstetrics (FIGO) advocates limiting exposure to chemicals present in everyday products during pregnancy. To date, the chemicals, and the risks related, are not well-known, as well by perinatal health professionals (PHP) as by pregnant women (PW). AIMS: to estimate the sensitivity to the environment and the perception of risks related to chemical substances by pregnant women.

Methodology

A descriptive cross-over study was carried out among pregnant women ((followed or hospitalized in different health establishments in Auvergne). The collection of data (socio-demographic characteristics, sensitivity to the environment, use of cosmetics, perception of environmental risks) was carried out by interviewers, using a standardized questionnaire. The statistical analysis (logistic regression) was performed with Modalisa® 8.0 (Kynos, Paris).

Results

Three hundred questionnaires were analyzed. The sensitivity to the environment is estimated at 6.3 ± 1.7 (scale 0 to 10). For the majority of women, exposure to chemicals is primarily related to the use of cleaning products, DIY products, and gardening products. Food can also be a source of exposure (especially for pesticides). On the other hand, cosmetics are not perceived as products containing chemical substances, with potential risk to health. This vision of chemical substances is related to age, educational level, socio-professional category and sensitivity to the environment. Only 5% (19/300) of PW considered health professionals as referents on chemical substances and environmental problems.

Conclusions

This study highlighted the sensitivity of pregnant women to environmental issues, but a lack of knowledge of chemicals and the risks which they represent for health. It is important to reinforce the information given to pregnant women by perinatal health professionals about healthy behaviors.

Key messages

Pregnant women don’t know all sources of exposure to chemical substances. Training in environmental health must be increased for perinatal health professionals.

Improving image quality of mid-trimester fetal sonography in obese women: role of ultrasound propagation velocity

OBJECTIVE

The quality of ultrasound images is impaired in obese patients. All ultrasound scanners are calibrated for an ultrasound propagation velocity of 1540 m/s, but the propagation in fatty tissue is slower (in the order of 1450 m/s). The main objective of this study was to evaluate the quality of images obtained with different ultrasound propagation velocity settings during the mid-trimester fetal ultrasound examination in obese patients.

METHODS

This was a cross-sectional study using image sets of four recommended scanning planes collected from 32 obese pregnant women during their mid-trimester fetal scan. Each image set comprised three images obtained successively at three different propagation velocity settings (1540 m/s, 1480 m/s and 1420 m/s). A panel of 114 experts assessed the quality of 100 image sets, grading them from A (most acceptable) to C (least acceptable). Scanning-plane-specific indicators of adiposity (fatty layer thickness, probe-to-organ distance) were analyzed for each scanning plane.

RESULTS

The experts had a mean of 18.1 ± 10.2 years of experience. The grade distribution (A, B, C) differed significantly (P < 0.0001) between the three propagation velocity settings tested; at the lower speed of 1480 m/s, images were most often graded A, while at the conventional speed of 1540 m/s, they were most often graded C. Regardless of the scanning plane, the thicker the fatty layer of the abdominal wall in a given plane, the lower the preferred speed (P < 0.0001).

CONCLUSION

The construction of images taking into account ultrasound propagation velocities lower than 1540 m/s can improve significantly the quality of images obtained during mid-trimester fetal ultrasonography in obese women. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Shear wave elastography safety in fetus: A quantitative health risk assessment

PURPOSE

To identify the effects of shear wave elastography in the fetus for evaluation in widespread use.

MATERIALS AND METHODS

The Health Risk Assessment method proposed by the National Research Council was used with literature to evaluate the safety of shear wave elastography for the fetus regarding its potential effects in human tissues.

RESULTS

The experimental and epidemiologic data from 25 articles showed that shear wave elastography maintained the same thermal effect as pulsed Doppler ultrasound already authorized in obstetrics, and that cavitation effect on fetal tissue is improbable. Nonetheless, the vibratory character of shear waves could induce displacement of fetal tissue while potential effects of very short duration energy peaks of the radiation force focused wave front remain unknown.

CONCLUSION

The actual knowledge does not provide enough information to assess the effects of shear wave elastography on fetal tissues, thus these points have to be explored by further experimental studies.

Are there risk factors for false-positive malformation diagnoses on obstetric ultrasound? A nested case-control study

INTRODUCTION

In a population-based study, we found an overall false-positive rate of 8.8% for the second and third trimester ultrasounds. Although numerous studies have been performed to examine factors which lead to false negatives, the same is not true for the factors associated with false positives. The principal objective of this study was to look for risk factors for false-positive diagnoses of fetal malformations on obstetric ultrasound scans.

MATERIAL AND METHODS

In this nested case-control study, the case infants were those whose mother had a false-positive antenatal ultrasound diagnosis of a malformation during the second or third trimester (ultrasound false-positives) and who were live - or stillborn in Auvergne in 2006-2010. The control group comprised all children who were ultrasound true-negatives in 2005 and 2007. The study included 46 cases and 184 controls, matched according to the level of the maternity unit in which they were born.

RESULTS

Most false-positive diagnoses were minor malformations. The mean term at this false-positive diagnosis was 27.7±5.4 weeks; in 46.8% of cases, the diagnosis was made during the second-trimester ultrasound. A single malformation was suspected in 95.7% of the cases. In 97.9% of cases, only one anatomical system was affected. In all, 49 malformations were identified among the 46 cases and their distribution differed according to anatomical system. The only risk factor identified was a body mass index (BMI)<25 (ORa=1.7; 95%CI: 1.2-2.4).

DISCUSSION

A maternal BMI<25 was the only risk factor identified for a false-positive ultrasound diagnosis of a fetal malformation.

[A policy of selective episiotomy in a ward: an example of medical professional assessment]

OBJECTIVES

To reduce the episiotomy rates, according to the Clinical Practice Guidelines, of 2005, from the French College of Obstetricians and Gynaecologists.

PATIENTS AND METHODS

A cross sectional study was conducted, in the university hospital maternities (Maternity 1 and 2) with a retrospective record from medical files. Patients who had delivered in those maternities, by vaginal route, after 22 weeks amenorrhea were eligible. The global rate of episiotomy was analysed from 2006 to 2008. A descriptive clinical study was performed with a retrospective analysis (from July to December 2005 on 100 medical files and from July to December 2007 on 85 files). Besides, a study of episiotomy rate was conducted from 2006 to 2008. Improvement actions were developed between the two phases of assessment of the audit: sharing and comparing the results to standardized episiotomy rates, and elaborating an informatized regional perinatality file with episiotomy related items and national recommendations.

RESULTS

Episiotomy rate decreased during the study, from 22.35% in 2005 to 19.34% in 2008, in the Ward 1 (p<0.0001) and from 33.62% in 2005 to 17.93% en 2008 (p<0.0001) in the Ward 2. An improvement was observed between the two periods of audits, for each item of the chart but without statistical signification.

DISCUSSION AND CONCLUSION

Theses procedures have led to a positive impact on practices thanks to the work group and because of the politics of the perinatal network in favour of an episiotomy reduction. We hope these results could be improved in the future.

[The evaluation of the level of integration within a perinatal network]

OBJECTIVES

Our goal was to evaluate the level of integration of general practitioners within the perinatal network in the Auvergne.

MATERIALS AND METHODS

A cross-sectional study was realized. The questionnaire was sent by post to the 1346 general practitioners who were members of the "Union régionale des médecins libéraux" (Regional association of private doctors in the Auvergne). Follow-up phone calls were also made.

RESULTS

The overall response to the questionnaire was 29.8%. Of those who replied, 76.3% were involved in the care of pregnant women or newly born babies. Among them, 51.2% had a consultation with a pregnant woman less than once a week and 53,5% had a consultation with a newly born more than once a week. A third were aware of the network and 25.7% had knowledge of the medical record provided by the network. Among them, 91.3% thought that a common medical record was necessary to improve the coordination of care. The answers differed according to age, area of responsibility, the administrative geographic position in the Auvergne, type of practise (hospital, private), and the sex of those who replied.

CONCLUSION

Despite a high a priori agreement, we must improve the level of information and training given to general practitioners within our perinatal network.

Accouchement du siège par voie vaginale: évolution de l'acceptabilité par les obstétriciens et les patientes

OBJECTIVE

To investigate the influence of obstetrician and patient respectively on mode of delivery in case of breech presentation at term.

PATIENTS AND METHODS

This retrospective study included all women with a singleton pregnancy in a breech presentation delivered at term in a tertiary care maternity unit from January 1998 to December 2004. Mode of delivery was suggested by a score based on maternal age, parity, obstetrical past history, radiopelvimetry and cephalopelvic confrontation. The obstetrician was free to follow or not the score indication and patient's informed consent was required concerning the mode of delivery. Our main outcome measurements were mode of delivery and neonatal parameters.

RESULTS

Two hundred cases were identified. Elective cesarean section increased progressively (from 52% in 1998 to 80% in 2004 [P=0,002]). Neonatal status and proportion of score in favour of vaginal birth remained stable during the study period. The rise in cesarean section rate was mainly due to patient's request (P=0,001) whereas the trend of obstetrician in favour of cesarean did not reach significance (P=0,3).

DISCUSSION AND CONCLUSION

The rise of elective cesarean section for term breech delivery in a maternity unit using a predefinite score is mainly induced by patient's request. This evolution has no effect on neonatal status.

Accouchement des grossesses gémellaires : enquête sur les politiques des maternités françaises

OBJECTIVES

To describe obstetrical policy variations concerning the delivery management in the case of twins, at term.

PATIENTS AND METHODS

A mail survey was undertaken among the medical supervisors of the maternity wards belonging to the AUDIPOG Network (N=170).

RESULTS

The participating rate was 73.35%. 124 answers were analysed. Elective caesarean was realized by 0.8% of participants for diamniotic twins and by 57% of cases for monamniotic twins An elective caesarean is planned for respectively 74% of answers if first (J1) and second twin (J2) are in a breech presentation, 81% if J1 is in breech and J2 in cephalic presentation, and 68% if J1 is in breech and J2 in transverse presentation. Delivery with J1 in breech and J2 in cephalic presentation had a higher risk than a delivery of a single breech at term. When J1 and J2 had a breech presentation 73% of participants thought that this delivery is more difficult than a delivery of a single breech at term. However, they were only 17.5% to consider that a delivery of twin with J1 in cephalic and J2 in breech presentation had a higher risk than a single breech delivery.

DISCUSSION AND CONCLUSION

Medical policy variations are not extensive except for X-ray pelvimetry and the presence for the delivery of one paediatrician and one anaesthesiologist. An elective caesarean policy for twins is infrequent in France.

Morbidité néonatale après attitude d'expectative suivie d'une naissance systématique à 34 semaines d'aménorrhée en situation de rupture prématurée des membranes

OBJECTIVE

To evaluate the neonatal morbidity and its risks factors in case of uncomplicated preterm rupture of membranes managed conservatively with subsequent planned delivery at 34 weeks of gestation.

PATIENTS AND METHODS

We studied retrospectively 42 consecutive neonates systematically delivered at 34 weeks of gestation after more than 48 hours of conservative management for uncomplicated preterm rupture of membranes. Conservative management was conducted in a single tertiary care center and consisted in corticotherapy and in antibiotherapy (amoxycilline during 7 days). We evaluated the neonatal mortality rate, the incidence of infection, respiratory distress, neurological disorders, and we looked for their prenatal risks factors.

RESULTS

Forty-two neonates were included. The median gestational age at rupture was 31.1 weeks of gestation (from 25 to 33.9 weeks). The median duration of expectant management was 20 days (from 2.4 to 65 days). We observed 7 cases of neonatal infection but no septic failure, 18 cases of respiratory distresses among which 9 required a tracheal intubation for a mean duration of 3.7 days, no perinatal encephalopathy (5 cases of subependymal haemorrhage) and no neonatal death. We isolated one single risk factor that was the lowest gestational age at rupture in case of subsequent respiratory distress (29.6 vs 31.9 weeks; P=0.02).

DISCUSSION AND CONCLUSION

Neonatal morbidity in this population consisted mainly in respiratory distresses with an increased incidence when gestational age at rupture decreased.

[Obstetrical prognosis of labour induction with mifepristone after 41 weeks of gestation]

OBJECTIVE

To compare the mode of delivery in two groups of patients selected by their response after induction of labour with mifepristone.

PATIENTS AND METHODS

We studied retrospectively 89 cases of labour induction with viable children after 41 weeks of gestation. Bishop scores were less than 6. Patients were given 200 mg of mifepristone per day for 48 h. They were retrospectively divided into group 1 (spontaneous onset of labour or premature rupture of membranes before the third day) and group 2 (not in labour by that date).

RESULTS

The mean Bishop score at inclusion was 3.1 +/- 1.3. Among the 51 patients (53.9%) in group 1, one required prostaglandins and we performed 10 cesarean sections. In group 2, the mean Bishop score at the 3rd day was 4.4 +/- 1.3 (P < 0.0001). Twenty-four patients required prostaglandins (P < 0.0001) and we performed 17 cesarean sections (P = 0.01). The number of cesarean sections increased with the dose of prostaglandins (P = 0.025). We observed no maternal or fetal complications.

DISCUSSION AND CONCLUSIONS

Mifepristone was successful in inducing labour spontaneously in over 50% of pregnancies after 41 weeks of gestation. In the other group, the probability of vaginal delivery was reduced especially when high doses of prostaglandins were required. After the use of mifepristone, we suggest to shorten the duration of prostaglandin administration (two applications of 2 mg dinoprostone) before performing cesarean section.

[Prenatal health in 2002-2003. Survey of medical practice. Results from the Audipog sentinel network]

Perinatal health survey has been ensured for 10 years by the AUDIPOG Sentinel Network (AUDIPOG, Association of Users of Computerized Files in Perinatology, Obstetrics and Gynecology). It was created, in 1994, by a group of birth specialists having the same concern for a common system of perinatal health survey and assessment of medical practices. Every year, the network includes about 100 voluntary maternity units pooling data about pregnant women and their newborns. To date, the AUDIPOG database comprises 180,000 births gathered between 1994 and 2003, including 78,287 births for the 2002 and 2003 period. The use of a standardization method of the rates makes it possible to provide valid estimations at the national level. This report presents the perinatal health indicators in 2002-2003 and confirms a very alarming situation: the rate of preterm births has not decreased since 1999 (7.1% of births) and high prematurity (< 33 weeks of gestation) affects 1.6% of newborns. Only 65% of high premature infants are born in care level III maternity units, while the figure of 80% has been reached as soon as 1999 and has not stopped to decrease since. The rate of cesarean section keeps on increasing, reaching 18.7% including 9.6% before the beginning of labour. The AUDIPOG network constitutes a continuous, and in real time, perinatal health survey and also a tool to assess medical practices. Members of the Audipog network can log in to the common data base, using the AUDIPOG website (http://audipog.inserm.fr), in order to find answers to their own questionnings and to compare their practices with the external reference formed by the network: such an access represents an innovating method of self-assessment of medical practices and quality control.

Récurrence de chorio-angiomes multiples : à propos d’un cas

Diffuse chorioangiomatosis is a rare placental pathology characterized by multiple chorioangiomas, inducing a high risk of fetal complications, especially cardiovascular, with a risk of fetal death. The physiopathology is not clearly established but seems to be related with an over-expression of vascular growth factors related to hypobaric-hypoxia. Here, we describe a case of recurrent chorioangiomatosis with fetal demise. No risk factors were identified (high altitude, genetic disease like Beckwith-Wiedemann, diabetes). Intra-amniotic, plasmatic values of alphafetoprotein and plasmatic beta gonadotrophin chorionic hormone remained low. Ultrasonographic assessment of placental thickness was in the normal range, at 22 and 32 weeks of gestation. In case of previous chorioangiomatosis, we recommend a weekly sonographic monitoring to diagnose fetal complications associated with an early inpatient hospitalization for daily surveillance at the age of previous accidents. Labor will be induced in case of fetal intolerance or systematically after 37-38 weeks of gestation.

First-trimester features of Fowler syndrome (hydrocephaly-hydranencephaly proliferative vasculopathy)

We describe the features of Fowler syndrome (proliferative vasculopathy and hydrocephaly-hydranencephaly) diagnosed in the first trimester. The pregnancy with no significant family history was referred for karyotyping and ultrasound examination after a cystic hygroma was seen at 12 weeks. At 13 weeks, ultrasound examination revealed hydrocephaly-hydranencephaly, fetal akinesia, and arthrogryposis associated with increased nuchal translucency. The parents opted for termination of pregnancy and the diagnosis of Fowler syndrome was confirmed by pathological examination of the fetus. Calcified necrotic lesions and proliferative vasculopathy were observed in the entire central nervous system including the brainstem and spinal cord. Cases previously reported in siblings suggest an autosomal recessive transmission but specific genetic antenatal diagnosis is not yet available. The diagnosis of proliferative vasculopathy and hydrocephaly-hydranencephaly (Fowler syndrome) should be considered whenever hydrocephaly-hydranencephaly associated with a fetal akinetic sequence are encountered at the end of the first trimester. Genetic counseling is recommended.

Use of transgenic mice model for understanding the placentation: towards clinical applications in human obstetrical pathologies?

The mammalian embryo and fetus are unable to develop without a well-established, functional placenta. This transitory yet indispensable structure attaches the conceptus to the uterus and establishes the vascular connections necessary for nutrient and gaseous exchange between maternal and fetal compartments. Genetic targeting strategy allows the generation of mice lacking a specific gene. Such approaches reveal: (i) the high incidence of mutant embryonic or fetal death in utero, and (ii) the extraembryonic (placental) causes of these deaths. Due to the similarities presented between mouse and human placenta, we propose to use the potential of mouse targeting experiments as a model in order to understand human obstetrical pathologies. In this paper, we first review genes that have been demonstrated to be required in mice for implantation, choriovitelline and chorioallantoic placentation. Using examples (integrins, homeoboxs, hepatocyte growth factor or epidermal growth factor receptor...) we demonstrate the reality and efficiency of such an approach. Other candidate genes (receptor of leukemia inhibitory factor, Wnt2 or retinoic acid receptor alpha...) in order to understand, prevent and treat human obstetrical pathologies.

Co-localization of KLF6 and KLF4 with pregnancy-specific glycoproteins during human placenta development

Pregnancy-specific glycoproteins (PSGs) are major placental proteins essential for the maintenance of normal gestation. However, little is known about their gene expression regulation during placentation. It was previously demonstrated that the human core promoter binding protein recently renamed Krüppel-like factor (KLF) 6 binds to a highly conserved sequence within the PSG promoters and is mainly expressed in human term placenta. Here, we determined the expression pattern of the 13 other KLFs during human placental development. We demonstrate that eight KLFs exhibit specific expression patterns in human placental tissues and membranes, in favor of a functional cooperation of specific KLFs during placentation. In addition, we demonstrate that KLF6, KLF4 and PSG proteins are co-expressed in same cell types of placental villi and membranes. This experimental evidence further strengthens the potential cross talk of both transcription factors for PSG gene regulation in vivo.

Esterification of vitamin A by the human placenta involves villous mesenchymal fibroblasts

Vitamin A (retinol) and its active derivatives (retinoic acids) are essential for growth and development of the mammalian fetus. Maternally derived retinol must pass the placenta to reach the developing fetus. Despite its apparent importance, little is known concerning placental transfer and metabolism of retinol, and particularly of placental production and storage of retinyl esters. To elucidate this metabolic pathway, we incubated, in the presence of retinol, 1) human full-term placental explants and 2) primary cultures of major cells types contributing to placental function: trophoblasts and villous mesenchymal fibroblasts. We used HPLC to determine the types and concentrations of retinyl esters produced by these explants and cells. About 14% of total cellular retinol in placental explants was esterified. The most abundant esters were myristate and palmitate. Primary cell cultures showed that fibroblasts efficiently produced retinyl esters, but trophoblasts did not. In both types of experiments, no retinyl esters were detected in the culture medium, suggesting that retinyl esters were produced for storage purpose. These results suggest that villous mesenchymal fibroblasts are primary sites of retinol esterification and storage in the placenta.

Effect of vitamin A status at the end of term pregnancy on the saturation of retinol binding protein with retinol

BACKGROUND

Vitamin A (retinol), which is required for normal fetal development and successful gestation, circulates in the blood bound to a specific protein, the retinol binding protein (RBP). Little is known about the transport and metabolism of this complex protein or about retinol status during normal human pregnancy.

OBJECTIVE

The aim of this study was to assess retinol status and transport modalities of retinol in well-nourished women with normal pregnancies, a population poorly investigated compared with pathologic and malnourished pregnant women.

DESIGN

The maternal blood and cord blood concentrations of retinol, vitamin E, beta-carotene, RBP, and transthyretin of pregnant French women at term (n = 27) were measured and compared with values from a nonpregnant control group (n = 27). In addition, holo-RBP (retinol bound), apo-RBP (retinol free), and total protein were assessed in both groups to enable the hemodilution occurring during pregnancy to be taken into consideration and to evaluate the extent of saturation of RBP with retinol.

RESULTS

Healthy pregnant women at term had normal serum circulatory amounts of retinol, vitamin E, binding proteins, and beta-carotene. However, they had less binding of retinol to RBP (holo-RBP: 49.9% in pregnant women, 54.0% in cord blood, and 77.5% in the control group).

CONCLUSION

The results of this study suggest that retinol homeostasis and transport are modified during normal human pregnancy.

[Complications of cordocentesis associated with fetal therapy]

OBJECTIVES

To evaluate the technical and obstetrical risk factors of percutaneous umbilical blood sampling (PUBS) when associated with simultaneous fetal therapy.

STUDY DESIGN

Retrospective study. One thousand PUBS have been performed in our department between 1984 and 1992. One hundred and forty one of them were done with another invasive fetal procedure. Technical and obstetrical circumstances were related to pregnancy follow-up and complications.

RESULTS

Pregnancy complication rate increased when PUBS was associated with another invasive procedure (fetal losses: 12.9%, premature rupture of membranes (PROM): 11.6%). No chorioamnionitis nor perinatal infection was observed. As expected, previous fetal status was a main risk factor. Significant relationships have been found between fetal loss risk and therapy procedures such as amnioinfusion and severe IUGR and as well as abnormal post operative fetal tracing. The duration of cord bleeding after needle retrieval was the single risk factor pointed out for PROM.

CONCLUSION

The study of the predictors of fetal complications is necessary to separate the genuine risk of previous fetal status and the risk of the invasive procedure itself.

Fetal umbilical cord catheterization under ultrasound guidance

Since 1984 we have performed 30 intrauterine exchange transfusions (IUET) under ultrasound guidance. In 4 pregnancies with anterior placenta, we performed 9 umbilical cord catheterizations in 11 IUET: the first with material for epidural analgesia and the others with a central venous catheter. The latest one was performed at 34 weeks, the earliest at 27 weeks and repeated up to 4 times. Every catheterization did not last more than 5 min and we did not find any infection, hematoma or placental or cord injury. All 4 pregnancies were delivered at 34-36 weeks and the babies are alive and healthy (the oldest is 4 years old). This technique, when possible, is a good alternative to long procedures with risk of fetal movements, and limits the risk of hematoma.