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Tohme P, Abi-Habib R, Nassar E, Hamed N, Abou-Ghannam G, Chalouhi GE. The Psychological Impact of the COVID-19 Outbreak on Pregnancy and Mother-infant Prenatal Bonding. Matern Child Health J 2022; 26:2221-2227. [PMID: 35972590 PMCID: PMC9379892 DOI: 10.1007/s10995-022-03464-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022]
Abstract
This study aimed to assess the impact of the COVID-19 stress and anxiety on prenatal attachment during the second trimester of gestation. Pregnancy is an important stage for mothers-to-be in creating representations of themselves as a “mother”, with the developing attachment relationship to the unborn child considered as a milestone in the future parent’s developmental trajectory. The outbreak of the COVID-19 pandemic and the national health measures installed can hence have consequences on these representations and on prenatal attachment. Our sample consisted of 95 mothers that were recruited from a prenatal ultrasound screening center. Results suggested that the COVID-19 pandemic significantly affected prenatal attachment (PAI) with significant correlations between PAI total score and age, anxiety (DASS) and stress (IES-R). When entered in one model looking for predictors of PAI total score, age and COVID-19 stress were the only variables found to significantly predict prenatal attachment. We argue for a cultural component in explaining these results, hypothesizing that stress could trigger defensive strategies, leading to more investment in the attachment relationship, potentially playing the role of a protective factor.
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Affiliation(s)
- Pia Tohme
- Department of Social And Education Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Rudy Abi-Habib
- Department of Social And Education Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon.
| | - Elma Nassar
- Department of Social And Education Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Nouran Hamed
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gaël Abou-Ghannam
- Department of Obstetrics and Gynecology, Bellevue Medical Center, Beirut, Lebanon
| | - Gihad E Chalouhi
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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2
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Salomon LJ, Alfirevic Z, Berghella V, Bilardo CM, Chalouhi GE, Da Silva Costa F, Hernandez-Andrade E, Malinger G, Munoz H, Paladini D, Prefumo F, Sotiriadis A, Toi A, Lee W. ISUOG Practice Guidelines (updated): performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2022; 59:840-856. [PMID: 35592929 DOI: 10.1002/uog.24888] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 06/15/2023]
Affiliation(s)
- L J Salomon
- Department of Obstetrics and Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Cité University, Paris, France
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - V Berghella
- Thomas Jefferson University, Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Philadelphia, PA, USA
| | - C M Bilardo
- University Medical Centre, Fetal Medicine Unit, Department of Obstetrics & Gynecology, Groningen, The Netherlands
| | - G E Chalouhi
- Maternité Necker-Enfants Malades, Université Paris Descartes, AP-HP, Paris, France
| | - F Da Silva Costa
- Maternal Fetal Medicine Unit, Gold Coast University Hospital and School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | | | - G Malinger
- Division of Ob-Gyn Ultrasound, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Munoz
- University of Chile Hospital, Fetal Medicine Unit, Obstetrics & Gynecology, Santiago, Chile
| | - D Paladini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - F Prefumo
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Toi
- Medical Imaging, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - W Lee
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, TX, USA
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Chalouhi GE, Guenuec A, Rameh G, Hamze H, Salomon LJ, Ville Y. Biplane mode for more precise intrauterine procedures. Am J Obstet Gynecol 2022; 226:215-219. [PMID: 34116039 DOI: 10.1016/j.ajog.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/14/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022]
Abstract
The evolution of ultrasound and the introduction of 3- and 4-dimensional ultrasound techniques led to a shift in the perception and usage of ultrasound in fetal medicine. The biplane mode might help in multiple fetal procedures, including but not limited to basic intrauterine thoracocentesis, thoracoamniotic shunting, amnioreduction, amnioinfusion, cordocentesis, intraumbilical infusion, and umbilical cord coagulation, with a possible reduction in the complication rate. Despite its theoretical usefulness, more studies are required to assess the clinical importance of this technique.
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Affiliation(s)
- Gihad E Chalouhi
- Department of Obstetrics and Fetal Medicine, Necker Enfants-Malades Hospital, Paris Descartes University, Paris, France; Department of Obstetrics and Gynecology, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon; Université de Paris, Paris, France
| | - Alexandra Guenuec
- Department of Obstetrics and Fetal Medicine, Necker Enfants-Malades Hospital, Paris Descartes University, Paris, France; Université de Paris, Paris, France
| | - Georges Rameh
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon
| | - Hassan Hamze
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon.
| | - Laurent J Salomon
- Department of Obstetrics and Fetal Medicine, Necker Enfants-Malades Hospital, Paris Descartes University, Paris, France; Université de Paris, Paris, France
| | - Yves Ville
- Department of Obstetrics and Fetal Medicine, Necker Enfants-Malades Hospital, Paris Descartes University, Paris, France; Université de Paris, Paris, France
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Chalouhi GE, Mouanness M, Abu-Rustum RS, Tolsgaard M. Ultrasound education in the context of COVID-19: challenges and way forward. Ultrasound Obstet Gynecol 2021; 58:653-657. [PMID: 34159647 DOI: 10.1002/uog.23712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 06/13/2023]
Affiliation(s)
- G E Chalouhi
- Obstetrics and Fetal Medicine Department, Necker-Enfants Malades Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Mouanness
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
- Rejuvenating Fertility Center, New York, NY, USA
| | - R S Abu-Rustum
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - M Tolsgaard
- Center for Clinical Education, Rigshospitalet, Capital Region and University of Copenhagen, Copenhagen, Denmark
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Snaifer E, Hassan H, Daher L, Sabbagh A, Farah M, Farekh I, Chalouhi GE. Obstetric Ultrasound Screening in a Rural Area of Lebanon One Small Step With a Promising Major Impact. J Ultrasound Med 2021; 40:483-489. [PMID: 32770573 DOI: 10.1002/jum.15423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Our aim was to evaluate the conditions and to weigh the potential impact of an obstetrical ultrasound screening intervention on pregnant patients in an underserved area of Lebanon with the presence of refugees. METHODS We performed a cross-sectional study in a rural region in North Lebanon. Monthly second-trimester obstetrical ultrasound scans were offered to patients. A thorough analysis of the population's characteristics was done, the anomalies discovered were documented and follow up recommendations were offered. RESULTS 268 screening ultrasounds were performed over a one-year period. The patients' mean age was 27.5 ± 8.5 years with a 35% consanguinity rate. A positive personal history of abnormalities was recognized in 34% of cases, and a positive family history in 21% of them. The average gestational age was of 23.3 ± 1.4 weeks of gestation. We found a rate of 8.6% inaccurate dating, 20% growth abnormalities, and 12% morphological abnormalities requiring follow-up. These latter included defects affecting multiple organ systems among which renal, neurological, and cardiac structures were the most frequently affected (2.5%, 2%, and 1.6% respectively). Overall, 35.8% of the screened cases required a follow-up for 1 or more abnormal findings. CONCLUSIONS The findings confirmed the necessity to introduce a prenatal ultrasound screening program in rural areas of Lebanon where refugees are settled. The lack of adequate ultrasound screening in these regions presents major threats that can hinder any pregnancy. Our simple intervention tackles the burden of diagnosis of these risks in up to 35.8% of pregnancies and thus can help improve outcomes.
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Affiliation(s)
- Elie Snaifer
- Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Hala Hassan
- Saint George Hospital University Medical Center, Beirut, Lebanon
- Centre Hospitalier Rene Dubos, Pontoise, France
| | - Lea Daher
- Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | | | | | - Issa Farekh
- Hotel Dieu de France, Beirut, Lebanon
- Order of Malta, Beirut, Lebanon
| | - Gihad E Chalouhi
- Order of Malta, Beirut, Lebanon
- Fetal Medicine Division, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon
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Corroenne R, Al Ibrahim A, Stirnemann J, Zayed LH, Essaoui M, Russell NE, Chalouhi GE, Salomon LJ, Ville Y. Management of monochorionic twins discordant for structural fetal anomalies. Prenat Diagn 2020; 40:1375-1382. [PMID: 32394424 DOI: 10.1002/pd.5734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To review the perinatal management and outcomes of monochorionic twin pregnancies (MC) discordant for congenital anomalies (DCA). METHODS Retrospective, study of all MC DCA cases referred to our tertiary referral center from 1997 to 2018. We excluded cases complicated with twin-to-twin transfusion syndrome, twin anemia-polycythemia sequence, twin reversed arterial perfusion sequence or selective intra-uterine growth restriction. Patients were counseled about the possibility of expectant (EM) or interventional management (selective feticide [SF] or termination of the entire pregnancy [TOP]). RESULTS One hundred eight of 4157 (2.6%) MC pregnancies were discordant for anomaly. Fifty two of 108 n(48.1%) underwent SF at a mean gestational age of 31.4 ± 5.9 weeks while 52/108(48.1%) opted for EM. Livebirth rate of the healthy co-twin was similar between the two groups (SF: 88.5% vs EM: 82.7%, P = .87). In the SF group, six healthy co-twins (6/52, 11.5%) died 5.3 ± 3.1 days after SF of the abnormal co-twin. In the EM group, in-utero demise of the abnormal twin occurred in 9 of 52 (17.3%) of the cases and was followed by the spontaneous demise of the healthy co-twin in 4 of 9 (44.4%) of these cases. CONCLUSION Selective feticide does not seem to significantly alter survival of the healthy co-twin compared to EM.
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Affiliation(s)
- Romain Corroenne
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France
| | - Abdullah Al Ibrahim
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France
| | - Julien Stirnemann
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France
| | - Louay Hassan Zayed
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France
| | - Mohamed Essaoui
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France
| | - Noirin E Russell
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France
| | - Gihad E Chalouhi
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France
| | - Laurent J Salomon
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France
| | - Yves Ville
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France
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Clark AE, Shaw CJ, Bello F, Chalouhi GE, Lees CC. Quantitating skill acquisition with optical ultrasound simulation. Australas J Ultrasound Med 2020; 23:183-193. [PMID: 34760598 PMCID: PMC8411749 DOI: 10.1002/ajum.12221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/13/2020] [Revised: 05/06/2020] [Accepted: 06/26/2020] [Indexed: 11/05/2022] Open
Abstract
Objective To investigate and compare the effect of simulator training on quantitative scores for ultrasound-related skills for trainees with novice level ultrasound experience and expert ultrasound operators. Methods Three novice (comprising of 11, 32, 23 participants) and one expert (10 participants) subgroups undertook an ultrasound simulation training session. Pre- and post-training test scores were collected for each subgroup. Outcome measures were as follows: mean accuracy score for obtaining the correct anatomical plane, percentage of correctly acquired target planes, mean number of movements, time to achieve image, distance travelled by probe and accumulated angling of the probe. Results The novices showed improvement in image acquisition after completion of the simulation training session with an improvement in the rate of correctly acquired target planes from 28-57% to 39-83%. This was not replicated in the experts. The novice's individual ratios based on pre- vs. post-training metrics improved between 1.7- and 4.3-fold for number of movements, 1.9- and 6.7-fold for distance, 2.0- and 5.2-fold for time taken and 1.8- and 7.3-fold for accumulated angling. Among the experts, there was no relationship between pre-training simulator metrics and years of ultrasound experience. Conclusions The individual simulation metrics suggest the sessions were delivered at an appropriate level for basic training as novice trainees were able to show demonstrable improvements in both efficiency and accuracy on the simulator. Experts did not improve after the simulation modules, and the novice scores post-training were similar to those of experts, suggesting the exercises were valid in testing ultrasound skills at novice but not expert level.
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Affiliation(s)
- Anna E Clark
- Queen Charlotte's and Chelsea Hospital Imperial Healthcare NHS Trust London UK
| | - Caroline J Shaw
- Queen Charlotte's and Chelsea Hospital Imperial Healthcare NHS Trust London UK.,Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction Imperial College London London UK
| | - Fernando Bello
- Faculty of Medicine, Department of Surgery & Cancer Imperial College London Chelsea and Westminster Campus London UK
| | - Gihad E Chalouhi
- École de Simulation pour L'enseignement et le Perfectionnement en Échographie Gynécologique et Obstétricale (SimECHOle) Paris France.,Department of Obstetrics and Gynecology Division of Fetal Medicine American University of Beirut Medical Center American University of Beirut Beirut Lebanon.,Basic Training Task Force Education Committee International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) London UK
| | - Christoph C Lees
- Queen Charlotte's and Chelsea Hospital Imperial Healthcare NHS Trust London UK.,Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction Imperial College London London UK.,Department of Development and Regeneration KU Leuven B - 3000 Leuven Belgium
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8
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Chalouhi GE, Millischer AÉ, Mahallati H, Siauve N, Melbourne A, Grevent D, Vinit N, Heidet L, Aigrain Y, Ville Y, Blanc T, Salomon LJ. The use of fetal MRI for renal and urogenital tract anomalies. Prenat Diagn 2019; 40:100-109. [PMID: 31736096 DOI: 10.1002/pd.5610] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/20/2022]
Abstract
Fetal anomalies are detected in approximately 2% of all fetuses and, among these, genitourinary tract abnormalities account for 30% to 50% of all structural anomalies present at birth. Although ultrasound remains the first line diagnostic modality, fetal MRI provides important additional structural and functional information, especially with the development of faster sequences and the use of functional sequences. The added value of MRI-based imaging is three-fold: (a) improvement of diagnostic accuracy by adequate morphological examination, (b) detection of additional anomalies, and (c) in addition, MRI has the potential to provide information regarding renal function. In this review, we describe the role of fetal MRI in the anatomical evaluation of renal and urogenital tract anomalies, and we also touch upon the contribution of functional MRI to the diagnostic workup of these conditions.
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Affiliation(s)
- Gihad E Chalouhi
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Division of Fetal Medicine, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon.,Université de Paris, Paris, France
| | - Anne-Élodie Millischer
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France
| | - Houman Mahallati
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Department of Radiology, University of Calgary, Calgary, Canada
| | - Nathalie Siauve
- Imagerie Médicale, Hôpital Louis Mourier APHP, Colombes, France
| | - Andrew Melbourne
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - David Grevent
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France
| | - Nicolas Vinit
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France
| | - Laurence Heidet
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Pediatric Nephrology Department, Hôpital Universitaire Necker-Enfants Malades, Sorbonne Paris Cité University, Paris, France
| | - Yves Aigrain
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France
| | - Yves Ville
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France
| | - Thomas Blanc
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France.,INSERM U1151-CNRS UMR 8253, Université de Paris, Institut Necker-Enfants Malades, Paris, France.,Université de Paris, Paris, France
| | - Laurent J Salomon
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Université de Paris, Paris, France
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Gueneuc A, De Garnier J, Dommergues M, Rivière M, Ville Y, Chalouhi GE. [Impact of sonography simulation in the training of midwifery students]. ACTA ACUST UNITED AC 2019; 47:776-782. [PMID: 31288093 DOI: 10.1016/j.gofs.2019.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE During their studies, French midwives need to acquire basic ultrasound skills to measure the amniotic fluid index, fetal biometry and identify fetal lie and placental positions. They have a clinical ultrasound training during their curriculum to acquire these skills. Assess the contribution that a training on an obstetrical ultrasound simulator (OUS) could make to the competence of midwives and to evaluate the best time to integrate it into their curriculum. METHODS Forty students in their 4th and final year in midwifery were randomized into 2 groups. Group A learned with the traditional academic course, with a clinical ultrasound training which was followed by an evaluation on an OUS (E1A). Group B was evaluated on a simulator before the clinical ultrasound training (E1B). After these initial assessments, both groups were provided with learning and training sessions on OUS, and re-evaluated in the same exercise (E2A and E2B). Group B then completed its clinical ultrasound training and was evaluated one month later on the simulator (E3B). The evaluation consisted of scoring the biometry images according to previously published quality criteria, and of assessing their competence based on a published objective and structured assessment score of ultrasound skills (OSAUS). RESULTS Evaluation 1 found comparable OSAUS scores (2.375/5 vs. 2.24/5 P=0.52) between the two groups (E1A vs. E1B) but a significantly higher image quality score for Group A (P=0.02). In Evaluation 2, an improvement was noted for both groups with comparable OSAUS averages between the two groups (P=0.76). After the clinical training of Group B, their OSAUS score (E3B) was significantly better than that of Group A (E1A) after their clinical training (3.45/5 vs. 2.375/5 [P=0.00017]). The same was true for the quality of their images (12.67/16 vs. 9.95/16 [P=0.003]). CONCLUSION Ultrasound simulation-based training, as an adjunct to ultrasound clinical training, significantly improves obstetrical ultrasound skills. The best time to train on simulators seems to be prior to clinical training on real patients.
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Affiliation(s)
- A Gueneuc
- École de simulation pour l'enseignement et le perfectionnement en échographie gynécologique et obstétricale (SimECHOle), 75006 Paris, France; Service d'obstétrique et de médecine fœtale, université Paris Descartes, Sorbonne Paris cité, hôpital Necker-enfants-malades, AP-HP, 75015 Paris, France
| | - J De Garnier
- Service d'obstétrique et de médecine fœtale, université Paris Descartes, Sorbonne Paris cité, hôpital Necker-enfants-malades, AP-HP, 75015 Paris, France
| | - M Dommergues
- Service de gynécologie et d'obstétrique, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - M Rivière
- École de sages-femmes, hôpital Saint-Antoine, AP-HP, 75012 Paris, France
| | - Y Ville
- École de simulation pour l'enseignement et le perfectionnement en échographie gynécologique et obstétricale (SimECHOle), 75006 Paris, France; Service d'obstétrique et de médecine fœtale, université Paris Descartes, Sorbonne Paris cité, hôpital Necker-enfants-malades, AP-HP, 75015 Paris, France
| | - G E Chalouhi
- École de simulation pour l'enseignement et le perfectionnement en échographie gynécologique et obstétricale (SimECHOle), 75006 Paris, France; Service d'obstétrique et de médecine fœtale, université Paris Descartes, Sorbonne Paris cité, hôpital Necker-enfants-malades, AP-HP, 75015 Paris, France; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Faculty of Medicine and Medical Center, 1107 Beyrouth, Liban.
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10
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Gueneuc A, Chalouhi GE, Borali D, Mediouni I, Stirnemann J, Ville Y. Fetoscopic Release of Amniotic Bands Causing Limb Constriction: Case Series and Review of the Literature. Fetal Diagn Ther 2019; 46:246-256. [PMID: 30726851 DOI: 10.1159/000495505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 04/11/2018] [Accepted: 11/14/2018] [Indexed: 11/19/2022]
Abstract
The aim of this study was to review the perioperative complication rates and neonatal outcomes after fetoscopic release of amniotic bands that caused bilateral limb constrictions. We present 5 cases of limb constriction by amniotic bands occurring spontaneously or following fetoscopic surgery and also include a review of 21 previously published cases. The cases were analyzed for indication, surgical technique, and postoperative follow-up. In our population and the literature, the majority of the children acquired a functional limb (75%), with few perioperative complications (15%). Fetal morbidity was mainly linked to the consequences of preterm premature rupture of the membranes (38.4%) and preterm birth (34.7 GW). The mortality rate was low (7.7%). This review only describes amniotic bands causing limb constriction, and illustrates that fetoscopic surgery for their release is technically feasible with an acceptable perioperative complication rate. However, the 75% success rate is very likely to be an overestimation of the true success rate. In view of these observations we cannot recommend treatment for cases where the fetus has been extensively affected by the bands. We believe, however, that we could consider this technique for a fraction of amniotic band syndrome cases isolated to the limb constrictions. This kind of surgery should be proposed as a potential treatment for amniotic band syndrome.
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Affiliation(s)
- Alexandra Gueneuc
- Fetal Medicine Unit, Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,National Referral Centre for the Management of Complicated Monochorionic Pregnancies, Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Université Paris Descartes, APHP, Paris, France
| | - Gihad E Chalouhi
- Fetal Medicine Unit, Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Université Paris Descartes, Sorbonne Paris Cité, Paris, France, .,National Referral Centre for the Management of Complicated Monochorionic Pregnancies, Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Université Paris Descartes, APHP, Paris, France, .,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon,
| | - Denisa Borali
- Fetal Medicine Unit, Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Imen Mediouni
- Fetal Medicine Unit, Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,National Referral Centre for the Management of Complicated Monochorionic Pregnancies, Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Université Paris Descartes, APHP, Paris, France
| | - Julien Stirnemann
- Fetal Medicine Unit, Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,National Referral Centre for the Management of Complicated Monochorionic Pregnancies, Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Université Paris Descartes, APHP, Paris, France
| | - Yves Ville
- Fetal Medicine Unit, Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,National Referral Centre for the Management of Complicated Monochorionic Pregnancies, Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Université Paris Descartes, APHP, Paris, France
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Tolsgaard MG, Chalouhi GE. Use of ultrasound simulators for assessment of trainee competence: trendy toys or valuable instruments? Ultrasound Obstet Gynecol 2018; 52:424-426. [PMID: 29667240 DOI: 10.1002/uog.19071] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 06/08/2023]
Affiliation(s)
- M G Tolsgaard
- Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES) Rigshospitalet, Copenhagen, Denmark
- Basic Training Task Force, Education Committee, International Society of Ultrasound in Obstetrics and Gynecology (ISUOG)
| | - G E Chalouhi
- Basic Training Task Force, Education Committee, International Society of Ultrasound in Obstetrics and Gynecology (ISUOG)
- SimECHOle, École de Simulation pour l'enseignement et le perfectionnement en Échographie Gynécologique et Obstétricale, Paris, France
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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12
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Chalouhi GE, Gueneuc A, Levaillant JM, Ville Y. ["Fake it until they make it": Practical obstetrical and gynecological ultrasound education nowadays in France]. ACTA ACUST UNITED AC 2017; 45:579-581. [PMID: 29108903 DOI: 10.1016/j.gofs.2017.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Indexed: 10/18/2022]
Affiliation(s)
- G E Chalouhi
- SimECHOle, école de simulation pour l'enseignement et le perfectionnement en échographie gynécologique et obstétricale, 75015 Paris, France; Service d'obstétrique et de médecine fœtale, université Paris Descartes, Sorbonne Paris Cité, hôpital Necker-Enfants-Malades, AP-HP, Paris, France; Faculté de médecine, université Saint-Joseph, rue de Damas, BP 11-5076, Riad El Solh Beyrouth 1107 2180 Beyrouth, Liban.
| | - A Gueneuc
- SimECHOle, école de simulation pour l'enseignement et le perfectionnement en échographie gynécologique et obstétricale, 75015 Paris, France; Service d'obstétrique et de médecine fœtale, université Paris Descartes, Sorbonne Paris Cité, hôpital Necker-Enfants-Malades, AP-HP, Paris, France
| | - J M Levaillant
- SimECHOle, école de simulation pour l'enseignement et le perfectionnement en échographie gynécologique et obstétricale, 75015 Paris, France; Service de gynécologie obstétrique, hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Y Ville
- SimECHOle, école de simulation pour l'enseignement et le perfectionnement en échographie gynécologique et obstétricale, 75015 Paris, France; Service d'obstétrique et de médecine fœtale, université Paris Descartes, Sorbonne Paris Cité, hôpital Necker-Enfants-Malades, AP-HP, Paris, France
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13
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Siauve N, Hayot PH, Deloison B, Chalouhi GE, Alison M, Balvay D, Bussières L, Clément O, Salomon LJ. Assessment of human placental perfusion by intravoxel incoherent motion MR imaging. J Matern Fetal Neonatal Med 2017; 32:293-300. [PMID: 28974131 DOI: 10.1080/14767058.2017.1378334] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To provide functional information on the human placenta, including perfusion, and diffusion, with no contrast agent injection, and to study correlations between intravoxel incoherent motion (IVIM) placental parameters and fetal growth. MATERIALS AND METHODS MRI was performed in women undergoing legal termination of pregnancy at 17-34 weeks, including a 4-b-value and 11-b-value DW sequences. The apparent diffusion coefficient (ADC), the restricted diffusion coefficient (D), the pseudoperfusion coefficient (D*), and the perfusion fraction (f) were calculated. Their relationships with gestational age, Z-scores for fetal and placental weight were evaluated by means of regression analysis. Logistic regression analysis was used to assess the ability of IVIM parameters to predict/detect intrauterine growth retardation (SGA). RESULTS Fifty-five pregnant women, including nine cases of SGA (16%), were included in the study. The ADC (n = 55) showed a quadratic correlation with gestational age (p < .001) and a linear correlation with the fetal weight Z-score (p = .02). Mean ADC values were significantly different between normally growing and SGA fetuses (2.37 ± 0.25 versus 2.29 ± 0.33 10-3.mm2.s-1, p=.048). The perfusion fraction f (n = 23) showed a quadratic correlation with gestational age (p = .017) and a linear correlation with the fetal weight Z - score (p = .008). Mean f values differed significantly between normally growing and SGA fetuses (42.55 ± 9.30% versus 27.94 ± 8.76%, p = .002). The receiver operating characteristics (ROC) curve for f to predict SGA was produced (area under the ROC curve = 0.9). CONCLUSIONS The observed association between f and fetal weight suggests that fMRI could be suitable for studying placental insufficiency and for identifying risk of SGA.
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Affiliation(s)
- Nathalie Siauve
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,c Assistance Publique: Hôpitaux de Paris , Hôpital Européen Georges Pompidou , Paris , France
| | - Pierre Humbert Hayot
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
| | - Benjamin Deloison
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
| | - Gihad E Chalouhi
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
| | - Marianne Alison
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France
| | - Daniel Balvay
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,e Plateforme d'Imagerie du Vivant , Université Paris Descartes, Sorbonne Paris Cité , Paris , France
| | - Laurence Bussières
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
| | - Olivier Clément
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France
| | - Laurent J Salomon
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
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Chalouhi GE, Morency AM, De Vlieger R, Martinez JM, Blanc T, Hodges R, Gueneuc A, Ryan G, Deprest J, Gratacos E, Ville Y. Prenatal incision of ureterocele causing bladder outlet obstruction: a multicenter case series. Prenat Diagn 2017; 37:968-974. [DOI: 10.1002/pd.5091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/01/2017] [Accepted: 06/08/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Gihad E. Chalouhi
- Fetal Medicine Unit, Obstetrics and Fetal Medicine Department, Necker-Enfants Malades Hospital; Université Paris Descartes; Sorbonne Paris Cité Paris France
- Faculty of Medicine; Saint Joseph University; Beirut Lebanon
| | - Anne-Maude Morency
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital; University of Toronto; Toronto ON Canada
| | - Roland De Vlieger
- Department of Obstetrics and Gynecology; University Hospitals KU Leuven; Belgium
| | - José Maria Martinez
- BCNatal, Barcelona Center for Maternal-Fetal Medicine and Neonatology, Hospital Clınic and Hospital Sant Joan de Dieu, IDIBAPS; University of Barcelona, and Centro de Investigacion Biomedica en Red de Enfermedades Raras (CIBERER) - Maternal-Fetal Medicine and Neonatology; Barcelona Spain
| | - Thomas Blanc
- Department of Pediatric Surgery, Necker-Enfants Malades Hospital; Université Paris Descartes; Sorbonne Paris Cité Paris France
| | - Ryan Hodges
- Fetal Medicine Unit, Obstetrics and Fetal Medicine Department, Necker-Enfants Malades Hospital; Université Paris Descartes; Sorbonne Paris Cité Paris France
| | - Alexandra Gueneuc
- Fetal Medicine Unit, Obstetrics and Fetal Medicine Department, Necker-Enfants Malades Hospital; Université Paris Descartes; Sorbonne Paris Cité Paris France
| | - Greg Ryan
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital; University of Toronto; Toronto ON Canada
| | - Jan Deprest
- Department of Obstetrics and Gynecology; University Hospitals KU Leuven; Belgium
| | - Eduard Gratacos
- BCNatal, Barcelona Center for Maternal-Fetal Medicine and Neonatology, Hospital Clınic and Hospital Sant Joan de Dieu, IDIBAPS; University of Barcelona, and Centro de Investigacion Biomedica en Red de Enfermedades Raras (CIBERER) - Maternal-Fetal Medicine and Neonatology; Barcelona Spain
| | - Yves Ville
- Fetal Medicine Unit, Obstetrics and Fetal Medicine Department, Necker-Enfants Malades Hospital; Université Paris Descartes; Sorbonne Paris Cité Paris France
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15
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Paladini D, Deloison B, Rossi A, Chalouhi GE, Gandolfo C, Sonigo P, Buratti S, Millischer AE, Tuo G, Ville Y, Pistorio A, Cama A, Salomon LJ. Vein of Galen aneurysmal malformation (VGAM) in the fetus: retrospective analysis of perinatal prognostic indicators in a two-center series of 49 cases. Ultrasound Obstet Gynecol 2017; 50:192-199. [PMID: 27514305 DOI: 10.1002/uog.17224] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 04/19/2016] [Revised: 08/08/2016] [Accepted: 08/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Vein of Galen aneurysmal malformation (VGAM) is a rare fetal anomaly, the neurological outcome of which can be good with appropriate perinatal management. However, most fetal series are too small to allow reliable statistical assessment of potential prognostic indicators. Our aim was to assess, in a two-center series of 49 cases, the prognostic value of several prenatal variables, in order to identify possible prenatal indicators of poor outcome, in terms of mortality and cerebral disability. METHODS This was a retrospective study involving 49 cases of VGAM diagnosed prenatally and managed at two centers over a 17-year period (1999-2015). All cases had undergone detailed prenatal cerebral and cardiac assessment by grayscale ultrasound, color and pulsed-wave Doppler and magnetic resonance imaging (MRI). Ultrasound and MRI examination reports and images were reviewed and outcome information was obtained from medical reports. Volume of the VGAM (on ultrasound and MRI) was calculated and development of straight-sinus dilatation, ventriculomegaly and other major brain abnormalities was noted. Cardiothoracic ratio, tricuspid regurgitation and reversed blood flow across the aortic isthmus were evaluated on fetal echocardiography. Major brain lesions were considered by definition to be associated with poor outcome in all cases. Pregnancy and fetoneonatal outcome were known in all cases. Fetoneonatal outcome and brain damage were considered as dependent variables in the statistical evaluation. Poor outcome was defined as death, late termination of pregnancy due to association with related severe brain anomalies or severe neurological impairment. RESULTS At a mean follow-up time of 20 (range, 0-72) months, 36.7% of the whole series and 52.9% of the cases which did not undergo late termination were alive and free of adverse sequelae. Five (10.2%) cases showed progression of the lesion between diagnosis and delivery. On univariate analysis, dilatation of the straight sinus, VGAM volume ≥ 20 000 mm3 and tricuspid regurgitation were all significantly related to poor outcome. However, on logistic regression analysis, the only variables associated significantly with poor outcome were tricuspid regurgitation and, to a lesser extent, VGAM volume ≥ 20 000 mm3 . The former was also the only variable associated with brain damage. CONCLUSIONS Major brain lesions, tricuspid regurgitation and, to a lesser extent, VGAM volume ≥ 20 000 mm3 are the only prenatal variables associated with poor outcome in fetal VGAM. Prenatal multidisciplinary counseling should be based on these variables. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - B Deloison
- Maternité, Hôpital Universitaire Necker-Enfants Malades, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - A Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - G E Chalouhi
- Maternité, Hôpital Universitaire Necker-Enfants Malades, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C Gandolfo
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - P Sonigo
- Radio-Pédiatrie, Hôpital Universitaire Necker-Enfants Malades, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - S Buratti
- Neonatal and Pediatric Intensive Care Unit, Department of Critical Care and Perinatal Medicine, Istituto Giannina Gaslini, Genoa, Italy
| | - A E Millischer
- Radio-Pédiatrie, Hôpital Universitaire Necker-Enfants Malades, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - G Tuo
- Department of Pediatric Cardiology and Cardiac Surgery, Istituto Giannina Gaslini, Genoa, Italy
| | - Y Ville
- Maternité, Hôpital Universitaire Necker-Enfants Malades, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - A Pistorio
- Epidemiology and Biostatistics Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - A Cama
- Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - L J Salomon
- Maternité, Hôpital Universitaire Necker-Enfants Malades, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
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Gondra L, Décramer S, Chalouhi GE, Muller F, Salomon R, Heidet L. Hyperechogenic kidneys and polyhydramnios associated with HNF1B gene mutation. Pediatr Nephrol 2016; 31:1705-8. [PMID: 27286685 DOI: 10.1007/s00467-016-3421-6] [Citation(s) in RCA: 12] [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: 04/07/2016] [Revised: 05/08/2016] [Accepted: 05/13/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND HNF1B mutation is the leading cause of isolated hyperechogenic fetal kidneys with normal or moderately large size. Although most cases have normal amniotic fluid volume, some cases present with early oligohydramnios and renal failure associated with high perinatal mortality. CASE DIAGNOSIS/TREATMENT Here we report on seven fetuses from six unrelated families, carrying an HNF1B mutation, and presenting with polyhydramnios during the second or third trimester of pregnancy. Polyhydramnios was transitory in two cases. None of the mothers was presenting gestational diabetes. Bilateral hyperechogenic kidneys with size between -2.5 and +2 SD was the most common renal phenotype at prenatal US. Two patients were born prematurely at 28 and 32 weeks of gestation, respectively. Both presented high urine output the first days of life with urinary salt and potassium loss requiring hydro-electrolytic compensation. All mutations were large deletions removing the whole HNF1B gene. CONCLUSIONS In the absence of maternal diabetes, HNF1B mutation can be associated with polyhydramnios, probably due to fetal polyuria. Thus, HNF1B mutation represents a differential diagnosis of polyhydramnios associated with hyperechogenic (and sometimes enlarged) kidneys.
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Affiliation(s)
- Leire Gondra
- Service de Néphrologie Pédiatrique, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Hôpital Necker-Enfants Malades, Assistance Publique- Hôpitaux de Paris, 149 rue de Sèvres, Paris Cedex 15, 75743, France
| | - Stéphane Décramer
- Service de Néphrologie Pédiatrique, Centre de Référence du Sud Ouest des Maladies Rénales Rares (SORARE), Hôpital Purpan, Toulouse, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institute of Cardiovascular and Metabolic Diseases, Toulouse, France.,Université de Toulouse III Paul Sabatier, Toulouse, France
| | - Gihad E Chalouhi
- Obstetrics and Foetal Medicine Department, Necker-Enfants-Malades Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Françoise Muller
- Biochimie-Hormonologie, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Rémi Salomon
- Service de Néphrologie Pédiatrique, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Hôpital Necker-Enfants Malades, Assistance Publique- Hôpitaux de Paris, 149 rue de Sèvres, Paris Cedex 15, 75743, France.,Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Laurence Heidet
- Service de Néphrologie Pédiatrique, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Hôpital Necker-Enfants Malades, Assistance Publique- Hôpitaux de Paris, 149 rue de Sèvres, Paris Cedex 15, 75743, France.
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Chalouhi GE, Bernardi V, Gueneuc A, Houssin I, Stirnemann JJ, Ville Y. Evaluation of trainees' ability to perform obstetrical ultrasound using simulation: challenges and opportunities. Am J Obstet Gynecol 2016; 214:525.e1-525.e8. [PMID: 26546849 DOI: 10.1016/j.ajog.2015.10.932] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/06/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Evaluation of trainee's ability in obstetrical ultrasound is a time-consuming process, which requires involving patients as volunteers. With the use of obstetrical ultrasound simulators, virtual reality could help in assessing competency and evaluating trainees in this field. OBJECTIVE The objective of the study was to test the validity of an obstetrical ultrasound simulator as a tool for evaluating trainees following structured training by comparing scores obtained on obstetrical ultrasound simulator with those obtained on volunteers and by assessing correlations between scores of images and of dexterity given by 2 blinded examiners. STUDY DESIGN Trainees, taking the 2013 French national examination for the practice of obstetrical ultrasound were asked to obtain standardized ultrasound planes both on volunteer pregnant women and on an obstetrical ultrasound simulator. These planes included measurements of biparietal diameter, abdominal circumference, and femur length as well as reference planes for cardiac 4-chamber and outflow tracts, kidneys, stomach/diaphragm, spine, and face. Images were stored and evaluated subsequently by 2 national examiners who scored each picture according to previously established quality criteria. Dexterity was also evaluated and subjectively scored between 0 and 10. The Raghunathan's modification of Pearson, Filon's z, Spearman's rank correlation, and analysis of variance tests were used to assess correlations between the scores by the 2 examiners and scores of dexterity and also to compare the final scores between the 2 different methods. RESULTS We evaluated 29 trainees. The mean dexterity scores in simulation (6.5 ± 2.0) and real examination (5.9 ± 2.3) were comparable (P = .31). Scores with an obstetrical ultrasound simulator were significantly higher than those obtained on volunteers (P = .027). Nevertheless, there was a good correlation between the scores of the 2 examiners judging on simulation (R = 0.888) and on volunteers (R = 0.873) (P = .81). CONCLUSION An obstetrical ultrasound simulator is as good a method as volunteer-based examination for evaluating practical skills in trainees following structured training in obstetrical ultrasound. The threshold for success/failure should, however, be adapted as candidates obtain higher scores on the simulator. Advantages of the obstetrical ultrasound simulator include the absence of location and time constraints without the need to involve volunteers or to interfere with the running of ultrasound clinics. However, an obstetrical ultrasound simulator still lacks the ability to evaluate the trainees' ability to interact with patients.
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Chalouhi GE, Quibel T, Benzina N, Bernard JP, Essaoui M, Ville Y. [Outcome of triplet pregnancies managed for twin-to-twin transfusion syndrome: A single center experience]. ACTA ACUST UNITED AC 2016; 45:929-935. [PMID: 26995685 DOI: 10.1016/j.jgyn.2015.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/02/2015] [Revised: 07/28/2015] [Accepted: 08/25/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Study the outcomes of triplet pregnancies (GGG) complicated with twin-to-twin transfusion syndrome (TTTS) treated with laser fetoscopy. METHODS Retrospective study of interventions, outcomes and perinatal follow-up of GGG treated for TTS. RESULTS Between 2002 and 2013, 25 GGG complicated by TTTS were seen in our center, 20 dichorionic and 5 monochorionic. The mean gestational age (GA) at diagnosis of TTTS was 19.7 GW (±2.4) with 2, 4, 16 and 1 pregnancies at Quintero's stage I, II, III and V, respectively. They had a fetoscopy at an average GA of 19 GW and 6 days. There were 3 (13.0%) late miscarriages. The average GA at delivery was of 29.6 GW overall (26.3 GW and 31.1 GW in monochorionic and dichorionic pregnancies respectively). The overall fetal survival rate was 57.97% (40% and 66.7% in the group of monochorionic dichorionic pregnancies, respectively). However, neonatal mortality (<28 days) is 17.5%. CONCLUSION GGG operated by fetoscopy for TTTS have a survival rate of three, at least 2 and at least 1 fetus of 21.7%, 69.6% and 82.6% respectively. The overall fetal survival rate is 59.97%. There is a tendency for better survival rates in dichorionic GGG compared to monochorionic GGG (P=0.079).
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Affiliation(s)
- G E Chalouhi
- Centre maladies rares, syndrome transfuseur-transfusé, hôpital Necker-Enfants-Malades, AP-HP, 75015 Paris, France; Maternité et service de médecine fœtale, hôpital Necker-Enfants-Malades, université Paris Descartes, Sorbonne Paris Cité, AP-HP, 149, rue de Sèvres, Paris, France
| | - T Quibel
- Service de gynécologie obstétrique, centre hospitalier intercommunal Poissy-Saint-Germain-en-Laye, 78300 Poissy, France
| | - N Benzina
- Centre maladies rares, syndrome transfuseur-transfusé, hôpital Necker-Enfants-Malades, AP-HP, 75015 Paris, France; Maternité et service de médecine fœtale, hôpital Necker-Enfants-Malades, université Paris Descartes, Sorbonne Paris Cité, AP-HP, 149, rue de Sèvres, Paris, France
| | - J-P Bernard
- Centre maladies rares, syndrome transfuseur-transfusé, hôpital Necker-Enfants-Malades, AP-HP, 75015 Paris, France; Maternité et service de médecine fœtale, hôpital Necker-Enfants-Malades, université Paris Descartes, Sorbonne Paris Cité, AP-HP, 149, rue de Sèvres, Paris, France
| | - M Essaoui
- Centre maladies rares, syndrome transfuseur-transfusé, hôpital Necker-Enfants-Malades, AP-HP, 75015 Paris, France; Maternité et service de médecine fœtale, hôpital Necker-Enfants-Malades, université Paris Descartes, Sorbonne Paris Cité, AP-HP, 149, rue de Sèvres, Paris, France
| | - Y Ville
- Centre maladies rares, syndrome transfuseur-transfusé, hôpital Necker-Enfants-Malades, AP-HP, 75015 Paris, France; Maternité et service de médecine fœtale, hôpital Necker-Enfants-Malades, université Paris Descartes, Sorbonne Paris Cité, AP-HP, 149, rue de Sèvres, Paris, France.
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Beauquier-Maccotta B, Chalouhi GE, Picquet AL, Carrier A, Bussières L, Golse B, Ville Y. Impact of Monochorionicity and Twin to Twin Transfusion Syndrome on Prenatal Attachment, Post Traumatic Stress Disorder, Anxiety and Depressive Symptoms. PLoS One 2016; 11:e0145649. [PMID: 26751570 PMCID: PMC4709103 DOI: 10.1371/journal.pone.0145649] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 06/22/2015] [Accepted: 12/07/2015] [Indexed: 11/19/2022] Open
Abstract
Monochronioric (MC) twin pregnancies are considered as high-risk pregnancies with potential complications requiring in-utero interventions. We aimed to assess prenatal attachment, anxiety, post-traumatic stress disorder (PTSD) and depressive symptoms in MC pregnancies complicated with Twin-To-Twin-transfusion syndrome (TTTS) in comparison to uncomplicated monochorionic (UMC) and dichorionic pregnancies (DC). Auto-questionnaires were filled out at diagnosis of TTTS and at successive milestones. Prenatal attachment, PTSD, anxiety and perinatal depression were evaluated respectively by the Prenatal Attachment Inventory (PAI) completed for each twin, the Post-traumatic Checklist Scale (PCLS), the State-Trait Anxiety Inventory (STAI) and the Edinburgh Perinatal Depression Scale (EPDS). There was no significant difference in the PAI scores between the two twins. In the DC and UMC groups, PAI scores increased throughout pregnancy, whilst it didn't for TTTS group. TTTS and DC had a similar prenatal attachment while MC mothers expressed a significantly higher attachment to their fetuses and expressed it earlier. At the announcement of TTTS, 72% of the patients present a score over the threshold at the EPDS Scale, with a higher score for TTTS than for DC (p = 0.005), and UMC (p = 0.007) at the same GA. 30% of mothers in TTTS group have PTSD during pregnancy. 50% of TTTS- patients present an anxiety score over the threshold (STAI-Scale), with a score significantly higher in TTTS than in UMC (p<0.001) or DC (p<0.001). The proportion of subject with a STAI-State over the threshold is also significantly higher in TTTS than in DC at 20 GW (p = 0.01) and at 26 GW (p<0.05). The STAI-state scores in UMC and DC increase progressively during pregnancy while they decrease significantly in TTTS. TTTS announcement constitutes a traumatic event during a pregnancy with an important risk of PTSD, high level of anxiety and an alteration of the prenatal attachment. These results should guide the psychological support provided to these patients.
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Affiliation(s)
- Berengere Beauquier-Maccotta
- Department of Child and Adolescent Psychiatry, Necker-Enfants-Malades Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Gihad E. Chalouhi
- Obstetrics and Fetal Medicine Department, Necker-Enfants-Malades Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Rare Disease Center- TTTS, Necker-Enfants-Malades Hospital, APHP, Paris, France
| | - Anne-Laure Picquet
- Rare Disease Center- TTTS, Necker-Enfants-Malades Hospital, APHP, Paris, France
| | - Aude Carrier
- Obstetrics and Fetal Medicine Department, Necker-Enfants-Malades Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Rare Disease Center- TTTS, Necker-Enfants-Malades Hospital, APHP, Paris, France
| | - Laurence Bussières
- Rare Disease Center- TTTS, Necker-Enfants-Malades Hospital, APHP, Paris, France
| | - Bernard Golse
- Department of Child and Adolescent Psychiatry, Necker-Enfants-Malades Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Yves Ville
- Obstetrics and Fetal Medicine Department, Necker-Enfants-Malades Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Rare Disease Center- TTTS, Necker-Enfants-Malades Hospital, APHP, Paris, France
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Siauve N, Chalouhi GE, Deloison B, Alison M, Clement O, Ville Y, Salomon LJ. Functional imaging of the human placenta with magnetic resonance. Am J Obstet Gynecol 2015; 213:S103-14. [PMID: 26428488 DOI: 10.1016/j.ajog.2015.06.045] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 11/29/2022]
Abstract
Abnormal placentation is responsible for most failures in pregnancy; however, an understanding of placental functions remains largely concealed from noninvasive, in vivo investigations. Magnetic resonance imaging (MRI) is safe in pregnancy for magnetic fields of up to 3 Tesla and is being used increasingly to improve the accuracy of prenatal imaging. Functional MRI (fMRI) of the placenta has not yet been validated in a clinical setting, and most data are derived from animal studies. FMRI could be used to further explore placental functions that are related to vascularization, oxygenation, and metabolism in human pregnancies by the use of various enhancement processes. Dynamic contrast-enhanced MRI is best able to quantify placental perfusion, permeability, and blood volume fractions. However, the transplacental passage of Gadolinium-based contrast agents represents a significant safety concern for this procedure in humans. There are alternative contrast agents that may be safer in pregnancy or that do not cross the placenta. Arterial spin labeling MRI relies on magnetically labeled water to quantify the blood flows within the placenta. A disadvantage of this technique is a poorer signal-to-noise ratio. Based on arterial spin labeling, placental perfusion in normal pregnancy is 176 ± 91 mL × min(-1) × 100 g(-1) and decreases in cases with intrauterine growth restriction. Blood oxygen level-dependent and oxygen-enhanced MRIs do not assess perfusion but measure the response of the placenta to changes in oxygen levels with the use of hemoglobin as an endogenous contrast agent. Diffusion-weighted imaging and intravoxel incoherent motion MRI do not require exogenous contrast agents, instead they use the movement of water molecules within tissues. The apparent diffusion coefficient and perfusion fraction are significantly lower in placentas of growth-restricted fetuses when compared with normal pregnancies. Magnetic resonance spectroscopy has the ability to extract information regarding metabolites from the placenta noninvasively and in vivo. There are marked differences in all 3 metabolites N-acetyl aspartate/choline levels, inositol/choline ratio between small, and adequately grown fetuses. Current research is focused on the ability of each fMRI technique to make a timely diagnosis of abnormal placentation that would allow for appropriate planning of follow-up examinations and optimal scheduling of delivery. These research programs will benefit from the use of well-defined sequences, standardized imaging protocols, and robust computational methods.
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Affiliation(s)
- Nathalie Siauve
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Hôpital Européen Georges Pompidou, Paris, France
| | - Gihad E Chalouhi
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Benjamin Deloison
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Marianne Alison
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France
| | - Olivier Clement
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; Hôpital Européen Georges Pompidou, Paris, France
| | - Yves Ville
- EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Laurent J Salomon
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France.
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Quibel T, Deloison B, Chammings F, Chalouhi GE, Siauve N, Alison M, Bessières B, Gennisson JL, Clément O, Salomon LJ. Placental elastography in a murine intrauterine growth restriction model. Prenat Diagn 2015; 35:1106-11. [PMID: 26193351 DOI: 10.1002/pd.4654] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 06/30/2015] [Accepted: 07/01/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To compare placental elasticity in normal versus intrauterine growth restriction (IUGR) murine pregnancies using shear wave elastography (SWE). METHODS Intrauterine growth restriction was created by ligation of the left uterine artery of Sprague-Dawley rats on E17. Ultrasonography (US) and elastography were performed 2 days later on exteriorized horns after laparotomy. Biparietal diameter (BPD) and abdominal diameter (AD) were measured and compared in each horn. Placental elasticity of each placenta was compared in the right and left horns, respectively, using the Young's modulus, which increases with increasing stiffness of the tissue. RESULTS Two hundred seventeen feto-placental units from 18 rats were included. Fetuses in the left ligated horn had smaller biometric measurements than those in the right horn (6.7 vs 7.2 mm, p < 0.001, and 9.2 vs 11.2 mm, p < 0.001 for BPD and AD, respectively). Mean fetal weight was lower in the pups from the left than the right horn (1.65 vs 2.11 g; p < 0.001). Mean (SD) Young's modulus was higher for placentas from the left than the right horn (11.7 ± 1.5 kPa vs 8.01 ± 3.8 kPa, respectively; p < 0.001), indicating increased stiffness in placentas from the left than the right horn. There was an inverse relationship between fetal weight and placental elasticity (r = 0.42; p < 0.001). CONCLUSION Shear wave elastography may be used to provide quantitative elasticity measurements of the placenta. In our model, placentas from IUGR fetuses demonstrated greater stiffness, which correlated with the degree of fetal growth restriction.
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Affiliation(s)
- T Quibel
- Departments of Obstetrics and Gynecology, CHI Poissy Saint Germain, 10 rue Champ, Gaillard, Poissy, BP 3082, France.,INSERM UMR 970, PARCC, Paris, France.,EA FETUS 7328, Université Paris Descartes, Paris, France
| | - B Deloison
- INSERM UMR 970, PARCC, Paris, France.,EA FETUS 7328, Université Paris Descartes, Paris, France.,Maternité Necker-Enfants Malade, Assistance Publique Hopitaux de Paris, Faculté de Médecine, Univeristé Paris Descartes, Paris, France
| | | | - G E Chalouhi
- INSERM UMR 970, PARCC, Paris, France.,Maternité Necker-Enfants Malade, Assistance Publique Hopitaux de Paris, Faculté de Médecine, Univeristé Paris Descartes, Paris, France
| | - N Siauve
- INSERM UMR 970, PARCC, Paris, France
| | - M Alison
- INSERM UMR 970, PARCC, Paris, France
| | - B Bessières
- Département de Génétique Histologie-Embryologie-Cytogénétique, Hopital Necker-Enfant Malades, AP-HP, Paris, France
| | - J L Gennisson
- Institut Langevin Ondes et Images, ESPCI ParisTech, Paris, France
| | - O Clément
- INSERM UMR 970, PARCC, Paris, France
| | - L J Salomon
- INSERM UMR 970, PARCC, Paris, France.,EA FETUS 7328, Université Paris Descartes, Paris, France.,Maternité Necker-Enfants Malade, Assistance Publique Hopitaux de Paris, Faculté de Médecine, Univeristé Paris Descartes, Paris, France
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Chalouhi GE. Re: Sustained effect of simulation-based ultrasound training on clinical performance: a randomized trial. M. G. Tolsgaard, C. Ringsted, E. Dreisler, L. N. Nørgaard, J. H. Petersen, M. E. Madsen, N. L. C. Freiesleben, J. L. Sørensen and A. Tabor. Ultrasound Obstet Gynecol 2015; 46: 312-318. Ultrasound Obstet Gynecol 2015; 46:264-265. [PMID: 26338236 DOI: 10.1002/uog.15659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- G E Chalouhi
- Obstetrics and Fetal Medicine Department, Necker-Enfants-Malades Hospital, APHP, Universite Paris Descartes, Sorbonne Paris Cite, Paris, France.
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Chao C, Chalouhi GE, Bouhanna P, Ville Y, Dommergues M. Randomized Clinical Trial of Virtual Reality Simulation Training for Transvaginal Gynecologic Ultrasound Skills. J Ultrasound Med 2015; 34:1663-1667. [PMID: 26283753 DOI: 10.7863/ultra.15.14.09063] [Citation(s) in RCA: 18] [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: 09/26/2014] [Accepted: 12/16/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To compare the impact of virtual reality simulation training and theoretical teaching on the ability of inexperienced trainees to produce adequate virtual transvaginal ultrasound images. METHODS We conducted a randomized controlled trial with parallel groups. Participants included inexperienced residents starting a training program in Paris. The intervention consisted of 40 minutes of virtual reality simulation training using a haptic transvaginal simulator versus 40 minutes of conventional teaching including a conference with slides and videos and answers to the students' questions. The outcome was a 19-point image quality score calculated from a set of 4 images (sagittal and coronal views of the uterus and left and right ovaries) produced by trainees immediately after the intervention, using the same simulator on which a new virtual patient had been uploaded. Experts assessed the outcome on stored images, presented in a random order, 2 months after the trial was completed. They were blinded to group assignment. The hypothesis was an improved outcome in the intervention group. Randomization was 1 to 1. RESULTS The mean score was significantly greater in the simulation group (n = 16; mean score, 12; SEM, 0.8) than the control group (n = 18; mean score, 9; SEM, 1.0; P= .0302). CONCLUSIONS The quality of virtual vaginal images produced by inexperienced trainees was greater immediately after a single virtual reality simulation training session than after a single theoretical teaching session.
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Affiliation(s)
- Coline Chao
- Hôpital Universitaire Pitié Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France (C.C., M.D.); Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France (G.E.C., Y.V.); Université René Descartes, Paris, France (G.E.C., Y.V.); Hôpital Poissy Saint-Germain en Laye, Saint-Germain en Laye, France (P.B.); and Université Pierre et Marie Curie, Paris, France (M.D.)
| | - Gihad E Chalouhi
- Hôpital Universitaire Pitié Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France (C.C., M.D.); Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France (G.E.C., Y.V.); Université René Descartes, Paris, France (G.E.C., Y.V.); Hôpital Poissy Saint-Germain en Laye, Saint-Germain en Laye, France (P.B.); and Université Pierre et Marie Curie, Paris, France (M.D.)
| | - Philippe Bouhanna
- Hôpital Universitaire Pitié Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France (C.C., M.D.); Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France (G.E.C., Y.V.); Université René Descartes, Paris, France (G.E.C., Y.V.); Hôpital Poissy Saint-Germain en Laye, Saint-Germain en Laye, France (P.B.); and Université Pierre et Marie Curie, Paris, France (M.D.)
| | - Yves Ville
- Hôpital Universitaire Pitié Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France (C.C., M.D.); Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France (G.E.C., Y.V.); Université René Descartes, Paris, France (G.E.C., Y.V.); Hôpital Poissy Saint-Germain en Laye, Saint-Germain en Laye, France (P.B.); and Université Pierre et Marie Curie, Paris, France (M.D.)
| | - Marc Dommergues
- Hôpital Universitaire Pitié Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France (C.C., M.D.); Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France (G.E.C., Y.V.); Université René Descartes, Paris, France (G.E.C., Y.V.); Hôpital Poissy Saint-Germain en Laye, Saint-Germain en Laye, France (P.B.); and Université Pierre et Marie Curie, Paris, France (M.D.).
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Chalouhi GE, Bernardi V, Ville Y. Ultrasound simulators in obstetrics and gynecology: state of the art. Ultrasound Obstet Gynecol 2015; 46:255-63. [PMID: 25346451 DOI: 10.1002/uog.14707] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 10/16/2014] [Accepted: 10/17/2014] [Indexed: 05/09/2023]
Affiliation(s)
- G E Chalouhi
- Obstetrics and Fetal Medicine Department, Necker-Enfants-Malades Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - V Bernardi
- Obstetrics and Fetal Medicine Department, Necker-Enfants-Malades Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department of Women and Children's Health, Università degli Studi di Padova, Padova, Italy
| | - Y Ville
- Obstetrics and Fetal Medicine Department, Necker-Enfants-Malades Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Chalouhi GE, Benedetti S, Alby C, Benzina N, Ville Y. Cause of fetal demise in first-trimester parvovirus infection: anemia, placentitis or myocarditis? Ultrasound Obstet Gynecol 2014; 44:618-619. [PMID: 24862083 DOI: 10.1002/uog.13416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 05/09/2014] [Indexed: 06/03/2023]
Affiliation(s)
- G E Chalouhi
- Obstetrics and Fetal Medicine Department, Necker-Enfants-Malades Hospital, APHP, Paris V University, Paris, France
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Boujenah J, Ssi-Yan-Kan G, Prevot S, Chalouhi GE, Deffieux X. A vaginal Gartner duct cyst presenting as a cystocele during pregnancy. Eur J Obstet Gynecol Reprod Biol 2014; 180:202-4. [PMID: 24913935 DOI: 10.1016/j.ejogrb.2014.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 03/26/2014] [Accepted: 05/20/2014] [Indexed: 11/20/2022]
Affiliation(s)
- Jeremy Boujenah
- AP-HP, Hôpital Antoine Béclère, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Clamart F-92141, France; Université Paris-Sud, Faculté de Médecine, Orsay F-91405, France
| | | | - Sophie Prevot
- AP-HP, Hôpital Antoine Béclère, Service d'Anatomopathologie, Clamart F-92141, France
| | - Gihad E Chalouhi
- AP-HP, Hôpital Necker, Service de Gynécologie-Obstétrique, Paris F-75007, France
| | - Xavier Deffieux
- AP-HP, Hôpital Antoine Béclère, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Clamart F-92141, France; Université Paris-Sud, Faculté de Médecine, Orsay F-91405, France; GREEN GRC 01 (UPMC), Groupe de RecherchE cliniquE en Neuro-Urologie, Site Antoine Béclère, Clamart F-92141, France.
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Affiliation(s)
- G E Chalouhi
- INSERM, Paris Cardiovascular Research Center-PARCC, Paris, France; Department of Obstetrics and Fetal Medicine, Paris Descartes University, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpital de Paris, France
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Joyeux L, Chalouhi GE, Ville Y, Sapin E. [Maternal-fetal surgery for spina bifida: future perspectives]. ACTA ACUST UNITED AC 2014; 43:443-54. [PMID: 24582882 DOI: 10.1016/j.jgyn.2014.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/14/2014] [Accepted: 01/21/2014] [Indexed: 12/29/2022]
Abstract
Open spina bifida or myelomeningocele (MMC) is a frequent congenital abnormality (450 cases per year in France) associated with high morbidity. Immediate postnatal surgery is aimed at covering the exposed spinal cord, preventing infection, treating hydrocephalus with a ventricular shunt. MMC surgical techniques haven't achieved any major progress in the past decades. Numerous experimental and clinical studies have demonstrated the MMC "two-hit" hypothetic pathogenesis: a primary embryonic congenital abnormality of the nervous system due to a failure in the closure of the developing neural tube, followed by secondary damages of spinal cord and nerves caused by long-term exposure to amniotic fluid. This malformation frequently develops cranial consequences, i.e. hydrocephalus and Chiari II malformation, due to leakage of cerebrospinal fluid. After 30 years of research, a randomized trial published in February 2011 proved open maternal-fetal surgery (OMFS) for MMC to be a real therapeutic option. Comparing prenatal to postnatal surgery, it confirmed better outcomes of MMC children after a follow up of 2.5 years: enhancement of lower limb motor function, decrease of the degree of hindbrain herniation associated with the Chiari II malformation and the need for shunting. At 5 years of age, MMC children operated prenatally seems to have better neurocognitive, motor and bladder-sphincter outcomes than those operated postnatally. However, risks of OMFS exist: prematurity for the fetus and a double hysterotomy at approximately 3-month interval for the mother. Nowadays, it seems crucial to inform parents of MMC patients about OMFS and to offer it in France. Future research will improve our understanding of MMC pathophysiology and evaluate long-term outcomes of OMFS. Tomorrow's prenatal surgery will be less invasive and more premature using endoscopic, robotic or percutaneous techniques. Beforehand, Achilles' heel of maternal-fetal surgery, i.e. preterm premature rupture of membranes, preterm labor and preterm birth, must be solved.
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Affiliation(s)
- L Joyeux
- Service de chirurgie pédiatrique, hôpital d'enfants, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon, France.
| | - G E Chalouhi
- Service de gynécologie-obstétrique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - Y Ville
- Service de gynécologie-obstétrique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - E Sapin
- Service de chirurgie pédiatrique, hôpital d'enfants, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon, France
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Chalouhi GE, Salomon LJ, Fontanges M, Althuser M, Haddad G, Scemama O, Chabot JM, Duyme M, Fries N. Formative assessment based on an audit and feedback improves nuchal translucency ultrasound image quality. J Ultrasound Med 2013; 32:1601-1605. [PMID: 23980221 DOI: 10.7863/ultra.32.9.1601] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The purpose of this work was to study the impact of an audit and feedback on the quality of routine first-trimester nuchal transparency ultrasound images. METHODS Eighty-eight sonographers were each sent 2 different series of 30 consecutive nuchal translucency images at a mean interval of 3 months to a dedicated, protected server for remote double-blind independent analysis based on the new Collège Français d'Echographie Foetale/Centre National de la Recherche Scientifique image-scoring method (https://www.cfef.org/evaluation/ISMCFEFCNRS.pdf). The sonographers were classified as low (score below the median) or high (score above the median) scorers for each series. Before their second evaluation, 73 of the 88 sonographers received a feedback report on their first series of images, whereas the other 15 participants received no feedback. The baseline characteristics of the participants who did and did not receive feedback were comparable. RESULTS Participants who received feedback increased their average score significantly, from a mean ± SD of 11.1 ± 1.3 to 13.4 ± 1.4 among low scorers (P < .00001) and from 15.1 ± 1.2 to 16.0 ± 1.4 among high scorers (P < .001), whereas no significant change was seen among participants who received no feedback (low scorers, 10.9 ± 1.5 to 12.1 ± 2.0; P = .11; high scorers, 14.7 ± 1.3 to 14.6 ± 1.3; P = .99). The proportion of satisfactory images increased by 48% among low scorers who received feedback. CONCLUSIONS Formative assessment based on a moderately intensive audit and feedback is feasible and effective for improving the quality of routine first-trimester nuchal transparency ultrasound images.
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Affiliation(s)
- Gihad E Chalouhi
- Department of Obstetrics and Fetal Medicine, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
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Russell NE, Chalouhi GE, Dirocco F, Zerah M, Ville Y. Not all large neural tube defects have a poor prognosis: a case of prenatally diagnosed limited dorsal myeloschisis. Ultrasound Obstet Gynecol 2013; 42:238-239. [PMID: 23576463 DOI: 10.1002/uog.12477] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Chalouhi GE, Alison M, Deloison B, Thiam R, Autret G, Balvay D, Cuenod CA, Clément O, Salomon LJ, Siauve N. Fetoplacental oxygenation in an intrauterine growth restriction rat model by using blood oxygen level-dependent MR imaging at 4.7 T. Radiology 2013; 269:122-9. [PMID: 23696681 DOI: 10.1148/radiol.13121742] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To investigate blood oxygen level-dependent (BOLD) magnetic resonance (MR) imaging in an intrauterine growth restriction (IUGR) rat model as a noninvasive in vivo tool to evaluate the response of the fetoplacental units (FPUs) to oxygenation MATERIALS AND METHODS All procedures were approved by the animal care committee. The study was performed between February and July 2010. The IUGR model based on the ligation of the left uterine vascular pedicle at embryonic day 17 of gestation was validated by weighing placentas and fetuses after MR imaging. FPUs in the left and right uterine horns were IUGR cases and controls, respectively. A small-animal 4.7-T MR imager was used. Multiple gradient-echo sequence (repetition time msec/echo time msec, 800/1.8-49.8) was performed at embryonic day 19. T2* relaxation time was measured before and after maternal hyperoxygenation for live FPUs in placenta, fetal liver, and brain. The effect of hyperoxygenation on BOLD MR imaging was analyzed with change in T2* between hyperoxygenation and ambient air. After dissection, live fetuses from both horns were identified and weighed. Changes in T2* were compared based on Student t tests. A mixed model was used to compare BOLD effect among horns and organs. RESULTS Sixteen rats were studied. There was a significant fetal weight decrease in the IUGR FPUs (-21.9%; P < .001). Change in T2* differed significantly between IUGR cases and controls for placenta (5.25 msec vs 11.25 msec; P < .001) and fetal brain (3.7 msec vs 7.17 msec; P = .02), whereas there was no significant difference in the fetal liver (2.72 msec vs 3.18 msec; P = .47). CONCLUSION BOLD MR imaging at 4.7 T can be used to evaluate the response to oxygenation in normal and IUGR FPUs. This technique has a potential role in the assessment of human pregnancy.
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Affiliation(s)
- Gihad E Chalouhi
- INSERM, U970, Paris Cardiovascular Research Center-PARCC, Paris, France; Department of Obstetrics and Fetal Medicine, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, 149 rue de Sèvres, Paris 75015, France; Department of Radiology, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
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Salomon LJ, Alfirevic Z, Bilardo CM, Chalouhi GE, Ghi T, Kagan KO, Lau TK, Papageorghiou AT, Raine-Fenning NJ, Stirnemann J, Suresh S, Tabor A, Timor-Tritsch IE, Toi A, Yeo G. ISUOG practice guidelines: performance of first-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2013; 41:102-13. [PMID: 23280739 DOI: 10.1002/uog.12342] [Citation(s) in RCA: 344] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Chalouhi GE, Marangoni MA, Quibel T, Deloison B, Benzina N, Essaoui M, Al Ibrahim A, Stirnemann JJ, Salomon LJ, Ville Y. Active management of selective intrauterine growth restriction with abnormal Doppler in monochorionic diamniotic twin pregnancies diagnosed in the second trimester of pregnancy. Prenat Diagn 2012; 33:109-15. [PMID: 23280487 DOI: 10.1002/pd.4031] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aims to compare outcomes of active management of monochorionic diamniotic twin pregnancies complicated with severe intrauterine growth restriction (IUGR) of one twin before 24 weeks with continuous or intermittent absent or reversed end-diastolic flow (AREDF) in the umbilical artery, with or without twin-to-twin transfusion syndrome (TTTS). METHOD This study is a retrospective comparison of 45 consecutive cases of severe selective IUGR (s-IUGR) defined as an estimated fetal weight at or below the fifth centile with a >25% weight discordance and AREDF in the umbilical artery before 24 weeks and 166 consecutive cases of TTTS stage III, with AREDF in the donor (TTTS3D) and also with s-IUGR. These were treated by either selective laser photocoagulation of chorionic vessels (SLPCV) or cord coagulation (CC). RESULTS The 166 cases of TTTS3D were treated by SLPCV, whereas 23 and 22 cases of s-IUGR were treated by SLPCV and CC, respectively. Overall survival was 52.17% or 45.45% in s-IUGR treated by SLPCV or CC, respectively, and 48.49% in TTTS3D. The survival of appropriately grown for gestational age (AGA) twins following CC (90.9%) was higher than that following SLPCV in s-IUGR (74%) or in recipient twins of TTTS3D (55.42%) (p = 0.001). Survival of the IUGR twin was 30% and 41.56% with SLPCV in s-IUGR and TTTS3D, respectively. CONCLUSIONS Active management of severe IUGR with AREDF in the umbilical artery seems beneficial. Survival rates with SLPCV were similar in s-IUGR and TTTS3D. However, there was a trend for higher survival rates in the AGA twin for CC. The choice of the technique should be driven by objective counseling on survival of both IUGR and AGA twins and therefore by the utility-based ethical values expressed by the pregnant woman.
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Affiliation(s)
- G E Chalouhi
- National Referral Centre for Management of Complicated Monochorionic Pregnancies, Department of Obstetrics and Fetal Medicine, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, 75015, Paris, France
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Deloison B, Chalouhi GE, Sonigo P, Zerah M, Millischer AE, Dumez Y, Brunelle F, Ville Y, Salomon LJ. Hidden mortality of prenatally diagnosed vein of Galen aneurysmal malformation: retrospective study and review of the literature. Ultrasound Obstet Gynecol 2012; 40:652-658. [PMID: 22605540 DOI: 10.1002/uog.11188] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/03/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the prognosis of prenatally diagnosed vein of Galen aneurysmal malformation (VGAM) in a large cohort with this condition and to review the literature on prenatally diagnosed VGAM. METHODS This was a retrospective study of all cases of prenatally diagnosed VGAM managed in our referral center during a 12-year period. VGAM was categorized as being either isolated or associated with any other abnormality, based on fetal ultrasound and magnetic resonance imaging findings. Poor outcomes comprised termination of pregnancy with confirmation of antenatal findings, perinatal death and severe cardiac and/or neurological impairment in survivors. The literature was also reviewed for similar cases. RESULTS Twenty-one cases of prenatally diagnosed VGAM were managed in our center. Four (19.0%) cases were isolated and 17 (81.0%) were associated with other anomalies. There were nine terminations (42.9%) and six neonatal deaths (28.6%). Six children (28.6%) were still alive at last follow-up, of whom three had abnormal neurological development. VGAM associated with other anomalies was strongly associated with a poor outcome compared with isolated forms (P < 0.0001). One hundred and nine cases from the literature were also reviewed. CONCLUSION Fetuses with prenatally diagnosed VGAM have unexpectedly poor outcomes in the presence of cardiac or cerebral anomalies, while those with strictly isolated VGAM tend to have more favorable outcomes. Our literature review corroborates these findings.
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Affiliation(s)
- B Deloison
- Department of Obstetrics and Fetal Medicine and SFAPE (Société Française d'Amélioration des Pratiques Echographique), Paris Descartes University, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants, Paris, France
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Mousty E, Chalouhi GE, El Sabbagh A, Khen-Dunlop N, Kuleva M, Salomon LJ, Ville Y. Secondary bladder herniation in isolated gastroschisis justifies increased surveillance. Prenat Diagn 2012; 32:888-92. [PMID: 22718102 DOI: 10.1002/pd.3928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Revised: 05/22/2012] [Accepted: 05/26/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To assess the perinatal outcome of fetuses with gastroschisis complicated by secondary bladder herniation. POPULATION AND MATERIALS: This was a retrospective study of all cases of isolated gastroschisis associated with bladder herniation managed at our institution. Prenatal ultrasound, obstetrical and perinatal information were collected. Pathology reports were also gathered. RESULTS Out of 105 cases of gastroschisis managed at our institution, six (5.7%) were associated with secondary bladder herniation, two of them being diagnosed postnatally. Median gestational age at diagnosis of bladder herniation was 33.6 weeks (range 31-36) in five female and one male fetuses. Bladder herniation was associated with bowel dilatation in four cases (67%) and with pyelic dilatation in one case (17%). Despite increased surveillance, one male fetus died in utero. In four other cases, cesarean section was performed for fetal distress (three cases) or hyperechogenic bowels (one case). The five survivors had primary abdominal closure (n = 2) or staged repair (n = 3) with uneventful follow-up. CONCLUSION Bladder herniation was present in 6% of apparently isolated gastroschisis. There was one intrauterine fetal death and four other cases were delivered for fetal distress. Increased surveillance seems justified.
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Affiliation(s)
- E Mousty
- Department of Obstetrics and Fetal Medicine, Necker-Enfants-Malades Medical School, Paris Descartes University, 149 rue de Sèvres, 75015, Paris, France
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Deloison B, Chalouhi GE, Bernard JP, Ville Y, Salomon LJ. Outcomes of fetuses with small head circumference on second-trimester ultrasonography. Prenat Diagn 2012; 32:869-74. [DOI: 10.1002/pd.3923] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 04/30/2012] [Accepted: 05/13/2012] [Indexed: 11/06/2022]
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Stirnemann JJ, Chalouhi GE, Forner S, Saidji Y, Salomon LJ, Bernard JP, Ville Y. First-trimester uterine scar assessment by transvaginal ultrasound. Am J Obstet Gynecol 2011; 205:551.e1-6. [PMID: 21893310 DOI: 10.1016/j.ajog.2011.06.104] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [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: 02/09/2011] [Revised: 05/15/2011] [Accepted: 06/28/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of the study was to describe the assessment of lower segment uterine scar (LSCS) by transvaginal ultrasound (TVUS) during a first-trimester scan. STUDY DESIGN Patients with a history of LSCS were prospectively enrolled over a 6 month period. Four groups were defined: type 1A, thin scar within cervicoisthmic canal (CIC); type 1B, thin above the internal os (IO); type 2A, dehiscent within the CIC; type 2B, dehiscent above the IO. Accuracy of first-trimester TVUS was investigated by blind testing a panel of 14 operators over a web-based dataset. RESULTS The scar was visualized in 122 of 123 patients enrolled. Types 1A, 1B, 2A, and 2B occurred in 49.2%, 3.3%, 38.3%, and 9.2%, respectively. When blind tested, fetal medicine specialists achieved a median sensitivity of 82% and specificity of 100% for the detection of a scar. These were 83% and 87% for nonspecialists. CONCLUSION First-trimester uterine scar assessment may become a valuable tool in early recognition of patients at risk of subsequent perinatal complications.
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Affiliation(s)
- Julien J Stirnemann
- Department of Obstetrics and Maternal-Fetal Medicine, GHU Necker-Enfants Malades, Université Paris Descartes, Paris, France
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Chalouhi GE, Muller F, Dreux S, Ville Y, Chardot C. Prenatal non-visualization of fetal gallbladder: beware of biliary atresia! Ultrasound Obstet Gynecol 2011; 38:237-240. [PMID: 21611993 DOI: 10.1002/uog.9058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Chalouhi GE, Essaoui M, Stirnemann J, Quibel T, Deloison B, Salomon L, Ville Y. Laser therapy for twin-to-twin transfusion syndrome (TTTS). Prenat Diagn 2011; 31:637-46. [PMID: 21660997 DOI: 10.1002/pd.2803] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 05/10/2011] [Accepted: 05/10/2011] [Indexed: 11/06/2022]
Abstract
Monochorionic twins are subjected to specific complications which originate in either imbalance or abnormality of the single placenta serving two twins including twin-to-twin transfusion syndrome. The diagnosis is well established in overt clinical forms with the association of polyuric polyhydramnios and oliguric oligohydramnios. The best treatment of cases presenting before 26 weeks of gestion is fetoscopic laser ablation of the intertwin anastomoses on the chorionic plate. Although subjected to subtle variations, the core technique follows robust guidelines which could help understanding and acquiring the required skills and experience to perform this procedure. However appropriate and tailored hands-on training and appropriate perinatal set-up are critical not only for surgical management but also for the follow-up and management of related complications.
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Affiliation(s)
- G E Chalouhi
- National Referral Centre for the Management of Complicated Monochorionic Pregnancies, Department of Obstetrics and Fetal Medicine, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, 75015 Paris, France
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Salomon LJ, Chalouhi GE, Stirnemann JJ, Bernard JP, Ville Y. Cerebral ventricle width measurements vary in relation to gestational age, fetal gender and cephalometry. Ultrasound Obstet Gynecol 2011; 37:370-371. [PMID: 21105019 DOI: 10.1002/uog.8889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Chalouhi GE, Deloison B, Siauve N, Aimot S, Balvay D, Cuenod CA, Ville Y, Clément O, Salomon LJ. Dynamic contrast-enhanced magnetic resonance imaging: definitive imaging of placental function? Semin Fetal Neonatal Med 2011; 16:22-8. [PMID: 20851065 DOI: 10.1016/j.siny.2010.09.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The placenta constitutes a complex circulatory interface between the mother and fetus, but the relationship between the maternal and fetal circulation is still very difficult to study in vivo. There is growing evidence that magnetic resonance imaging (MRI) is useful and safe during pregnancy, and MRI is increasingly used for fetal and placental anatomical imaging. MRI functional imaging is now a modern obstetric tool and has the potential to provide new insights into the physiology of the human placenta. Placental perfusion has been studied during the first pass of an MR contrast agent, by arterial spin labeling, diffusion imaging, T1 and T2 relaxation time measurement using echo-planar imaging, and by a combination of magnetization transfer with established stereological methods. The BOLD (blood oxygen level-dependent) effect offers new perspectives for functional MRI evaluation of the placenta.
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Affiliation(s)
- G E Chalouhi
- Laboratoire de Recherche en Imagerie (LRI), INSERM U970, Equipe N°2, Paris Cardiovascular Research Center - PARCC, 56 rue Leblanc, 75015 Paris, France
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Chalouhi GE, Harb C, Atallah D, Mansour F, Ghanem I, Dagher F. Total hip replacement at thirty years. Case report of crippling complications of a transient osteoporosis of the hip during pregnancy. Eur J Obstet Gynecol Reprod Biol 2010; 149:226-7. [DOI: 10.1016/j.ejogrb.2009.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 11/07/2009] [Accepted: 11/15/2009] [Indexed: 11/30/2022]
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Chalouhi GE, Harb CA, Atallah DM, Golfier FR. Extraperitoneal endometriosis as a differential diagnosis of an inguinal lump. Eur J Obstet Gynecol Reprod Biol 2008; 138:121-2. [PMID: 17374433 DOI: 10.1016/j.ejogrb.2007.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 01/12/2007] [Accepted: 02/05/2007] [Indexed: 10/23/2022]
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