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Fourgeaud J, Magny JF, Couderc S, Garcia P, Maillotte AM, Benard M, Pinquier D, Minodier P, Astruc D, Patural H, Parat S, Guillois B, Garenne A, Guilleminot T, Parodi M, Bussières L, Ghout I, Ville Y, Leruez-Ville M. Predictors of the Outcome at 2 Years in Neonates With Congenital Cytomegalovirus Infection. Pediatrics 2024; 153:e2023063531. [PMID: 38487823 DOI: 10.1542/peds.2023-063531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Approximately 20% of neonates with congenital cytomegalovirus (cCMV) develop long-term sequelae. The ability to accurately predict long-term outcomes as early as the neonatal period would help to provide for appropriate parental counseling and treatment indications. With this study, we aimed to identify neonatal predictive markers of cCMV long-term outcomes. METHODS As this study's subjects, we chose neonates diagnosed with cCMV in 13 hospitals throughout France recruited from 2013 to 2017 and evaluated for at least 2 years with thorough clinical, audiology, and imaging evaluations and psychomotor development tests. RESULTS A total of 253 neonates were included, and 3 were later excluded because of the identification of a genetic disorder. A total of 227 were followed up for 2 years: 187/227 (82%) and 34/227 (15%) were infected after a maternal primary or nonprimary infection, respectively, 91/227 (40%) were symptomatic at birth, and 44/227 (19%) had cCMV sequelae. Maternal primary infection in the first trimester was the strongest prognosis factor (odds ratio = 38.34 [95% confidence interval, 5.02-293], P < .001). A predictive model of no risk of sequelae at 2 years of age according to normal hearing loss at birth, normal cerebral ultrasound, and normal platelet count had 98% specificity, 69% sensitivity, and 0.89 area under the curve (95% confidence interval, 0.83-0.96). CONCLUSIONS In the studied population, children with normal hearing at birth, normal platelet count at birth, and a normal cranial ultrasound had no risk of neurologic sequelae and a low risk of delayed unilateral sensorineural hearing loss. The use of this model based on readily available neonatal markers should help clinicians establish a personalized care pathway for each cCMV neonate.
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Affiliation(s)
- Jacques Fourgeaud
- URP 7328 FETUS, Université Paris Cité, Paris, France
- Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections
| | | | - Sophie Couderc
- Maternity, Hospital Intercommunal Poissy-Saint Germain, Poissy, France
| | - Patricia Garcia
- Neonatology and Intensive Care Department, AP-HM, Hospital La Conception, Marseille, France
| | | | - Melinda Benard
- Department of Neonatology, Toulouse University Hospital, Infinity, Université Toulouse, CNRS, Inserm, UPS, Toulouse, France
| | - Didier Pinquier
- Department of Neonatology, Rouen University Hospital, Rouen, France
| | | | - Dominique Astruc
- Department of Neonatology, Strasbourg University Hospital, Strasbourg, France
| | - Hugues Patural
- Department of Neonatology, Saint-Etienne, University Hospital, Saint-Etienne, France
| | - Sophie Parat
- Maternity, AP-HP, Hospital Cochin, Paris, France
| | - Bernard Guillois
- Department of Neonatology, CHU de Caen, Caen, France
- Université Caen Normandie Medical School, Caen, France
| | | | - Tiffany Guilleminot
- URP 7328 FETUS, Université Paris Cité, Paris, France
- Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections
| | | | - Laurence Bussières
- URP 7328 FETUS, Université Paris Cité, Paris, France
- Clinical Research Unit, P-HP
| | - Idir Ghout
- Cegedim Health Data, Boulogne-Billancourt, France
| | - Yves Ville
- URP 7328 FETUS, Université Paris Cité, Paris, France
- Maternity, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Marianne Leruez-Ville
- URP 7328 FETUS, Université Paris Cité, Paris, France
- Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections
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Codaccioni C, Arthuis C, Deloison B, Bault JP, Henry C, Mahallati H, Bussières L, Ville Y, Grévent D, Salomon LJ. Offline ultrasound-ultrasound fusion imaging for assessment of normal fetal brain development: the way forward? Ultrasound Obstet Gynecol 2023; 61:549-551. [PMID: 36565442 DOI: 10.1002/uog.26149] [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: 08/23/2022] [Revised: 11/27/2022] [Accepted: 12/16/2022] [Indexed: 05/04/2023]
Affiliation(s)
- C Codaccioni
- EA Fetus 7328 and LUMIERE Platform, Université de Paris, Paris, France
| | - C Arthuis
- EA Fetus 7328 and LUMIERE Platform, Université de Paris, Paris, France
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Nantes, Nantes, France
| | - B Deloison
- EA Fetus 7328 and LUMIERE Platform, Université de Paris, Paris, France
| | - J-P Bault
- EA Fetus 7328 and LUMIERE Platform, Université de Paris, Paris, France
| | - C Henry
- EA Fetus 7328 and LUMIERE Platform, Université de Paris, Paris, France
| | - H Mahallati
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - L Bussières
- EA Fetus 7328 and LUMIERE Platform, Université de Paris, Paris, France
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Y Ville
- EA Fetus 7328 and LUMIERE Platform, Université de Paris, Paris, France
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - D Grévent
- EA Fetus 7328 and LUMIERE Platform, Université de Paris, Paris, France
- Service de Radiologie, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - L J Salomon
- EA Fetus 7328 and LUMIERE Platform, Université de Paris, Paris, France
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
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Huchon C, Drioueche H, Koskas M, Agostini A, Bauville E, Bourdel N, Fernandez H, Fritel X, Graesslin O, Legendre G, Lucot JP, Panel P, Raiffort C, Giraudet G, Bussières L, Fauconnier A. Operative Hysteroscopy vs Vacuum Aspiration for Incomplete Spontaneous Abortion: A Randomized Clinical Trial. JAMA 2023; 329:1197-1205. [PMID: 37039805 PMCID: PMC10091175 DOI: 10.1001/jama.2023.3415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/22/2023] [Indexed: 04/12/2023]
Abstract
Importance Vacuum aspiration is commonly used to remove retained products of conception in patients with incomplete spontaneous abortion. Scarring of the uterine cavity may occur, potentially impairing future fertility. A procedural alternative, operative hysteroscopy, has gained popularity with a presumption of better future fertility. Objective To assess the superiority of hysteroscopy to vacuum aspiration for subsequent pregnancy in patients with incomplete spontaneous abortion who intend to have future pregnancy. Design, Setting, and Participants The HY-PER randomized, controlled, single-blind trial included 574 patients between November 6, 2014, and May 3, 2017, with a 2-year duration of follow-up. This multicenter trial recruited patients in 15 French hospitals. Individuals aged 18 to 44 years and planned for surgery for an incomplete spontaneous abortion with plans to subsequently conceive were randomized in a 1:1 ratio. Interventions Surgical treatment by hysteroscopy (n = 288) or vacuum aspiration (n = 286). Main Outcomes and Measures The primary outcome was a pregnancy of at least 22 weeks' duration during 2-year follow-up. Results The intention-to-treat analyses included 563 women (mean [SD] age, 32.6 [5.4] years). All aspiration procedures were completed. The hysteroscopic procedure could not be completed for 19 patients (7%), 18 of which were converted to vacuum aspiration (8 with inability to completely resect, 7 with insufficient visualization, 2 with anesthetic complications that required a shortened procedure, 1 with equipment failure). One hysteroscopy failed due to a false passage during cervical dilatation. During the 2-year follow-up, 177 patients (62.8%) in the hysteroscopy group and 190 (67.6%) in the vacuum aspiration (control) group achieved the primary outcome (difference, -4.8% [95% CI, -13% to 3.0%]; P = .23). The time-to-event analyses showed no statistically significant difference between groups for the primary outcome (hazard ratio, 0.87 [95% CI, 0.71 to 1.07]). Duration of surgery and hospitalization were significantly longer for hysteroscopy. Rates of new miscarriages, ectopic pregnancies, Clavien-Dindo surgical complications of grade 3 or above (requiring surgical, endoscopic, or radiological intervention or life-threatening event or death), and reinterventions to remove remaining products of conception did not differ between groups. Conclusions and Relevance Surgical management by hysteroscopy of incomplete spontaneous abortions in patients intending to conceive again was not associated with more subsequent births or a better safety profile than vacuum aspiration. Moreover, operative hysteroscopy was not feasible in all cases. Trial Registration ClinicalTrials.gov Identifier: NCT02201732.
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Affiliation(s)
- Cyrille Huchon
- Department of Gynecology and Obstetrics, APHP, Hopital Lariboisière, University of Paris Cité, Paris, France
- Université Paris-Saclay, UVSQ, Unité de Recherche 7285, Risques Cliniques et Sécurité en Santé des Femmes et en Santé Périnatale (RISCQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, CHI Poissy-St-Germain, Poissy CEDEX, France
| | - Hocine Drioueche
- Department of Clinical Research, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France
| | - Martin Koskas
- Université Paris-Saclay, UVSQ, Unité de Recherche 7285, Risques Cliniques et Sécurité en Santé des Femmes et en Santé Périnatale (RISCQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, APHP, Hôpital Bichat, Paris, France
| | - Aubert Agostini
- Department of Gynecology and Obstetrics, Hôpital La Conception, Marseille CEDEX 5, France
| | - Estelle Bauville
- Department of Gynecology and Obstetrics, Rennes University Hospital, Rennes CEDEX 2, France
| | - Nicolas Bourdel
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand CEDEX 1, Faculty of Medicine, ISIT – Université d’Auvergne, Clermont-Ferrand, France
| | - Hervé Fernandez
- Department of Gynecology and Obstetrics, AP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, 94270, France
- Centre for Epidemiology and Population Health-INSERM U1018, Université Paris Sud, Le Kremlin Bicêtre, France
| | - Xavier Fritel
- Department of Gynecology and Obstetrics, CHU de Poitiers, Université de Poitiers, Faculté de Médecine et Pharmacie, Inserm CIC1402, Poitiers, France
| | - Olivier Graesslin
- Department of Gynecology and Obstetrics, Hôpital Alix de Champagne, CHU de Reims, Reims, France
| | - Guillaume Legendre
- Department of Gynecology and Obstetrics, CHU d’Angers, Angers CEDEX 01, France
| | - Jean-Philippe Lucot
- Department of Gynecology and Obstetrics, Hôpital Jeanne-de-Flandre, CHRU de Lille, Lille, France
| | - Pierre Panel
- Department of Gynecology and Obstetrics, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Cyril Raiffort
- Department of Gynecology and Obstetrics, APHP, Hôpital Louis Mourier, Département Hospitalier Universitaire Risque et Grossesse, Colombes, University of Paris Cité, Paris, France
| | - Géraldine Giraudet
- Department of Gynecology and Obstetrics, Hôpital Jeanne-de-Flandre, CHRU de Lille, Lille, France
| | - Laurence Bussières
- Clinical Unit Research/Clinic Investigation Center, Paris Descartes, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Arnaud Fauconnier
- Université Paris-Saclay, UVSQ, Unité de Recherche 7285, Risques Cliniques et Sécurité en Santé des Femmes et en Santé Périnatale (RISCQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, CHI Poissy-St-Germain, Poissy CEDEX, France
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Fourgeaud J, Magny JF, Couderc S, Garcia P, Maillotte AM, Benard M, Pinquier D, Minodier P, Astruc D, Patural H, Ugolin M, Parat S, Guillois B, Garenne A, Guilleminot T, Parodi M, Bussières L, Ville Y, Leruez-Ville M. Clinical Value of Serial Quantitative Analysis of Cytomegalovirus DNA in Blood and Saliva Over the First 24 Months of Life in Congenital Infection: The French Cymepedia Cohort. J Pediatr 2023; 253:197-204.e5. [PMID: 36181870 DOI: 10.1016/j.jpeds.2022.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate cytomegalovirus (CMV) viral load dynamics in blood and saliva during the first 2 years of life in symptomatic and asymptomatic infected infants and to identify whether these kinetics could have practical clinical implications. STUDY DESIGN The Cymepedia cohort prospectively included 256 congenitally infected neonates followed for 2 years. Whole blood and saliva were collected at inclusion and months 4 and 12, and saliva at months 18 and 24. Real-time CMV polymerase chain reaction (PCR) was performed, results expressed as log10 IU/mL in blood and in copies per milliliter in saliva. RESULTS Viral load in saliva progressively decreased from 7.5 log10 at birth to 3.3 log10 at month 24. CMV PCR in saliva was positive in 100% and 96% of infants at 6 and 12 months, respectively. In the first month of life, neonatal saliva viral load of less than 5 log10 was related to a late CMV transplacental passage. Detection in blood was positive in 92% of neonates (147/159) in the first month of life. No viral load threshold values in blood or saliva could be associated with a high risk of sequelae. Neonatal blood viral load of less than 3 log10 IU/mL had a 100% negative predictive value for long-term sequelae. CONCLUSIONS Viral loads in blood and saliva by CMV PCR testing in congenital infection fall over the first 24 months. In this study of infants affected mainly after primary maternal infection during pregnancy, all salivary samples were positive in the first 6 months of life and sequelae were not seen in infants with neonatal blood viral load of less than 3 log10 IU/mL.
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Affiliation(s)
- Jacques Fourgeaud
- Research Unit 73-28, Université Paris Cité, Paris, France; Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections, AP-HP, Hôpital Necker Enfants Malades, Paris, France.
| | - Jean-François Magny
- Research Unit 73-28, Université Paris Cité, Paris, France; Neonatal Intensive Care Unit, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Sophie Couderc
- Maternity, Hospital Intercommunal Poissy-Saint Germain, Poissy, France
| | - Patricia Garcia
- Neonatology and Intensive Care Department, AP-HM, Hospital La Conception, Marseille, France
| | | | - Melinda Benard
- Department of Neonatalogy, Toulouse University Hospital, Toulouse, France
| | - Didier Pinquier
- Department of Neonatology, Rouen University Hospital, Rouen, France
| | | | - Dominique Astruc
- Department of Neonatology, Strasbourg University Hospital, Strasbourg, France
| | - Hugues Patural
- Neonatal Intensive Care Unit, University Hospital, Saint-Etienne, France
| | - Melissa Ugolin
- Pediatric Department, Neonatology, CHU Rennes and CIC1414, Rennes, France
| | - Sophie Parat
- Maternity, AP-HP, Hospital Cochin, Paris, France
| | - Bernard Guillois
- Department of Neonatalogy, CHU de Caen, Caen, France; Medical School, Université Caen Normandie, Caen, France
| | - Armelle Garenne
- Neonatal and Pediatric Intensive Care Unit, CHRU Brest, Brest, France
| | - Tiffany Guilleminot
- Research Unit 73-28, Université Paris Cité, Paris, France; Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Marine Parodi
- Otology Department, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Laurence Bussières
- Research Unit 73-28, Université Paris Cité, Paris, France; Clinical Research Unit, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Yves Ville
- Research Unit 73-28, Université Paris Cité, Paris, France; Maternity, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Marianne Leruez-Ville
- Research Unit 73-28, Université Paris Cité, Paris, France; Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections, AP-HP, Hôpital Necker Enfants Malades, Paris, France
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Bussières L, Gobert D, Black DO, Vaillancourt L. Metastatic pulmonary adenocarcinoma to an anophthalmic socket. Canadian Journal of Ophthalmology 2022; 58:e134-e136. [PMID: 36435208 DOI: 10.1016/j.jcjo.2022.11.007] [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: 05/29/2022] [Revised: 09/21/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022]
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Fourgeaud J, Boithias C, Walter-Nicolet E, Kermorvant E, Couderc S, Parat S, Pol C, Mousset C, Bussières L, Guilleminot T, Ville Y, Nkam L, Grimaldi L, Parodi M, Leruez-Ville M. Performance of Targeted Congenital Cytomegalovirus Screening in Newborns Failing Universal Hearing Screening: A Multicenter Study. Pediatr Infect Dis J 2022; 41:478-481. [PMID: 35093998 DOI: 10.1097/inf.0000000000003474] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) is the most frequent cause of congenital infection and ≈20% of all infected neonates present or will develop sensorineural hearing loss. Targeted congenital CMV (cCMV) screening in newborns who failed universal newborn hearing screening has been proposed as a strategy to identify neonates with both hearing loss and cCMV infection who could benefit from antiviral treatment implemented within the first month of life. OBJECTIVES To evaluate the feasibility and performance of cCMV targeted screening in a French setting. METHODS Neonates were recruited in 5 maternity centers in greater Paris. A saliva sample for CMV polymerase chain reaction (PCR) testing was collected in neonates who failed newborn hearing screening. Outcomes including CMV PCR result and confirmation of hearing loss by an otorhinolaryngologist specialist were documented. RESULTS Two-hundred thirty-six newborns were included and a saliva sample was collected in 98% (231/236) of them. The result of CMV PCR was available at a median of 9 days (7-10 days) of life and in 96% of cases within the first month of life. Two neonates were infected with CMV. The result of the otorhinolaryngologist assessment was available in 75% (178/236) of cases at a median of 16 days (9-26 days). Hearing loss was confirmed in 2.8% (5/178). The 2 infected neonates had hearing loss confirmed at 5 and 8 days of life and were treated with valganciclovir at days 9 and 16, respectively. CONCLUSIONS The result of this study confirms that targeted cCMV screening is feasible in these French settings.
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Affiliation(s)
- Jacques Fourgeaud
- From the EA 73-28, Université de Paris
- AP-HP, Hospital Necker-E.M., Virology Department, Reference Laboratory for Cytomegalovirus Infections, Paris, France
| | - Claire Boithias
- AP-HP, Hospital Bicêtre, Neonatal Intensive Care Unit, Le Kremlin-Bicêtre, France
| | - Elisabeth Walter-Nicolet
- INSERM, U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center; and Medicine and Neonatal Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Elsa Kermorvant
- AP-HP, Hospital Necker-E.M., Neonatal Intensive Care Unit, Université de Paris, Paris, France
| | - Sophie Couderc
- Hospital Intercommunal Poissy-Saint Germain, Maternity, Poissy, France
| | - Sophie Parat
- AP-HP, Hospital Cochin, Maternity, Paris, France
| | - Christine Pol
- AP-HP, Hospital Bicêtre, Otology Department, Le Kremlin-Bicêtre, France
| | - Carole Mousset
- Hospital Saint Joseph, Otology Department, Paris, France
| | - Laurence Bussières
- From the EA 73-28, Université de Paris
- AP-HP, Hospital Necker-E.M., Clinical Research Unit
| | - Tiffany Guilleminot
- From the EA 73-28, Université de Paris
- AP-HP, Hospital Necker-E.M., Virology Department, Reference Laboratory for Cytomegalovirus Infections, Paris, France
| | - Yves Ville
- From the EA 73-28, Université de Paris
- AP-HP, Hospital Necker-E.M., Maternity
| | - Lionelle Nkam
- AP-HP, Hôpital Ambroise Paré, Unité de Recherche Clinique, Paris Saclay Ouest, Boulogne, France
| | - Lamiae Grimaldi
- AP-HP, Hôpital Ambroise Paré, Unité de Recherche Clinique, Paris Saclay Ouest, Boulogne, France
| | - Marine Parodi
- AP-HP, Hospital Necker-E.M, Otology Department, Paris, France
| | - Marianne Leruez-Ville
- From the EA 73-28, Université de Paris
- AP-HP, Hospital Necker-E.M., Virology Department, Reference Laboratory for Cytomegalovirus Infections, Paris, France
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Bussières L, Black DO, Molgat Y. Myiasis of the exenterated orbital cavity: Case report and video. Am J Ophthalmol Case Rep 2022; 25:101319. [PMID: 35146196 PMCID: PMC8818493 DOI: 10.1016/j.ajoc.2022.101319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/29/2021] [Accepted: 01/20/2022] [Indexed: 10/25/2022] Open
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Quibel T, Winer N, Bussières L, Vayssière C, Deruelle P, Defrance M, Rozenberg P, Bouyer J, Dupuis N, Renaudin B, Dugave L, Banaszkiewicz N, Garabedian C, Ville Y. Impact of COVID-19-Related Lockdown on Delivery and Perinatal Outcomes: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11030756. [PMID: 35160207 PMCID: PMC8837050 DOI: 10.3390/jcm11030756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 02/05/2023] Open
Abstract
Objective: The magnitude and direction of effects on pregnancy outcomes of the lockdown imposed during COVID-19 have been uncertain and debated. Therefore, we aimed to quantify delivery and perinatal outcomes during the first nationwide lockdown due to the COVID-19 pandemic compared with the same durations of time for the pre- and post-lockdown periods. Study design: This was a retrospective cohort study of six university hospital maternity units distributed across France, each of which serves as the obstetric care referral unit within its respective perinatal network. Maternal and perinatal outcomes were compared between the lockdown period and same-duration (i.e., 55-day) periods before and after the 2020 lockdown (pre-lockdown: 22 January–16 March; lockdown: 17 March–10 May; post-lockdown: 11 May–4 July). We compared the overall rates of Caesarean delivery (CD), pre-labor CD, labor induction, operative vaginal delivery, severe postpartum hemorrhage (≥1 L), severe perineal tear, maternal transfusion, and neonatal mortality and morbidity (1- and 5-min Apgar scores < 7), hypoxia and anoxia (umbilical arterial pH < 7.20 or <7.10, respectively), and admission to a neonatal intensive care unit before discharge. Adjusted odds ratios were estimated using logistic regression, controlling for region of birth, maternal age category, multiparity, multiple pregnancies, diabetes, and hypertensive disorders. Results: The study sample consisted of 11,929 women who delivered consecutively at one of the six maternity units studied (4093 pre-lockdown, 3829 during lockdown, and 4007 post-lockdown) and their 12,179 neonates (4169 pre-lockdown, 3905 during lockdown, and 4105 post-lockdown). The maternal and obstetric characteristics of the women delivering during the lockdown period were alike those delivering pre- and post-lockdown on maternal age, parity, body mass index, rate of complication by hypertensive disorders or insulin-treated diabetes, and gestational age at delivery. Overall CD rates were similar during the three periods (23.6%, 24.8%, and 24.3% pre-lockdown, lockdown, and post-lockdown, respectively) and no outcome differed significantly during lockdown compared to pre- and post-lockdown. These findings were consistent across maternity units. Conclusion: The maternal and perinatal outcomes are reassuring regarding the performance of the health-care system during the COVID-19 lockdown studied. Such information is crucial, because additional COVID-19-related lockdowns might still be needed. They are also instructive regarding potential future pandemics.
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Affiliation(s)
- Thibaud Quibel
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, 78300 Poissy, France; (M.D.); (P.R.)
- UVSQ, Inserm, Team U1018, Clinical Epidemiology, Centre de Recherche en Épidé-miologie et Santé des Populations (CESP), Paris Saclay University, 78180 Montigny-le-Bretonneux, France;
- Correspondence: ; Tel.: +33-01-39275131; Fax: +33-01-39274479
| | - Norbert Winer
- Obstetrics and Gynecology Department, Centre Hospitalier Universitaire de Nantes, 44035 Nantes, France; (N.W.); (N.B.)
- UMR PhAN 1280 NUN INRAE F-44000 University Nantes, 44035 Nantes, France
| | - Laurence Bussières
- Obstetrics, and Fetal Medicine and Surgery Department, Hôpital Necker-Enfants Maladies, AP-HP, 75007 Paris, France; (L.B.); (B.R.); (Y.V.)
- EHU 7328 PACT, Université de Paris, 75006 Paris, France
| | - Christophe Vayssière
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 31059 Toulouse, France; (C.V.); (N.D.)
- UMR1295 CERPOP (Centre for Epidemiology and Population Health Research), Team SPHERE (Study of Perinatal, Paedriatric and Adolescent Health: Epidemiological Research and Evaluation), Toulouse III University, 31062 Toulouse, France
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Avenue Moliere, 67000 Strasbourg, France;
| | - Manon Defrance
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, 78300 Poissy, France; (M.D.); (P.R.)
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, 78300 Poissy, France; (M.D.); (P.R.)
- UVSQ, Inserm, Team U1018, Clinical Epidemiology, Centre de Recherche en Épidé-miologie et Santé des Populations (CESP), Paris Saclay University, 78180 Montigny-le-Bretonneux, France;
| | - Jean Bouyer
- UVSQ, Inserm, Team U1018, Clinical Epidemiology, Centre de Recherche en Épidé-miologie et Santé des Populations (CESP), Paris Saclay University, 78180 Montigny-le-Bretonneux, France;
| | - Ninon Dupuis
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 31059 Toulouse, France; (C.V.); (N.D.)
| | - Benoit Renaudin
- Obstetrics, and Fetal Medicine and Surgery Department, Hôpital Necker-Enfants Maladies, AP-HP, 75007 Paris, France; (L.B.); (B.R.); (Y.V.)
| | - Louise Dugave
- CHU Lille, Department of Obstetrics, 59000 Lille, France; (L.D.); (C.G.)
| | - Nathalie Banaszkiewicz
- Obstetrics and Gynecology Department, Centre Hospitalier Universitaire de Nantes, 44035 Nantes, France; (N.W.); (N.B.)
| | - Charles Garabedian
- CHU Lille, Department of Obstetrics, 59000 Lille, France; (L.D.); (C.G.)
- University Lille, ULR 2694 METRICS, 59000 Lille, France
| | - Yves Ville
- Obstetrics, and Fetal Medicine and Surgery Department, Hôpital Necker-Enfants Maladies, AP-HP, 75007 Paris, France; (L.B.); (B.R.); (Y.V.)
- EHU 7328 PACT, Université de Paris, 75006 Paris, France
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9
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Garabedian C, Dupuis N, Vayssière C, Bussières L, Ville Y, Renaudin B, Dugave L, Winer N, Banaszkiewicz N, Rozenberg P, Defrance M, Legris ML, Quibel T, Deruelle P. Impact of COVID-19 Lockdown on Preterm Births, Low Birthweights and Stillbirths: A Retrospective Cohort Study. J Clin Med 2021; 10:jcm10235649. [PMID: 34884351 PMCID: PMC8658711 DOI: 10.3390/jcm10235649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/20/2021] [Revised: 11/24/2021] [Accepted: 11/27/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: The effect of lockdowns during the coronavirus (COVID-19) pandemic on pregnancy outcomes remains uncertain. We aimed to evaluate the association between the COVID-19-related lockdown and pregnancy outcomes in maternity hospitals in France. Study design: This was a retrospective cohort study from six tertiary referral hospitals in different regions of France. Three 55-day periods were compared: pre-lockdown from 22 January 2020, lockdown from 17 March 2020, and post-lockdown from 11 May 2020 to 4 July 2020. We included all women who delivered singleton or multiple pregnancies, who delivered at ≥24 weeks of gestation and with birthweights ≥500 g. We documented gestational ages at the delivery of liveborn and stillborn infants (‘stillbirths’). These were categorized as having a very low birthweight (VLBW, <1500 g), or a low birthweight (LBW, <2500 g). Adjustments were made for place of birth, maternal age, parity and diabetes, and hypertensive disorders, as well as for multiple pregnancies. Results: In total, 11,929 women delivered in the six selected centers. This figure is constituted of 4093, 3829, and 4007 deliveries in the pre-lockdown (1), peri-lockdown (2), and post-lockdown (3) periods, respectively. There were no differences in pregnancy outcomes between these three periods. Overall, birth rates <27+6 weeks, between weeks 28+0 and 31+6, and between 32+0 and weeks 36+6 were 1.0%, 1.9%, and 4.4%, respectively. After adjustment, these rates were stable between periods 1 and 2 (adjusted odds ratio, aOR 0.90; 95% confidence interval, CI 0.69–1.19) and between periods 2 and 3 (aOR 1.04; 95% CI 0.80–1.36). Although more VLBW neonates were born during lockdown (3.5% vs. 2.6%, p = 0.03), this difference did not persist after adjustment (aOR 0.84, CI 95% 0.64–1.10). The LBW rates were similar during the three periods at 12.5% overall. The stillbirth rate was unaffected by the lockdown. Conclusion: The pregnancy outcomes (preterm birth, LBW, VLBW, and stillbirth rates) were not modified by the COVID-19 lockdown in our cohort study in France. Considering the discrepancies in results and methodological issues in previous published studies, there is not sufficient evidence to conclude that such lockdowns have any impact on perinatal outcomes.
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Affiliation(s)
- Charles Garabedian
- CHU Lille, Department of Obstetrics, F 59000 Lille, France;
- University Lille, ULR 2694 METRICS, F 59000 Lille, France
- Correspondence: ; Tel.: +33-320446626
| | - Ninon Dupuis
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 31059 Toulouse, France; (N.D.); (C.V.)
| | - Christophe Vayssière
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 31059 Toulouse, France; (N.D.); (C.V.)
- UMR1295 CERPOP (Centre for Epidemiology and Population Health Research), Team SPHERE (Study of Perinatal, Paedriatric and Adolescent Health: Epidemiological Research and Evaluation), Toulouse III University, 31062 Toulouse, France
| | - Laurence Bussières
- Obstetrics, Fetal Surgery, Medicine and Imaging Department, AP-HP, Hôpital Necker-Enfants Malades, 75007 Paris, France; (L.B.); (Y.V.); (B.R.)
- EHU 7328 PACT, Université de Paris, 75006 Paris, France
| | - Yves Ville
- Obstetrics, Fetal Surgery, Medicine and Imaging Department, AP-HP, Hôpital Necker-Enfants Malades, 75007 Paris, France; (L.B.); (Y.V.); (B.R.)
- EHU 7328 PACT, Université de Paris, 75006 Paris, France
| | - Benoît Renaudin
- Obstetrics, Fetal Surgery, Medicine and Imaging Department, AP-HP, Hôpital Necker-Enfants Malades, 75007 Paris, France; (L.B.); (Y.V.); (B.R.)
| | - Louise Dugave
- CHU Lille, Department of Obstetrics, F 59000 Lille, France;
| | - Norbert Winer
- Obstetrics and Gynecology Department, Centre Hospitalier Universitaire de Nantes, University Nantes, 44035 Nantes, France; (N.W.); (N.B.)
- UMR PhAN 1280 NUN INRAE, F-44000, University Nantes, 44035 Nantes, France
| | - Nathalie Banaszkiewicz
- Obstetrics and Gynecology Department, Centre Hospitalier Universitaire de Nantes, University Nantes, 44035 Nantes, France; (N.W.); (N.B.)
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, 78300 Poissy, France; (P.R.); (M.D.); (T.Q.)
- UVSQ, Inserm, Team U1018, Clinical Epidemiology, CESP, Paris Saclay University, 78180 Montigny-le-Bretonneux, France
| | - Manon Defrance
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, 78300 Poissy, France; (P.R.); (M.D.); (T.Q.)
| | - Marie-Laure Legris
- Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Avenue Moliere, 67000 Strasbourg, France; (M.-L.L.); (P.D.)
| | - Thibaud Quibel
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, 78300 Poissy, France; (P.R.); (M.D.); (T.Q.)
- UVSQ, Inserm, Team U1018, Clinical Epidemiology, CESP, Paris Saclay University, 78180 Montigny-le-Bretonneux, France
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Avenue Moliere, 67000 Strasbourg, France; (M.-L.L.); (P.D.)
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10
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Jacquier M, Arthuis C, Grévent D, Bussières L, Henry C, Millischer-Bellaiche AE, Mahallati H, Ville Y, Siauve N, Salomon LJ. Dynamic contrast enhanced magnetic resonance imaging: A review of its application in the assessment of placental function. Placenta 2021; 114:90-99. [PMID: 34507031 DOI: 10.1016/j.placenta.2021.08.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 06/02/2021] [Accepted: 08/23/2021] [Indexed: 01/02/2023]
Abstract
It is important to develop a better understanding of placental insufficiency given its role in common maternofetal complications such as preeclampsia and fetal growth restriction. Functional magnetic resonance imaging offers unprecedented techniques for exploring the placenta under both normal and pathological physiological conditions. Dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) is an established and very robust method to investigate the microcirculatory parameters of an organ and more specifically its perfusion. It is currently a gold standard in the physiological and circulatory evaluation of an organ. Its application to the human placenta could enable to access many microcirculatory parameters relevant to the placental function such as organ blood flow, fractional blood volume, and permeability surface area, by the acquisition of serial images, before, during, and after administration of an intravenous contrast agent. Widely used in animal models with gadolinium-based contrast agents, its application to the human placenta could be possible if the safety of contrast agents in pregnancy is established or they are confirmed to not cross the placenta.
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Affiliation(s)
- Mathilde Jacquier
- Obstetrics and Gynecology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Necker - Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France; EA FETUS 7328 and LUMIERE Unit, Université de Paris, France
| | - Chloé Arthuis
- EA FETUS 7328 and LUMIERE Unit, Université de Paris, France; Obstetrics and Gynecology Department, CHU Nantes, 38 Boulevard Jean Monnet, 44000, Nantes, France
| | - David Grévent
- EA FETUS 7328 and LUMIERE Unit, Université de Paris, France; Radiology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Necker - Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - Laurence Bussières
- Obstetrics and Gynecology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Necker - Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France; EA FETUS 7328 and LUMIERE Unit, Université de Paris, France
| | - Charline Henry
- EA FETUS 7328 and LUMIERE Unit, Université de Paris, France
| | - Anne-Elodie Millischer-Bellaiche
- EA FETUS 7328 and LUMIERE Unit, Université de Paris, France; Radiology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Necker - Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - Houman Mahallati
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Yves Ville
- Obstetrics and Gynecology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Necker - Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France; EA FETUS 7328 and LUMIERE Unit, Université de Paris, France
| | - Nathalie Siauve
- Radiology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Louis Mourier, 178 Rue des Renouillers, 92700, Colombes, France; INSERM, U970, Paris Cardiovascular Research Center - PARCC, Paris, France
| | - Laurent J Salomon
- Obstetrics and Gynecology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Necker - Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France; EA FETUS 7328 and LUMIERE Unit, Université de Paris, France.
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11
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Rozon JP, Bussières L, Black DO. Teaching of the lateral tarsal strip technique using a duct tape simulation. Can J Ophthalmol 2021; 57:e120. [PMID: 34332929 DOI: 10.1016/j.jcjo.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/29/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Jean-Philippe Rozon
- From the Faculty of Medicine, Université Laval, Quebec City, Que.; Department of Ophthalmology, Centre Universitaire d'Ophtalmologie, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Que..
| | | | - Daniel Ovid Black
- Department of Ophthalmology, Centre Universitaire d'Ophtalmologie, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Que
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12
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Leruez-Ville M, Ren S, Magny JF, Jacquemard F, Couderc S, Garcia P, Maillotte AM, Benard M, Pinquier D, Minodier P, Astruc D, Patural H, Ugolin M, Parat S, Guillois B, Garenne A, Parodi M, Bussières L, Stirnemann J, Sonigo P, Millischer AE, Ville Y. Accuracy of prenatal ultrasound screening to identify fetuses infected by cytomegalovirus which will develop severe long-term sequelae. Ultrasound Obstet Gynecol 2021; 57:97-104. [PMID: 32339337 DOI: 10.1002/uog.22056] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 02/11/2020] [Revised: 04/06/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To compare the ability of detailed routine ultrasound examination, performed without knowledge of maternal serology and fetal status, with that of targeted prenatal imaging performed in prenatal diagnostic units in cases of known fetal infection to identify cytomegalovirus (CMV)-infected fetuses that will develop long-term sequelae. METHODS All prenatal imaging reports were collected for 255 children with congenital CMV in a registered cohort between 2013 and 2017 (NCT01923636). All women had undergone detailed routine fetal ultrasound examination at 20-24 and 30-34 weeks as part of routine antenatal care. All cases of known fetal CMV infection had also undergone targeted prenatal ultrasound examination. Postnatal structured follow-up for up to 48 months of age involved clinical, audiological and neurological assessment, including Brunet-Lezine scoring. Long-term sequelae (> 12 months) were considered to be mild in cases with isolated unilateral hearing loss and/or vestibular disorders, and severe in cases with bilateral hearing loss and/or neurological sequelae. All imaging reports were analyzed retrospectively with the knowledge of congenital CMV infection, searching for reference to findings that were, or could have been, related to fetal infection. Findings were analyzed in relation to whether the cases were diagnosed with CMV in utero or only postnatally. RESULTS There were 237 children with complete follow-up data (> 12 months), for a median of 24 (range, 12-48) months. Of these, 30% (71/237) were diagnosed with CMV prenatally and 70% (166/237) were diagnosed within 3 weeks after birth. 72.5% (29/40) of children with long-term sequelae, including 74% (14/19) with severe long-term sequelae, were not identified in the prenatal period. Among those diagnosed prenatally, the sensitivity of prenatal imaging for predicting long-term sequelae and severe long-term sequelae was 91% and 100%, respectively, while, in the group diagnosed only postnatally, non-specific infection-related ultrasound findings had been reported without raising suspicion in 48% of cases with long-term sequelae and 64% of those with severe long-term sequelae. CONCLUSIONS Routine detailed ultrasound examination in pregnancy is not an appropriate screening tool for congenital CMV infection that leads to long-term sequelae, in contrast with the high performance of targeted prenatal imaging in known cases of fetal infection. The non-specific nature of ultrasound features of CMV and their evolution, and a lack of awareness of caregivers about congenital CMV, are likely explanations. Awareness of the sonologist regarding congenital CMV and knowledge of the maternal serological status in the first trimester seem key to the performance of prenatal ultrasound. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Leruez-Ville
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- AP-HP, Hospital Necker-E.M., Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections, Paris, France
| | - S Ren
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - J-F Magny
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- AP-HP, Hospital Necker-E.M., Neonatal Intensive Care Unit, Paris, France
| | - F Jacquemard
- American Hospital of Paris, Prenatal Diagnostic Unit, Neuilly, France
| | - S Couderc
- Hospital Intercommunal Poissy-Saint Germain, Maternity, Poissy, France
| | - P Garcia
- AP-HM, Hospital La Conception, Neonatology and Intensive Care Department, Marseille, France
| | - A-M Maillotte
- CHU Nice, Hospital L'Archet, Neonatal Intensive Care Unit, Nice, France
| | - M Benard
- Toulouse University Hospital, Department of Neonatology, Toulouse, France
| | - D Pinquier
- Rouen University Hospital, Department of Neonatology, Rouen, France
| | - P Minodier
- AP-HM, Hospital Nord, Emergency Care Department, Marseille, France
| | - D Astruc
- Strasbourg University Hospital, Department of Neonatology, Strasbourg, France
| | - H Patural
- University Hospital, Neonatal Intensive Care Unit, Saint-Etienne, France
| | - M Ugolin
- CHU Rennes and CIC1414, Pediatric Department, Neonatology, Rennes, France
| | - S Parat
- AP-HP, Hospital Cochin, Maternity, Paris, France
| | - B Guillois
- CHU de Caen, Department of Neonatology, Caen, France
- Université Caen Normandie, Medical School, Caen, France
| | - A Garenne
- CHRU Brest, Neonatal and Pediatric Intensive Care Unit, Brest, France
| | - M Parodi
- AP-HP, Hospital Necker-E.M., Otology Department, Paris, France
| | - L Bussières
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- AP-HP, Hospital Necker-E.M., Clinical Research Unit, Paris, France
| | - J Stirnemann
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- AP-HP, Hospital Necker-E.M., Maternity, Paris, France
| | - P Sonigo
- AP-HP, Hospital Necker-E.M., Radiology Department, Paris, France
| | - A E Millischer
- AP-HP, Hospital Necker-E.M., Radiology Department, Paris, France
| | - Y Ville
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- AP-HP, Hospital Necker-E.M., Maternity, Paris, France
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13
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Faure-Bardon V, Magny JF, Parodi M, Couderc S, Garcia P, Maillotte AM, Benard M, Pinquier D, Astruc D, Patural H, Pladys P, Parat S, Guillois B, Garenne A, Bussières L, Guilleminot T, Stirnemann J, Ghout I, Ville Y, Leruez-Ville M. Sequelae of Congenital Cytomegalovirus Following Maternal Primary Infections Are Limited to Those Acquired in the First Trimester of Pregnancy. Clin Infect Dis 2020; 69:1526-1532. [PMID: 30596974 DOI: 10.1093/cid/ciy1128] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [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: 09/11/2018] [Accepted: 12/27/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The known relationship between the gestational age at maternal primary infection an the outcome of congenital CMV is based on small, retrospective studies conducted between 1980 and 2011. They reported that 32% and 15% of cases had sequelae following a maternal primary infection in the first and second or the third trimester, respectively. We aimed to revisit this relationship prospectively between 2011 and 2017, using accurate virological tools. METHODS We collected data on women with a primary infection and an infected child aged at least 1 year at the time of analysis. An accurate determination of the timing of the primary infection was based upon serial measurements of immunoglobulin (Ig) M and IgG and on IgG avidity in sera collected at each trimester. The case outcome was assessed according to a structured follow-up between birth and 48 months. RESULTS We included 255 women and their 260 fetuses/neonates. The dating of the maternal infection was prospective in 86% of cases and retrospective in 14%. At a median follow-up of 24 months, the proportion of sensorineural hearing loss and/or neurologic sequelae were 32.4% (95% confidence interval [CI] 23.72-42.09) after a maternal primary infection in the first trimester, 0 (95% CI 0-6.49) after an infection in the second trimester, and 0 (95% CI 0-11.95) after an infection in the third trimester (P < .0001). CONCLUSIONS These results suggest that a cytomegalovirus infection can be severe only when the virus hits the fetus in the embryonic or early fetal period. Recent guidelines recommend auditory follow-ups for at least 5 years for all infected children. This raises parental anxiety and generates significant costs. We suggest that auditory and specialized neurologic follow-ups may be recommended only in cases of a maternal infection in the first trimester.
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Affiliation(s)
- Valentine Faure-Bardon
- Equipe d'Accueil, Paris Descartes University, Sorbonne Paris CitéArchet, France.,Maternity, Hospital Necker-E.M, Paris, France
| | - Jean-François Magny
- Equipe d'Accueil, Paris Descartes University, Sorbonne Paris CitéArchet, France.,Neonatal Intensive Care Unit, Hospital Necker-E.M, France
| | - Marine Parodi
- Otology Department, Assistance Publique de Paris, Hospital Necker-E.M, France
| | - Sophie Couderc
- Maternity, Hospital Intercommunal Poissy-Saint Germain, Marseille, France
| | - Patricia Garcia
- Neonatology and Intensive Care Department, Assistance Publique de Marseille, Hospital La Conception, Marseille, France
| | - Anne-Marie Maillotte
- Neonatal Intensive Care Unit, Centre Hospitalier Universitaire Nice, Hospital L'Archet, Marseille, France
| | - Melinda Benard
- Department of Neonatalogy, Toulouse University Hospital, Saint-Etienne, France
| | - Didier Pinquier
- Department of Neonatalogy, Rouen University Hospital, Saint-Etienne, France
| | - Dominique Astruc
- Department of Neonatalogy, Strasbourg University Hospital, Saint-Etienne, France
| | - Hugues Patural
- Neonatal Intensive Care Unit, University Hospital, Saint-Etienne, France
| | - Patrick Pladys
- Pediatric Department, Neonatology, Centre Hospitalier Universitaire Rennes and Centre d'Investigation Clinique, France
| | - Sophie Parat
- Maternity, Assistance Publique Hopitaux de Paris (AP-HP), Hospital Cochin, France
| | - Bernard Guillois
- Department of Neonatalogy, Centre Hospitalier Universitaire de Caen, France.,Medical School, Université Caen Normandie, France
| | - Armelle Garenne
- Brest, Neonatal and Pediatric Intensive Care Unit, Centre Hospitalier Régional Universitaire, France
| | - Laurence Bussières
- Equipe d'Accueil, Paris Descartes University, Sorbonne Paris CitéArchet, France.,Clinical Research Unit, AP-HP, Hospital Necker-E.M., France
| | - Tiffany Guilleminot
- Equipe d'Accueil, Paris Descartes University, Sorbonne Paris CitéArchet, France.,Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections, AP-HP, Hospital Necker-E.M., France
| | - Julien Stirnemann
- Equipe d'Accueil, Paris Descartes University, Sorbonne Paris CitéArchet, France.,Maternity, Hospital Necker-E.M, Paris, France
| | - Idir Ghout
- Unité de Recherche Clinique et Département de Santé Publique, AP-HP, Hôpital Ambroise Paré, Boulogne, France.,University Versaille-Saint-Quentin, Unité Mixte de recherche S, Université Versailles St-Quentin-en-Yvelines, Montigny, France
| | - Yves Ville
- Equipe d'Accueil, Paris Descartes University, Sorbonne Paris CitéArchet, France.,Maternity, Hospital Necker-E.M, Paris, France
| | - Marianne Leruez-Ville
- Equipe d'Accueil, Paris Descartes University, Sorbonne Paris CitéArchet, France.,Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections, AP-HP, Hospital Necker-E.M., France
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14
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Le Bras A, Salomon LJ, Bussières L, Malan V, Elie C, Mahallati H, Ville Y, Vekemans M, Durand-Zaleski I. Cost-effectiveness of five prenatal screening strategies for trisomies and other unbalanced chromosomal abnormalities: model-based analysis. Ultrasound Obstet Gynecol 2019; 54:596-603. [PMID: 31006923 DOI: 10.1002/uog.20301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/15/2019] [Revised: 04/08/2019] [Accepted: 04/12/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of five prenatal screening strategies for trisomies (13/18/21) and other unbalanced chromosomal abnormalities (UBCA), following the introduction of cell-free DNA (cfDNA) analysis. METHODS A model-based cost-effectiveness analysis was performed to estimate prevalence, safety, screening-program costs and healthcare costs of five different prenatal screening strategies, using a virtual cohort of 652 653 pregnant women in France. Data were derived from the French Biomedicine Agency and published articles. Uncertainty was addressed using one-way sensitivity analysis. The five strategies compared were: (i) cfDNA testing for women with a risk following first-trimester screening of ≥ 1/250; (ii) cfDNA testing for women with a risk of ≥ 1/1000 (currently recommended); (iii) cfDNA testing in the general population (regardless of risk); (iv) invasive testing for women with a risk of ≥ 1/250 (historical strategy); and (v) invasive testing for women with a risk of ≥ 1/1000. RESULTS In our virtual population, at similar risk thresholds, cfDNA testing compared with invasive testing was cheaper but less effective. Compared with the historical strategy, cfDNA testing at the ≥ 1/1000 risk threshold was a more expensive strategy that detected 158 additional trisomies, but also 175 fewer other UBCA. Implementation of cfDNA testing in the general population would give an incremental cost-effectiveness ratio of €9 166 689 per additional anomaly detected compared with the historical strategy. CONCLUSION Extending cfDNA to lower risk thresholds or even to all pregnancies would detect more trisomies, but at greater expense and with lower detection rate of other UBCA, compared with the historical strategy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Le Bras
- AP-HP, DRCI-URC Eco Ile-de-France, Paris, France
| | - L J Salomon
- AP-HP, Hôpital Necker-Enfants Malades, Department of Obstetrics and Gynecology, Paris, France
- Collège Français d'Echographie Foetale (CFEF), France
| | - L Bussières
- AP-HP, Hôpital Necker-Enfants Malades, Department of Obstetrics and Gynecology, Paris, France
- AP-HP, Hôpital Necker-Enfants Malades, Clinical Unit Research/Clinic Investigation Center, Paris, France
| | - V Malan
- INSERM U1163, Hôpital Necker-Enfants Malades, Paris, France
- AP-HP, Hôpital Necker-Enfants Malades, Department of Histology, Embryology and Cytogenetics, Paris, France
| | - C Elie
- AP-HP, Hôpital Necker-Enfants Malades, Clinical Unit Research/Clinic Investigation Center, Paris, France
| | - H Mahallati
- AP-HP, Hôpital Necker-Enfants Malades, Department of Obstetrics and Gynecology, Paris, France
| | - Y Ville
- AP-HP, Hôpital Necker-Enfants Malades, Department of Obstetrics and Gynecology, Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - M Vekemans
- AP-HP, Hôpital Necker-Enfants Malades, Department of Histology, Embryology and Cytogenetics, Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - I Durand-Zaleski
- AP-HP, DRCI-URC Eco Ile-de-France, Paris, France
- Assistance Publique-Hôpitaux de Paris, Service de Santé Publique, Henri Mondor-Albert-Chenevier, Créteil, France
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Seror V, L’Haridon O, Bussières L, Malan V, Fries N, Vekemans M, Salomon LJ, Ville Y. Women's Attitudes Toward Invasive and Noninvasive Testing When Facing a High Risk of Fetal Down Syndrome. JAMA Netw Open 2019; 2:e191062. [PMID: 30924894 PMCID: PMC6450316 DOI: 10.1001/jamanetworkopen.2019.1062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Noninvasive prenatal testing (NIPT) using cell-free DNA in maternal blood is increasingly common compared with invasive testing (IT) in routine antenatal detection of Down syndrome (DS). OBJECTIVE To assess attitudes and decision making in pregnant women facing a risk of fetal DS greater than 1 in 250 as established by combined first trimester screening at 11 to 14 weeks of gestation. DESIGN, SETTING, AND PARTICIPANTS Survey study in which data were collected from pregnant women at high risk of fetal DS participating in a randomized clinical trial. Data were collected from April 8, 2014, to April 7, 2016, in 57 prenatal diagnosis centers in France. Data were analyzed in 2018. INTERVENTIONS Data on attitudes were collected prior to offering randomization between NIPT and IT, whereas data on decision making and test results were collected as part of the clinical trial. MAIN OUTCOME AND MEASURES The primary outcome related to attitudes. A hierarchical cluster analysis was conducted to identify clusters with contrasting attitudes. Logistic regression analyses were used to identify factors associated with attitudes. RESULTS All 2436 consecutive women to whom the study was proposed (mean [SD] age, 36.3 [5.0] years) answered the questionnaire: 515 (21.1%) expressed preference toward IT with complete karyotyping, whereas 1843 (75.7%) favored NIPT with almost certain but limited information. Hierarchical cluster analysis yielded 4 different clusters that mainly differed in attitudes toward risk taking and extent of information seeking. Factors likely associated with attitudes driven by risk aversion were mostly age and religious beliefs (adjusted odds ratio [aOR], 1.03; 95% CI, 1.00-1.05; P = .03 and aOR, 1.62; 95% CI, 1.29-2.04; P < .001, respectively), whereas higher nuchal translucency measurements by ultrasonography were associated with attitudes driven by ambiguity aversion (aOR, 1.67; 95% CI, 1.27-2.20; P < .001). For attitudes involving both risk and ambiguity aversion at different extents, lower education was associated with highly valuing all possibilities of getting information on pregnancy, whereas higher education was associated with highly valuing information on fetal DS as a primary concern (aOR, 0.54; 95% CI, 0.44-0.67; P < .001 and aOR, 1.44; 95% CI, 1.20-1.74; P < .001, respectively). In all, decision making was in line with attitudes. CONCLUSIONS AND RELEVANCE Aversion to risk of fetal loss related to IT and aversion to ambiguity generated by incomplete information from NIPT played a major role in shaping attitudes and decision making. Informed decision making should require pregnant women at high risk of DS to receive extensive information on targeted abnormalities by both tests.
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Affiliation(s)
- Valerie Seror
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU Méditerranée Infection, Marseille, France
| | | | - Laurence Bussières
- Clinical Unit Research/Clinic Investigation Center, Paris Descartes, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Department of Obstetrics and Gynecology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Valérie Malan
- Department of Histology-Embryology and Cytogenetics, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM U1163, Hôpital Necker-Enfants Malades, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Nicolas Fries
- Department of Obstetrics and Gynecology, CHU de Montpellier, Montpellier, France
- Collège Français d'Echographie Fœtale, Chateaubriand, France
| | - Michel Vekemans
- Department of Histology-Embryology and Cytogenetics, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Laurent J. Salomon
- Department of Obstetrics and Gynecology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
- Groupe de Recherche en Obstétrique et Gynécologie, Paris, France
- Collège Français d'Echographie Fœtale, Chateaubriand, France
| | - Yves Ville
- Department of Obstetrics and Gynecology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
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16
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Malan V, Bussières L, Winer N, Jais JP, Baptiste A, Le Lorc’h M, Elie C, O’Gorman N, Fries N, Houfflin-Debarge V, Sentilhes L, Vekemans M, Ville Y, Salomon LJ. Effect of Cell-Free DNA Screening vs Direct Invasive Diagnosis on Miscarriage Rates in Women With Pregnancies at High Risk of Trisomy 21: A Randomized Clinical Trial. JAMA 2018; 320:557-565. [PMID: 30120476 PMCID: PMC6583003 DOI: 10.1001/jama.2018.9396] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
IMPORTANCE Cell-free DNA (cfDNA) tests are increasingly being offered to women in the first trimester of pregnancies at a high risk of trisomy 21 to decrease the number of required invasive fetal karyotyping procedures and their associated miscarriages. The effect of this strategy has not been evaluated. OBJECTIVE To compare the rates of miscarriage following invasive procedures only in the case of positive cfDNA test results vs immediate invasive testing procedures (amniocentesis or chorionic villus sampling) in women with pregnancies at high risk of trisomy 21 as identified by first-trimester combined screening. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted from April 8, 2014, to April 7, 2016, in 57 centers in France among 2111 women with pregnancies with a risk of trisomy 21 between 1 in 5 and 1 in 250 following combined first-trimester screening. INTERVENTIONS Patients were randomized to receive either cfDNA testing followed by invasive testing procedures only when cfDNA tests results were positive (n = 1034) or to receive immediate invasive testing procedures (n = 1017). The cfDNA testing was performed using an in-house validated method based on next-generation sequencing. MAIN OUTCOMES AND MEASURES The primary outcome was number of miscarriages before 24 weeks' gestation. Secondary outcomes included cfDNA testing detection rate for trisomy 21. The primary outcome underwent 1-sided testing; secondary outcomes underwent 2-sided testing. RESULTS Among 2051 women who were randomized and analyzed (mean age, 36.3 [SD, 5.0] years), 1997 (97.4%) completed the trial. The miscarriage rate was not significantly different between groups at 8 (0.8%) vs 8 (0.8%), for a risk difference of -0.03% (1-sided 95% CI, -0.68% to ∞; P = .47). The cfDNA detection rate for trisomy 21 was 100% (95% CI, 87.2%-100%). CONCLUSIONS AND RELEVANCE Among women with pregnancies at high risk of trisomy 21, offering cfDNA screening, followed by invasive testing if cfDNA test results were positive, compared with invasive testing procedures alone, did not result in a significant reduction in miscarriage before 24 weeks. The study may have been underpowered to detect clinically important differences in miscarriage rates. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02127515.
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Affiliation(s)
- Valérie Malan
- Department of Histology-Embryology and Cytogenetics, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
- INSERM U1163, Hôpital Necker–Enfants Malades, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Laurence Bussières
- Department of Obstetrics and Gynecology, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
- Clinical Unit Research/Clinic Investigation Center, Paris Descartes, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, CHU de Nantes, UMR 1280 PHAN (Physiologie des Adaptations Nutritionnelles), INRA University, Nantes, France
- Groupe de Recherche en Obstétrique et Gynécologie (GROG), Paris, France
| | - Jean-Philippe Jais
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
- Department of Biostatistics and Medical Informatics, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
| | - Amandine Baptiste
- Clinical Unit Research/Clinic Investigation Center, Paris Descartes, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
| | - Marc Le Lorc’h
- Department of Histology-Embryology and Cytogenetics, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
| | - Caroline Elie
- Clinical Unit Research/Clinic Investigation Center, Paris Descartes, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
| | - Neil O’Gorman
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
- Department of Obstetrics and Gynecology, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
| | - Nicolas Fries
- Department of Obstetrics and Gynecology, CHU de Montpellier, Montpellier, France
- Collège Français d’Echographie Fœtale (CFEF), Chateaubriand, France
| | - Véronique Houfflin-Debarge
- Groupe de Recherche en Obstétrique et Gynécologie (GROG), Paris, France
- Department of Obstetrics and Gynecology, CHU de Lille, Lille, France
| | - Loic Sentilhes
- Groupe de Recherche en Obstétrique et Gynécologie (GROG), Paris, France
- Department of Obstetrics and Gynecology, CHU d’Angers, Angers, France
- Department of Obstetrics and Gynecology, CHU de Bordeaux, Bordeaux, France
| | - Michel Vekemans
- Department of Histology-Embryology and Cytogenetics, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Yves Ville
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
- Department of Obstetrics and Gynecology, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
| | - Laurent J. Salomon
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
- Department of Obstetrics and Gynecology, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
- Groupe de Recherche en Obstétrique et Gynécologie (GROG), Paris, France
- Collège Français d’Echographie Fœtale (CFEF), Chateaubriand, France
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Le Lous M, Mediouni I, Chalouhi G, Salomon LJ, Bussières L, Carrier A, Bernard JP, Ville Y. Impact of laser therapy for twin-to-twin transfusion syndrome on subsequent pregnancy. Prenat Diagn 2018; 38:293-297. [PMID: 29417606 DOI: 10.1002/pd.5227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/19/2018] [Accepted: 01/20/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The objective of our study was to determine the impact of laser therapy for twin-to-twin transfusion syndrome (TTTs) on subsequent pregnancies. METHODS This was a monocentric retrospective observational study. Women treated by laser fetoscopy for TTTs were asked to answer a postal questionnaire about subsequent pregnancies. The primary outcome was fecundity (number of pregnancies and time to pregnancy). We also assessed pregnancy complications, birth weight, and gestational age at delivery. Pregnancy complications included the following: threatened preterm labor, preeclampsia, placenta accreta, postpartum hemorrhage, and psychological disorders. Our study population was compared with an external control group made up of mothers of monochorionic twins without TTTs. RESULTS We included 122 cases managed at the Necker Hospital between 2008 and 2012 and 39 controls. The median conception time was longer in the TTTs group (6.4 ± 11.1 versus 2 ± 1.6 months, P = .03). The numbers of live childbirths at the end of those pregnancies were equivalent (77.6% versus 66.7%, P = .56). Birth weight (3317 ± 726 versus 3240 ± 382 g, P = .81) and gestational age at delivery (38.2 ± 6.8 WG versus 39.5 ± 1.2 WG, P = .64) were similar, with no increase of obstetrical complications compared with the control group. DISCUSSION Twin-to-twin transfusion syndrome and its treatment do not seem to impact subsequent pregnancies.
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Affiliation(s)
- Maela Le Lous
- Department of Obstetrics and Gynecology, University Hospital of Rennes, Rennes, France
| | - Imen Mediouni
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France
| | - Gihad Chalouhi
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France.,Sorbonne Paris-Cité, Paris Descartes University, Paris, France
| | - Laurent J Salomon
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France.,Sorbonne Paris-Cité, Paris Descartes University, Paris, France
| | - Laurence Bussières
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France
| | - Aude Carrier
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France
| | - Jean-Pierre Bernard
- 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.,Sorbonne Paris-Cité, Paris Descartes University, Paris, France
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18
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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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Bussières L, Casanova C. Neural Processing of Second-Order Motion in the Suprasylvian Cortex of the Cat. Cereb Cortex 2017; 27:1347-1357. [PMID: 26733532 DOI: 10.1093/cercor/bhv320] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Neuronal responses to second-order motion, that is, to spatiotemporal variations of texture or contrast, have been reported in several cortical areas of mammals, including the middle-temporal (MT) area in primates. In this study, we investigated whether second-order responses are present in the cat posteromedial lateral suprasylvian (PMLS) cortex, a possible homolog of the primate area MT. The stimuli used were luminance-based sine-wave gratings (first-order) and contrast-modulated carrier stimuli (second-order), which consisted of a high-spatial-frequency static grating (carrier) whose contrast was modulated by a low-spatial-frequency drifting grating (envelope). Results indicate that most PMLS neurons responded to second-order motion and for the vast majority of cells, first- and second-order preferred directions were conserved. However, responses to second-order stimuli were significantly reduced when compared to those evoked by first-order gratings. Circular variance was increased for second-order stimuli, indicating that PMLS direction selectivity was weaker for this type of stimulus. Finally, carrier orientation selectivity was either absent or very broad and had no influence on the envelope's orientation selectivity. In conclusion, our data show that PMLS neurons exhibit similar first- and second-order response profiles and that, akin primate area MT cells, they perform a form-cue invariant analysis of motion signals.
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Affiliation(s)
- L Bussières
- École d'optométrie, Université de Montréal.,Département de Physiologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada H3C 3J7
| | - C Casanova
- École d'optométrie, Université de Montréal
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20
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Malan V, Bussières L, Salomon LJ. [Cell-free fetal DNA screening tests for trisomy 21]. ACTA ACUST UNITED AC 2016; 44:675-678. [PMID: 27839716 DOI: 10.1016/j.gyobfe.2016.10.002] [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: 09/24/2016] [Indexed: 10/20/2022]
Affiliation(s)
- V Malan
- Service de cytogénétique, hôpital Necker-Enfants-Malades, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - L Bussières
- Service de gynécologie-obstétrique, hôpital Necker-Enfants-Malades, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - L J Salomon
- Service de gynécologie-obstétrique, hôpital Necker-Enfants-Malades, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France.
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21
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Leruez-Ville M, Ghout I, Bussières L, Stirnemann J, Magny JF, Couderc S, Salomon LJ, Guilleminot T, Aegerter P, Benoist G, Winer N, Picone O, Jacquemard F, Ville Y. In utero treatment of congenital cytomegalovirus infection with valacyclovir in a multicenter, open-label, phase II study. Am J Obstet Gynecol 2016; 215:462.e1-462.e10. [PMID: 27083761 DOI: 10.1016/j.ajog.2016.04.003] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/22/2016] [Accepted: 04/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Congenital infection with human cytomegalovirus is a major cause of morbidity and mortality. A randomized controlled trial showed that high-dosage valacyclovir prevents cytomegalovirus disease in transplant recipients. Fetuses showing ultrasound features of infection are at high risk of being symptomatic at or before birth. In a pilot study, oral administration of high-dosage valacyclovir to mothers significantly decreased viral load and produced therapeutic concentrations in the blood of infected fetuses. A randomized controlled trial comparing prenatal treatment with valacyclovir against placebo in infected fetuses failed to recruit because women declined randomization. Randomized controlled trials in fetal medicine have often proven unacceptable by women who decline termination of pregnancy and are not prepared to resign themselves to the odds of the natural history of the disease. OBJECTIVE We evaluated the efficacy of oral valacyclovir, 8 g daily, for pregnant women carrying a symptomatic cytomegalovirus-infected fetus, targeting a high-risk group for developing both neurosensory and neurological impairment. STUDY DESIGN We designed a multicenter, open-label, phase II study with 1 arm, using one of Simon's optimal 2-stage designs. Symptomatic fetuses were defined by the presence of measurable extracerebral or mild cerebral ultrasound symptoms. They were treated in utero from prenatal diagnosis at a median of 25.9 weeks' gestation until delivery or termination of pregnancy. Fetuses with severe brain anomalies on ultrasound were not included as were cases completely asymptomatic at presentation, because treatment was unlikely to modify either outcome. The primary endpoint was the proportion of asymptomatic neonates born to treated mothers. RESULTS At the interim analysis, 8 of 11 women delivered an asymptomatic neonate (required: ≥7). In step 2, 32 additional cases were included for a total of 43; the final number of asymptomatic neonates was 34, more than the 31 required to indicate efficacy according to the Simon 2-stage design. They remained asymptomatic at 12 months. High-dosage valacyclovir given for a median of 89 days to pregnant women carrying a moderately infected fetus was efficient at giving birth to asymptomatic neonates. Fetal blood viral loads decreased and platelet counts increased, both significantly (P = .01 and P < .001, respectively), between treatment initiation and birth after treatment completion, regardless of duration of fetal infection. Compared with a historical cohort obtained by a metaanalysis of the literature, the use of valacyclovir (8 g daily) significantly increased the proportion of asymptomatic neonates from 43% without treatment to 82% with treatment. Although the pill burden was high (16 pills a day) adherence to treatment was >90%. Finally, valacyclovir at this high dosage was extremely well tolerated. CONCLUSION Our results indicate that high-dosage valacyclovir given in pregnancy is effective for improving the outcome of moderately symptomatic infected fetuses. Although this study is not a randomized controlled trial, this is the first study reporting the efficacy of an antiviral drug to treat cytomegalovirus-infected fetuses. Moreover, this first study will allow new trials to be conducted, using valacyclovir as a baseline safe and effective treatment in pregnancy, to be compared to the new emerging and more potent anticytomegalovirus drugs that have not currently been tested in pregnancy.
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Alberti A, Salomon LJ, Le Lorc'h M, Couloux A, Bussières L, Goupil S, Malan V, Pelletier E, Hyon C, Vialard F, Rozenberg P, Bouhanna P, Oury JF, Schmitz T, Romana S, Weissenbach J, Vekemans M, Ville Y. Non-invasive prenatal testing for trisomy 21 based on analysis of cell-free fetal DNA circulating in the maternal plasma. Prenat Diagn 2016; 35:471-6. [PMID: 25643828 DOI: 10.1002/pd.4561] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 01/04/2015] [Accepted: 01/14/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE By-the-book implementation of non-invasive prenatal test and clinical validation for trisomy 21. STUDY DESIGN Publicly funded prospective study of 225 cases. Women at risk for trisomy 21 > 1/250 based on combined ultrasound and serum markers during first or second trimester were eligible following an informed consent. The technique was established from the available literature and performed on 10 mL of venous blood collected prior to chorionic villus sampling or amniocentesis. Investigators were blinded to the fetal karyotype. Results were expressed in Z-scores of the percentage of each chromosome. RESULTS Among 976 eligible cases, 225 were processed: 8 were used for pretesting phase and 23 to build a reference set. One hundred thirty six euploid cases and 47 with trisomy 21 were then run randomly. Eleven cases yielded no result (4.8%). Z-scores were above 3 (7.58+/-2.41) for chromosome 21 in all 47 trisomies and in none of the euploid cases (0.11+/-1.0). Z-scores were within normal range for the other chromosomes in both groups. Using a cut-off of 3, sensitivity and specificity were of 100% 95% CI [94.1, 100] and 100% 95% CI [98, 100], respectively. CONCLUSION Non-invasive prenatal test for trisomy 21 is a robust strategy that can be translated from seminal publications. Publicly funded studies should refine its indications and cost-effectiveness in prenatal screening and diagnosis. © 2015 John Wiley & Sons, Ltd.
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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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Kuleva M, Castaing O, Fries N, Bernard JP, Bussières L, Fontanges M, Moeglin D, Salomon LJ. A standardized approach for the assessment of the lower uterine segment at first trimester by transvaginal ultrasound: a flash study. J Matern Fetal Neonatal Med 2015; 29:1376-81. [PMID: 26043645 DOI: 10.3109/14767058.2015.1051956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/13/2022]
Abstract
OBJECTIVES To evaluate the reproducibility of a standardized approach to lower uterine segment (LUS) imaging by transvaginal ultrasound at 11-14 weeks. METHODS This was a "flash" study lasting for 1 month. Obstetrician-sonographers performing more than 50 first trimester ultrasounds per year participated. All consecutive women attending for their 11-14 weeks scan were included. A standardized, transvaginal approach to the imaging of LUS was defined. The sonographers recorded one or two images of the LUS. The quality of the images was assessed by sonographers and reviewed by an independent fetal medicine specialist using the same scoring system. Inter and intra-reviewer variability was assessed. RESULTS Seventy-one sonographers and 851 pregnant women participated. The mean (±SD) and medium (IQR) scores attributed by sonographer versus reviewer were 5.01 (±0.92) and 5 [4-6] versus 4.68 (±1.14) and 5 [4-5.24], p = 0.08. The mean [95% CI] difference of -0.33 [-2.6;2] was recorded. There was good, moderate and poor agreement in 74.4%, 16.7% and 8.9% cases, respectively. Variability in inter-reviewer and intra-reviewer was low with the mean [95% CI] difference of -0.1 [-1.6;1.4] and -0.1 [-1.4;1.2] respectively. CONCLUSIONS A standardized approach to LUS imaging at 11-14 weeks is feasible and highly reproducible in a large population.
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Affiliation(s)
- Marina Kuleva
- a Hôpital Necker-Enfants Malades , Maternité, Paris , France and
| | - Olivier Castaing
- b Collège Français d'Echographie Fœtale (CFEF), AP-HP, Université Paris Descartes , Paris , France
| | - Nicolas Fries
- b Collège Français d'Echographie Fœtale (CFEF), AP-HP, Université Paris Descartes , Paris , France
| | | | - Laurence Bussières
- b Collège Français d'Echographie Fœtale (CFEF), AP-HP, Université Paris Descartes , Paris , France
| | - Marianne Fontanges
- b Collège Français d'Echographie Fœtale (CFEF), AP-HP, Université Paris Descartes , Paris , France
| | - Daniel Moeglin
- b Collège Français d'Echographie Fœtale (CFEF), AP-HP, Université Paris Descartes , Paris , France
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Mouawia H, Saker A, Jais JP, Benachi A, Bussières L, Lacour B, Bonnefont JP, Frydman R, Simpson JL, Paterlini-Brechot P. Circulating trophoblastic cells provide genetic diagnosis in 63 fetuses at risk for cystic fibrosis or spinal muscular atrophy. Reprod Biomed Online 2012; 25:508-20. [PMID: 23000084 DOI: 10.1016/j.rbmo.2012.08.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 08/16/2012] [Accepted: 08/16/2012] [Indexed: 10/27/2022]
Abstract
This study sought to determine whether a reliable non-invasive prenatal diagnosis (NI-PND) of cystic fibrosis (CF) or spinal muscular atrophy (SMA) can be achieved through analysis of circulating fetal trophoblastic cells (CFTC). The kinetics of CFTC circulation were also studied. CFTC were isolated by isolation by size of epithelial tumour/trophoblastic cells at 9-11 weeks of gestation, before chorionic villus sampling (CVS), from the blood of 63 pregnant women at 25% risk for having a child affected by either CF (n=32) or SMA (n=31). Collected cells were laser-microdissected, short tandem repeat-genotyped to determine fetal origin and blindly assessed for mutation analysis. CFTC were independently analysed weekly (4-12 weeks of gestation) in 14 women who achieved pregnancy following IVF. Diagnostic results were compared with those obtained by CVS. All seven CF and seven SMA pregnancies carrying an affected fetus were correctly identified as well as non-affected pregnancies. CFTC provided 100% diagnostic sensitivity (95% CI 76.8-100%) and specificity (95% CI 92.7-100%) in these 63 consecutive pregnancies at risk for CF or SMA. CFTC were found to circulate from 5 weeks of gestation and can be used to develop an early and reliable approach for NI-PND. We sought to determine whether a reliable non-invasive prenatal diagnosis (NI-PND) of two rare genetic diseases - cystic fibrosis (CF) and spinal muscular atrophy (SMA) - can be achieved through analysis of circulating fetal trophoblastic cells (CFTC) in blood of pregnant women. We also studied the time of appearance and circulation of CFTC in maternal blood. CFTC were isolated from maternal blood by isolation by size of epithelial tumour/trophoblastic cells (ISET; an approach for cell isolation from blood) at 9-11 weeks of gestation before chorionic villus sampling (CVS) from the blood of 63 pregnant women at 25% risk for having a child affected by either CF (n=32) or SMA (n=31). Collected cells were analysed by genetic test to determine fetal origin and blindly assessed for mutation analysis. We independently analysed CFTC in maternal blood samples taken weekly (4-12 weeks of gestation) from 14 women who achieved pregnancy following IVF. Diagnostic results were compared with those obtained by CVS. All seven CF and seven SMA pregnancies carrying an affected fetus were correctly identified as well as non-affected pregnancies. CFTC provided 100% diagnostic sensitivity and specificity in these 63 consecutive pregnancies at risk for CF or SMA. CFTC were found to circulate from 5 weeks of gestation and can be used to develop an early and reliable approach for NI-PND.
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Paterlini-Brechot P, Mouawia H, Jais JP, Benachi A, Bussières L, Saker A, Lacour B, Bonnefont JP, Frydman R. C37 Clinical validation of a non-invasive test for prenatal diagnosis of cystic fibrosis and spinal muscular atrophy based on genetic analysis of circulating trophoblastic cells. Reprod Biomed Online 2010. [DOI: 10.1016/s1472-6483(10)62291-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vialard F, Salomon LJ, Winer N, Bussières L, Molina Gomes D, Ville Y. Fetal karyotype in feto-fetal transfusion syndrome: a 7-year experience. Prenat Diagn 2009; 29:804-5. [PMID: 19399755 DOI: 10.1002/pd.2272] [Citation(s) in RCA: 1] [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] [Indexed: 11/11/2022]
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Rozenberg P, Bussières L, Senat MV. Dépistage de la trisomie 21 en France: le consensus du pire. ACTA ACUST UNITED AC 2007; 36:95-103. [PMID: 17289296 DOI: 10.1016/j.jgyn.2006.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 09/21/2006] [Revised: 11/30/2006] [Accepted: 12/22/2006] [Indexed: 10/28/2022]
Abstract
Down syndrome screening has been based on second trimester maternal serum markers assay for many years. Another late strategy was based on the "genetic sonogram" performed in early second trimester in high-risk populations selected on maternal age or second trimester maternal serum markers. New strategies for Down syndrome screening have emerged over the last 10 years, with higher sensitivity and lower false-positive rates. First trimester ultrasound examination is a successful screening test; the sensitivity of nuchal translucency measurement is of 60 to 77% for a 5% false-positive rate. Combining nuchal translucency measurement with PAPP-A and free beta-hCG assay (first trimester combined screening) increases the sensitivity up to 82%. The most specific strategy is based on the integrated test, i.e., the integration of the quadruple test performed in second trimester (inhibine dimeric A, total beta-hCG, AFP, and uE3 assay) to the first trimester combined screening: for a 85% detection rate, the false-positive rate is estimated to 0.9%. However, it is ethical only with the patient agreement because it prevents access to the results of first trimester combined screening, and deprives the patient of an early diagnosis by CVS. Therefore, alternative strategies were proposed: step-wise sequential screening and contingent sequential screening. In the step-wise screening, karyotype is offered when the result of the combined test is beyond a specified threshold. If the combined test result is below this threshold, quadruple test is offered, and the final risk is calculated in the second trimester by integrating the results of the quadruple test with those of the combined test. Contingent screening also begins with the first trimester-combined test. According to its results, the patients are considered in one of the 3 following risk groups: high, intermediate, or low risk. An early karyotype is proposed to the high-risk group after combined testing. The low risk group is reassured and thus the quadruple test is not performed. The quadruple test is proposed to the intermediate risk group and final risk is calculated by the integration of the combined test result into the quadruple test result. The global detection rate of the step-wise or contingent sequential screening is estimated to 84% for a false-positive rate of 2%.
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Affiliation(s)
- P Rozenberg
- Département de Gynécologie - Obstétrique, Université Versailles - Saint-Quentin, Centre Hospitalier Poissy-Saint-Germain, 10, rue du Champ-Gaillard, BP 3082, 78303 Poissy cedex, France.
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Rozenberg P, Bussières L, Chevret S, Bernard JP, Malagrida L, Cuckle H, Chabry C, Durand-Zaleski I, Bidat L, Lacroix I, Moulis M, Roger M, Jacquemot MC, Bault JP, Boukobza P, Boccara P, Vialat F, Giudicelli Y, Ville Y. Dépistage de la trisomie 21 par le test combiné du premier trimestre suivi par l'échographie du second trimestre en population générale. ACTA ACUST UNITED AC 2007; 35:303-11. [PMID: 17350315 DOI: 10.1016/j.gyobfe.2007.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recent studies have reported the efficacy of first trimester combined screening for Down Syndrome based on maternal age, serum markers (human chorionic gonadotropin, pregnancy-associated plasma protein A), and ultrasound measurement of fetal nuchal translucency. However, those do not incorporate the value of the widely accepted routine 20-22 week anomaly scan. STUDY DESIGN We carried out a multi-centre, interventional study in the unselected population of a single health authority in order to assess the performance of first trimester combined screening, followed by routine second trimester ultrasound examination and/or screening by maternal serum markers (free beta-hCG and alpha-fetoprotein measurement or total hCG, alpha-fetoprotein and unconjugated estriol measurement) when incidentally performed. Detection and screen positive rates were estimated using a correction method for non verified issues. A cost analysis was also performed. RESULTS During the study period, 14,934 women were included. Fifty-one cases of Down Syndrome were observed, giving a prevalence of 3.4 per 1000 pregnancies. Of these, 46 were diagnosed through first (N=41) or second (N=5) trimester screening. Among the 5 screen-negative Down syndrome cases, all were diagnosed postnatally after an uneventful pregnancy. Detection and screen positive rates of first trimester combined screening were 79.6% and 2.7%, respectively. These features reached 89.7 and 4.2%, respectively when combined with second trimester ultrasound screening. The average cost of the full screening procedure was 108 euro (120 $) per woman and the cost per diagnosed Down syndrome pregnancy was 7,118 euro (7,909 $). CONCLUSION Our findings suggest that one pragmatic interventional two-step approach using first-trimester combined screening followed by second trimester detailed ultrasound examination is a suitable and acceptable option for Down syndrome screening in pregnancy.
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Affiliation(s)
- P Rozenberg
- Département de gynécologie-obstétrique, biologie de la reproduction et cytogénétique, CHI Poissy-Saint-Germain, hôpital Poissy-Saint-Germain, université Versailles-Saint-Quentin, Poissy, France.
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Senat MV, Bussières L, Couderc S, Roume J, Rozenberg P, Bouyer J, Ville Y. Long-term outcome of children born after a first-trimester measurement of nuchal translucency at the 99th percentile or greater with normal karyotype: a prospective study. Am J Obstet Gynecol 2007; 196:53.e1-6. [PMID: 17240232 PMCID: PMC1933588 DOI: 10.1016/j.ajog.2006.08.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [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: 03/21/2006] [Revised: 06/23/2006] [Accepted: 08/01/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study was undertaken to assess the long-term outcome of children born after a first-trimester measurement of nuchal translucency (NT) at the 99th percentile or greater during routine first-trimester screening in an unselected population. STUDY DESIGN One hundred sixty-two infants were born alive. Clinical examination as well as a questionnaire to the parents (Ages and Stages Questionnaires [ASQ]) at the age of 2 years were obtained in 160 children. Our study population was compared with an external control group made of the 370 term control children. RESULTS The prevalence of abnormal clinical pediatric examination and ASQ results at 2 years were not associated with NT thickness. Comparison with an external control group did not demonstrate an increased incidence of developmental delay. CONCLUSION Parents should be informed that when the fetus is shown to be normal by ultrasound at 22-24 weeks of gestation the risk of adverse neonatal outcome or developmental delay in early childhood is not increased.
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Affiliation(s)
- Marie-Victoire Senat
- Service d'obstétrique-gynécologie, pédiatrie et génétique
CHI Poissy Saint-GermainFR
| | | | - Sophie Couderc
- Service d'obstétrique-gynécologie, pédiatrie et génétique
CHI Poissy Saint-GermainFR
| | - Joelle Roume
- Service d'obstétrique-gynécologie, pédiatrie et génétique
CHI Poissy Saint-GermainFR
| | - Patrick Rozenberg
- Service d'obstétrique-gynécologie, pédiatrie et génétique
CHI Poissy Saint-GermainFR
| | - Jean Bouyer
- Epidémiologie, Démographie et Sciences Sociales: santé reproductive, sexualité et infection à VIH
INSERM : U569 INED IFR69Université Paris Sud - Paris XISecteur Bleu
82, Rue du General Leclerc
94276 LE KREMLIN BICETRE CEDEX,FR
| | - Yves Ville
- Service d'obstétrique-gynécologie, pédiatrie et génétique
CHI Poissy Saint-GermainFR
- * Correspondence should be adressed to: Yves Ville
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Rozenberg P, Bussières L, Chevret S, Bernard JP, Malagrida L, Cuckle H, Chabry C, Durand-Zaleski I, Bidat L, Lacroix I, Moulis M, Roger M, Jacquemot MC, Bault JP, Boukobza P, Boccara P, Vialard F, Giudicelli Y, Ville Y. Screening for Down syndrome using first-trimester combined screening followed by second-trimester ultrasound examination in an unselected population. Am J Obstet Gynecol 2006; 195:1379-87. [PMID: 16723105 DOI: 10.1016/j.ajog.2006.02.046] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [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: 11/26/2005] [Revised: 02/27/2006] [Accepted: 02/27/2006] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Recent studies have reported the efficacy of first-trimester combined screening for Down syndrome based on maternal age, serum markers (human chorionic gonadotropin, pregnancy-associated plasma protein A), and ultrasound measurement of fetal nuchal translucency. However, those do not incorporate the value of the widely accepted routine 20-22 weeks' anomaly scan. STUDY DESIGN We carried out a multicenter, interventional study in the unselected population of a single health authority in order to assess the performance of first-trimester combined screening, followed by routine second trimester ultrasound examination and/or screening by maternal serum markers (free beta-hCG and alpha-fetoprotein measurement or total hCG, alpha-fetoprotein, and unconjugated estriol measurement) when incidentally performed. Detection and screen positive rates were estimated using a correction method for nonverified issues. A cost analysis was also performed. RESULTS During the study period, 14,934 women were included. Fifty-one cases of Down syndrome were observed, giving a prevalence of 3.4 per 1000 pregnancies. Of these, 46 were diagnosed through first (n = 41) or second (n = 5) trimester screening. Among the 5 screen-negative Down syndrome cases, all were diagnosed postnatally after an uneventful pregnancy. Detection and screen positive rates of first-trimester combined screening were 79.6% and 2.7%, respectively. These features reached 89.7%, and 4.2%, respectively, when combined with second-trimester ultrasound screening. The average cost of the full screening procedure was 108 euros (120 dollars) per woman and the cost per diagnosed Down syndrome pregnancy was 7,118 euros (7909 dollars). CONCLUSION Our findings suggest that 1 pragmatic interventional 2-step approach using first-trimester combined screening followed by second-trimester detailed ultrasound examination is a suitable and acceptable option for Down syndrome screening in pregnancy.
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Affiliation(s)
- Patrick Rozenberg
- Department of Obstetrics and Gynecology, Reproductive Biology and Cytogenetics, Poissy-Saint Germain Hospital, University Versailles-St Quentin, Poissy, France.
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Douard MC, di Palma M, d'Agostino P, Chevret S, Kriegel I, Falissard B, Thierry P, George B, Bussières L, Misset JL. Prospective, double-blind, randomized trial of equimolar mixture of nitrous oxide/oxygen to prevent pain induced by insertion of venous access ports in cancer patients. Support Care Cancer 2005; 14:161-6. [PMID: 16094519 DOI: 10.1007/s00520-005-0852-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2004] [Accepted: 05/25/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND To assess the efficacy of equimolar mixture of nitrous oxide/oxygen (EMNO) to prevent pain induced by venous access ports (VAPs) implantation in cancer patients. PATIENTS AND METHODS In a randomized, double-blind study on an adult population not knowing the effects of EMNO, cancer patients were randomly assigned to breath via a facial mask, EMNO or a placebo mixture comprising 50% oxygen and 50% nitrogen. The primary end-point was the patients' assessment of the severity of pain evaluated using a visual analog scale (VAS, 0 to 100) and the proportion of patients suffering pain in each group. The secondary criteria were side effects, tolerability of EMNO, and the level of satisfaction of both the patients and the medical team. RESULTS Eighty-three adults (42 in the EMNO group and 41 in the placebo group) were included. VAPs were implanted in the jugular vein in 95% of patients. In the placebo group, 78% of the patients declared that they found VAP implantation painful vs. 34% in the EMNO group (p=0.001). The severity of the pain was reduced by 50% in the EMNO group in comparison with placebo (p=0.0125). Although the median time to perform implantation was strictly identical in both groups (20 min), the estimated duration of surgery seemed longer to patients in the control group. Patient and investigator satisfaction indexes were >90% in both groups. CONCLUSION EMNO provides an effective solution for the prevention of pain during placement of VAPs.
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Affiliation(s)
- Marie Cécile Douard
- Department of Anesthesiology, Hopital Saint Louis, AP-HP, Université Paris VII, 1, avenue Claude Vellefaux, 75010, Paris, France.
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Bussières L, Rozenberg P, Bault JP, Ville Y. [First trimester Down syndrome screening program using nuchal translucency and maternal serum markers: the Echo PAPP-A.78 study]. ACTA ACUST UNITED AC 2004; 33:S61-6. [PMID: 14968021 DOI: 10.1016/s0368-2315(04)96667-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Successive development of different methods to screen down syndrome (DS) have had unexpected effects, leading to an inflation in the number of karyotypes ordered and the number of induced abortions. In our district (Yvelines, France), DS screening leads to perform 16% karyotypes rate. Rapid progress in biology and ultrasonography has enabled us to correct this overprescription by conducting an early screening program using a combination of ultrasound graphic and new biochemical markers (Pregnancy-associated plasma protein A and the free fraction of ss-hCG) which allow an overall evaluation of risk. This method has high sensitivity (85%) and leads to a false positive rate karyotypes in about 5% of pregnancies. The purpose of the study conducted between January 1, 2001 and December 31, 2002 in the Yvelines was to confirm the validity of this method and determine its reproducibility in routine practice. Five partners contributed to the study: the Regional delegation for clinical research of the Paris-public assistance hospitals (AP-HP), the district health insurance fund (CPAM 78), the Yvelines maternity network which includes all ten maternity wards in the district, and the Echo 78 association which includes all ultrasoundgraphists working in the district who accepted to participate as investigators, as well as five biology laboratories where DS screening was performed.
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Affiliation(s)
- L Bussières
- Service de Gynécologie Obstétrique et Biologie de la Reproduction, Centre Hospitalier de Poissy-Saint-Germain, 78300 Poissy
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Edouga D, Hugueny B, Gasser B, Bussières L, Laborde K. Recovery after relief of fetal urinary obstruction: morphological, functional and molecular aspects. Am J Physiol Renal Physiol 2001; 281:F26-37. [PMID: 11399643 DOI: 10.1152/ajprenal.2001.281.1.f26] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The effects of obstruction [urinary tract obstruction (UTO)] and relief on renal development were examined in an experimental model in the fetal lamb. Bladder outlet obstruction was performed at 60 days of gestation; relief was performed by vesicoamniotic shunting at 90 days of gestation. Studies were carried out in obstructed (OF60; n = 11), shunted (SF; n = 5), and control fetuses (CF; n = 11) at 120 days of gestation. Fetal UTO produced either hydronephrosis (64%) or dysplasia (36%); dysplasia was always associated with a reduction in the number of glomeruli [950 +/- 99 (dysplasia) vs. 1,852 +/- 249 (CF) glomeruli/section]. Obstructed fetuses had lower creatinine clearance [0.76 +/- 0.41 (OF60) vs. 0.96 +/- 0.21 (CF) ml x min(-1) x kg(-1)], higher sodium fractional excretion [17.2 +/- 20.3 (OF60) vs. 2.4 +/- 3.7% (CF)], and higher urinary concentration [80 +/- 30 (OF60) vs. 43 +/- 22 (CF) micromol/l] than controls. In SF, the number of glomeruli was increased at 120 days of gestation (1,643 +/- 106 glomeruli/section) compared with nondiverted fetuses (1,379 +/- 502 glomeruli/section), and the temporal pattern of PAX2, disrupted after obstruction, was restored. In conclusion, early fetal UTO leads to either renal hydronephrosis with normal glomerular development or dysplasia with a decreased number of glomeruli; in utero urine diversion performed before the end of nephrogenesis may allow a reversal of the glomerulogenesis arrest observed.
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Affiliation(s)
- D Edouga
- Department of Physiology, Necker-Enfants Malades Hospital, Institut National de la Santé et la Recherche Médicale Unité 356, Institut Fédératif de Recherche 58, Paris, France
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Pinto G, Bussières L, Recasens C, Souberbielle JC, Zerah M, Brauner R. Hormonal factors influencing weight and growth pattern in craniopharyngioma. Horm Res 2001; 53:163-9. [PMID: 11044799 DOI: 10.1159/000023562] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Patients operated on for craniopharyngioma frequently suffer from hyperphagia and are obese, but their statural growth is normal despite growth hormone (GH) deficiency. We have evaluated the hormonal factors influencing changes in weight and growth in 17 children before and 1, 3-6, 12, and/or 24 months after surgical resection of a craniopharyngioma performed at 7.7 +/- (SE) 1 years of age. Of these, 15 patients had a GH deficiency before surgery, and all had complete pituitary deficiency after it. The plasma fasting insulin concentrations before surgery were positively correlated with body mass index (BMI, kg/m(2); p < 0.05), plasma insulin-like growth factors (IGFI, p = 0.03, and IGFII, p = 0.04), and leptin (p = 0.03). They increased significantly 1 month after surgery and continued to increase thereafter, whereas leptin increased significantly only 3-6 months after surgery, paralleling changes in BMI. The plasma fasting insulin concentrations before surgery were also positively correlated with the weight changes (12.3 +/- 2.3 kg, p < 0.01) during the 12 months after surgery, but not with changes in BMI SDS (3.1 +/- 0.5, p = 0.07). Both expressions of weight change were correlated with the concomitant growth rates (4.8 +/- 0.7 cm, p < 0.01). IGFI was above the 10th percentile for children with idiopathic short stature in 10 of 15 patients with craniopharyngioma-induced GH deficiency and IGF-binding protein 3 in 14 of 15 patients. Craniopharyngioma itself modified the control of insulin secretion, and surgery increased the insulin secretion which continued in the same way in a given patient after surgery. The increased insulin secretion in turn increases weight and keeps IGFI nearly normal. This may explain the normal growth rate despite the complete lack of GH.
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Affiliation(s)
- G Pinto
- Department of Pediatric Endocrinology, Université René-Descartes and Hôpital Necker-Enfants Malades, Paris, France
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Bussières L, Souberbielle JC, Pinto G, Adan L, Noel M, Brauner R. The use of insulin-like growth factor 1 reference values for the diagnosis of growth hormone deficiency in prepubertal children. Clin Endocrinol (Oxf) 2000; 52:735-9. [PMID: 10848878 DOI: 10.1046/j.1365-2265.2000.00999.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study was done to determine whether the use of reference values obtained in children with idiopathic short stature (ISS) improved the clinical value of serum insulin-like growth factor I (IGF-1) as a tool for diagnosing GH deficiency (GHD) in prepubertal children. PATIENTS AND METHODS Serum IGF-1 was measured with a new IRMA kit (IGFI-RIA CT, Cis Bio, Gif sur Yvette, France) in 168 prepubertal normal children and in prepubertal children with ISS (n = 68), organic GHD due to a craniopharyngioma (oGHD, n = 15) and permanent idiopathic GHD (iGHD, n = 28). RESULTS IGF-1 was lower (P < 0.001) in iGHD than in either ISS or oGHD and was below the fifth percentile of the normal range in 29/68 ISS (43%), 8/15 oGHD (53%) and 28/28 (100%) iGHD patients. Three oGHD (20%) and two iGHD (7%) patients had a serum IGF-1 below the fifth percentile of the normal group but above the fifth percentile of the ISS group. Thus, a serum IGF-1 below the fifth percentile of the normal group distinguished between normal children and iGHD with 100% sensitivity, between normal and oGHD with 53% sensitivity and between normal and all GHD (idiopathic + organic) with 84% sensitivity; the overall specificity was only 57%. Conversely, a serum IGF-1 below the fifth percentile of the ISS population distinguished between ISS and iGHD with 93% sensitivity, between ISS and oGHD with 33% sensitivity and between ISS and all GHD with 72% sensitivity; the overall specificity was then 95%. CONCLUSIONS A serum IGF-1 within the normal range virtually excludes idiopathic GHD but does not rule out organic GHD, whereas an IGF-1 below the ISS range is strongly in favour of GHD, after exclusion of poor nutritional status and/or liver disease. An IGF-1 below the normal range but in the idiopathic short stature range gives no definitive conclusion even when it is associated with a low GH peak. Thus, whereas reference values obtained in normal children must be used to interpret serum IGF-1 in short prepubertal children, reference data obtained in idiopathic short stature children should also be taken into account.
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Affiliation(s)
- L Bussières
- Department of Physiology, Hôpital Necker-Enfants Malades, Université R Descartes, Paris, France
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Adan L, Bussières L, Dinand V, Zerah M, Pierre-Kahn A, Brauner R. Growth, puberty and hypothalamic-pituitary function in children with suprasellar arachnoid cyst. Eur J Pediatr 2000; 159:348-55. [PMID: 10834520 DOI: 10.1007/s004310051285] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED A suprasellar arachnoid cyst may cause disorders of growth, puberty and hypothalamic-pituitary function, due to the proximity of the cyst to the hypothalamic-pituitary area. A total of 30 patients (17 boys) with cyst diagnosed at 4.3 +/- 1 years were routinely evaluated at 5.4 +/- 1 years; 24 of them had one or multiple cyst derivations. Some 23 cases had an abnormal height, weight or puberty: short (< -2SD, 5 cases) or tall ( > 2SD, 10 cases) stature, overweight (body mass index, BMI, > 2SD, 6 cases), central precocious puberty (10 cases) and/or no progression of pubertal development (3 cases). The growth hormone (GH) peaks after pharmacological stimulation test were low (< 10 MICROg/L) in 16 patients, confirmed by a second evaluation in 8/11 of them. The plasma free thyroxine was low in five patients, prolactin was high in two and the cortisol and concomitant plasma and urinary osmolalities were normal. BMI was correlated negatively with the GH peaks (r = -0.37, P < 0.01) and positively with the plasma leptin concentrations (r = 0.55, P < 0.01). The plasma fasting insulin concentrations were also correlated negatively with the GH peaks (r = -0.55, P < 0.02) and positively with the plasma insulin-like growth factor I concentrations (r = 0.64, P < 0.002). The adult height (12 cases) was at 4SD in 1 and < -2SD in 4 patients, two of whom had precocious puberty untreated with gonadotropin releasing hormone (GnRH) analogue, and two had untreated GH deficiency. The adult height of those treated was normal. One girl had primary amenorrhoea and two boys had low plasma testosterone, despite a normal gonadotropin response to a GnRH test. CONCLUSION Suprasellar arachnoid cysts may cause deficiencies of growth hormone and thyrotropin, stimulation of the hypothalamic-pituitary-gonadal axis, tall stature and/or overweight. These last two disorders may be due to hyperinsulinism, itself due to suprasellar arachnoid cyst.
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Affiliation(s)
- L Adan
- Department of Paediatric Endocrinology, Hôpital Necker-Enfants Malades, Paris, France
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Adan L, Bussières L, Trivin C, Souberbielle JC, Brauner R. Effect of short-term testosterone treatment on leptin concentrations in boys with pubertal delay. Horm Res 2000; 52:109-12. [PMID: 10725773 DOI: 10.1159/000023445] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Testosterone administration increases growth hormone (GH) secretion and decreases the plasma leptin concentration in men. We evaluated the effect of increased GH secretion due to short-term testosterone treatment on leptin concentrations. Ten boys aged 14.8 +/- 0.2 (mean +/- SE) years with transient GH deficiency caused by pubertal delay were evaluated before and after (3 months) 4 intramuscular injections of 100 mg testosterone heptylate, given at 15-day intervals. The leptin concentration decreased from 5.4 +/- 1.3 to 3. 6 +/- 1.1 microgram/l (p < 0.001), despite a weight gain of 3.4 +/- 0.5 kg. There were significant increases in body mass index (BMI), from -0.2 +/- 0.5 to 0.2 +/- 0.5 SD, p < 0.005, in GH peak after stimulation test, from 6.3 +/- 0.5 to 21.7 +/- 2.9 microgram/l, p < 0. 0003, in plasma testosterone, from 0.6 +/- 0.1 to 6.5 +/- 1.3 microgram/l, p < 0.001, in insulin-like growth factor-I (IGF-I), from 152 +/- 21 to 330 +/- 30 microgram/l, p < 0.0001, and in IGF-binding protein-3 (IGFBP-3), from 4.2 +/- 0.5 to 5.4 +/- 0.4 mg/l, p < 0.01. But there were no changes in blood glucose (4.7 +/- 0.1 and 4.8 +/- 0.1 mmol/l), or plasma fasting insulin (9.0 +/- 1.2 and 8.1 +/- 1.3 mIU/l). The leptin concentrations were positively correlated with the BMI before (p < 0.03) and after (p < 0.04) testosterone, but not with the GH peak after stimulation, or with plasma testosterone, IGF-I or IGFBP-3. The leptin and insulin concentrations after testosterone treatment were positively correlated (p < 0.04). Thus, short-term testosterone treatment of boys with pubertal delay decreases their leptin concentrations. The lack of correlation with GH secretion or with its changes, despite the dramatic increase in GH secretion, and the lack of change in insulin are additional features suggesting that testosterone increases the leptin concentration mainly by an effect on adipose tissue.
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Affiliation(s)
- L Adan
- Pediatric Endocrinology Department, Université René Descartes and Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
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Van Peborgh P, Morineau G, Bussières L, Escourrou P, Ville Y. Twin-to-twin transfusion syndrome: polyhydramnios-associated changes in maternal plasma volume and maternal plasma aldosterone concentrations. A preliminary study. Fetal Diagn Ther 1998; 13:184-6. [PMID: 9708444 DOI: 10.1159/000020835] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Our aim was to evaluate the consequences of polyhydramnios on maternal plasma volume and maternal serum aldosterone and atrial natriuretic peptide (ANP) concentrations in monochorionic twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS). METHODS The maternal plasma volume, ionograms as well as plasma ANP and aldosterone concentrations were compared in normal monochorionic diamniotic twin pregnancies and in TTTS. RESULTS The maternal plasma volume was normal in TTTS despite severe polyhydramnios. The plasma aldosterone concentration was higher in pregnancies complicated by TTTS. CONCLUSION The high plasma aldosterone concentration is likely to maintain normal plasma volume despite progressive extravascular volume enhancement. This suggests that TTTS is present early in pregnancy as a chronic phenomenon starting before its clinical expression and may trigger compensatory maternal hyperaldosteronism.
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Affiliation(s)
- P Van Peborgh
- Fetal Medicine, Unit, Hôpital A.-Béclère, Clamart, France
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Abstract
The neurohumoral events associated with neurocardiogenic syncope remain unclear. The simultaneous assessment of changes in endothelium-dependent and independent hormones and in autonomic balance in patients with tilt-induced syncope has been incompletely studied. Forty-six healthy subjects aged between 21 and 83 years (mean +/- SEM 47 +/- 3) underwent a 30-minute head-up tilt test at 60 degrees. Fourteen subjects (10 females and 4 male subjects) exhibited syncope at 16 +/- 2 minutes into the tilt. Hemodynamics were recorded every 5 minutes and blood samples for the measure of catecholamines, endothelin-1 (ET-1), and angiotensin-II (AT-II), were drawn at baseline, and 5, 10, 15, and 30 minutes into the tilt and immediately before syncope. Heart rate variability was analyzed by 5-minute segments during the test. Both catecholamines and ET-1 levels increased consistently in response to head-up tilt in subjects able to tolerate the test. Epinephrine increased to a greater extent before syncope. In contrast, ET-1 failed to increase at any time during the tilt and just before syncope. AT-II increased at 30 minutes into the tilt only in the control group. Finally, power in high-frequency bands decreased less in the group with syncope. Thus, compared with subjects able to tolerate a head-up tilt test, patients with syncope exhibit a greater increase in adrenomedullary activation, no significant increase in ET-1 levels, and a blunting in the decrease of vagal tone before syncope. The lack of increase in ET-1 during tilt may play a role in the inability to support orthostatic stress.
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Affiliation(s)
- M White
- Department of Medicine, Montreal Heart Institute, Quebec, Canada
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41
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White M, Courtemanche M, Stewart DJ, Talajic M, Mikes E, Cernacek P, Vantrimpont P, Leclerc D, Bussières L, Rouleau JL. Age- and gender-related changes in endothelin and catecholamine release, and in autonomic balance in response to head-up tilt. Clin Sci (Lond) 1997; 93:309-16. [PMID: 9404222 DOI: 10.1042/cs0930309] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
1. There is an increase in circulating levels of vasoconstrictive hormones and an alteration in baroreceptor responsiveness with aging. The role of changes in endothelium-dependent and -independent vasoconstrictive hormones in relation to age and gender, with simultaneous assessment of autonomic balance in response to head-up tilt, has been incompletely studied. 2. Sixteen young [25 +/- 3 years (mean +/- SEM)] and 16 older normal volunteers (68 +/- 7 years) underwent a 30 min head-up tilt test at 60 degrees. Haemodynamics were measured every 5 min and blood samples for neurohormone measurement were drawn at baseline, 5, 10, 15 and 30 min into the test. Heart rate variability was analysed in 5 min segments at the baseline, and during the test. The younger subjects exhibited a greater increase in heart rate and diastolic blood pressure, despite lower absolute levels of noradrenaline (norepinephrine) and endothelin-1. Analysis of heart rate variability yielded a decrease in both high- and low-frequency bands in the aged; power at low-frequency decreased only in the young subjects. The age-related differences in blood pressure and noradrenaline levels were markedly attenuated in the female subjects. In addition, endothelin-1 levels and power spectral measurements at low frequency were the lowest in younger females throughout the tilt. 3. Despite attenuated cardiovascular response to tilt, both systemic adrenergic 'drive' and endothelin-1 levels increase in parallel with aging. Thus, endothelium-dependent and -independent vasoconstrictive hormone levels increase with age in the resting state and in response to neurohumoral stimulation in humans.
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Affiliation(s)
- M White
- Department of Medicine, Montreal Heart Institute, Quebec, Canada
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42
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Muller F, Dommergues M, Bussières L, Aegerter P, Le Fiblec B, Uzan S, Oury JF, Colau JC, Dumez Y. Prenatal screening for Down syndrome: should first trimester ultrasound replace maternal serum screening? Early Hum Dev 1996; 47 Suppl:S37-9. [PMID: 9031838 DOI: 10.1016/s0378-3782(96)01817-8] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- F Muller
- Hôpital Ambroise Paré, Boulogne, France
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Muller F, Dommergues M, Bussières L, Lortat-Jacob S, Loirat C, Oury JF, Aigrain Y, Niaudet P, Aegerter P, Dumez Y. Development of human renal function: reference intervals for 10 biochemical markers in fetal urine. Clin Chem 1996; 42:1855-60. [PMID: 8906088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Evaluation of fetal renal function by analysis of fetal urine sampled in utero may improve perinatal care after a prenatal diagnosis of bilateral obstructive uropathy. We provide reference intervals for 10 fetal urinary compounds and examine their variation with gestational age. Forty-one fetuses with bilateral obstructive uropathy (urine sampled between 20 and 38 weeks of gestational age) had normal, healthy values for serum creatinine (< or = 50 mumol/L) at ages 1-2 years. These cases were thus assumed to represent a reasonable approximation to healthy values. Sodium and beta 2-microglobulin concentrations significantly decreased with gestational age; calcium, ammonia, and creatinine significantly increased; glucose, phosphorus, chloride, urea, and total protein concentrations did not vary. Our results provide reference values for prenatal evaluation of fetal renal function and suggest that glomerular filtration of macromolecules and tubular reabsorption of glucose and phosphorus are mature by 20 weeks of gestation, whereas tubular reabsorption of sodium and beta 2-microglobulin increases progressively during the second half of gestation.
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Affiliation(s)
- F Muller
- Hôpital Ambroise Paré, Boulogne, Université Paris V, France
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44
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Muller F, Dommergues M, Bussières L, Lortat-Jacob S, Loirat C, Oury JF, Aigrain Y, Niaudet P, Aegerter P, Dumez Y. Development of human renal function: reference intervals for 10 biochemical markers in fetal urine. Clin Chem 1996. [DOI: 10.1093/clinchem/42.11.1855] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Evaluation of fetal renal function by analysis of fetal urine sampled in utero may improve perinatal care after a prenatal diagnosis of bilateral obstructive uropathy. We provide reference intervals for 10 fetal urinary compounds and examine their variation with gestational age. Forty-one fetuses with bilateral obstructive uropathy (urine sampled between 20 and 38 weeks of gestational age) had normal, healthy values for serum creatinine (< or = 50 mumol/L) at ages 1-2 years. These cases were thus assumed to represent a reasonable approximation to healthy values. Sodium and beta 2-microglobulin concentrations significantly decreased with gestational age; calcium, ammonia, and creatinine significantly increased; glucose, phosphorus, chloride, urea, and total protein concentrations did not vary. Our results provide reference values for prenatal evaluation of fetal renal function and suggest that glomerular filtration of macromolecules and tubular reabsorption of glucose and phosphorus are mature by 20 weeks of gestation, whereas tubular reabsorption of sodium and beta 2-microglobulin increases progressively during the second half of gestation.
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Affiliation(s)
- F Muller
- Hôpital Ambroise Paré, Boulogne, Université Paris V, France
| | - M Dommergues
- Hôpital Ambroise Paré, Boulogne, Université Paris V, France
| | - L Bussières
- Hôpital Ambroise Paré, Boulogne, Université Paris V, France
| | - S Lortat-Jacob
- Hôpital Ambroise Paré, Boulogne, Université Paris V, France
| | - C Loirat
- Hôpital Ambroise Paré, Boulogne, Université Paris V, France
| | - J F Oury
- Hôpital Ambroise Paré, Boulogne, Université Paris V, France
| | - Y Aigrain
- Hôpital Ambroise Paré, Boulogne, Université Paris V, France
| | - P Niaudet
- Hôpital Ambroise Paré, Boulogne, Université Paris V, France
| | - P Aegerter
- Hôpital Ambroise Paré, Boulogne, Université Paris V, France
| | - Y Dumez
- Hôpital Ambroise Paré, Boulogne, Université Paris V, France
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Muller F, Savey L, Le Fiblec B, Bussières L, Ndayizamba G, Colau JC, Giraudet P. Maternal serum human chorionic gonadotropin level at fifteen weeks is a predictor for preeclampsia. Am J Obstet Gynecol 1996; 175:37-40. [PMID: 8694072 DOI: 10.1016/s0002-9378(96)70247-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Our purpose was to study the correlation between maternal serum human chorionic gonadotropin levels measured at 15 to 18 weeks of amenorrhea and pregnancy-induced hypertension, preeclampsia, and small-for-gestational-age neonates. STUDY DESIGN Prospective trisomy 21 human chorionic gonadotropin screening data from 5776 patients were examined in a retrospective investigation of the relationship between human chorionic gonadotropin and pregnancy-induced hypertension (234 cases), preeclampsia (34 cases), and small-for-gestational-age neonates (238 cases). RESULTS Maternal serum human chorionic gonadotropin (multiples of the median) was higher in the three populations with pathologic disorders. This difference was statistically significant in patients with small-for-gestational-age neonates (p < 0.0163) and preeclampsia (p < 0.0001) but not in those with pregnancy-induced hypertension. In the preeclampsia subgroup, with a cutoff value of 2 multiples of the median, specificity was 32% and sensitivity was 10%; with a cutoff value of 1 multiples of the median, specificity was 100% and sensitivity was 50%. CONCLUSION High maternal serum human chorionic gonadotropin levels at 15 weeks are related to a risk for preeclampsia. Depending on the human chorionic gonadotropin cutoff value, 32% or 100% of preeclampsia patients would be selected. The usefulness of preventive aspirin treatment from the fifteenth week needs more investigation in a larger multicenter study of preeclampsia.
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Affiliation(s)
- F Muller
- Service de Biochimie, Hôpital Ambroise Paré, Boulogne, France
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Abstract
A population at increased risk for fetal trisomy 21 can be defined by means of maternal serum markers. Various markers have been used since 1984, and the following have proved most valuable: hCG, free beta hCG, AFP, and estriol. Two prenatal screening periods should be distinguished: first trimester (8-14 weeks) and second trimester (14-18 weeks). Only the latter has been prospectively evaluated. In a prospective study, we assayed hCG in second trimester serum. A risk factor combining maternal age and hCG was defined and amniocentesis was offered to patients at increased risk for fetal trisomy 21. Out of 51,048 patients under 38 years of age, 135 had a trisomy 21-affected fetus. In 36,697 patients under 35, we observed 70 cases of trisomy 21, of which 41 (59%) were in the group at risk. Karyotyping was performed in 7.1% of these patients. In 11,351 patients aged 35-37 years, there were 65 cases of trisomy 21, of which 52 (80%) were in the group at risk. Karyotyping was performed in 26.8% of these patients. In our experience, parallel assaying of maternal serum AFP only detects a further 1% of trisomy 21 pregnancies for the same number of amniocenteses. These results confirm the findings of all previous prospective studies: maternal hCG screening is the most effective method of detecting trisomy 21 in the general population.
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Affiliation(s)
- F Muller
- Hôpital Ambroise Paré, Boulogne, France
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47
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Muller F, Bussières L, Chevallier B. [Maternal serum markers of fetal trisomy 21]. Presse Med 1995; 24:1265-9. [PMID: 7501610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Down's syndrome is the most frequent genetic disease. Each year, in France, there are 1,100 trisomy 21-affected newborns. this chromosomal disease is the most frequent cause of mental retardation raising an important public health problem. Prenatal diagnosis of chromosomal anomalies is based on fetal karyotyping, but cannot be proposed in all situations because of the cost and the risk of fetal death due to amniocentesis. The aim of screening is to define patients at increased risk for trisomy 21. Three criteria are currently used to define an at risk-population: maternal age, ultrasound anomalies, and maternal serum markers. In France, amniocentesis is proposed to patients over 38 years of age. Ultrasound signs for trisomy 21 are often difficult to identify at routine echography. Based on a prospective study of 51,048 women under 38 years of age, we observed that maternal serum hCG at 15 weeks can detect 59% of all trisomy 21 cases while the yield for amniocentesis is 6.1%.
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Affiliation(s)
- F Muller
- Laboratoire de Biochimie, Hôpital Ambroise Paré, Boulogne
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Muller F, Bussières L, Pèlissier MC, Oury JF, Boué C, Uzan S, Boué A. Do racial differences exist in second-trimester maternal hCG levels? A study of 23,369 patients. Prenat Diagn 1994; 14:633-6. [PMID: 7971765 DOI: 10.1002/pd.1970140721] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In Down syndrome screening by maternal serum human chorionic gonadotropin (hCG) determination at 15, 16, 17, and 18 weeks of gestation, we prospectively examined 23,369 sera from white (21,549), North African (970), black African (525), and Asian (325) patients. When expressed as multiples of the median (MOM), no difference was observed between white, North African, and black African patients. However, higher serum hCG concentrations were noted in Asians, for whom we therefore recommend correction of hCG values before calculation of the risk of Down syndrome.
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Affiliation(s)
- F Muller
- Hôpital Ambroise Paré, Boulogne, France
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Bussières L, Wieckowski J, Revillon Y, Chourrout Y, Sachs C, Laborde K. Creation of experimental urethral obstruction in utero: evaluation of fetal renal function. Eur J Pediatr Surg 1993; 3:161-5. [PMID: 8353117 DOI: 10.1055/s-2008-1063534] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Management of obstructive uropathy diagnosed in utero would be markedly enhanced by the availability of a simple, safe and quantitative fetal renal function test to predict postnatal renal function. In order to allow experimental evaluation of such a parameter, we adjusted a model of complete urethral obstruction with urachal ligation in 30 fetal lambs at 79 or 99 days of gestation. The method described allows obstruction in male and female fetuses as early as 79 days of gestation, with an overall high survival rate (control: 12/14; obstructed: 23/29), although lower (6/12) when obstruction is performed early (79 days) during gestation. Consequences of obstruction were examined on the 121st day of gestation. Severe hydronephrosis, ureteral and calyceal dilatation, with or without ascites and pulmonary hypoplasia were observed in all fetuses; creatinine clearance determined in utero was decreased in both groups with obstruction (early and late) vs control group: 1.15 +/- 0.5, NS, and 0.58 +/- 0.4, p < 0.01 vs 1.61 +/- 0.8 ml/min/kg respectively. In both obstructed groups, fetuses with ascites displayed lower plasma creatinine concentration and higher creatinine clearance values when compared to fetuses without ascites. In conclusion, the experimental model of obstructive uropathy described appears efficient and easily reproducible, allowing therefore the evaluation of a predictive parameter of postnatal renal function. Our preliminary results suggest that renal fetal function is more dependent on the degree of obstruction than on the term of its creation.
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Affiliation(s)
- L Bussières
- Service de Physiologie, Hôpital Necker-Enfants Malades, Paris, France
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Shahedi M, Laborde K, Bussières L, Sachs C. Acute and early effects of aldosterone on Na-K-ATPase activity in Madin-Darby canine kidney epithelial cells. Am J Physiol 1993; 264:F1021-6. [PMID: 8391751 DOI: 10.1152/ajprenal.1993.264.6.f1021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The time course and mechanism of early effects of aldosterone on renal Na-K-adenosinetriphosphatase (Na-K-ATPase) activity and number of units were studied in MDCK cells. Aldosterone induced a time- and dose-dependent stimulation of Na-K-ATPase activity. The stimulatory effect of aldosterone on activity and number of pump units increased progressively and was inhibited by spironolactone. In presence of cycloheximide, the stimulatory effect of aldosterone on activity and number of catalytic sites persisted to the same extent until 30 min and decreased by 20% after 60 min. In these cells, dimethylamiloride addition during preincubation abolished the aldosterone-induced stimulation in Na-K-ATPase activity up to 60 min. In contrast, furosemide addition did not alter the effect of aldosterone on Na-K-ATPase activity. The present study demonstrates an early effect of aldosterone on Na-K-ATPase activity that can be separated into the following two successive periods: 1) increase in pump number due to insertion of presynthetized units secondary to Na entry through an amiloride-sensitive apical pathway; and 2) an increase in pump number by de novo protein synthesis.
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Affiliation(s)
- M Shahedi
- Département de Physiologie, Faculté de Médecine, Necker Enfants Malades, Paris, France
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