Yvan Vial - Academia.edu (original) (raw)
Papers by Yvan Vial
Obstetrics & Gynecology, Sep 1, 2014
To evaluate antenatal surveillance strategies and the optimal timing of delivery for monoamniotic... more To evaluate antenatal surveillance strategies and the optimal timing of delivery for monoamniotic twin pregnancies. METHODS: Obstetric and perinatal outcomes were retrospectively retrieved for 193 monoamniotic twin pregnancies. Fetal and neonatal outcomes were compared between fetuses followed in an inpatient setting and those undergoing intensive outpatient follow-up from 26 to 28 weeks of gestation until planned cesarean delivery between 32 and 35 weeks of gestation. The risk of fetal death was compared with the risk of neonatal complications. RESULTS: Fetal deaths occurred in 18.1% of fetuses (70/ 386). Two hundred ninety-five neonates from 153 pregnancies were born alive after 23 weeks of gestation. There were 17 neonatal deaths (5.8%), five of whom had major congenital anomalies. The prospective risk of a nonrespiratory neonatal complication was lower than the prospective risk of fetal death after 32 4/7 weeks of gestation (95% confidence interval 32 0/7-33 4/7). The incidence of death or a nonrespiratory neonatal complication was not significantly different between fetuses managed as outpatients (14/106 [13.2%]) or inpatients (15/142 [10.5%]; P5.55). Our statistical power to detect a difference in outcomes between these groups was low. CONCLUSIONS: The in utero risk of a monoamniotic twin fetus exceeds the risk of a postnatal nonrespiratory complication at 32 4/7 weeks of gestation. If close fetal surveillance is instituted after 26-28 weeks of gestation and delivery takes place at approximately 33 weeks of gestation, the risk of fetal or neonatal death is low, no matter the surveillance setting.
medRxiv (Cold Spring Harbor Laboratory), Jun 12, 2023
Objective: To assess the accuracy of corpus callosum (CC) and its sub-segments' biometry by super... more Objective: To assess the accuracy of corpus callosum (CC) and its sub-segments' biometry by super-resolution (SR) 3-dimensional fetal brain MRI in comparison to measurements in 2-dimensional or 3-dimensional ultrasonography (US) and clinical low-resolution T2-weighted MRI sequences (T2WS). Method: We performed fetal brain biometry of the overall length of the CC, the heights of its sub-segments and its area by two observers (one junior observer, obs1, and one senior pediatric neuroradiologist, obs2) in a cohort of 57 subjects (between 21 and 35 weeks of gestational age (GA), including 11 cases of partial agenesis of CC). Obs1 made measures on US, T2WS, and SR, and obs2 in T2WS and SR. Regression curves of CC biometry with GA were done. Statistical analysis of inter-modality (US vs. T2WS, US vs. SR, and T2WS vs SR) agreement for single observer (obs1) and inter-modality (US vs. T2WS, and US vs. SR) between observers (obs1 vs obs2) were also conducted. Results: Our study shows a high concordance through GA of CC measurements performed by SR in comparison with US, with a higher agreement than biometry based on T2WS clinical acquisitions. For obs1, SR measurements are highly concordant to US (except for the genu and the CC length) and helps visualizing the splenium. For obs2, SR measurements are highly concordant to US, except for the rostrum and the CC length. Rostrum and Genu (forming the anterior callosum) are the subsegments with larger variability. Regression This is a provisional file, not the final typeset article curves by SR overlay more accurately those from the literature (by US) for the CC length, the splenium and the body than T2WS. Conclusion: Super-resolution MRI could be used in the biometrical assessment of the CC, providing measurements close to US, except for the anterior part of the CC Thanks to its 3D-visualisation capacity and improved through plane spatial resolution, it allows to perform CC biometry more frequently than on T2WS. 1 INTRODUCTION The corpus callosum (CC) is the largest brain commissure connecting homologous structures of both cerebral hemispheres and is fully formed after complex embryogenesis steps in-utero at 20 weeks of gestation (1). The corpus callosum is divided into four parts: the rostrum, the genu, the body and the splenium, from the most anterior to the most posterior part. Complete or partial agenesis of the corpus callosum (cCCA and pCCA, respectively) are among the most frequent brain malformations prenatally detected, with an estimated prevalence of 0.3 to 0.7% in the general population and of 2 to 3% in people suffering from neurodevelopmental disorders (2). The neurodevelopmental outcome in children born with a CC anomaly, now grouped over the term failed commissuration, is extremely heterogeneous, ranging from normal neurodevelopment to severe delay, depending not only on the specific type of CC anomaly, but also on the presence or absence of potentially associated cerebral and/or extra-cerebral malformations (3). Today, the main challenge does not lie in establishing the diagnosis, but in estimating the neurodevelopmental prognosis which remains very difficult to predict, as shown by post-natal follow-up studies (4). Therefore, the assessment of the integrity of the fetal CC, with an accurate biometrical and morphological analysis, is crucial for the evaluation of the pre-and post-natal management and the prognosis (5). Ultrasound (US) and Magnetic Resonance Imaging (MRI) are complementary methods for evaluating fetal brain structural development. At the occasion of the routine 2 nd trimester ultrasound examination, a screening for callosal abnormalities takes place. Direct evidence of a cCCA or pCCA, by absence of CC visualization, completely or partially, respectively, usually requires a mid-sagittal image. As this plane is not included in the required planes for the screening, we usually rely on indirect signs of CC absence on an axial image, such as the absence of the cavum of the septum pellucidum, that are more or less present according to the missing part (6). Anomalies of the CC also comprise the dysplasias, like the hypo-or hyperplasia where the CC is abnormally thin or thick, respectively. In case of a suspected callosal abnormality, an additional detailed US (a so-called neurosonogram, usually acquired transvaginally), is eventually performed by an expert and relies on the 3D imaging and sagittal, axial, and coronal views. Structural magnetic resonance T2-weighted sequences (T2WS) are recommended at 32 weeks of GA as a complement to the targeted US to either confirm and characterize or to rule out a suspected callosal abnormality and to look for other cerebral malformations (7,8). These two imaging modalities have their strengths and weaknesses and the study of the CC remains their biggest source of disagreement (3). Even if debated (9), mainly because of the lack of clarity regarding the way US exams were performed, a recent large prospective multicenter study, the MERIDIAN study, showed that, in failed commissuration, MRI was more accurate than US in detecting and characterizing CC anomalies, and this changed the prognosis and the clinical management in around 45% of the cases (3,10). Indeed, while US has better spatial resolution than MRI and benefits from 3D reconstruction techniques (11), it may be limited by the position of the fetus, mother habitus or oligohydramnios for example. However, without contesting the
Ultrasound in Obstetrics & Gynecology, Oct 1, 2020
Ultrasound in Obstetrics & Gynecology, May 19, 2023
Fetal Diagnosis and Therapy, 2023
Established Facts • Gómez-López-Hernández syndrome is a rare neurocutaneous disease characterized... more Established Facts • Gómez-López-Hernández syndrome is a rare neurocutaneous disease characterized by the association of rhombencephalosynapsis with trigeminal anesthesia, alopecia, and facial dysmorphism. • A genetic etiology for this syndrome is postulated, although no recurrent chromosomal or genetic variants have been identified to date. • Postnatal framework to diagnose Gómez-López-Hernández syndrome is inappropriate for prenatal diagnosis. Novel Insights • As the exact genetic etiology remains unknown, prenatal diagnosis is mainly based on imaging and adaptation of postnatal criteria to fetuses. • The association of rhombencephalosynapsis with characteristic facial dysmorphism on ultrasound is evocative of Gómez-López-Hernández syndrome.
PubMed, Feb 19, 2020
Management of patients at high risk of extreme premature birth between 23 and 26 weeks should be ... more Management of patients at high risk of extreme premature birth between 23 and 26 weeks should be performed by an experienced multidisciplinary team. In order to optimize guidance for couples with regard to this complex decision, we developed joint guidelines between obstetricians and neonatologists, in order to standardize practices and insure individualized care plans. Fetal outcome is not solely associated with gestational age but is multifactorial, and this should be considered when counseling parents. Thus, enhancement of fetal lung maturation, a major prognostic factor, should be promptly acted upon when delivery is anticipated. Antenatal corticosteroids should not be withheld while awaiting the parents' ultimate decision on neonatal care.
PubMed, Oct 23, 2019
Following the introduction of non-invasive tests, antenatal screening for trisomy 21 underwent im... more Following the introduction of non-invasive tests, antenatal screening for trisomy 21 underwent important changes. Clinicians had to rapidly adapt their practice, especially in the field of antenatal counseling. On a population wide scale, new strategies and guidelines have been implemented. This article reviews the basic concepts of antenatal screening, including the use of non-invasive cell-free fetal DNA testing.
Ultrasound in Obstetrics & Gynecology, Oct 1, 2018
atrium by a suture-less technique. The postoperative course was uncomplicated and the baby was di... more atrium by a suture-less technique. The postoperative course was uncomplicated and the baby was discharged home on day 14 of life.
PubMed, Oct 25, 2017
We conducted a retrospective study was conducted in the Centre Hospitalier Universitaire Vaudois ... more We conducted a retrospective study was conducted in the Centre Hospitalier Universitaire Vaudois (CHUV) including all births between the 1st January 1997 and 31st December 2011 to analyze the cesarean section (CS) rate using the different groups of the Robson classification in a Swiss maternity hospital. The overall CS rate was 29 %, mainly related to group 5 (multiparous with previous CS) and group 2 (nulliparous women induced or who had CS before labor). The study also shows that induction of labor on maternal request in nulliparous at term (group 2a) increased significantly the risk of CS compared to induction of labor for medical reason (p<0.001). The Robson classification system appears as a simple tool for monitoring CS rates. The main strategies for reducing CS rates will be through better selection of women for VBAC (vaginal birth after caesarean) and limitation of induction of labor, especially in nulliparous women.
Frontiers in Pediatrics, Dec 4, 2017
Introduction: Bronchopulmonary sequestration (BPS) may cause prenatal pleural effusion (PE) or ev... more Introduction: Bronchopulmonary sequestration (BPS) may cause prenatal pleural effusion (PE) or even hydrops. This case describes a fetus presenting with severe PE, which prenatally waned completely under steroid treatment, yet surprisingly reappeared rapidly after birth, requiring early surgical intervention. Case description: A male fetus was diagnosed with left BPS and severe PE. After three courses of prenatal steroid therapy for each recurrence of PE from 27 weeks of gestation, we observed a complete regression of PE prenatally. Yet, PE recurred 18 h after birth and persisted after repeated drainages and steroid therapy. Early total resection of the extralobar BPS was performed and led to complete recovery without recurrence of PE. Conclusion: This report underlines that in cases of BPS presenting with prenatal PE needing fetal intervention, even if full regression of PE is observed before birth, there might be a need for surgical excision during the neonatal period.
PubMed, Oct 1, 1999
Symphysiotomy is regularly performed in developing countries where cesarean section can be a sour... more Symphysiotomy is regularly performed in developing countries where cesarean section can be a source of significant short-term and long-term morbidity. However, this method can be useful in some rare occasions and should be taught in our countries, at least theoretically. Such a case is presented with a review describing the present surgical technique, its indications and limits with special reference to its possible complications.
PubMed, Sep 2, 1999
The loss of a fetus in a multiple pregnancy is relatively frequent. The main risk factor is a mon... more The loss of a fetus in a multiple pregnancy is relatively frequent. The main risk factor is a monochorionic twin pregnancy. If fetal loss occurs after 16 weeks of pregnancy, the survivor is also at increased risk of intrauterine death. In monochorionic twins, the risk of neurological sequelae can be as high as 25%. These lesions are due to acute episodes of hypoperfusion immediately following the death of the co-twin. Maternal complications including coagulation disorders are rare. The management will vary according to the type of placenta, the gestational age and the condition of the surviving twin. When the last trimenon has been reached, rapid delivery is probably the safest management. In monochorinoic biamniotic twins, the risk to the survivor often justifies the induction of delivery between 28 and 32 weeks of gestation after steroids have been administered. In most cases, before the 28th week of gestation, a conservative management will be proposed. In monochorionic monoamniotic twins, immediate delivery should be considered as soon as fetal viability is reached.
PubMed, 2000
This case report concerns a 35-year-old woman suffering from gravidic cholestasis, thrombocytosis... more This case report concerns a 35-year-old woman suffering from gravidic cholestasis, thrombocytosis and iterative vomiting episodes who underwent an elective cesarean section at week 35 because of recent herpetic vulvitis. Large bilateral ovarian tumors were observed which were interpreted as pregnancy luteomas. Nevertheless a biopsy of the right ovary was performed. Histologic examination revealed massive luteinization of the ovarian stroma. In addition, large tumor cells were found dispersed throughout the ovary as well as in vascular spaces as either isolated or clustered signet-ring cells. In search of the primary tumor, gastroscopy revealed a gastric ulcer in the antrum. The biopsies of the ulcer margins as well as those taken at distance demonstrated signet-ring cells in the lamina propria. Bilateral salpingo-oophorectomy and total gastrectomy were performed. In spite of postoperative chemotherapy, the patient died of disease 5 months after diagnosis.
American Journal of Obstetrics and Gynecology, Oct 1, 2002
OBJECTIVE Antibodies to the 70-kd heat shock protein were evaluated as biomarkers for cytomegalov... more OBJECTIVE Antibodies to the 70-kd heat shock protein were evaluated as biomarkers for cytomegalovirus infection. STUDY DESIGN Fetal sera that was obtained by cordocentesis at 22 to 25 weeks of gestation from 53 mothers with a confirmed primary cytomegalovirus infection and 28 mothers (control group) without cytomegalovirus infection who had been screened for Rh incompatibility, were assayed by enzyme-linked immunosorbent assay for immunoglobulin M and G anti-70-kd heat shock protein antibodies. RESULTS Eighteen of 53 fetuses (34.0%) from cytomegalovirus-positive mothers were infected, which was determined by culture or polymerase chain reaction. Anti-70-kd heat shock protein immunoglobulin M was detected in 17 of 18 sera (94.4%) from cytomegalovirus-infected fetuses, in 3 of 35 sera (8.6%) from uninfected fetuses, and in 0 of 28 sera from the control group (P <.0001). The level of antibody reactivity was correlated positively with fetal disease. Anti-70-kd heat shock protein immunoglobulin G was detected in sera from 52 of 53 fetuses (98.1%) from cytomegalovirus-infected mothers. CONCLUSION The anti-70-kd heat shock protein immunoglobulin M assay may be of value in the assessment of fetal cytomegalovirus infection in pregnant women with a primary cytomegalovirus infection.
Prenatal Diagnosis, 2006
To present clinical findings of a child with paternal uniparental isodisomy 14 (pat UPD14) focusi... more To present clinical findings of a child with paternal uniparental isodisomy 14 (pat UPD14) focusing on relevant prenatal characteristics. Ultrasonography at 23 weeks of gestation of a 37-year-old multigravid woman revealed a fetus with polyhydramnios, small thorax, and short, distinctively angled ribs. Fetal karyotype was 46,XY. The child was born spontaneously at 35 weeks with poor neonatal adaptation. From birth, he presented with severe respiratory insufficiency due to severe thoracic malformation. Clinical examination revealed a small, bell-shaped thorax, redundant lax skin, mild contractures of the fingers and dysmorphic facial features. Chest X rays showed short, abnormally curved ribs that suggested the possibility of pat UPD14, which was confirmed by molecular analysis. Pat UPD14 is associated with a distinct clinical phenotype. Prognosis is poor because of severe respiratory insufficiency and neurodevelopmental retardation. Our report confirms salient postnatal signs of previous descriptions, especially the characteristic radiological abnormalities with ribs showing a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;coat-hanger&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; configuration. Retrospective fetal ultrasound of our case allowed the identification of this pathognomonic feature prenatally, which makes it possible to consider pat UPD14 at routine prenatal sonography, in particular in combination with a small bell-shaped thorax and polyhydramnios.
Emerging Infectious Diseases, Mar 1, 2014
Waddlia chondrophila is an intracellular bacterium suspected to cause human and bovine abortion. ... more Waddlia chondrophila is an intracellular bacterium suspected to cause human and bovine abortion. We confirmed an association between antibodies against W. chondrophila and human miscarriage and identified this organism in placenta or genital tract of women who had had miscarriages. These results suggest a possible role of W. chondrophila infection in miscarriage. DISPATCHES 460 Emerging Infectious Diseases • www.cdc.gov/eid
Obstetrics & Gynecology, Sep 1, 2014
To evaluate antenatal surveillance strategies and the optimal timing of delivery for monoamniotic... more To evaluate antenatal surveillance strategies and the optimal timing of delivery for monoamniotic twin pregnancies. METHODS: Obstetric and perinatal outcomes were retrospectively retrieved for 193 monoamniotic twin pregnancies. Fetal and neonatal outcomes were compared between fetuses followed in an inpatient setting and those undergoing intensive outpatient follow-up from 26 to 28 weeks of gestation until planned cesarean delivery between 32 and 35 weeks of gestation. The risk of fetal death was compared with the risk of neonatal complications. RESULTS: Fetal deaths occurred in 18.1% of fetuses (70/ 386). Two hundred ninety-five neonates from 153 pregnancies were born alive after 23 weeks of gestation. There were 17 neonatal deaths (5.8%), five of whom had major congenital anomalies. The prospective risk of a nonrespiratory neonatal complication was lower than the prospective risk of fetal death after 32 4/7 weeks of gestation (95% confidence interval 32 0/7-33 4/7). The incidence of death or a nonrespiratory neonatal complication was not significantly different between fetuses managed as outpatients (14/106 [13.2%]) or inpatients (15/142 [10.5%]; P5.55). Our statistical power to detect a difference in outcomes between these groups was low. CONCLUSIONS: The in utero risk of a monoamniotic twin fetus exceeds the risk of a postnatal nonrespiratory complication at 32 4/7 weeks of gestation. If close fetal surveillance is instituted after 26-28 weeks of gestation and delivery takes place at approximately 33 weeks of gestation, the risk of fetal or neonatal death is low, no matter the surveillance setting.
medRxiv (Cold Spring Harbor Laboratory), Jun 12, 2023
Objective: To assess the accuracy of corpus callosum (CC) and its sub-segments' biometry by super... more Objective: To assess the accuracy of corpus callosum (CC) and its sub-segments' biometry by super-resolution (SR) 3-dimensional fetal brain MRI in comparison to measurements in 2-dimensional or 3-dimensional ultrasonography (US) and clinical low-resolution T2-weighted MRI sequences (T2WS). Method: We performed fetal brain biometry of the overall length of the CC, the heights of its sub-segments and its area by two observers (one junior observer, obs1, and one senior pediatric neuroradiologist, obs2) in a cohort of 57 subjects (between 21 and 35 weeks of gestational age (GA), including 11 cases of partial agenesis of CC). Obs1 made measures on US, T2WS, and SR, and obs2 in T2WS and SR. Regression curves of CC biometry with GA were done. Statistical analysis of inter-modality (US vs. T2WS, US vs. SR, and T2WS vs SR) agreement for single observer (obs1) and inter-modality (US vs. T2WS, and US vs. SR) between observers (obs1 vs obs2) were also conducted. Results: Our study shows a high concordance through GA of CC measurements performed by SR in comparison with US, with a higher agreement than biometry based on T2WS clinical acquisitions. For obs1, SR measurements are highly concordant to US (except for the genu and the CC length) and helps visualizing the splenium. For obs2, SR measurements are highly concordant to US, except for the rostrum and the CC length. Rostrum and Genu (forming the anterior callosum) are the subsegments with larger variability. Regression This is a provisional file, not the final typeset article curves by SR overlay more accurately those from the literature (by US) for the CC length, the splenium and the body than T2WS. Conclusion: Super-resolution MRI could be used in the biometrical assessment of the CC, providing measurements close to US, except for the anterior part of the CC Thanks to its 3D-visualisation capacity and improved through plane spatial resolution, it allows to perform CC biometry more frequently than on T2WS. 1 INTRODUCTION The corpus callosum (CC) is the largest brain commissure connecting homologous structures of both cerebral hemispheres and is fully formed after complex embryogenesis steps in-utero at 20 weeks of gestation (1). The corpus callosum is divided into four parts: the rostrum, the genu, the body and the splenium, from the most anterior to the most posterior part. Complete or partial agenesis of the corpus callosum (cCCA and pCCA, respectively) are among the most frequent brain malformations prenatally detected, with an estimated prevalence of 0.3 to 0.7% in the general population and of 2 to 3% in people suffering from neurodevelopmental disorders (2). The neurodevelopmental outcome in children born with a CC anomaly, now grouped over the term failed commissuration, is extremely heterogeneous, ranging from normal neurodevelopment to severe delay, depending not only on the specific type of CC anomaly, but also on the presence or absence of potentially associated cerebral and/or extra-cerebral malformations (3). Today, the main challenge does not lie in establishing the diagnosis, but in estimating the neurodevelopmental prognosis which remains very difficult to predict, as shown by post-natal follow-up studies (4). Therefore, the assessment of the integrity of the fetal CC, with an accurate biometrical and morphological analysis, is crucial for the evaluation of the pre-and post-natal management and the prognosis (5). Ultrasound (US) and Magnetic Resonance Imaging (MRI) are complementary methods for evaluating fetal brain structural development. At the occasion of the routine 2 nd trimester ultrasound examination, a screening for callosal abnormalities takes place. Direct evidence of a cCCA or pCCA, by absence of CC visualization, completely or partially, respectively, usually requires a mid-sagittal image. As this plane is not included in the required planes for the screening, we usually rely on indirect signs of CC absence on an axial image, such as the absence of the cavum of the septum pellucidum, that are more or less present according to the missing part (6). Anomalies of the CC also comprise the dysplasias, like the hypo-or hyperplasia where the CC is abnormally thin or thick, respectively. In case of a suspected callosal abnormality, an additional detailed US (a so-called neurosonogram, usually acquired transvaginally), is eventually performed by an expert and relies on the 3D imaging and sagittal, axial, and coronal views. Structural magnetic resonance T2-weighted sequences (T2WS) are recommended at 32 weeks of GA as a complement to the targeted US to either confirm and characterize or to rule out a suspected callosal abnormality and to look for other cerebral malformations (7,8). These two imaging modalities have their strengths and weaknesses and the study of the CC remains their biggest source of disagreement (3). Even if debated (9), mainly because of the lack of clarity regarding the way US exams were performed, a recent large prospective multicenter study, the MERIDIAN study, showed that, in failed commissuration, MRI was more accurate than US in detecting and characterizing CC anomalies, and this changed the prognosis and the clinical management in around 45% of the cases (3,10). Indeed, while US has better spatial resolution than MRI and benefits from 3D reconstruction techniques (11), it may be limited by the position of the fetus, mother habitus or oligohydramnios for example. However, without contesting the
Ultrasound in Obstetrics & Gynecology, Oct 1, 2020
Ultrasound in Obstetrics & Gynecology, May 19, 2023
Fetal Diagnosis and Therapy, 2023
Established Facts • Gómez-López-Hernández syndrome is a rare neurocutaneous disease characterized... more Established Facts • Gómez-López-Hernández syndrome is a rare neurocutaneous disease characterized by the association of rhombencephalosynapsis with trigeminal anesthesia, alopecia, and facial dysmorphism. • A genetic etiology for this syndrome is postulated, although no recurrent chromosomal or genetic variants have been identified to date. • Postnatal framework to diagnose Gómez-López-Hernández syndrome is inappropriate for prenatal diagnosis. Novel Insights • As the exact genetic etiology remains unknown, prenatal diagnosis is mainly based on imaging and adaptation of postnatal criteria to fetuses. • The association of rhombencephalosynapsis with characteristic facial dysmorphism on ultrasound is evocative of Gómez-López-Hernández syndrome.
PubMed, Feb 19, 2020
Management of patients at high risk of extreme premature birth between 23 and 26 weeks should be ... more Management of patients at high risk of extreme premature birth between 23 and 26 weeks should be performed by an experienced multidisciplinary team. In order to optimize guidance for couples with regard to this complex decision, we developed joint guidelines between obstetricians and neonatologists, in order to standardize practices and insure individualized care plans. Fetal outcome is not solely associated with gestational age but is multifactorial, and this should be considered when counseling parents. Thus, enhancement of fetal lung maturation, a major prognostic factor, should be promptly acted upon when delivery is anticipated. Antenatal corticosteroids should not be withheld while awaiting the parents' ultimate decision on neonatal care.
PubMed, Oct 23, 2019
Following the introduction of non-invasive tests, antenatal screening for trisomy 21 underwent im... more Following the introduction of non-invasive tests, antenatal screening for trisomy 21 underwent important changes. Clinicians had to rapidly adapt their practice, especially in the field of antenatal counseling. On a population wide scale, new strategies and guidelines have been implemented. This article reviews the basic concepts of antenatal screening, including the use of non-invasive cell-free fetal DNA testing.
Ultrasound in Obstetrics & Gynecology, Oct 1, 2018
atrium by a suture-less technique. The postoperative course was uncomplicated and the baby was di... more atrium by a suture-less technique. The postoperative course was uncomplicated and the baby was discharged home on day 14 of life.
PubMed, Oct 25, 2017
We conducted a retrospective study was conducted in the Centre Hospitalier Universitaire Vaudois ... more We conducted a retrospective study was conducted in the Centre Hospitalier Universitaire Vaudois (CHUV) including all births between the 1st January 1997 and 31st December 2011 to analyze the cesarean section (CS) rate using the different groups of the Robson classification in a Swiss maternity hospital. The overall CS rate was 29 %, mainly related to group 5 (multiparous with previous CS) and group 2 (nulliparous women induced or who had CS before labor). The study also shows that induction of labor on maternal request in nulliparous at term (group 2a) increased significantly the risk of CS compared to induction of labor for medical reason (p<0.001). The Robson classification system appears as a simple tool for monitoring CS rates. The main strategies for reducing CS rates will be through better selection of women for VBAC (vaginal birth after caesarean) and limitation of induction of labor, especially in nulliparous women.
Frontiers in Pediatrics, Dec 4, 2017
Introduction: Bronchopulmonary sequestration (BPS) may cause prenatal pleural effusion (PE) or ev... more Introduction: Bronchopulmonary sequestration (BPS) may cause prenatal pleural effusion (PE) or even hydrops. This case describes a fetus presenting with severe PE, which prenatally waned completely under steroid treatment, yet surprisingly reappeared rapidly after birth, requiring early surgical intervention. Case description: A male fetus was diagnosed with left BPS and severe PE. After three courses of prenatal steroid therapy for each recurrence of PE from 27 weeks of gestation, we observed a complete regression of PE prenatally. Yet, PE recurred 18 h after birth and persisted after repeated drainages and steroid therapy. Early total resection of the extralobar BPS was performed and led to complete recovery without recurrence of PE. Conclusion: This report underlines that in cases of BPS presenting with prenatal PE needing fetal intervention, even if full regression of PE is observed before birth, there might be a need for surgical excision during the neonatal period.
PubMed, Oct 1, 1999
Symphysiotomy is regularly performed in developing countries where cesarean section can be a sour... more Symphysiotomy is regularly performed in developing countries where cesarean section can be a source of significant short-term and long-term morbidity. However, this method can be useful in some rare occasions and should be taught in our countries, at least theoretically. Such a case is presented with a review describing the present surgical technique, its indications and limits with special reference to its possible complications.
PubMed, Sep 2, 1999
The loss of a fetus in a multiple pregnancy is relatively frequent. The main risk factor is a mon... more The loss of a fetus in a multiple pregnancy is relatively frequent. The main risk factor is a monochorionic twin pregnancy. If fetal loss occurs after 16 weeks of pregnancy, the survivor is also at increased risk of intrauterine death. In monochorionic twins, the risk of neurological sequelae can be as high as 25%. These lesions are due to acute episodes of hypoperfusion immediately following the death of the co-twin. Maternal complications including coagulation disorders are rare. The management will vary according to the type of placenta, the gestational age and the condition of the surviving twin. When the last trimenon has been reached, rapid delivery is probably the safest management. In monochorinoic biamniotic twins, the risk to the survivor often justifies the induction of delivery between 28 and 32 weeks of gestation after steroids have been administered. In most cases, before the 28th week of gestation, a conservative management will be proposed. In monochorionic monoamniotic twins, immediate delivery should be considered as soon as fetal viability is reached.
PubMed, 2000
This case report concerns a 35-year-old woman suffering from gravidic cholestasis, thrombocytosis... more This case report concerns a 35-year-old woman suffering from gravidic cholestasis, thrombocytosis and iterative vomiting episodes who underwent an elective cesarean section at week 35 because of recent herpetic vulvitis. Large bilateral ovarian tumors were observed which were interpreted as pregnancy luteomas. Nevertheless a biopsy of the right ovary was performed. Histologic examination revealed massive luteinization of the ovarian stroma. In addition, large tumor cells were found dispersed throughout the ovary as well as in vascular spaces as either isolated or clustered signet-ring cells. In search of the primary tumor, gastroscopy revealed a gastric ulcer in the antrum. The biopsies of the ulcer margins as well as those taken at distance demonstrated signet-ring cells in the lamina propria. Bilateral salpingo-oophorectomy and total gastrectomy were performed. In spite of postoperative chemotherapy, the patient died of disease 5 months after diagnosis.
American Journal of Obstetrics and Gynecology, Oct 1, 2002
OBJECTIVE Antibodies to the 70-kd heat shock protein were evaluated as biomarkers for cytomegalov... more OBJECTIVE Antibodies to the 70-kd heat shock protein were evaluated as biomarkers for cytomegalovirus infection. STUDY DESIGN Fetal sera that was obtained by cordocentesis at 22 to 25 weeks of gestation from 53 mothers with a confirmed primary cytomegalovirus infection and 28 mothers (control group) without cytomegalovirus infection who had been screened for Rh incompatibility, were assayed by enzyme-linked immunosorbent assay for immunoglobulin M and G anti-70-kd heat shock protein antibodies. RESULTS Eighteen of 53 fetuses (34.0%) from cytomegalovirus-positive mothers were infected, which was determined by culture or polymerase chain reaction. Anti-70-kd heat shock protein immunoglobulin M was detected in 17 of 18 sera (94.4%) from cytomegalovirus-infected fetuses, in 3 of 35 sera (8.6%) from uninfected fetuses, and in 0 of 28 sera from the control group (P <.0001). The level of antibody reactivity was correlated positively with fetal disease. Anti-70-kd heat shock protein immunoglobulin G was detected in sera from 52 of 53 fetuses (98.1%) from cytomegalovirus-infected mothers. CONCLUSION The anti-70-kd heat shock protein immunoglobulin M assay may be of value in the assessment of fetal cytomegalovirus infection in pregnant women with a primary cytomegalovirus infection.
Prenatal Diagnosis, 2006
To present clinical findings of a child with paternal uniparental isodisomy 14 (pat UPD14) focusi... more To present clinical findings of a child with paternal uniparental isodisomy 14 (pat UPD14) focusing on relevant prenatal characteristics. Ultrasonography at 23 weeks of gestation of a 37-year-old multigravid woman revealed a fetus with polyhydramnios, small thorax, and short, distinctively angled ribs. Fetal karyotype was 46,XY. The child was born spontaneously at 35 weeks with poor neonatal adaptation. From birth, he presented with severe respiratory insufficiency due to severe thoracic malformation. Clinical examination revealed a small, bell-shaped thorax, redundant lax skin, mild contractures of the fingers and dysmorphic facial features. Chest X rays showed short, abnormally curved ribs that suggested the possibility of pat UPD14, which was confirmed by molecular analysis. Pat UPD14 is associated with a distinct clinical phenotype. Prognosis is poor because of severe respiratory insufficiency and neurodevelopmental retardation. Our report confirms salient postnatal signs of previous descriptions, especially the characteristic radiological abnormalities with ribs showing a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;coat-hanger&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; configuration. Retrospective fetal ultrasound of our case allowed the identification of this pathognomonic feature prenatally, which makes it possible to consider pat UPD14 at routine prenatal sonography, in particular in combination with a small bell-shaped thorax and polyhydramnios.
Emerging Infectious Diseases, Mar 1, 2014
Waddlia chondrophila is an intracellular bacterium suspected to cause human and bovine abortion. ... more Waddlia chondrophila is an intracellular bacterium suspected to cause human and bovine abortion. We confirmed an association between antibodies against W. chondrophila and human miscarriage and identified this organism in placenta or genital tract of women who had had miscarriages. These results suggest a possible role of W. chondrophila infection in miscarriage. DISPATCHES 460 Emerging Infectious Diseases • www.cdc.gov/eid