Origine fœtale des maladies de l'adulte : quelle importance pour la pratique obstétricale ?

The Developmental Origins of Human Adult Disease are thought to be secondary to a perturbation of the embryonic or fetal development, which leads to metabolic disorders such as diabetes or hypertension at adulthood. Maternal undernutrition or overnutrition, repeated glucocorticosteroids administered to the mother, or placental dysfunction are the most frequently considered causal factors. Therefore, it is necessary that the obstetrician is aware of these phenomena, as this knowledge may contribute to the prevention of adult diseases. Little is known yet, on the pathophysiological or epigenetic mechanisms that lead to theses observations, and more studies are needed both in humans and animal models.     

Grossesse et fibrome : quelles complications ?

ObjectiveWe have observed the association between uterine leiomyomas and complications during pregnancy, delivery and post-partum among our patients over the last 10 years.Patients and methodsWe realized a retrospective case-control study comparing pregnancy and delivery outcomes in women with and without leiomyomas. In order to strengthen our observations, we conducted both univariate and multivariate analyses, and carefully respected 3 matching criteria between the two groups: age, parity and date of delivery.ResultsOver a ten-year period, 117 (0.38%) women with at least one leiomyoma would give birth – among the 30,805 births registered in our unit. By multivariate analysis, the presence of leiomyomas was significantly associated with women's age over 35 (adjusted odds ratio [AOR] 2.48, 95% confidence interval (CI) [1.31–4.67]), smoking (AOR=4.3, [1.82–10.13]), cystitis (AOR = 6.55, [2.12–20.16]), hydramnios (AOR = 5.12, [1.57–16.65]), threatened preterm labor (AOR = 3.99, [1.66–9.56]), first trimester bleeding (AOR = 3.92, [1.62–13.26]), anaemia during pregnancy (AOR = 2.97, [1.30–6.78]), labor dystocia (AOR = 11.79, [2.80–49.56]), retained placenta (AOR = 4.25, [1.49–12.11] and neonatal pediatric intensive care (AOR = 4.44, [1.19–16.60]). Regarding cesarean delivery, the multivariate analysis found that women with several leiomyomas underwent 8.48 times more cesarean sections than women with a single leiomyoma (p = 0.001).Discussion and conclusionOur study shows how specific features are to be kept in mind regarding obstetric outcomes for women with leiomyomas. These results emphasise the need for good perinatal care and raise the question of the treatment of those leiomyomas before pregnancy with the development of non-invasive procedures.     

Mort fœtale in utero : étiologies et prise en charge à l’hôpital Laennec de Creil

Objective

Determine epidemiological and etiological aspects of in utero fetal death (IUFD) to derive a support and especially adequate prevention.

Materials and methods

We conducted a retrospective study from 1 June 2007 to 31 May 2012 on cases of fetal death in the Hospital of Creil.

Results

The incidence of fetal death was 4.41‰ Primiparous mothers, women less than 35 years, had obstetric histories, toxic habits, personal defects, or genetic diseases; those consulted in hospitals and/or by obstetricians occupied a considerable proportion. In order of frequency, we found placental pathologies (41%), fetal pathologies (33.3%), maternal diseases (12.8%), infectious diseases (5.1%), intrapartum causes (5.1%), and umbilical cord pathologies (2.6%). The delivery was by natural methods in 84.6% of cases. All patients underwent vasculo-renal and infectious assessments, and histological examination of the appendices.

Conclusion

The autopsy and examination of the placenta are important etiological research of fetal death. More times a week obstetrical Doppler and monitoring of the fetal heart may contribute to the significant decrease in the frequency of this pathology.     

Sommeil et cancer du sein : existe-t-il un lien ?

The aim of this review is to evaluate the impact of sleep on breast cancer risk. Given the supposed protective role played by melatonin in breast cancer, it is interesting to study the effect of sleep, which is the moment of melatonin synthesis. Articles were extracted from the PUBMED database between 2000 and 2012 with the following keywords “sleep duration”, “sleep quality”, “breast cancer risk” and “melatonin”. In total, 10 articles were selected. Most prospective cohort studies found a decrease in the risk of breast cancer varying from 38 to 72% for “long sleepers”. Furthermore, a meta-analysis of the studies assessing the link between breast cancer risk and urinary concentration of 6-sulfatoxy-melatonin (6MT), which is melatonin's main metabolite, found a 34% decrease for patients with the highest 6MT concentration. Even though other studies are necessary to confirm these results, it seems already adequate to detect sleep disorders and to try to treat them.     

Malformations utérines et voie d’accouchement : analyse de 304 cas entre 2000 et 2010 au CHRU de Lille

ObjectivesThis study aimed to determine the conditions and way of delivery in women with congenital uterine malformations.Patients and methodsThis retrospective study included a cohort of patients with malformed uterus giving birth in Lille University Hospital between 2000 and 2010, features such as way of delivery, labour, foetal presentation were compared with those patients without uterine malformation.ResultsPatients with uterine anomalies had significantly higher rates of breech présentation (36.51% vs 4.52%; P < 0.01) and cesarean section (55.26% vs 18.70%; P < 0.01) compared to the group of women with a normal uterus.Discussion and conclusionOur results suggest that women with uterine malformation should be informed that they have an increased risk of caesarean section due to more frequent malpresentations.     

Vitamine D et cancer du sein : y a-t-il un lien ?

ObjectiveThe aim of this review is to know the relationship between breast cancer and vitamin D, synthesised by skin or brought by food or supplementation.Material and methodsThe selected articles were extracted from the Pubmed database between 1998 and 2012. The keywords used were: “25-hydroxyvitamin D”, “breast cancer recurrence”, “breast cancer risk”, “serum levels of vitamin D”, “vitamin D intake”. A total of 37 articles were selected.ResultsThe sun exposure, via the skin vitamin D synthesis, is associated with a decreased risk of breast cancer. This decrease seems also likely for food contributions and an over 400 IU per day vitamin D supplementation. An inverse relationship between plasma 25-hydroxyvitamin D (25-OH-D) level and breast cancer risk has been suggested. An increased 25-OH-D level seems associated with a decreased risk of breast cancer recurrence.ConclusionRecommendations concerning a vitamin D supplementation could be established, but should be supported by additional studies.