Comment choisir le spermatozoïde en ICSI ?

The selection of the individual spermatozoon in ICSI is routinely performed by the observation of its motility and morphology. However, in case of severe oligoasthenozoospermia or non-obstructive azoospermia needing the use of testicular sperm, other methods are necessary to help the embryologist making this choice. According to some authors, sperm processing before ICSI seems to limit the DNA fragmentation index, and in this way improve ICSI outcomes. Moreover, IMSI is potentially a good option in some specific indications such as severe teratozoospermia, or repeated ICSI failures. Other methods based on sperm structure, as sperm head birefringence observation, or based on its function, like the hyaluronic acid or zona pellucida binding capacity, could be of interest, but still need to be confirmed. Finally, in case of akinetozoospermia, the use of functional tests, such as pentoxifylline test, HOS-test, or to a lesser extent laser touch, makes the selection of viable spermatozoa easier. Nevertheless, studies on larger series have to be conducted to evaluate and precise the interest of each of these methods and their indications, before considering an application on larger scale.     

Quel test biologique utiliser en cas de suspicion de rupture des membranes ?

Rupture of membranes (ROM) occurs frequently and requires specific management depending on gestational age in order to avoid maternal and fetal complications. In 80% of cases, ROM is associated with large amniotic fluid (AF) leakage making diagnosis easy. The aim of the current review is to precise which biological test is useful for the physician facing ambiguous clinical picture. Vaginal pH assessment demonstrates alkalinisation (6.5-7.5) when AF is present (sensitivity 73-91%, specificity 72-83%). Drying test, fern test or fetal cells staining have been supplanted by detection of AF proteins. Diamine oxidase activity required specific radioanalytical assay leading to restrictive use and progressive abandon. Immunoassay tests detecting Insulin-like Growth Factor-Binding Protein-1 (IGFBP-1) or Placental Alpha 1-Microglobulin (PAMG-1) are currently considered as the most useful tools for ROM diagnosis. Literature fails to provide sufficient evidence that one of these two approaches should be favoured. Distinction between IGFBP-1?and PAMG-1?remains controversial as they seem to correspond to the same molecule.     

Faut-il réaliser une scintigraphie osseuse dans le bilan d’extension des cancers du sein de petite taille ?

We conducted a retrospective study including 517 patients with invasive breast cancer classified pT1 less than 20 mm. We estimated the relevance of bone scan in the screening of metastases at the time of primary presentation, as well as the costs incurred by such a screening. Postoperative systematic bone scan did not detect the two cases of synchronous bone metastases in this population. No bone metastasis was detected in groups with the highest metastatic risks (low profitability for all pT1 classified cancers). Bone scan's rate of false positive was high (17%). The global cost was estimated at 110,770 euros, that was 215 euros per patient (208 to 232 euros in the risk groups).     

Place de l’imagerie dans le diagnotic des cancers du sein bilatéraux synchrones

ObjectiveTo investigate the role of imaging procedures in the diagnosis of synchronous bilateral breast cancer (SBBC)Patients and methodsThe patient group consisted of consecutive women undergoing managed for SBBC in our institution between January 2006 and July 2012. We defined SBBC as bilateral breast tumors diagnosed simultaneously or up to 3 months after initial diagnosis. Clinical data included comorbidities, BMI (kg/m²), preoperative breast imaging modalities used and their findings.ResultsOf the 2322 patients with newly diagnosed breast cancer treated on the study period, 46 patients with the diagnosis of SBBC were enrolled to the study. A total of 41.3% patients had family history of breast cancer. A total of 56.52% had clinical symptoms. The most frequent situation of diagnosis (32.6%) was the association of a palpable tumor and a contralateral radiologic abnormality. MRI permitted the diagnosis of 19.6% occult contralateral lesions.Discussion and conclusionClinical examination and conventional imaging procedures (mammography and sonography) detects the majority (76%) of synchronous contralateral breast cancers. A family history of breast cancer, a multifocal breast tumor or the presence of an invasive lobular carcinoma should be arguments for the realization of a breat MRI to eliminate contralateral malignancy.     

Protocoles de replacement d’embryons congelés : le cycle spontané donne-t-il de bons résultats ?

ObjectiveFrozen embryos’ transfer optimize the pregnancy rates per retrieval. In France, 60% of transfer cycles occur in stimulated cycles. The aim of this study was to evaluate the outcomes of frozen embryo transfers in spontaneous, substituted and stimulated cycle.Patients and methodsThis retrospective study includes patients who are 18–43 years old and had a frozen embryo transfer between 1st January 2008 and 31st December 2008. Three transfer protocols have been used: the spontaneous cycle (group 1), substituted cycle (group 2), and stimulated cycle (group 3). The characteristics of couples, embryonic parameters and data transfer cycles, and their outcomes were evaluated.Result(s)Among the 333 patients, 132 were included in the first group, 24 in the second group and 177 in the third group. After checking the homogeneity of the three groups, we found pregnancy rates (respectively 20.49 vs 13.04% and 11.32%, P = 0.0348), and deliveries (respectively 13.93 vs 8,7 and 6.29%, P = 0.0314), significantly higher in spontaneous cycles.Discussion and conclusionCurrently there is no consensus on the best technique for endometrial preparation for frozen embryo transfer. Our results support transfers in spontaneous cycle for normo-ovulating patients. Natural cycles can achieve good pregnancy rates while minimizing the costs and side effects.     

Impact de la formation des échographistes de première intention sur le taux de détection anténatal des cardiopathies congénitales et sur leur pronostic postnatal

Abstract

Routine prenatal ultrasound screening for the detection of possible cardiopathy has existed in Upper Normandy, France, since 1987 including continuous training of obstetric ultrasonographers. We evaluated the impact of this training on the antenatal rate of detection for congenital heart disease and its postnatal prognosis.

Methods

A retrospective study was undertaken from January 2003 to December 2008 in cardiopediatric units of Upper Normandy. All foetuses and infants with a diagnosed major cardiac defect were classified into three groups, with no possibility of anatomic surgical repair (group I), with a risk of early decompensation (group II), with anatomic surgical repair but without early decompensation (group III). Prenatal and postnatal mortality and morbidity were reported.

Results

Two hundred (and) forty-nine major congenital heart defects were detected prenatally and 103 postnatally. The prenatal detection rate was 71% (94, 52.3 and 79.1% for groups I, II and III, P < 0.0001). Total pre and postoperative mortality was not related to prenatal diagnosis of congenital heart disease. The mortality and the morbidity were significantly lower in the diagnosed group of transposition of the great arteries and obstruction of the left outflow tract.

Conclusion

Prenatal detection of major cardiac defects has continued to reach a high success in Upper Normandy. However, 50% of urgent neonatal heart cases often remain undiagnosed, and therefore, the neonatologist must treat this patient population with particular care. Prenatal diagnosis can reduce preoperative mortality and morbidity of cardiopathy with a risk of early decompensation with specific neonatal intensive care.     

Infections buccodentaires et complications de la grossesse : connaissances et attitudes des professionnels de santé

ObjectiveThe abundance of recent studies on the relationship between oral diseases and complications of pregnancy leads to questions on knowledge of health professionals. This study aims to establish an inventory of knowledge and practice of health professionals in France on this issue.Patients and methodsA questionnaire on knowledge of the relationship between oral diseases and complications of pregnancy was referred to gynaecologists and obstetricians, midwives and dentists. This study was conducted at the University Hospital of Nantes and Le Mans General Hospital.ResultsEighty-seven professionals of pregnancy and 259 dentists responded to the survey. Bleeding gums and pregnancy gingivitis are the oral manifestations most cited by all practitioners. There is however a difference concerning the epulis and caries risk. The most cited Pregnancy complications are risk of premature delivery and chorioamniotitis. Only dentists had received initial training on pregnancy complications. Finally, all health professionals point to the lack of continued education on this topic.Discussion and ConclusionThere is a good knowledge of the pregnancy complications associated with oral disease despite the lack of training of pregnancy, but the attitudes of care are not still in adequacy. It appears necessary to strengthen the training of all practitioners in this field. The design and implementation of a specific questionnaire on oral health status could allow better identification of the patients at risk by the professionals of pregnancy, and optimize so the care of pregnant women.