Anonymat du don de gamètes : protection d'un modèle social ou atteinte aux droits de l'homme ?

The French legislation about gamete donation imposes anonymity between the donor and the demanders, in reference to the principles of protection of the human dignity that are applied in other fields of biomedicine. We are here wondering about this choice: does this obligation really protect the human rights that are one of the ethical bases of law? At the time the French law was written, anonymity in gamete donation was inherited from the practice of the French CECOS but it has now become controversial. Many European countries have opened the access to the genetic origins. There is no evidence for this practice to be an efficient protection of the respect of human body and the disinterested nature of donation. Concerning gametes, it seems that it protects a social object, the parental project, but that it has no influence on the protection of parenthood, filiation, and the concept that humankind is not only biological. At last, we analyse the most important human rights documents to assume the hypothesis that anonymous gamete donation, although not violating the human rights, is an implement for Foucault's biopower, far from protecting the ethical foundations of human dignity.     

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.     

Rôle joué par les événements de filiation dans l'infertilité masculine

The object of this study is the family history of a set of infertile men, through a filiation event grid. This study examines the genealogical tree established during the genetic session, which precedes an ICSI procedure, and applies this filiation grid to a sample of 30 men met in the ART department and to a reference group of 30 fertile men met in a maternity hospital after the birth of their child. The results show statistical differences in the filiation events of both populations. We can therefore assume that difficulties in the past generations may play a part in some cases of male infertility.     

Quels sont actuellement les espoirs réels de grossesse après cryoconservation ovarienne ?

Survival rates for cancers that occur in childhood and adolescence have improved over the last decades, and preservation of future fertility in these patients has become a relevant issue. Premature ovarian failure is a consequence of exposing women to chemotherapeutic drugs and ionizing radiation. Ovarian cryopreservation is an alternative to cryopreservation of embryos or oocytes for theses patients. Ovarian cryopreservation aims to reimplant ovarian tissue after complete remission into the pelvic cavity (orthotopique site) or a heterotopic site like the abdominal wall or the forearm. In vitro folliculogenesis, that aims at the maturation of ovarian cortex primordial follicles cryopreserved for a FIV, is still in an experimental research stage. In this review, the objective was to evaluate the real hopes of pregnancy after ovarian cryopreservation. Indeed, many teams offer ovarian cryopreservation at present time, although only two pregnancies have been achieved to date. In both cases, it can be discussed whether the fertilized oocyte originated from the transplant or from the native ovary. Furthermore, the potential for reintroduction of cancerous cells may limit this technique in cancers that are known to have a risk of ovarian dissemination. The hopes engendered by ovarian cryopreservation, but also its limits, must be explained to the patients before an ovarian surgery for cryopreservation.     

Peut-on encore réaliser des rotations instrumentales par spatules de Thierry ? Étude préliminaire chez la primipare

Objectives

To study immediate perineal and neonatal outcomes after instrumental rotational performed with Thierry's spatula among primiparous, and compare subsequent perineal tear with occiput posterior position delivery.

Materials and methods

The study was performed from December 2005 to June 2006 at Paule-de-Viguier hospital (Toulouse university hospital) including all persistent occiput posterior vaginal deliveries among primiparous (49 patients). Mode of delivery was: 1) seven patients with spontaneous occiput anterior vaginal delivery (14.3%); 2) seven patients with rotational extraction using spatula with occiput anterior delivery (30.6%); 3) twenty-seven patients with instrumental extraction and occiput posterior delivery (55.1%). Maternal and fetal parameters were studied prospectively.

Results

Spatula was performed for failure of progress in 71.4% of cases (n = 30) and for no reassuring fetal status in 28.6% of cases (n = 12). In “rotational group”, only one perineal tear was observed (Third degree) (6.6%) versus seven in “occiput posterior extraction group” (26%) with three severe perineal lacerations. Neonatal superficial lesions are frequent (26,6% after rotation versus 11.6% after occiput posterior extraction). None severe traumatic tears were observed.

Conclusion

Instrumental rotation using Thierry's spatula seems to be less deleterious for maternal perineum than occiput posterior extraction, without increasing neonatal complications. Theses preliminary results have to be confirmed by more important prospective works.     

La primiparité est-elle le seul facteur de risque des lésions du sphincter anal en cours d'accouchement ?

OBJECTIVE: Primiparity has been identified as the main risk factor of type 3 and 4 perineal injuries The purpose of our study, according to a population-based observational study, was to identify other clinical risk factors for lesions during vaginal delivery. PATIENTS AND METHODS: Two groups have been compared. Group A or study group (n=63) was defined as parturients with three or four-degree perineal tears. Group B or control group (n=67) included women who delivered vaginally without any perineal lesion during the same period. Characteristics of the population were compared: maternal age, race, maternal weight, BMI (Body Mass Index), parity, mode of anaesthesia, gestational age, post maturity, length of labor, fetal weight, mode of delivery (assisted or not). Specific characteristics were also compared, obesity, shoulder dystocia, type of presentation, episiotomy and dose of ocytocin. RESULTS: Primiparity was significantly associated with higher frequency of sphincter lacerations (71 vs 43%, p=0.001). The patients of group A were with significantly higher weight than the patients of control group (67 vs 63 kg, p=0.036). Futhermore the BMI was different in the two groups (25,6 vs 23,4, p=0.003). There was a significant difference according to the length of the second part of labor (68 vs 48 min, p=0.037) and the posterior variety (32 vs 4%, p<0.001). The occurrence of shoulder dystocia was only just significant (6 vs 0%, p=0.052). Assisted-extraction is highly associated with perineal injuries (44 vs 1%, p<0.001). Futhermore the instrument has been concerned by the difference: Tarnier's forceps-assisted extraction (14 vs 1%, p=0.003), Suzor's forceps-assisted extraction (16 vs 0%, p=0.0005), Thierry's spatula-assisted extraction (14 vs 0%, p=0,0005). The association forceps and episiotomy has been found with higher frequency of perineal injury (43 vs 1%, p<0,0001). There were no difference between the 2 groups according fetal characteristics, type of analgesia, maternal age, gestational age, post-maturity or dose of ocytocin. DISCUSSION AND CONCLUSION: Primiparity is not the only risk factor of perineal injuries. Other risk factors have been found: assisted-extraction, occiput posterior fetal head position, and association episiotomy and assisted-extraction. Black origin seems to be protective.     

Peut-on prendre en charge l'allo-immunisation plaquettaire fœtomaternelle de manière non invasive ? Expérience sur dix ans

OBJECTIVES: Our purpose was to study a non-invasive management of fetomaternal alloimmune thrombocytopenia (FMAIT). PATIENTS AND METHODS: Between 1996 and 2005, 18 women were treated. The population was divided into 2 groups: patients with a history of intracranial haemorrhage (ICH) in the older sibling received weekly intravenous immunoglobulin (IVIG) therapy to the mother (1 g/kg per week) without initial cordocentesis whereas patients with a history of neonatal thrombocytopenia did not undergo any treatment. RESULTS: All pregnancies with a previous FMAIT were monitored with serial ultrasound scans without cordecentesis. 15 patients had HPA-1, 2 HPA-3 and 1 HPA-5 immunizations. Weekly intravenous immunoglobulin therapy was administered in 5 patients with a history of ICH in the older sibling. Two of these delivered thrombocytopenic children; one had a platelet count < 50 x 10(9)/l. For the 13 women (one twin) who had a sibling with neonatal thrombocytopenia, 11/14 newborns had a platelet count < 50 x 10(9)/l. Predelivery fetal blood sampling were performed in 8/18 pregnancies. The neonatal periods of the 19 children were uncomplicated and no ICHs were observed. DISCUSSION AND CONCLUSION: Our results suggest that a non-invasive strategy avoiding serial cordocentesis may be an effective therapy in patients who are at risk of fetal and neonatal alloimmune thrombocytopenia.     

L'œdème aigu du poumon chez des patientes en menace d'accouchement prématuré traitées par inhibiteurs calciques : place de facteurs prédisposants ou pharmacologiques spécifiques ?

Calcium channel blockers of the dihydropyridin's family have been associated with the onset of an acute pulmonary edema when they are used as a treatment of preterm labor. We report here four cases of pulmonary edema in pregnant women treated with nicardipine (Loxen) for preterm labor. The physiopathology of pulmonary edema, the pharmacology of calcium channel blockers of dihydropyridin's family and the detailed analysis of our cases and those of the literature make us discuss of the role of these agents and associated population and risk factors in such complication.