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Le Touquet – Paris-Plage, France

Bence C.,Service dAddictologie | Bonord A.,Service de Prise en Charge de la Toxicomanie et de la Dependance | Rebillard C.,Service de Psychiatrie Perinatale | Vaast P.,Center Pluridisciplinaire Of Diagnostic Prenatal | And 5 more authors.
Pediatrics | Year: 2016

Tianeptine, an atypical antidepressant, has been found to exhibit a potential for abuse. The use of therapeutic doses of tianeptine during pregnancy has never raised safety concerns. However, the impact of tianeptine abuse on the mother-child dyad has never been assessed. We report herein the case of a female patient who presented with dependence on tianeptine, with the use of >650 mg of the drug per day. She had 2 successive pregnancies with similar doses. The state of dependence remained unidentified throughout the first pregnancy, but just after delivery, her full-term newborn exhibited unexpected neonatal abstinence syndrome (NAS). The NAS was successfully treated with morphine, although both the mother's and newborn's urine drug screen was negative. The causality of tianeptine in inducing NAS was retrospectively assessed as "probable" by using a validated causality algorithm. During the second pregnancy, this patient sought addiction treatment and was admitted for residential detoxification treatment in her seventh month of pregnancy. Delivery occurred at full term with a low birth weight neonate. No further developmental insults or medical problems were subsequently identified in the 2 children. Maternal tianeptine dependence during pregnancy may induce a type of NAS that mimics opiate NAS. This finding appears to be consistent with a recent finding of the agonist action of tianeptine on the opiate μ-receptor. © 2016 by the American Academy of Pediatrics.

Morin J.-F.,University of Monastir | Botton E.,Laboratoire Of Biologie Medicale | Jacquemard F.,Center Pluridisciplinaire Of Diagnostic Prenatal | Richard-Gireme A.,Thermo Fisher Scientific
Annales de Biologie Clinique | Year: 2013

The Fetal medicine foundation (FMF) has developed a new algorithm called Prenatal Risk Calculation (PRC) to evaluate Down syndrome screening based on free hCG™, PAPP-A and nuchal translucency. The peculiarity of this algorithm is to use the degree of extremeness (DoE) instead of the multiple of the median (MoM). The biologists measuring maternal seric markers on KryptorTM machines (Thermo Fisher Scientific) use Fast Screen pre I plus software for the prenatal risk calculation. This software integrates the PRC algorithm. Our study evaluates the data of 2.092 patient files of which 19 show a foetal abnormality. These files have been first evaluated with the ViewPoint software based on MoM. The link between DoE and MoM has been analyzed and the different calculated risks compared. The study shows that Fast Screen pre I plus software gives the same risk results as ViewPoint software, but yields significantly fewer false positive results.

Gorincour G.,Espace Ethique Mediterraneen | Gorincour G.,Center Pluridisciplinaire Of Diagnostic Prenatal | Tassy S.,Espace Ethique Mediterraneen | Payot A.,Service de neonatologie | And 5 more authors.
Gynecologie Obstetrique Fertilite | Year: 2011

Objective: To evaluate the caregivers' opinions regarding decision-making in termination of pregnancy (TOP) for fetal anomaly. Material and methods: Questionnaire survey using a semi-structured survey based on visual analogue scales, sent to all multidisciplinary centres for prenatal diagnosis in France. Answers were received from 26 centres nation-wide. Results: Response rate was 39% (213 responses received over 550 questionnaires sent). Fifty-five percent of respondents were women, 90% physicians, 7,5% midwives. A vast majority (69.8%) believes that their own convictions play a bigger role in decision in real practice than in their ideal. The major decisional factors in decision-making for TOP are: the long-term prognosis of the anomaly, a specialized opinion on its curability, the quality of the information given to the future parents, their expressed opinion, the existence of a multidisciplinary decision, the ability of the future parents to understand the medical data, the obtention of a medical consensus, the proof level of the medical information. For only 55% of the respondents, the current legal framework is adequate to manage the situations that result from prenatal diagnostic practices today. The question of late third-trimester TOP raises ethical debate: over a third (37%) see no ethical difference between TOP and withdrawal of care during the neonatal period; the majority (48% versus 43%) feel that ethically speaking a neonate and a foetus at 39 weeks gestational age (GA) should not be treated differently; 37% of the respondents feel that current practice is likely to lead to eugenism. Discussion and conclusion: As far as TOP is concerned, the huge discrepancies in responses from the professionals highlight the ongoing ethical debate, especially concerning the concept of informed choice in TOP, which we believe should be entirely revisited. © 2011 Elsevier Masson SAS. All rights reserved.

Katorza E.,Service de radiologie | Nahama-Allouche C.,Service de radiologie | Castaigne V.,Service de gynecologie obstetrique | Gonzales M.,Service de Genetique et Embryologie Medicales | And 6 more authors.
Pediatric Radiology | Year: 2011

Background: Analysis of the middle ear with fetal MRI has not been previously reported. Objective: To show the contribution of fetal MRI to middle ear imaging. Materials and methods: The tympanic cavity was evaluated in 108 fetal cerebral MRI examinations (facial and/or cerebral malformation excluded) and in two cases, one of Treacher Collins syndrome (case 1) and the other of oculo-auriculo-vertebral (OUV) spectrum (case 2) with middle ear hypoplasia identified by MRI at 27 and 36 weeks' gestation, respectively. Results: In all 108 fetuses (mean gestational age 32.5 weeks), the tympanic cavity and T2 hypointensity related to the ossicles were well visualised on both sides. Case 1 had micro/retrognathia and bilateral external ear deformity and case 2 had retrognathism with a left low-set and deformed ear. MRI made it possible to recognize the marked hypoplasia of the tympanic cavity, which was bilateral in case 1 and unilateral in case 2. Both syndromes are characterized by craniofacial abnormalities including middle ear hypoplasia, which cannot be diagnosed with US. Conclusion: The middle ear cavity can be visualized with fetal MRI. We emphasize the use of this imaging modality in the diagnosis of middle ear hypoplasia. © 2010 Springer-Verlag.

Vinurel N.,Hopital Femme Mere Enfant | Van Nieuwenhuyse A.,Center Pluridisciplinaire Of Diagnostic Prenatal | Cagneaux M.,Hopital Femme Mere Enfant | Cagneaux M.,Center Pluridisciplinaire Of Diagnostic Prenatal | And 9 more authors.
Ultrasound in Obstetrics and Gynecology | Year: 2014

In order to illustrate the significance of a new anatomical finding, distortion of the interhemispheric fissure (DIHF) associated with impacted medial borders of the frontal lobes, we report a retrospective observational study of 13 fetuses in which DIHF was identified on prenatal imaging. In 10 cases there were associated anatomical anomalies, including mainly midline anomalies (syntelencephaly (n = 2), lobar holoprosencephaly (n = 1), Aicardi syndrome (n = 2)), but also schizencephaly (n = 1), cortical dysplasia (n = 1) and more complex cerebral malformations (n = 3), including neural tube defect in two cases. Chromosomal anomaly was identified in two cases, including 6p deletion in a case without associated central nervous system anomalies and a complex mosaicism in one of the cases with syntelencephaly. In two cases, the finding was apparently isolated on both pre- and postnatal imaging, and the children were doing well at follow-up, aged 4 and 5 years. The presence of DIHF on prenatal imaging may help in the diagnosis of cerebral anomalies, especially those involving the midline. If DIHF is apparently isolated on prenatal ultrasound, magnetic resonance imaging is recommended for careful analysis of gyration and midline, especially optic and olfactory structures. Karyotyping is also recommended. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

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