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Saint-André-lez-Lille, France

Obesity during pregnancy increases the risk of complications for both the mother (gestational hypertension, diabetes mellitus) and the newborn (malformations and macrosomia). Deliveries are also more difficult with more c-section and failure in peridural analgesia. A specific organization in the perinatal network should improve the management of these women, especially for morbid obesity. © Springer Paris 2009. Source

Petit F.,Service de Genetique Clinique | Devisme L.,Laboratoire Eurasante | Toutain A.,Service de Genetique | Houfflin-Debarge V.,Maternite Jeanne de Flandre | And 3 more authors.
European Journal of Medical Genetics

Crane-Heise syndrome is a rare lethal and autosomal recessive condition which has been first reported in 1981 in three siblings presenting intrauterine growth retardation, a poorly mineralised calvarium, characteristic facial features comprising cleft lip and palate, hypertelorism, anteverted nares, low-set and posteriorly rotated ears, vertebral anomalies and absent clavicles. Since then, to our knowledge, only one isolated case and two siblings were reported with similar findings. We present two further cases, diagnosed after termination of pregnancy at 24 weeks' gestation in one case and straight after birth in the other, both very similar to the previously reported ones, and broaden the clinical spectrum of this entity. To our knowledge, no molecular mechanism has been identified in Crane-Heise syndrome so far. © 2010 Elsevier Masson SAS. Source

Arsene E.,Maternite Jeanne de Flandre | Clouqueur E.,Maternite Jeanne de Flandre | Stichelbout M.,Service danatomopathologie | Devisme L.,Service danatomopathologie | And 3 more authors.
Journal de Gynecologie Obstetrique et Biologie de la Reproduction

Twin pregnancies combining complete hydatidiform mole and coexistent fetus are a rare situation (incidence in 1/20,000 in 1/100,000 pregnancies) and a challenge for diagnosis. Their complications can be important-bleeding, preeclampsia, miscarriage-and their management remains complex and controversial. In case of continuing the pregnancy, nearly 40% of women have lives babies. Three quarters of fetal loss occur before 24 weeks gestation. We report here three new cases; only one of these cases had a favorable outcome. © 2015 Elsevier Masson SAS. Source

Ducloy-Bouthors A.-S.,Maternite Jeanne de Flandre
Annales Francaises d'Anesthesie et de Reanimation

Clotting disorders are associated with the severe, early and complicated forms of PE. Compensated hypercoagulability states associated with a thrombocytopenia (PLT<150k/mm3) affect 25 to 50% of severe PE patients. Laboratory markers of platelet and endothelial activation are the early increase of fibronectin levels, the worsening of the thrombocytopenia and the raised platelet turnover. The excessive thrombin formation is physiologically compensated by a rise in thrombin-antithrombin (TAT) complex levels, which is the most specific marker of a PE pregnancy, and a decrease in anti-thrombin (AT) activity. The placenta induced depression of the fibrinolysis appears to contribute towards the hypercoagulable state. The etiological importance of the erythrocyte and leucocyte activation with regards to the abnormal clotting activation is highlighted in the setting of maternal systematic inflammatory disease. The state of compensated coagulopathy found in the PE patient can suffer a pro-coagulatory imbalance because of a quantitative, or a qualitative failure (i.e. thrombophilia) of the physiological coagulation inhibitors, or a combination of both. This disseminated intravascular coagulation, qualified as chronic, is associated with clinically evident signs of fœto-placental unit impairment (i.e. IUGR, foetal death) with or without systemic repercussions in the mother (i.e. renal failure, HELLP syndrome, eclampsia). This set of haemostatic disturbances found in the PE patient is a dynamic phenomenon, which can evolve by the hour therefore requires frequent laboratory investigations. Delivery remains the only curative treatment for these haemostatic disturbances. A better understanding of the aetiology of DIC in PE, an early detection method and a specific identification of the at-risk patients could allow prophylactic and curative treatment. © 2010. Source

Munaut C.,University of Liege | Lorquet S.,University of Liege | Pequeux C.,University of Liege | Coulon C.,Maternite Jeanne de Flandre | And 7 more authors.

Background: Several studies have suggested that the main features of preeclampsia (PE) are consequences of endothelial dysfunction related to excess circulating anti-angiogenic factors, most notably, soluble sVEGFR-1 (also known as sFlt-1) and soluble endoglin (sEng), as well as to decreased PlGF. Recently, soluble VEGF type 2 receptor (sVEGFR-2) has emerged as a crucial regulator of lymphangiogenesis. To date, however, there is a paucity of information on the changes of VEGFR-2 that occur during the clinical onset of PE. Therefore, the aim of our study was to characterize the plasma levels of VEGFR-2 in PE patients and to perform VEGFR-2 immunolocalization in placenta. Methodology/Principal findings: By ELISA, we observed that the VEGFR-2 plasma levels were reduced during PE compared with normal gestational age matched pregnancies, whereas the VEGFR-1 and Eng plasma levels were increased. The dramatic drop in the VEGFR-1 levels shortly after delivery confirmed its placental origin. In contrast, the plasma levels of Eng and VEGFR-2 decreased only moderately during the early postpartum period. An RT-PCR analysis showed that the relative levels of VEGFR-1, sVEGFR-1 and Eng mRNA were increased in the placentas of women with severe PE. The relative levels of VEGFR-2 mRNA as well as expressing cells, were similar in both groups. We also made the novel finding that a recently described alternatively spliced VEGFR-2 mRNA variant was present at lower relative levels in the preeclamptic placentas. Conclusions/Significance: Our results indicate that the plasma levels of anti-angiogenic factors, particularly VEGFR-1 and VEGFR-2, behave in different ways after delivery. The rapid decrease in plasma VEGFR-1 levels appears to be a consequence of the delivery of the placenta. The persistent circulating levels of VEGFR-2 suggest a maternal endothelial origin of this peptide. The decreased VEGFR-2 plasma levels in preeclamptic women may serve as a marker of endothelial dysfunction. © 2012 Munaut et al. Source

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