Maternite Jeanne de Flandre

Saint-André-lez-Lille, France

Maternite Jeanne de Flandre

Saint-André-lez-Lille, France
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Clouqueur E.,Maternite Jeanne de Flandre | Gautier S.,Center Regional Of Pharmacovigilance | Vaast P.,Maternite Jeanne de Flandre | Coulon C.,Maternite Jeanne de Flandre | And 3 more authors.
Journal de Gynecologie Obstetrique et Biologie de la Reproduction | Year: 2015

Tocolysis with calcium channel blockers is widespread in France. However, these molecules are off label use for this indication. The objective of this work is to give an update on all the side effects of calcium channel blockers published or reported to the National Bank of Pharmacovigilance. © 2014 Elsevier Masson SAS.


PubMed | Maternite Jeanne de Flandre and Center Regional Of Pharmacovigilance
Type: Journal Article | Journal: Journal de gynecologie, obstetrique et biologie de la reproduction | Year: 2015

Tocolysis with calcium channel blockers is widespread in France. However, these molecules are off label use for this indication. The objective of this work is to give an update on all the side effects of calcium channel blockers published or reported to the National Bank of Pharmacovigilance.We conducted a literature review incorporating the animal experimental data on calcium channel blockers, retrospective and prospective studies (randomized or not) comparing different tocolytics, and the published clinical case reports. Finally we inquired the National Bank of Pharmacovigilance for reported cases of adverse effects after use of calcium channel blockers as tocolytics.Adverse effects are found in 2% to 6% of patients after use of nifedipine, of which 0.9% to 1.9% are severe. These are mainly headache, flushes and arterial hypotension. Data on Nicardipine are more limited. For the latter, adverse effects specifically related to the route of administration (induced phlebitis) are described but it seems that other adverse effects reported are not more frequent. Several meta-analyses have demonstrated a decrease in maternal side effects when using calcium channel blockers compared to -agonists. Comparison of calcium channel blockers to Atosiban is less documented. More rare serious side effects are reported as clinical cases, consisting almost exclusively of cardiovascular complications (dyspnea, pulmonary edema, myocardial infarction, arterial hypotension). They are more common with Nicardipine than Nifedipine. Similar observations are found by querying the National Bank of Pharmacovigilance.The prescription of calcium channel blockers as tocolysis exposes patients to maternal side effects, which are not serious most of the time, and less frequent than with the -agonist. Severe maternal complications were nonetheless reported more frequently with Nicardipine than Nifedipine, which justifies avoiding Nicardipine in tocolysis. Nifedipine is the most studied molecule. It is not possible to define a maximum posology from literature data. It seems unreasonable to associate different tocolytics and necessary to closely monitor maternal blood pressure, the occurrence of a skin reaction or hypersensitivity, dyspnea or chest pain during treatment.


Munaut C.,University of Liège | Lorquet S.,University of Liège | Pequeux C.,University of Liège | Coulon C.,Maternite Jeanne de Flandre | And 7 more authors.
PLoS ONE | Year: 2012

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.


Fline-Barthes M.-H.,Maternite Jeanne de Flandre | Vandendriessche D.,Maternite Jeanne de Flandre | Vandendriessche D.,Center Hospitalier Of Roubaix | Gaugue J.,Center Hospitalier Of Roubaix | And 4 more authors.
Journal de Gynecologie Obstetrique et Biologie de la Reproduction | Year: 2015

Aim To evaluate auto-questionnaire use for psychosocial vulnerability and substance use (smoking, alcohol consumption, depression, intimate violence) screening during pregnancy versus usual medical report. Material and methods An auto-questionnaire based on validated tests (Fagerström/HSI, T-ACE, EPDS, SSQ6) was proposed to 1977 pregnant patients at their first obstetrical consultation. We compared results of auto-questionnaire and usual medical questioning. Results The auto-questionnaire was filled by 1676 pregnant patients (89.4 %). The two Fagerström/HIS questions showed that 20.7 % smoked during pregnancy. T-ACE score was better than usual medical questioning to detect excessive alcohol consumption (4.0 % vs 0.1 %, P < 0.05). Drug use before pregnancy was reported by 9.8 % patients in auto-questionnaire, but was only found in 4.9 % of medical files (P < 0.001). Seven percent patients reported at least 3 depressive symptoms on 4 purposed in auto-questionnaire. Intimate violence, physical or psychological, was reported in 9.4 %. All of these vulnerability factors were linked together, in auto-questionnaire or in usual medical reports. Conclusion Using auto-questionnaire based on standardized screening tests could help medical practioneers to detect psychosocial vulnerability and/or substance use during pregnancy. © 2014 Elsevier Masson SAS.


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.


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 | Year: 2015

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.


PubMed | Service danatomopathologie, University of Lille Nord de France and Maternite Jeanne de Flandre
Type: Case Reports | Journal: Journal de gynecologie, obstetrique et biologie de la reproduction | Year: 2015

Twin pregnancies combining complete hydatidiform mole and coexistent fetus are a rare situation (incidence in 1/20,000 in 1/100,000pregnancies) 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 24weeks gestation. We report here three new cases; only one of these cases had a favorable outcome.


Boyon C.,Maternite Jeanne de Flandre | Boyon C.,Coty | Giraudet G.,Maternite Jeanne de Flandre | Guerin Du Masgenet B.,Coty | And 3 more authors.
Gynecologie Obstetrique Fertilite | Year: 2013

Objective: Intrauterine device insertion is common. It is however not harmless and uterine perforation can be serious. Patients and methods: Eleven cases of uterine perforation after intrauterine device insertion were listed at Tourcoing hospital between 2005 and 2009. They were analyzed to identify risk factors of uterine perforation and specify management. Results: The main symptom was pelvic pain (4 cases), pregnancy occurrence (3 cases) or unability to remove the IUD (2 cases). The intrauterine device was set during the first 9 months of post-partum in 7 cases, 2 patients were still breastfeeding. Seven patients underwent laparoscopy, 2 needed switch for laparotomy, one was treated by laparotomy only and one was lost of follow-up. Discussion and conclusion: Incidence of uterine perforation after IUD insertion ranges from 0,1 to 3/1000. Pelvic pain is the most revealing symptom. Fifteen percent of perforations complicate with adjacent organ lesion. Perforation incidence seems greater if the intrauterine device is set during the 6 first weeks of post-partum and breastfeeding, but non influenced by operator practical experience. Ultrasound follow-up of patients carrying intrauterine device is controversial. Facing a suspicion of ectopic intrauterine device, pelvic ultrasound examination is the first step imaging modality and using 3D could be useful. If it fails to localize the intrauterine device, an abdominal X-ray must be performed. Ectopic intrauterine device removal is recommended. © 2013 Elsevier Masson SAS. Tous droits réservés.


Ducloy-Bouthors A.-S.,Maternite Jeanne de Flandre
Annales Francaises d'Anesthesie et de Reanimation | Year: 2010

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.


PubMed | Maternite Jeanne de Flandre
Type: Case Reports | Journal: Gynecologie, obstetrique & fertilite | Year: 2013

Intrauterine device insertion is common. It is however not harmless and uterine perforation can be serious.Eleven cases of uterine perforation after intrauterine device insertion were listed at Tourcoing hospital between 2005 and 2009. They were analyzed to identify risk factors of uterine perforation and specify management.The main symptom was pelvic pain (4 cases), pregnancy occurrence (3 cases) or inability to remove the IUD (2 cases). The intrauterine device was set during the first 9 months of post-partum in 7 cases, 2 patients were still breastfeeding. Seven patients underwent laparoscopy, 2 needed switch for laparotomy, one was treated by laparotomy only and one was lost of follow-up.Incidence of uterine perforation after IUD insertion ranges from 0,1 to 3/1000. Pelvic pain is the most revealing symptom. Fifteen percent of perforations complicate with adjacent organ lesion. Perforation incidence seems greater if the intrauterine device is set during the 6 first weeks of post-partum and breastfeeding, but non influenced by operator practical experience. Ultrasound follow-up of patients carrying intrauterine device is controversial. Facing a suspicion of ectopic intrauterine device, pelvic ultrasound examination is the first step imaging modality and using 3D could be useful. If it fails to localize the intrauterine device, an abdominal X-ray must be performed. Ectopic intrauterine device removal is recommended.

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