Objective: To evaluate the detection rate of prenatal diagnosis and its impact on outcome in congenital diaphragmatic hernia(CDH). Study design: We retrospectively studied 51 cases of CDH registered in the Auvergne ar...Objective: To evaluate the detection rate of prenatal diagnosis and its impact on outcome in congenital diaphragmatic hernia(CDH). Study design: We retrospectively studied 51 cases of CDH registered in the Auvergne area from January 1992 to December 2003 (Birth Defect Registry of Auvergne,Institut Europé en des Gé nomutations). Our main outcome measurements were the detection rate of prenatal diagnosis, the incidence and types of associated anomalies and outcome (termination of pregnancy, in utero fetal demise, neonatal death, survivalat the time of registration). Results: Twenty-nine cases of isolated CDH were identified of which 13 were detected prenatally (45% ) at a mean gestational age of 26.1 weeks and 22 cases of CDH with associated anomalies with prenatal diagnosis of CDH or any associated anomaly in 16 (73% ; p = 0.03) at a mean gestational age of 23.9 weeks. In the prenatally detectedgroup (29 cases), there was 1 (3% ) in utero fetal death (IUFD),17 (59% ) terminations of pregnancy (TOP) and 11 (38% ) live births with early neonatal death in 7 (24% ) cases despite delivery in a tertiary care centre in 10/11 cases (four survivors = 14% ). Most of the undetected cases were isolated CDH (16/22 = 73% ) of which 1 (5% ) was a stillborn and 21 (95% ) live births with 17 survivors (77% ) although 15/21 (71% ) were not born at the tertiary care centre (p = 0.001). The overall survival rate was 41% with a large variability depending on associated anomalies and prenatal diagnosis (p < 0.0001) (prenatally detected cases:3/13 (23% ) isolated CDH and 1/16 (6% ) CDH with associated anomalies; undetected cases: 13/16 (81% ) isolated CDH and 4/6 (67% ) CDH with associated anomalies). Conclusion: Prenatal diagnosis of CDH leads to the delivery of affected babies in tertiary care centres but it remains a challenge in particular for isolated CDH cases and it is associated with a lower survival rate. Associated anomalies contribute to prenatal detection, are related to a higher TOP rate but do not facilitate the detection of diaphragmatic defect per se.展开更多
Objective.-To compare the mode of delivery in two groups of patients selected by their response after induction of labour with mifepristone.Patien ts and methods.-We studied retrospectively 89cases of labour induction...Objective.-To compare the mode of delivery in two groups of patients selected by their response after induction of labour with mifepristone.Patien ts and methods.-We studied retrospectively 89cases of labour induction with viable children after 41weeks of gestation.Bishop scores were less than 6.Patients were given200mg of mifepris-tone per day for 48h.They were retrospectively divided into group 1(spontaneous onset of labour or prema ture rupture of membranes before the thir d day)and group 2(not in labour by that date).Results.-The mean Bishop score at inclusion was 3.1±1.3.Amon g the 51patients(53.9%)in group 1,one required prostagland ins andwe performed 10cesarean sections.In g roup 2,the mean Bishop score at the 3rd day was 4.4±1.3(P<0.0001).Twenty -four patients required prostaglandins(P<0.0001)andwe performed 17cesarean section s(P =0.01).The number of cesarean sections increased with the dose of prostaglandins(P =0.025).We observed no maternal or fetal complications.Discussion an d conclusions.-Mifepristone was successful in inducing labour sponta-neously in over 50%of pregnancies after 41weeks of gestation.In the other group,the pr obability of vaginal delivery was reduced especially when high doses of prostaglandinswere required.Afte r the use of mifepristone,we suggest to shorten the duration of prostaglandin admin-istration(two applications of 2mg dinoproston e)before performing cesarean section.展开更多
文摘Objective: To evaluate the detection rate of prenatal diagnosis and its impact on outcome in congenital diaphragmatic hernia(CDH). Study design: We retrospectively studied 51 cases of CDH registered in the Auvergne area from January 1992 to December 2003 (Birth Defect Registry of Auvergne,Institut Europé en des Gé nomutations). Our main outcome measurements were the detection rate of prenatal diagnosis, the incidence and types of associated anomalies and outcome (termination of pregnancy, in utero fetal demise, neonatal death, survivalat the time of registration). Results: Twenty-nine cases of isolated CDH were identified of which 13 were detected prenatally (45% ) at a mean gestational age of 26.1 weeks and 22 cases of CDH with associated anomalies with prenatal diagnosis of CDH or any associated anomaly in 16 (73% ; p = 0.03) at a mean gestational age of 23.9 weeks. In the prenatally detectedgroup (29 cases), there was 1 (3% ) in utero fetal death (IUFD),17 (59% ) terminations of pregnancy (TOP) and 11 (38% ) live births with early neonatal death in 7 (24% ) cases despite delivery in a tertiary care centre in 10/11 cases (four survivors = 14% ). Most of the undetected cases were isolated CDH (16/22 = 73% ) of which 1 (5% ) was a stillborn and 21 (95% ) live births with 17 survivors (77% ) although 15/21 (71% ) were not born at the tertiary care centre (p = 0.001). The overall survival rate was 41% with a large variability depending on associated anomalies and prenatal diagnosis (p < 0.0001) (prenatally detected cases:3/13 (23% ) isolated CDH and 1/16 (6% ) CDH with associated anomalies; undetected cases: 13/16 (81% ) isolated CDH and 4/6 (67% ) CDH with associated anomalies). Conclusion: Prenatal diagnosis of CDH leads to the delivery of affected babies in tertiary care centres but it remains a challenge in particular for isolated CDH cases and it is associated with a lower survival rate. Associated anomalies contribute to prenatal detection, are related to a higher TOP rate but do not facilitate the detection of diaphragmatic defect per se.
文摘Objective.-To compare the mode of delivery in two groups of patients selected by their response after induction of labour with mifepristone.Patien ts and methods.-We studied retrospectively 89cases of labour induction with viable children after 41weeks of gestation.Bishop scores were less than 6.Patients were given200mg of mifepris-tone per day for 48h.They were retrospectively divided into group 1(spontaneous onset of labour or prema ture rupture of membranes before the thir d day)and group 2(not in labour by that date).Results.-The mean Bishop score at inclusion was 3.1±1.3.Amon g the 51patients(53.9%)in group 1,one required prostagland ins andwe performed 10cesarean sections.In g roup 2,the mean Bishop score at the 3rd day was 4.4±1.3(P<0.0001).Twenty -four patients required prostaglandins(P<0.0001)andwe performed 17cesarean section s(P =0.01).The number of cesarean sections increased with the dose of prostaglandins(P =0.025).We observed no maternal or fetal complications.Discussion an d conclusions.-Mifepristone was successful in inducing labour sponta-neously in over 50%of pregnancies after 41weeks of gestation.In the other group,the pr obability of vaginal delivery was reduced especially when high doses of prostaglandinswere required.Afte r the use of mifepristone,we suggest to shorten the duration of prostaglandin admin-istration(two applications of 2mg dinoproston e)before performing cesarean section.
