J Gynecol Obst Bio R
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J Gynecol Obst Bio R · Oct 2007
Review[Clinical approach and epidemiological aspects of mood and anxiety disorders during pregnancy and postpartum. Review and synthesis].
The aim of this article is to review clinical and epidemiological data on pre- and postnatal anxious and depressive disorders. To this end, we systematically analysed definitions, prevalence, risk factors and obstetrical consequences of perinatal disorders, as reported in seminal as well as more recent publications. ⋯ The potential severity of bipolar disorders and puerperal psychosis is highlighted by the fact that they heavily contribute to maternal mortality. The specificity of perinatal disorders, their impact on public health, the extensive research and mounting knowledge in that field, provide ample justification for the recognition of perinatal psychiatry as a distinct branch of psychiatry.
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The Marfan's syndrome is an autosomal dominant genetic disorder resulting in a diminished strength of connective tissue. The ocular, skeletal and cardiovascular systems are mostly at risk. Principal complications of the disease are aortic dilatation and the risk of acute dissection. ⋯ No increase of obstetrical complications has been shown in these patients. Route of delivery also depends on the diameter of the aortic root: vaginal delivery is warranted if the aortic root is<40; cesarean section should be performed in the other cases. Thus, with appropriate supervision, women with Marfan's syndrome will tolerate pregnancy without any adverse effect.
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J Gynecol Obst Bio R · Feb 2006
Review[Prevention of fetomaternal rhesus-D allo-immunization. Perspectives].
At present, rhesus prophylaxis concerns RhD negative pregnant women, even though 30 to 40% of them are bearing a RhD negative child. Knowing the RhD fetal genotype could change this quite irrational practice of prophylaxis (exposing many more women than needed to blood derived products) without reducing its efficacy. RhD fetal genotype determined on amniotic fluid has an excellent sensitivity. ⋯ Another new perspective for rhesus prophylaxis is the attempt to substitute polyclonal IgG anti-D into human monoclonal IgG anti-D. The main difficulty is to elaborate monoclonal antibodies with a capacity to neutralize RhD positive red blood cells equivalent to those of polyclonal anti-D. A new generation of antibodies is in process and preliminary clinical results are suggesting a possible use of these monoclonal antibodies for future rhesus prophylaxis but long-term follow-up is required to draw further conclusions.
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J Gynecol Obst Bio R · Oct 2005
Review[Inflammatory bowel disease and pregnancy: report of 76 cases and review of the literature].
Obstetrical prognosis for women suffering from Crohn's disease and from ulcerative colitis, and consequences of pregnancy on inflammatory bowel diseases (IBD). ⋯ Control of IBD is the main obstetrical factor for prognosis. Starting pregnancy can be advised if the disease is quiescent, with rapid and efficient management of possible flare-ups. Delivery route must be determined on a case-by-case basis, each considering pregestational anal continence and the clinical presentation of the perineum.
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Fever during labor is quite frequent and may be an etiologic and therapeutic challenge for obstetric and anesthesia teams. Although an infectious cause should be suspected first, intrapartum fever can also be non-infectious, most frequently in association with epidural analgesia. In this article, we review what is presently known about the association between epidural analgesia and intrapartum fever. Neonatal consequences of intrapartum fever are also discussed.