Analgésie péridurale obstétricale et lombalgie du post-partum: un lien de cause à effet?
CHARLIER, Vanessa ; Brichant, Géraldine ; DEWANDRE, Pierre-Yves et al
in Revue Médicale de Liège (2012), 67(1), 16-20
backache is a common problem in the general population. the prevalence of backpain is increased during pregnancy and after delivery. early studies have suggested that labor epidural analgesia might be ... [more ▼]
backache is a common problem in the general population. the prevalence of backpain is increased during pregnancy and after delivery. early studies have suggested that labor epidural analgesia might be associated with an increased incidence of backache in the postpartum period. However, these initial studies were retrospective and their design included several methodological deficiencies. All the prospective studies published afterwards (prospective cohort studies and 3 ran- domized controlled trials) yield the same result : there is no relationship between labor epidural analgesia and long-term postpartum backpain. pregnant women must be aware of this in order to make an informed and appropriate choice about labor epidural analgesia, the most effective technique for intra- partum pain relief. [less ▲]Detailed reference viewed: 93 (8 ULg)
Le role de la genetique et de l'environnement dans le developpement de l'endometriose.
; Dehan, Pierre ; BELIARD, Aude et al
in Revue Médicale de Liège (2012), 67(5-6), 374-80
Endometriosis is usually described as a complex multifactorial disease involving dysregulation of estrogen metabolism, inflammatory and immunological mechanisms. Recently, many authors have questioned the ... [more ▼]
Endometriosis is usually described as a complex multifactorial disease involving dysregulation of estrogen metabolism, inflammatory and immunological mechanisms. Recently, many authors have questioned the environmental pollution and toxins in the formation and development of endometriotic lesions. Therefore, while dioxins and PCBs have been implicated, insufficient data are available until now to confirm this theory. Endometriosis has also been considered as a genetic disease. Indeed, early familial aggregation and twin studies noted a higher risk of endometriosis among relatives. However, demonstration of a genetic component in the pathogenesis of such a multifactorial disease is quite difficult due to many limitations such as ethnic differences, involvement of environmental factors and size of needed patients cohorts. Over the last decade, the epigenetic approach (DNA methylation, histones modifications and microRNA) has allowed to consider many new perspectives. Indeed, dysregulation (hyper- or hypomethylation) of many genes has already been highlighted. This method of analysis is the subject of numerous studies in order to develop diagnostic, prognostic and therapeutic tools for this disease which is becoming a real public health problem. [less ▲]Detailed reference viewed: 17 (6 ULg)
Management of severe preeclampsia
Brichant, Géraldine ; Dewandre, Pierre-Yves ; Foidart, Jean-Michel et al
in Acta Clinica Belgica (2010), 65(3), 163-169
Features of severe preeclampsia include severe proteinuric hypertension and symptoms of central nervous system dysfunction, hepatocellular injury, thrombocytopenia, oliguria, pulmonary oedema ... [more ▼]
Features of severe preeclampsia include severe proteinuric hypertension and symptoms of central nervous system dysfunction, hepatocellular injury, thrombocytopenia, oliguria, pulmonary oedema, cerebrovascular accident and severe intrauterine growth restriction. Women with severe preeclampsia must be hospitalized to confirm the diagnosis, to assess the severity of the disease, to monitor the progression of the disease and to try to stabilize the disease. Severe preeclampsia may be managed expectantly, in selected cases. The objective of expectant management in these patients is to improve neonatal outcome. Expectant management is based on antihypertensive treatment and prevention of end organ dysfunction. Antihypertensive treatment improves maternal outcome but has the potential to be deleterious for the foetus. Plasma volume expansion has been suggested for severe preeclampsia but trials failed to show any benefit. Magnesium sulfate is the anticonvulsivant of choice to treat or prevent eclampsia when indicated. Antenatal corticosteroids are recommended in severely preeclamptic women with 26-34 weeks gestation. Timing of delivery is based upon gestational age, severity of preeclampsia, maternal and foetal risks. [less ▲]Detailed reference viewed: 42 (10 ULg)
Manifestations hemodynamiques et respiratoires de la preeclampsie.
Brichant, Jean-François ; Brichant, Géraldine ; Dewandre, Pierre-Yves et al
in Annales Françaises d'Anesthésie et de Réanimation (2010), 29
The hemodynamic and cardiovascular changes seen during PE vary according to the natural history of the disease, its severity and eventual therapeutic measures taken. In the early stages of pregnancy ... [more ▼]
The hemodynamic and cardiovascular changes seen during PE vary according to the natural history of the disease, its severity and eventual therapeutic measures taken. In the early stages of pregnancy, patients who will eventually develop PE, present with a blood pressure which even though within normal limits, is higher than in other women. Similarly, their cardiac output is higher with a normal or decreased peripheral vascular resistance. As soon as the clinical signs of the disease appear, the hemodynamic picture usually shifts toward that of a high peripheral resistance with low cardiac output. Sometimes however, a clinically hyperkinetic circulation may be demonstrated. In PE patients, cardiac preload pressures are usually normal even though the circulatory volumes are lower by 600 to 800ml when compared to those found in normal pregnancy. The cardiac function is however usually preserved during PE. PE induces an exaggerated capillary permeability. This results in the worsening of the airway edema which may render the intubation very difficult. The increased capillary permeability contributes, among other factors, to the heightened risk of acute pulmonary edema. It is not justified to administer an anti-hypertensive treatment to PE women presenting with only moderate hypertension. An anti-hypertensive treatment must only be initiated whenever the hypertension is severe (i.e. SBP>/=160mmHg and/or DBP>/=110mmHg) in order to reduce the risk of maternal complications. In the absence of objective comparative data assessing anti-hypertensive agents for the PE patient, the choice of therapy relies predominantly on the practitioners' own experience. Systematic circulatory volume expansion has not been proven to improve the maternal nor the neonatal prognosis. Such treatment is to be reserved solely for situations in which correcting a hypo-volemia is absolutely necessary. The treatment of acute pulmonary edema in a PE patient is symptomatic and includes the administration of vasodilating agents and of diuretics. A benefit in setting-up an invasive monitoring of the pulmonary artery occlusive pressure has not been demonstrated. The sonographic surveillance of the hemodynamic state can however be useful in these circumstances. [less ▲]Detailed reference viewed: 33 (3 ULg)
Manifestations hémodynamiques et respiratoires de la prééclampsie
Brichant, Jean-François ; Brichant, Géraldine ; Dewandre, Pierre-Yves et al
in Pottecher, Thierry; Luton, Dominique (Eds.) Prise en charge multidisciplinaire de la prééclampsie (2009)Detailed reference viewed: 31 (4 ULg)
Persistence of an intact endometrial matrix and vessels structure in women exposed to VA-2914, a selective progesterone receptor modulator.
Ravet, Stéphanie ; Munaut, Carine ; Blacher, Silvia et al
in Journal of Clinical Endocrinology and Metabolism (2008), 93(11), 4525-31
Background: VA-2914 is a selective progesterone receptor modulator with potential contraceptive activity that induces amenorrhea, whereas progestins cause endometrial spotting and bleeding. This abnormal ... [more ▼]
Background: VA-2914 is a selective progesterone receptor modulator with potential contraceptive activity that induces amenorrhea, whereas progestins cause endometrial spotting and bleeding. This abnormal bleeding due to progestins is a consequence of focal stromal proteolysis by an increase in naked vessel size and density. Objective: Our objective was to quantify the effects of VA-2914 on endometrial vascularization, fibrillar matrix, and vascular endothelial growth factor (VEGF)-A expression in endometrial biopsies from 41 women before and after 12 wk daily treatment with a placebo, or 2.5, 5, or 10 mg VA-2914. Methods: Collagen fibrillar network was stained by silver impregnation. Vessel area, density, and structure were quantified with a computer-assisted image analysis system after double immunostaining using an anti-von Willebrand factor (endothelial cells) and an anti- smooth muscle actin (vascular smooth muscle cells) marker antibody. VEGF-A mRNAs were quantified by RT-PCR and localized by immunohistochemistry. Results: The endometrial vessels, collagen network, and mRNA levels of VEGF-A were identical during the luteal phase at baseline and in VA-2914 treated women. VEGF-A distribution was unchanged. Conclusions: VA-2914 does not alter the endometrial matrix and cells, and does not modify the endometrial vessel morphology as compared with baseline biopsies. [less ▲]Detailed reference viewed: 28 (2 ULg)