Prenatal diagnosis crucial for identifying risks

Newborns, especially premature infants, are vulnerable. Better perinatal diagnosis and better management in dedicated networks should eventually lead to better control of perinatal and maternal mortality despite the increasing number of premature births.

Intervene very early and prepare

Approximately 7% of the 800,000 children born each year do so before term, that is, before 37 weeks of amenorrhea (SA). 13,000 of them, who are born before even 33 SA, are very premature, particularly vulnerable. 60% of these births come from multiple pregnancies, favored by medically assisted procreation techniques. Another factor of increasing prematurity is the age of mothers: one in five women who give birth today is more than 34 years old ... The risks of complications related to these late pregnancies sometimes force the medical team to decide on a premature birth.

Treatment of pathologies linked to prematurity

The number of malformations has increased steadily since the 1980s, largely because of the average age at first pregnancy, which is now 30 years. According to figures from the Biomedicine Agency, nearly 8,000 children per year would be born with severe disability resulting from one or more malformations if prenatal diagnosis did not exist ... This diagnosis also makes it possible to avoid Many cases of death in utero and to prepare for a better care of the newborn.

The ultrasound thus detects on average 60% of the malformations. As for trisomy 21, ultrasound and combined biological assay strategies, they are effective for 75-90% of cases. Moreover, thanks to the early recognition of uterine growth retardation, with the aid of ultrasound, 20,000 children per year are saved because they are then born prematurely. Prenatal screening now affects at least 7 out of 10 women.

The first treatment performed in utero was that of fetal anemia due to rhesus incompatibility. But since the possibilities of intervention have multiplied. It is now possible to drain, to puncture organs, to coagulate vessels by endoscopic surgery. It is also possible, immediately at birth, to intervene to treat a cardiac abnormality or diaphragmatic hernia, which will allow the lungs to take their place.

Finally, it is better to be prepared before birth by ultrasound to a physical, visible "defect" that can be curable, such as a labio-palatine cleft, or invisible, a urinary malformation for example.
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Beyond adapting the place of birth to the age of the fetus and its state of health, permitted by perinatal networks in general and maternity hospitals in particular, a number of recent advances make it safer The birth of preterm babies. Moreover, there is the possibility of transferring the mother and the unborn child from a Type I maternity to a Type II or III center, for pregnancies at risk, whatever the term, within A regional perinatal network.

Another contribution to the rise in the life expectancy of these premature infants: corticosteroids, administered to the mother in the days prior to delivery, accelerate the maturation of the lungs and reduce Half the rate of occurrence of hyaline membrane disease (MMH). This disease creates respiratory insufficiency caused by a deficiency in pulmonary surfactant (substance lining the alveoli of the lungs), formerly the major cause of their death. Finally, with an exogenous surfactant of animal origin (cow or pig), it is possible to treat or prevent MMH, reduce the risk of complications (such as pneumothorax).

Among the avenues for the future, the prevention of brain damage and developmental care, which aim to stimulate the sensory brain to preserve its functions.

Communication of the AP-HP on May 29, 2009, Accompany the unborn child to the AP-HP, with the Prs Pierre-Henri Jarreau (Cochin-Saint-Vincent de Paul in Paris) and Jean-François Oury Robert Debré in Paris)

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