Organisation de l'information et des données statistiques dans le domaine de l'environnement: propositions méthodologiques

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Foetal heart rate recording: analysis and comparison of different methodologies

Monitoring foetal health is a very important task in clinical practice to appropriately plan pregnancy management and delivery. In the third trimester of pregnancy, ultrasound cardiotocography is the most employed diagnostic technique: foetal heart rate and uterine contractions signals are simultaneously recorded and analysed in order to ascertain foetal health. Because ultrasound cardiotocography interpretation still lacks of complete reliability, new parameters and methods of interpretation, or alternative methodologies, are necessary to further support physicians’ decisions. To this aim, in this thesis, foetal phonocardiography and electrocardiography are considered as different techniques. Further, variability of foetal heart rate is thoroughly studied. Frequency components and their modifications can be analysed by applying a time-frequency approach, for a distinct understanding of the spectral components and their change over time related to foetal reactions to internal and external stimuli (such as uterine contractions). Such modifications of the power spectrum can be a sign of autonomic nervous system reactions and therefore represent additional, objective information about foetal reactivity and health. However, some limits of ultrasonic cardiotocography still remain, such as in long-term foetal surveillance, which is often recommendable mainly in risky pregnancies. In these cases, the fully non-invasive acoustic recording, foetal phonocardiography, through maternal abdomen, represents a valuable alternative to the ultrasonic cardiotocography. Unfortunately, the so recorded foetal heart sound signal is heavily loaded by noise, thus the determination of the foetal heart rate raises serious signal processing issues. A new algorithm for foetal heart rate estimation from foetal phonocardiographic recordings is presented in this thesis. Different filtering and enhancement techniques, to enhance the first foetal heart sounds, were applied, so that different signal processing techniques were implemented, evaluated and compared, by identifying the strategy characterized on average by the best results. In particular, phonocardiographic signals were recorded simultaneously to ultrasonic cardiotocographic signals in order to compare the two foetal heart rate series (the one estimated by the developed algorithm and the other provided by cardiotocographic device). The algorithm performances were tested on phonocardiographic signals recorded on pregnant women, showing reliable foetal heart rate signals, very close to the ultrasound cardiotocographic recordings, considered as reference. The algorithm was also tested by using a foetal phonocardiographic recording simulator developed and presented in this research thesis. The target was to provide a software for simulating recordings relative to different foetal conditions and recordings situations and to use it as a test tool for comparing and assessing different foetal heart rate extraction algorithms. Since there are few studies about foetal heart sounds time characteristics and frequency content and the available literature is poor and not rigorous in this area, a data collection pilot study was also conducted with the purpose of specifically characterising both foetal and maternal heart sounds. Finally, in this thesis, the use of foetal phonocardiographic and electrocardiographic methodology and their combination, are presented in order to detect foetal heart rate and other functioning anomalies. The developed methodologies, suitable for longer-term assessment, were able to detect heart beat events correctly, such as first and second heart sounds and QRS waves. The detection of such events provides reliable measures of foetal heart rate, potentially information about measurement of the systolic time intervals and foetus circulatory impedance.

Symbolic Dynamics Analysis: a new methodology for foetal heart rate variability analysis

Cardiotocography (CTG) is a widespread foetal diagnostic methods. However, it lacks of objectivity and reproducibility since its dependence on observer's expertise. To overcome these limitations, more objective methods for CTG interpretation have been proposed. In particular, many developed techniques aim to assess the foetal heart rate variability (FHRV). Among them, some methodologies from nonlinear systems theory have been applied to the study of FHRV. All the techniques have proved to be helpful in specific cases. Nevertheless, none of them is more reliable than the others. Therefore, an in-depth study is necessary. The aim of this work is to deepen the FHRV analysis through the Symbolic Dynamics Analysis (SDA), a nonlinear technique already successfully employed for HRV analysis. Thanks to its simplicity of interpretation, it could be a useful tool for clinicians. We performed a literature study involving about 200 references on HRV and FHRV analysis; approximately 100 works were focused on non-linear techniques. Then, in order to compare linear and non-linear methods, we carried out a multiparametric study. 580 antepartum recordings of healthy fetuses were examined. Signals were processed using an updated software for CTG analysis and a new developed software for generating simulated CTG traces. Finally, statistical tests and regression analyses were carried out for estimating relationships among extracted indexes and other clinical information. Results confirm that none of the employed techniques is more reliable than the others. Moreover, in agreement with the literature, each analysis should take into account two relevant parameters, the foetal status and the week of gestation. Regarding the SDA, results show its promising capabilities in FHRV analysis. It allows recognizing foetal status, gestation week and global variability of FHR signals, even better than other methods. Nevertheless, further studies, which should involve even pathological cases, are necessary to establish its reliability.

Antiepileptic drugs and pregnancy. Population based pharmaco-epidemiological study on prescription patterns, pregnancy outcome and foetal health

Aims of the study: To assess the prevalence of Antiepileptic Drug (AED) exposure in pregnant women with or without epilepsy and the comparative risk of terminations of pregnancy (TOPs), spontaneous abortions, stillbirth, major congenital malformations (MCMs) and foetal growth retardation (FGR) following intrauterine AED exposure in the Emilia Romagna region (RER), Northern Italy (4 million inhabitants). Methods: Data were obtained from official regional registries: Certificate of Delivery Assistance, Hospital Discharge Card, reimbursed prescription databases and Registry of Congenital Malformations. We identified all the deliveries, hospitalized abortions and MCMs occurred between January 2009 and December 2011. Results: We identified 145,243 pregnancies: 111,284 deliveries (112,845 live births and 279 stillbirths), 16408 spontaneous abortions and 17551 TOPs. Six hundred and eleven pregnancies (0.42% 95% Cl: 0.39-0.46) were exposed to AEDs. Twenty-one per cent of pregnancies ended in TOP in the AED group vs 12% in the non-exposed (OR:2.24; CI 1.41-3.56). The rate of spontaneous abortions and stillbirth was comparable in the two groups. Three hundred fifty-three babies (0.31%, 95% CI: 0.28-0.35) were exposed to AEDs during the first trimester. The rate of MCMs was 2.3% in the AED group (2.2% in babies exposed to monotherapy and 3.1% in babies exposed to polytherapy) vs 2.0% in the non-exposed. The risk of FGR was 12.7 % in the exposed group compared to 10% in the non-exposed. Discussion and Conclusion: The prevalence of AED exposure in pregnancy in the RER was 0.42%. The rate of MCMs in children exposed to AEDs in utero was almost superimposable to the one of the non-exposed, however polytherapy carried a slightly increased risk . The rate of TOPs was significantly higher in the exposed women. Further studies are needed to clarify whether this high rate reflects a higher rate of MCMs detected prenatally or other more elusive reasons.

Repeated intrauterine IgG infusions in fetal alloimmune thrombocytopenia do not increase foetal platelet counts

Foetal alloimmune thrombocytopenia (FNAIT) is often treated transplacentally with maternally administered i.v. immunoglobulins, but not all foetuses show a consistent platelet increase during such treatment.

La 'grande chasse' chez les Pygmées Baka du Sud-Est Cameroun. Contribution à l'Anthropologie de l'environnement.

This thesis focuses on “The “great hunting” among the Baka pygmies of the Southeastern Cameroon. A contribution to Anthropology of environment. The problematic in the study is the confrontation of great hunting among the Baka with the institutional, socio-economic and ecological change in forest. The goal is to analyze the mechanisms of adaptation of this game against these changes that affect the Baka environment. The proposed hypothesis suggests that Baka Pygmies have restructured the preparatory ceremonies of the great hunting following changes that occurred in their environmental milieu. Certain ritual animals have been substituted. Hunting lands, tools, methods and periods were also modified. The great hunting is opened to Baka hunters and non Baka hunters. Qualitative techniques, including observation, interviews and focus group discussions were used for data collection. The observations allowed us to understand the reality of driving forces in the forest as well as tools for hunting, hunting land and even the species sought. Interviews and focus group discussions were consolidated data on the ancient practice of hunting for rituals like Jengi and Beka, on the current practice of this hunting and on the impact of the of the modification of this hunting practice on the Baka culture. The results of this research show that the Baka have taken important measure to adapt their great hunting to the changing time and space. But the restructuring of this hunting varies from one village to another. As and when we leave the depths of the forest to the city of Yokadouma the great hunting is practiced less and less. Baka use illegal hunting tools and even fully protected species in their great hunting and in rituals celebrations. The overexploitation of forest resources, the creation of protected areas, full protection of certain large mammals and the action of ecoguards are something of an obstacle to the ancient practice of hunting for ritual. In most of camp where hunting is no more existing, ritual ceremonies are less and less celebrated. The study is divided into five chapters. The first chapter is related to the literature review, the theoretical framework, the definition of concepts, the second focuses on the geographical presentation of the study area, the third chapter looks at factors affecting the great hunting, the fourth chapter deal with the changes observed in the Baka’s great hunting, and the fifth chapter examines consequences of the restriction or suppression of the hunt on the Baka socio culture.

[Determination of maternal and foetal serum lipid profile and placental oxidised low density lipoprotein accumulation in preeclampsia and normotensive pregnancies]

Oxidised low density lipoproteins (oxLDL) are key players in the development of atherosclerotic cardiovascular diseases. Since there are similarities between the pathogenesis of preeclampsia and atherosclerosis we hypothesised an increased accumulation of oxLDL at the materno-foetal and foeto-foetal interface within the placental tissue of preeclamptic women compared to women with normotensive pregnancies (controls). Moreover, we analysed maternal and foetal serum lipid parameters.

Les transports en commun à Madrid: un système intégré pour le développement durable.

Le grand Madrid se présente comme l’une des quelques grandes métropoles européennes où la mobilité globale en transports publics dépasse celle en voiture particulière, avec une répartition des déplacements motorisés à 54% en transports publics et 46% en véhicules privés (CRTM, 2006). Dans la seule ville de Madrid, la répartition est encore plus favorable aux transports publics, qui atteignent 61% de tous les voyages motorisés. Cette situation a été favorisée par la création du Consortium régional des transports de Madrid (CRTM) en 1986 en tant qu’autorité unique de transport public, dont les compétences s’étendent à Madrid et aux municipalités qui y adhèrent volontairement. La crise économique qui a atteint l’Espagne en 2008 a cependant fortement affecté la mobilité des habitants et donc la demande pour les transports publics. Entre 2007 et 2012 le nombre de déplacements en transports publics a baissé de 12,2%, ce qui reflète la baisse du PIB par habitant (-11,7%). Malgré cette situation très défavorable, la CRTM a pris, pour les transports en commun, des décisions qui visent à faire mieux avec moins, sans pour autant négliger les aspects liés à la qualité des transports, même si celle-ci pâtit d’une inévitable réduction des fréquences horaires