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Bayoumeu F, Vayssière C, Linet T, Agostini A, Benhamou D. [Not Available]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:98-99. [PMID: 34478902 DOI: 10.1016/j.gofs.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Indexed: 06/13/2023]
Affiliation(s)
- F Bayoumeu
- Service de gynécologie-obstétrique, hôpital Paule-de-Viguier, Toulouse III Paul-Sabatier, 31059 Toulouse, France
| | - C Vayssière
- Service de gynécologie-obstétrique, hôpital Paule-de-Viguier, Toulouse III Paul-Sabatier, 31059 Toulouse, France; UMR 1295, Centre d'épidémiologie et de recherche en santé des POPulations (CERPOP), Équipe SPHERE, 330, avenue de Grande-Bretagne, 31059 Toulouse, France.
| | - T Linet
- Service de gynécologie-obstétrique, centre hospitalier Loire Vendée Océan, Challans, France
| | - A Agostini
- Service de gynécologie-obstétrique, hôpital de la Conception, CHU de Marseille, Marseille, France
| | - D Benhamou
- Service d'anesthesie réanimation médecine périopératoire, Université Paris, France Saclay, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
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Blotière PO, Damase-Michel C, Weill A, Maura G. Dispensing of Potentially Harmful Prescription Drugs in 1.8 Million Pregnant Women in France: A Nationwide Study Based on Two Risk Classification Systems. Drug Saf 2021; 44:1323-1339. [PMID: 34613596 PMCID: PMC8626395 DOI: 10.1007/s40264-021-01117-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 12/01/2022]
Abstract
Introduction Nationwide prevalence of potentially harmful drug prescribing during pregnancy is unknown in France, and several risk classification systems (RCS) exist to guide prescribers. Objective The aim of this study was to estimate the nationwide prevalence of potentially harmful drug prescribing during pregnancy in France and to describe maternal characteristics associated with this prescription. Methods This drug utilisation study, conducted on the French health databases (67 million beneficiaries), included all pregnancies beginning in 2016–2017, regardless of pregnancy outcome. Potentially harmful drug prescribing was defined as at least one reimbursement during pregnancy of Swedish RCS category D drugs, Australian RCS category D/X drugs, or contraindicated drugs in France for drugs not listed in these two RCSs. Maternal characteristics associated with potentially harmful drug prescribing were described using a univariate logistic regression analysis. Results Among the 1,844,447 pregnant women identified, the prevalence of potentially harmful drug prescribing was higher according to the Australian RCS (3.9%) than according to the Swedish RCS (2.2%), with good agreement between the two RCSs (Kappa = 0.81 [0.74–0.87]). This prevalence increased to 9.2% and 6.9%, respectively, when considering contraindications in France. Prescribing of teratogenic drugs, including retinoids and valproate, was highest during the first trimester, whereas prescribing of foetotoxic drugs decreased after the first trimester but remained high for nonsteroidal anti-inflammatory drugs (N = 10,021). In women with no chronic diseases, polymedication (five or more drugs) was the strongest maternal characteristic associated with potentially harmful drug prescribing in both RCSs. Conclusions Potentially harmful drug prescribing during pregnancy is not uncommon in France. This study supports the comparative analysis of RCS to assess potentially harmful drug prescribing in claims databases. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-021-01117-4.
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Affiliation(s)
- Pierre-Olivier Blotière
- French National Health Insurance (Caisse Nationale de l'Assurance Maladie/Cnam), 50 avenue du Pr. André Lemierre, 75 986, Paris Cedex 20, France.
| | - Christine Damase-Michel
- Pharmacologie Médicale, Faculté de Médecine, Université de Toulouse UPS, Inserm CERPOP, CHU, Toulouse, France
| | - Alain Weill
- French National Health Insurance (Caisse Nationale de l'Assurance Maladie/Cnam), 50 avenue du Pr. André Lemierre, 75 986, Paris Cedex 20, France
| | - Géric Maura
- French National Health Insurance (Caisse Nationale de l'Assurance Maladie/Cnam), 50 avenue du Pr. André Lemierre, 75 986, Paris Cedex 20, France
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Pain Associated With Cervical Priming for First-Trimester Surgical Abortion: A Randomized Controlled Trial. Obstet Gynecol 2021; 137:1055-1060. [PMID: 33957651 DOI: 10.1097/aog.0000000000004376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the effect of cervical priming with mifepristone with that of misoprostol on pain perception during surgical induced abortion under paracervical block. METHODS We conducted a randomized, single-blind, two-center study of women undergoing surgical induced abortion at less than 14 weeks of gestation under paracervical block. Participants were randomized to receive cervical priming with 200 mg of oral mifepristone 36 hours or 400 micrograms buccal misoprostol 3 hours before surgery. The primary outcome was pain during mechanical cervical dilation evaluated by a 100-mm visual analog scale (VAS). Secondary outcomes were pain during aspiration, preoperative and postoperative pain, participant satisfaction, duration of the procedure, occurrence of complications, and ease of performing the procedure (assessed by a 100-mm VAS). We estimated that 110 women would have to be included to have 90% power to detect a 13mm-difference of VAS for pain. RESULTS Between June 2017 and May 2019, 314 women were eligible and 110 were randomized (55 in each group). Patient characteristics were similar in the two groups. The mean VAS score during mechanical cervical dilation was lower in the mifepristone group (35.6±21 vs 43.5±21, P=.04) as was the mean VAS during aspiration (34±24 vs 47.8±23, P=.003). The preoperative and postoperative mean VAS, satisfaction and duration of procedures were similar between groups. The procedure was significantly easier to perform in the mifepristone group (88±16 vs 80±23, P=.004). CONCLUSION Cervical priming with mifepristone for surgical induced abortion under paracervical block up to 14 weeks of gestation is more effective than misoprostol in reducing pain perception. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03043014.
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Schmitt A, Cardinale C, Loundou A, Miquel L, Agostini A. Nitrous oxide for pain management of first-trimester instrumental termination of pregnancy under local anaesthesia and/or minimal sedation: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 261:193-199. [PMID: 33971381 DOI: 10.1016/j.ejogrb.2021.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/17/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Inhalation of nitrous oxide and oxygen (N2O/O2) is used to reduce pain that is spontaneous or induced by procedures. N2O/O2 could be useful in the treatment of the pain in first-trimester termination of pregnancy performed under local anaesthesia and/or minimal sedation (FTOPL). OBJECTIVE To evaluate the usefulness of N2O/O2 to reduce pain in FTOPL. SEARCH STRATEGY Electronic databases including PubMed, Embase, and MEDLINE were searched using keywords. STUDY SELECTION All studies comparing the use of N2O/O2 versus a placebo in the management of pain during FTOPL during the first trimester were included. Of the 199 studies identified, four were deemed eligible for this meta-analysis. DATA COLLECTION The extracted results were perioperative pain, immediate and delayed postoperative pain, anxiety scores, and the secondary effects (nausea, vomiting). The data were analysed using Comprehensive Meta-Analysis software version 2.2.064. MAIN RESULTS There was a significant difference in favour of N2O/O2 for perioperative pain (p = 0.006; SMD = - 0.31; 95 % CI, -0.54 - -0.09). No difference was found, however, in postoperative pain, nor was there a difference in the secondary effects (nausea, vomiting) (p = 0.61). A significant decrease in postoperative anxiety scores was seen in the pooled placebo group (p = 0.049; SMD = 0.41; and 95 % CI, 0.001-0.83). CONCLUSIONS N2O/O2 reduces the pain of FTOPL. N2O/O2 could be recommended in FTOPL.
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Affiliation(s)
- A Schmitt
- Division of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France
| | - C Cardinale
- Division of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France
| | - A Loundou
- Department of Public Health, Aix-Marseille University, Marseille, France
| | - L Miquel
- Division of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France
| | - A Agostini
- Division of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France.
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Belloeil V, Tessier Cazeneuve C, Leclercq A, Mercier MB, Legendre G, Corroenne R. Impact of music therapy before first-trimester instrumental termination of pregnancy: a randomised controlled trial. BJOG 2020; 127:738-745. [PMID: 31957130 DOI: 10.1111/1471-0528.16102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To evaluate the impact of preoperative Music Therapy (MT) on pain in first-trimester termination of pregnancy (TOP) under local anaesthesia. DESIGN Randomised controlled trial comparing women undergoing a first-trimester TOP under local anaesthesia with or without a preoperative MT session. SETTING University Hospital of Angers from November 2016 to August 2017. POPULATION Women who underwent first-trimester TOP under local anaesthesia. METHODS Women allocated to the MT group underwent a preoperative 20-minute session of MT. MAIN OUTCOME MEASURES Pain was assessed using a visual analogue scale (VAS) just before the procedure, during the procedure, at the end of the procedure and upon returning to the ward. RESULTS A total of 159 women were randomised (80 in the MT group, and 79 in the control group). Two women were excluded from the control group and six from the MT group. Therefore, 77 women were analysed in the control group and 74 in the MT group. The intensity of pain was similar in the two groups just before the procedure (VAS 4.0 ± 2.9 versus 3.6 ± 2.5; P = 0.78), during the procedure (VAS 5.3 ± 2.5 versus 4.9 ± 2.9; P = 0.78), at the end of the procedure (VAS 2.7 ± 2.4 versus 2.6 ± 2.4; P = 0.43) and upon returning to the ward (VAS 1.8 ± 2.0 versus 1.5 ± 2.0; P = 0.84). The difference in pain between entering the department and returning to the room after the procedure was similar between the MT and control groups (difference in VAS 0.3 ± 2.5 versus 0.3 ± 2.4; P = 0.92). CONCLUSION An MT session before a TOP under local anaesthesia procedure resulted in no improvement in patient perception of pain during a first-trimester TOP. TWEETABLE ABSTRACT Music therapy before first-trimester termination of pregnancy under local anaesthesia did not improve the perception of pain.
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Affiliation(s)
- V Belloeil
- Department of Obstetrics and Gynaecology, University Hospital of Angers, Angers, France
| | - C Tessier Cazeneuve
- Department of Obstetrics and Gynaecology, University Hospital of Angers, Angers, France
| | - A Leclercq
- Department of Obstetrics and Gynaecology, University Hospital of Angers, Angers, France
| | - M B Mercier
- Department of Obstetrics and Gynaecology, University Hospital of Angers, Angers, France
| | - G Legendre
- Department of Obstetrics and Gynaecology, University Hospital of Angers, Angers, France
| | - R Corroenne
- Department of Obstetrics and Gynaecology, University Hospital of Angers, Angers, France
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Chen L, Zhou Y, Cai Y, Bao N, Xu X, Shi B. The ED95
of Nalbuphine in Outpatient-Induced Abortion Compared to Equivalent Sufentanil. Basic Clin Pharmacol Toxicol 2018; 123:202-206. [PMID: 29626849 DOI: 10.1111/bcpt.13022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/14/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Limei Chen
- Department of Anesthesiology; The First Affiliated Hospital; Wenzhou Medical University; Wenzhou Zhejiang Province China
| | - Yamei Zhou
- Department of Anesthesiology; Lishui Central Hospital; The Fifth Affiliated Hospital; Wenzhou Medical University; Lishui Zhejiang Province China
| | - Yaoyao Cai
- Department of Anesthesiology; The First Affiliated Hospital; Wenzhou Medical University; Wenzhou Zhejiang Province China
| | - Nana Bao
- Department of Anesthesiology; The First Affiliated Hospital; Wenzhou Medical University; Wenzhou Zhejiang Province China
| | - Xuzhong Xu
- Department of Anesthesiology; The First Affiliated Hospital; Wenzhou Medical University; Wenzhou Zhejiang Province China
| | - Beibei Shi
- Department of gynecology; The First Affiliated Hospital; Wenzhou Medical University; Wenzhou Zhejiang Province China
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Vayssière C, Gaudineau A, Attali L, Bettahar K, Eyraud S, Faucher P, Fournet P, Hassoun D, Hatchuel M, Jamin C, Letombe B, Linet T, Msika Razon M, Ohanessian A, Segain H, Vigoureux S, Winer N, Wylomanski S, Agostini A. Elective abortion: Clinical practice guidelines from the French College of Gynecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol 2018; 222:95-101. [PMID: 29408754 DOI: 10.1016/j.ejogrb.2018.01.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 01/04/2018] [Accepted: 01/16/2018] [Indexed: 12/12/2022]
Abstract
The number of elective abortions has been stable for several decades. Many factors explain women's choice of abortion in cases of unplanned pregnancies. Early initiation of contraceptive use and a choice of contraceptive choices appropriate to the woman's life are associated with lower rates of unplanned pregnancies. Reversible long-acting contraceptives should be favored as first-line methods for adolescents because of their effectiveness (grade C). Ultrasound scan before an elective abortion must be encouraged but should not be obligatory (professional consensus). As soon as the embryo appears on the ultrasound scan, the date of pregnancy is estimated by measuring the crown-rump length (CRL) or, from 11 weeks on, by measuring the biparietal diameter (BPD) (grade A). Because reliability of these parameters is ±5 days, the abortion may be done if measurements are respectively less than 90 mm for CRL and less than 30 mm for BPD (professional consensus). A medically induced abortion, performed with a dose of 200 mg mifepristone combined with misoprostol, is effective at any gestational age (Level of Evidence (LE) 1). Before 7 weeks, mifepristone should be followed 24-48 h later by misoprostol, administered orally, buccally, sublingually, or even vaginally followed if needed by a further dose of 400 μg after 3 h, to be renewed if needed after 3 h (LE 1, grade A). After 7 weeks, administration of misoprostol by the vaginal, sublingual, or buccal routes is more effective and better tolerated than by the oral route (LE 1). Cervical preparation is recommended for systematic use in surgical abortions (professional consensus). Misoprostol is a first-line agent for cervical preparation at a dose of 400 μg (grade A). Vacuum aspiration is preferable to curettage (grade B). A uterus perforated during surgical aspiration should not routinely be considered to be scarred (professional consensus). An elective abortion is not associated with a higher risk of subsequent infertility or ectopic pregnancy (LE 2). The medical consultation before an elective abortion generally does not affect the decision to end or continue the pregnancy, and most women are sufficiently certain about their choice at this time. Women appear to find the method used most acceptable and to be most satisfied when they were able to choose the method (grade B). Elective abortions are not associated with an increased rate of psychiatric disorders (LE 2). However, women with psychiatric histories are at a higher risk of psychological disorders after the occurrence of an unplanned pregnancy than women with such a history (LE 2). For surgical abortions, combined hormonal contraceptives - oral or transdermal - should be started on the day of the abortion, while the vaginal ring should be inserted 5 days afterwards (grade B). For medical abortions, the vaginal ring should be inserted in the week after mifepristone administration, while the combined contraceptives should begin the same day as the misoprostol or the day after (grade C). Contraceptive implants should be inserted on the same day as a surgical abortion, and may be inserted the day the mifepristone is administered for medical abortions (grade B and C respectively). In case of medical abortion, the implant can be inserted the same day the mifepristone is administered (grade C). Both the copper IUDs and levonorgestrel intrauterine system should be inserted on the day of the surgical abortion (grade A). After medical abortions, an IUD can be inserted in 10 days after mifepristone administration, after ultrasound scan verification of the absence of an intrauterine pregnancy (grade C).
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Affiliation(s)
- Christophe Vayssière
- Pôle Femme-Mère-Couple, service de gynecologie-obstétrique, Hôpital Paule de Viguier, CHU de Toulouse, Toulouse, France; UMR 1027 INSERM, Université Paul-Sabatier Toulouse III, Toulouse, France.
| | - Adrien Gaudineau
- Département de Gynécologie-Obstétrique, Hôpital de Hautepierre, CHU de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Luisa Attali
- Département de Gynécologie-Obstétrique, Hôpital de Hautepierre, CHU de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Karima Bettahar
- Département de Gynécologie-Obstétrique, Hôpital de Hautepierre, CHU de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Sophie Eyraud
- 3 rue Pierre d'Artagnan, 92350 Le Plessis-Robinson, France
| | - Philippe Faucher
- Unité fonctionnelle d'orthogénie, Hôpital Trousseau, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Patrick Fournet
- Service de Gynécologie Obstétrique, Centre Hospitalier du Belvedere 72, rue Louis Pasteur, 76451 Mont Saint Aignan, France
| | | | | | | | - Brigitte Letombe
- Service de Gynécologoe-Obstétrique, Hôpital Jeanne de Flandre, CHRU Lille, 2 av Oscar Lambret, 59000 Lille, France
| | - Teddy Linet
- Service de Gynécologie Obstétrique, Centre Hospitalier Loire Vendée Océan, Bd Guerin, 85300, Challans, France
| | - Marie Msika Razon
- MFPF, Mouvement français pour le planning familial, Tour Manto, Bd Massena, 75013 Paris, France
| | - Alexandra Ohanessian
- Service de Gynécologie-Obstétrique, Hôpital de la Conception, 147 bd Baille, 13005 Marseille, France
| | - Hélène Segain
- Service de Gynécologie-Obstétrique, CHI de Poissy-St-Germain, 45 rue du Champs Gaillard, 78303 Poissy, France
| | - Solène Vigoureux
- Service de gynécologie-obstétrique, Hôpital Bicêtre, GHU Sud, AP-HP, 94276 Le Kremlin-Bicêtre, France; Inserm, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), U1018, Equipe « Genre, Sexualité et Santé », 94276 Le Kremlin-Bicêtre, France
| | - Norbert Winer
- Service de Gynécologie-Obstétrique, CHU Hôtel-Dieu Nantes, 1 Place Alexis-Ricordeau, 44000 Nantes, France
| | - Sophie Wylomanski
- Service de Gynécologie-Obstétrique, CHU Hôtel-Dieu Nantes, 1 Place Alexis-Ricordeau, 44000 Nantes, France
| | - Aubert Agostini
- Service de Gynécologie-Obstétrique, Hôpital de la Conception, 147 bd Baille, 13005 Marseille, France
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