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Bouldouyre MA, Dauphin H, Cherradou N, Gros H. [Establishment and one-year evaluation of an internal medicine consultation in a maternity]. SANTE PUBLIQUE 2019; 30:671-677. [PMID: 30767482 DOI: 10.3917/spub.186.0671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE In the obstetric medicine movement and in response to requests for appointments in internal medicine by obstetricians and midwives, we created an internal medicine consultation within the maternity ward of our General Hospital, and provide feedback after 1 year. METHODS This retrospective descriptive study took place at the Robert Ballanger Intercommunal Hospital Center in Aulnay-sous-Bois in Seine-Saint-Denis (France) between 3rd March 2016 and 9th March 2017, the first year of the internal medicine consultation, one afternoon every 15 days, in the maternity level 2b. RESULTS Out of 121 appointments, 93 consultations were conducted for 63 patients. The main reasons were: thromboembolism (n=2), placental vascular disease (n=14), anemia (n=9), HIV infection (n=8), fetal deaths in utero (n=6), thrombocytopenia (n=6) and autoimmune biological abnormalities (n=3). Although none etiology was found for 16 patients (including 11 seen for placental vascular disease), a diagnosis was made in 75% of cases with a suitable therapeutic attitude. The diagnoses were varied: antiphospholipid syndrom, hypertension, but also discovery of a primary biliary cirrhosis, of a veritable pregnancy-induced immune thrombocytopenia induced by the pregnancy and of a lymphoma-associated on anemia. CONCLUSIONS This consultation provides satisfaction in terms of interdisciplinary organization and collaboration. It appears useful to patients, leading to prevention advice, various diagnoses and sometimes long-term follow-up.
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Cardinale C, Berbis J, Chau C, Bernard F, Arnoux D, Fratacci MF, Boubli L, Bretelle F. Two miscarriages, consecutive or non-consecutive, does it change something? J Gynecol Obstet Hum Reprod 2017; 46:721-725. [PMID: 28993281 DOI: 10.1016/j.jogoh.2017.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess the rate of anomalies in the etiological evaluation of patients presenting recurrent early miscarriages (RM) according to miscarriage chronology (number of miscarriages, history of live birth and succession of RM). METHODS Retrospective single centre study including RM, defined as at least 2 miscarriages at less than 14 weeks of gestation (WG) between the 1st January 2012 and the 31st December 2015. Clinical data and etiological evaluation include blood glucose levels, screening for antiphospholipid syndrome (APS), endocrine assessment, vitamin levels, pelvic imaging, karyotyping of both partners, chronic endometritis and thrombophilia screening. RESULTS Two hundred and eighty-eight patients were included over this period, 118 (41%) patients had no history of live birth. Two hundred and twenty-three (77%) patients had consecutive RM and 65 (22%) patients had non-consecutive RM. For consecutive RM, 62,8% had thrombophilic disorders versus 69,8% for non-consecutive RM (P>0,05); 44,7% had endocrine disorders or vitamin deficiencies versus 39,7%; 34,6% of patients with consecutive RM had uterine anomalies versus 45,5% respectively. No difference was found depending on the recurrence of RM or the history of live birth (P>0.05) apart from the age of the patient. Fifty-nine (17.4%) patients had uterine anomalies. There are 24 chronic endometritis on 31 biospsies performed. Seventy-eight (27%) patients were offered treatment. Ninety-four (90%) patients showed good therapy compliance. Eighty-one (78%) patients became pregnant. CONCLUSION An etiological evaluation provides, for over half of the cases, an etiology or the identification of risk factors responsible for RM, as well as in some cases offering an adapted, efficient, therapeutic approach. This evaluation should be offered regardless of the obstetric history of the patient.
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Affiliation(s)
- C Cardinale
- Service de gynécologie-obstétrique, gynepole, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France.
| | - J Berbis
- Service de gynécologie-obstétrique, gynepole, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; Public health department, AMU, Aix-Marseille université, 13385 Marseille, France; Unité de recherche sur les maladies infectieuses tropicales et emergentes, CNRS UMR 7278, Inserm U1095, Aix-Marseille université, 13385 Marseille, France
| | - C Chau
- Service de gynécologie-obstétrique, gynepole, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France
| | - F Bernard
- Unité de recherche sur les maladies infectieuses tropicales et emergentes, CNRS UMR 7278, Inserm U1095, Aix-Marseille université, 13385 Marseille, France
| | - D Arnoux
- Service de gynécologie-obstétrique, gynepole, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France
| | - M-F Fratacci
- Service de gynécologie-obstétrique, gynepole, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; Public health department, AMU, Aix-Marseille université, 13385 Marseille, France; Unité de recherche sur les maladies infectieuses tropicales et emergentes, CNRS UMR 7278, Inserm U1095, Aix-Marseille université, 13385 Marseille, France
| | - L Boubli
- Service de gynécologie-obstétrique, gynepole, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France
| | - F Bretelle
- Service de gynécologie-obstétrique, gynepole, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; Unité de recherche sur les maladies infectieuses tropicales et emergentes, CNRS UMR 7278, Inserm U1095, Aix-Marseille université, 13385 Marseille, France.
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Mekinian A, Cohen J, Kayem G, Carbillon L, Nicaise-Roland P, Gaugler B, Darai E, Bornes M, Fain O. Fausses couches précoces récurrentes inexpliquées : quelle est la place de l’immunomodulation ? Rev Med Interne 2017; 38:264-268. [DOI: 10.1016/j.revmed.2016.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/04/2016] [Accepted: 08/02/2016] [Indexed: 02/07/2023]
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